Translating Precision Health for Pediatrics: A Scoping Review.

Precision health aims to personalize treatment and prevention strategies based on individual genetic differences. While it has significantly improved healthcare for specific patient groups, broader translation faces challenges with evidence development, evidence appraisal, and implementation. These challenges are compounded in child health as existing methods fail to incorporate the physiology and socio-biology unique to childhood. This scoping review synthesizes the existing literature on evidence development, appraisal, prioritization, and implementation of precision child health. PubMed, Scopus, Web of Science, and Embase were searched. The included articles were related to pediatrics, precision health, and the translational pathway. Articles were excluded if they were too narrow in scope. In total, 74 articles identified challenges and solutions for putting pediatric precision health interventions into practice. The literature reinforced the unique attributes of children and their implications for study design and identified major themes for the value assessment of precision health interventions for children, including clinical benefit, cost-effectiveness, stakeholder values and preferences, and ethics and equity. Tackling these identified challenges will require developing international data networks and guidelines, re-thinking methods for value assessment, and broadening stakeholder support for the effective implementation of precision health within healthcare organizations. This research was funded by the SickKids Precision Child Health Catalyst Grant.

Concurrent randomized control trials of the 1-year efficacy of two couple relationship education programs: ELEVATE and Couples Connecting Mindfully.

A long-standing university-community partnership used a longitudinal randomized control trial to implement and evaluate two couple relationship education (CRE) curricula, ELEVATE and Couples Connecting Mindfully (CCM), among an economically and racially diverse population of adult couples. Married and non-married couples (n = 929 couples) completed baseline surveys and were randomly assigned to either one of the two program groups or to the control group by implementation site. Follow-up surveys were collected at 2 months, 6 months, and 1 year after baseline. Using an intent-to-treat approach, growth curve modeling comparisons of trajectories indicated program effects at 1 year post-baseline in key outcome areas. Both the ELEVATE and the CCM group reported significant gains in couple relationship skills, couple quality, and family harmony over time compared to the control group that experienced either no change or declines. Further, the ELEVATE group also demonstrated positive program effects on measures of mental health and sleep quality. An assessment of the central premise of CRE indicated that the immediate post-program improvements in couple relationship skills predicted later couple quality for both program groups. This study indicates that both ELEVATE and CCM can be considered evidence-based CRE programs for use with a broad population of couples.

Una asociación duradera entre la universidad y la comunidad utilizó un ensayo controlado aleatorizado y longitudinal para implementar y evaluar dos currículos de educación sobre las relaciones de pareja, ELEVATE y Couples Connecting Mindfully (CCM), entre una población de parejas adultas económicamente y racialmente diversa. Parejas casadas y no casadas (n = 929 parejas) contestaron encuestas en el momento basal, y luego, en el lugar de implementación, se las distribuyó aleatoriamente a alguno de los dos grupos del programa o al grupo de referencia. Se recogieron encuestas de seguimiento dos meses, seis meses y un año después del momento basal. Utilizando un método por intención de tratar, las comparaciones de trayectorias del modelo de curva del crecimiento indicaron efectos del programa un año después del momento basal en áreas de resultado claves. Tanto el grupo de ELEVATE como el de CCM informaron beneficios significativos en las habilidades para las relaciones de pareja, la calidad de la pareja y la armonía familiar con el tiempo en comparación con el grupo de referencia, que no tuvo ningún cambio ni empeoramientos. Además, el grupo de ELEVATE también demostró efectos del programa en las medidas de salud mental y calidad del sueño. Una evaluación de la premisa fundamental de la educación sobre las relaciones de pareja indicó que las mejoras inmediatas después del programa en las habilidades para las relaciones de pareja predijeron una posterior calidad de la pareja para ambos grupos del programa. Este estudio indica que tanto ELEVATE como CCM pueden considerarse programas factuales de educación sobre las relaciones de pareja aptos para su uso con una amplia población de parejas.

Exploratory analysis of Spirulina platensis LB 2340 growth in varied concentrations of anaerobically digested pig effluent (ADPE).

There is a significant interest in novel waste management solutions to treat wastewater from swine operations. Anaerobic digestion is a rising and prominent solution, but this technology still generates highly concentrated effluent that requires further remediation. Therefore, the aim of this study was to explore the feasibility of cultivating the cyanobacterium Spirulina platensis in swine effluent for future applications in biological waste treatment and value-added fermentation. To accomplish this goal, growth of S. platensis was characterized in varying proportions of ideal, synthetic Zarrouk medium and anaerobically digested pig effluent (ADPE) to obtain growth rate models. Results yielded a positive correlation between S. platensis growth rate and Zarrouk medium proportion, with the highest growth rate in 100% Zarrouk media but comparable growth in the 50/50% Zarrouk/ADPE mixture. This study demonstrates the potential for S. platensis to further improve the treatment efficacy of anaerobic digestion systems, and the exploratory analysis also highlights that further testing is required to investigate possible carbon availability, chemical inhibition, and overall nutrient reduction in ADPE. This research contributes important data toward the feasibility of producing value-added cyanobacterial biomass while simultaneously consuming excess nutrients to aid in agricultural wastewater management efforts and generate cost-effective products in a more sustainable manner.

Individual mental health and couple functioning following couple relationship education participation: Exploring prospective cross-lagged influences among changes.

Limited research on couple relationship education (CRE) programs explores the relationships among potential outcomes over time. This study conducted tests of processes of change in CRE participants' mental health and couple functioning, based on previous evidence of concurrent benefit in these domains following CRE participation. Using a diverse sample of 926 men and women we first tested the stress generation model (Journal of Abnormal Psychology, 1991, 100(4), 555-561) assumptions that individual functioning influences relational functioning. We found support for immediate changes in mental health predicting changes in couple functioning 6 months later. However, a full cross-lagged prospective model comparatively testing the stress generation model and the marital discord model (Depression in marriage: A model for etiology and treatment. Guilford, 1990), which emphasizes relational functioning impacts on individual well-being over time, revealed the stronger directional link for both men and women was from immediate changes in couple functioning to later changes in individual mental health. Practical implications and future research directions are suggested.

The Relationship Between Dimensions of Adult Attachment and Motivation for Faking Orgasm in Women.

Attachment and sexual behavior are both integral parts of adult romantic relationships. Attachment avoidance is linked to impersonal, egocentric sexual activities, whereas the sexuality of anxiously attached individuals revolves around relationship maintenance and the needs of the partner. In this attachment context, faking orgasm might serve as a means for relational regulation. The aim of our study was to investigate the links between dimensions of adult attachment and motives for faking orgasm in women. Young women completed measures of adult attachment and motivations for faking orgasm. Both attachment avoidance and attachment anxiety were related to the use of faked orgasm as a means to avoid negative, shameful feelings. Attachment avoidance was significantly associated with the intention to quickly end sexual intercourse through faking orgasm. Attachment anxiety was associated with the use of faked orgasm to increase sexual arousal and to elevate partners' self-esteem. Results are discussed with regard to relational and sexual goals associated with adult attachment orientations.

Leading from all levels: building supply chain leadership capacity in Equateur Province, Democratic Republic of Congo.

A well-functioning supply chain is a critical component of the health system to ensure high-quality medicines and health products are available when and where they are needed. However, because supply chains are complex systems, strong, competent leaders are needed to drive continuous improvement efforts. This paper documents the learnings from a supply chain leadership intervention in the Democratic Republic of Congo (DRC), which aimed to build leadership capacity in a cross-tier group of central/provincial/district-level leaders. The intervention, called the Leadership in Supply Chain Initiative, used an experiential learning curriculum to train 19 'champions' in Equateur Province, DRC. Based on self-assessments and key informant interviews, participants reported that the intervention increased their ability to lead change in the supply chain. In particular, participants and stakeholders noted that empowering district managers as leaders in the supply chain was important to improve supply chain performance, since they oversee service delivery points and are responsible for operationalising changes in the supply chain. Moreover, this intervention adds to evidence that leadership capacity is most effectively gained through experiential learning coupled with mentorship and coaching. Additional research is needed to determine the optimal duration of leadership building interventions and to better understand how supply chain leaders can be supported and mentored within the public health system.

Impact of pharmacy worker training and deployment on access to essential medicines for children under five in Malawi: a cluster quasi-experimental evaluation.

BACKGROUND: Poor access to essential medicines is common in many low- and middle-income countries, partly due to an insufficient and inadequately trained workforce to manage the medicines supply chain. We conducted a prospective impact evaluation of the training and deployment of pharmacy assistants (PAs) to rural health centers in Malawi. METHODS: A quasi-experimental design was used to compare access to medicines in two districts where newly trained PAs were deployed to health centers (intervention) and two districts with no trained PAs at health centers (comparison). A baseline household survey and two annual post-intervention household surveys were conducted. We studied children under five years with a history of fever, cough and difficulty in breathing, and diarrhea in the previous two weeks. We collected data on access to antimalarials, antibiotics and oral rehydration salts (ORS) during the childrens' symptomatic periods. We used difference-in-differences regression models to estimate the impact of PA training and deployment on access to medicines. RESULTS: We included 3974 children across the three rounds of annual surveys: 1840 (46%) in the districts with PAs deployed at health centers and 2096 (53%) in districts with no PAs deployed at health centers. Approximately 80% of children had a fever, nearly 30% had a cough, and 43% had diarrhea in the previous two weeks. In the first year of the program, the presence of a PA led to a significant 74% increase in the odds of access to any antimalarial, and a significant 49% increase in the odds of access to artemisinin combination therapies. This effect was restricted to the first year post-intervention. There was no effect of presence of a PA on access to antibiotics or ORS. CONCLUSION: The training and deployment of pharmacy assistants to rural health centers in Malawi increased access to antimalarial medications over the first year, but the effect was attenuated over the second year. Pharmacy assistants training and deployment demonstrated no impact on access to antibiotics for pneumonia or oral rehydration salts for diarrhea.

Energy-dense diet triggers changes in gut microbiota, reorganization of gut­brain vagal communication and increases body fat accumulation.

Obesity is associated with consumption of energy-dense diets and development of systemic inflammation. Gut microbiota play a role in energy harvest and inflammation and can influence the change from lean to obese phenotypes. The nucleus of the solitary tract (NTS) is a brain target for gastrointestinal signals modulating satiety and alterations in gut-brain vagal pathway may promote overeating and obesity. Therefore, we tested the hypothesis that high-fat diet­induced changes in gut microbiota alter vagal gut-brain communication associated with increased body fat accumulation. Sprague-Dawley rats consumed a low energy­dense rodent diet (LFD; 3.1 kcal/g) or high energy­dense diet (HFD, 5.24 kcal/g). Minocycline was used to manipulate gut microbiota composition. 16S Sequencing was used to determine microbiota composition. Immunofluorescence against IB4 and Iba1 was used to determine NTS reorganization and microglia activation. Nodose ganglia from LFD rats were isolated and co-cultured with different bacteria strains to determine neurotoxicity. HFD altered gut microbiota with increases in Firmicutes/Bacteriodetes ratio and in pro-inflammatory Proteobacteria proliferation. HFD triggered reorganization of vagal afferents and microglia activation in the NTS, associated with weight gain. Minocycline-treated HFD rats exhibited microbiota profile comparable to LFD animals. Minocycline suppressed HFD­induced reorganization of vagal afferents and microglia activation in the NTS, and reduced body fat accumulation. Proteobacteria isolated from cecum of HFD rats were toxic to vagal afferent neurons in culture. Our findings show that diet­induced shift in gut microbiome may disrupt vagal gut­brain communication resulting in microglia activation and increased body fat accumulation.

Scale Matters: A Cost-Outcome Analysis of an m-Health Intervention in Malawi.

BACKGROUND: The primary objectives of this study are to determine cost per user and cost per contact with users of a mobile health (m-health) intervention. The secondary objectives are to map costs to changes in maternal, newborn, and child health (MNCH) and to estimate costs of alternate implementation and usage scenarios. MATERIALS AND METHODS: A base cost model, constructed from recurrent costs and selected capital costs, was used to estimate average cost per user and per contact of an m-health intervention. This model was mapped to statistically significant changes in MNCH intermediate outcomes to determine the cost of improvements in MNCH indicators. Sensitivity analyses were conducted to estimate costs in alternate scenarios. RESULTS: The m-health intervention cost $29.33 per user and $4.33 per successful contact. The average cost for each user experiencing a change in an MNCH indicator ranged from $67 to $355. The sensitivity analyses showed that cost per user could be reduced by 48% if the service were to operate at full capacity. CONCLUSIONS: We believe that the intervention, operating at scale, has potential to be a cost-effective method for improving maternal and child health indicators.

Impact of pharmacy worker training and deployment on access to essential medicines and health outcomes in Malawi: protocol for a cluster quasi-experimental evaluation.

BACKGROUND: Access to essential medicines is core to saving lives and improving health outcomes of people worldwide, particularly in the low- and middle-income countries. Having a trained pharmacy workforce to manage the supply chain and safely dispense medicines is critical to ensuring timely access to quality pharmaceuticals and improving child health outcomes. METHODS/DESIGN: This study measures the impact of an innovative pharmacy assistant training program in the low-income country of Malawi on access to medicines and health outcomes. We employ a cluster quasi-experimental design with pre-and post-samples and decision analytic modeling to examine access to and the use of medicines for malaria, pneumonia, and diarrhea for children less than 5 years of age. Two intervention districts, with newly trained and deployed pharmacy assistants, and two usual care comparison districts, matched on socio-economic, geographic, and health-care utilization indicators, were selected for the study. A baseline household survey was conducted in March 2014, prior to the deployment of pharmacy assistants to the intervention district health centers. Follow-up surveys are planned at 12- and 24-months post-deployment. In addition, interviews are planned with caregivers, and time-motion studies will be conducted with health-care providers at the health centers to estimate costs and resources use. DISCUSSION: This impact evaluation is designed to provide data on the effects of a novel pharmacy assistant program on pharmaceutical systems performance, and morbidity and mortality for the most common causes of death for children under five. The results of this study should contribute to policy decisions about whether and how to scale up the health systems strengthening workforce development program to have the greatest impact on the supply chain and health outcomes in Malawi.

SMS versus voice messaging to deliver MNCH communication in rural Malawi: assessment of delivery success and user experience.

OBJECTIVE: To determine the difference in delivery success of health messages delivered through pushed SMS, pushed voice messages sent to personal phones, and voice messages retrieved from a community phone ("retrieved voice messaging"), as well as the difference in quality of the user experience. METHODS: We analyzed the project's electronic monitoring data between September 2011 and June 2013, including demographics, enrollment data, and messages sent and successfully delivered. We also collected and analyzed information from quarterly phone-based surveys with users to assess quality of the user experience, including acceptability, comprehension, new information learned, and reported behavior change. RESULTS: More than half of subscribers enrolled in the retrieved voice messaging service while nearly one-third enrolled in the pushed SMS service and less than 10% in pushed voice messaging. Message delivery success was highest among pushed SMS subscribers and lowest among retrieved voice subscribers. Overall, 99% of survey respondents reported trusting messages they received, and about 75% of respondents recalled the last message they received and learned something new. Almost 75% of respondents reported that they had already changed or intended to change their behavior based on received messages. Intended or actual behavior change was significantly higher among pushed SMS enrollees than among pushed or retrieved voice messaging enrollees (P = .01). CONCLUSION: All message modalities led to high levels of satisfaction, comprehension, and new information learned. Due to lower cost, higher delivery success, and higher levels of intended or actual behavior change, SMS is the preferred delivery modality. However, the majority of users included in this study did not have access to a personal phone, and retrieved voice messages provided an opportunity to access a population that otherwise could not be served. Providing multiple methods by which users could access the service was crucial in extending reach beyond literate personal phone owners.

The faking orgasm scale for women: psychometric properties.

The Faking Orgasm Scale for Women (FOS) was designed to assess women's self-reported motives for faking orgasm during oral sex and sexual intercourse. Exploratory factor analysis (EFA) was conducted on the responses of 481 heterosexual undergraduate females (M age = 20.33 years, SD = 2.48). Results of the EFA revealed that the FOS-Sexual Intercourse Subscale was composed of four factors: (1) Altruistic Deceit, faking orgasm out of concern for a partner's feelings; (2) Fear and Insecurity, faking orgasm to avoid negative emotions associated with the sexual experience; (3) Elevated Arousal, a woman's attempt to increase her own arousal through faking orgasm; and (4) Sexual Adjournment, faking orgasm to end sex. The analysis of the FOS-Oral Sex Subscale yielded four factors: (1) Altruistic Deceit; (2) Insecure Avoidance, faking orgasm to avoid feelings of insecurity; (3) Elevated Arousal; and (4) Fear of Dysfunction, faking orgasm to cope with concerns of being abnormal. Each factor of the two subscales was found to have excellent internal consistency. Confirmatory factor analysis on a separate sample of 398 heterosexual female undergraduates (M age = 20.52 years, SD = 2.55) confirmed the factor structure of each subscale with excellent fit statistics. The FOS should allow researchers and clinicians to better understand why women fake orgasm. Deepening this understanding may serve future research examining sexual desire, satisfaction, and dysfunction as well as have applications in sex and couples' therapy.

Pharmacy syringe purchase test of nonprescription syringe sales in San Francisco and Los Angeles in 2010.

The two main legal sources of clean needles for illicit injection drug users (IDUs) in California are syringe exchange programs (SEPs) and nonprescription syringe sales (NPSS) at pharmacies. In 2004, California became one of the last states to allow NPSS. To evaluate the implementation of NPSS and the California Disease Prevention Demonstration Project (DPDP), we conducted syringe purchase tests in San Francisco (SF) and Los Angeles (LA) between March and July of 2010. Large differences in implementation were observed in the two cities. In LA, less than one-quarter of the enrolled pharmacies sold syringes to our research assistant (RA), and none sold a single syringe. The rate of successful purchase in LA is the lowest reported in any syringe purchase test. In both sites, there was notable variation among the gauge size available, and price and quantity of syringes required for a purchase. None of the DPDP pharmacies in LA or SF provided the requisite health information. The findings suggest that more outreach needs to be conducted with pharmacists and pharmacy staff. The pharmacies' failure to disseminate the educational materials may result in missed opportunities to provide needed harm reduction information to IDUs. The varied prices and required quantities may serve as a barrier to syringe access among IDUs. Future research needs to examine reasons why pharmacies do not provide the mandated information, whether the omission of disposal options is indicative of pharmacies' reluctance to serve as disposal sites, and if the dual opt-in approach of NPSS/DPDP is a barrier to pharmacy enrollment.

Facets of perfectionism in a sample of hypersexual patients.

This study investigated the role of perfectionism in a treatment-seeking sample (N = 136) of adult men and women using the Perfectionism Inventory (PI) and the Hypersexual Behavior Inventory (HBI). Several facets of perfectionism were positively correlated with hypersexuality, with the concern over mistakes scale from the PI accounting for most of the predictive variance in patterns of hypersexual behavior measured by the HBI. Items associated with concern over mistakes closely parallel the construct of shame noted in other studies of hypersexual patients. To a lesser degree, the PI scale planfulness also showed a negative relationship with hypersexuality, suggesting tendencies of impulsivity in the current patients. These data reinforce the findings in other studies that patterns of harsh self-criticism and impulsivity seem to strongly influence hypersexual behavior.

Report of findings in a DSM-5 field trial for hypersexual disorder.

INTRODUCTION: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for hypersexual disorder (HD) have been proposed to capture symptoms reported by patients seeking help for out-of-control sexual behavior. The proposed criteria created by the DSM-5 Work Group on Sexual and Gender Identity Disorders require evaluation in a formal field trial. AIM: This DSM-5 Field Trial was designed to assess the reliability and validity of the criteria for HD in a sample of patients seeking treatment for hypersexual behavior, a general psychiatric condition, or a substance-related disorder. METHOD: Patients (N = 207) were assessed for psychopathology and HD by blinded raters to determine inter-rater reliability of the HD criteria and following a 2-week interval by a third rater to evaluate the stability of the HD criteria over time. Patients also completed a number of self-report measures to assess the validity of the HD criteria. MAIN OUTCOME MEASURES: HD and psychopathology were measured by structured diagnostic interviews, the Hypersexual Behavior Inventory, Sexual Compulsivity Scale, and Hypersexual Behavior Consequences Scale. Emotional dysregulation and stress proneness were measured by facets on the NEO Personality Inventory-Revised. RESULTS: Inter-rater reliability was high and the HD criteria showed good stability over time. Sensitivity and specificity indices showed that the criteria for HD accurately reflected the presenting problem among patients. The diagnostic criteria for HD showed good validity with theoretically related measures of hypersexuality, impulsivity, emotional dysregulation, and stress proneness, as well as good internal consistency. Patients assessed for HD also reported a vast array of consequences for hypersexual behavior that were significantly greater than those diagnosed with a general psychiatric condition or substance-related disorder. CONCLUSIONS: The HD criteria proposed by the DSM-5 Work Group on Sexual and Gender Identity Disorders appear to demonstrate high reliability and validity when applied to patients in a clinical setting among a group of raters with modest training on assessing HD.

Pharmacy participation in non-prescription syringe sales in Los Angeles and San Francisco counties, 2007.

Increasing sterile syringe access for injection drug users (IDUs) is one way to prevent HIV and hepatitis C virus (HCV) transmission in this population. In 2005, California Senate Bill 1159 allowed counties to adopt the Disease Prevention Demonstration Project (DPDP). Where enacted, the DPDP allows pharmacies that register with the county to sell up to ten syringes to adults without a prescription. In the current study, we describe pharmacy participation in nonprescription syringe sales (NPSS) in two counties in California and examine factors associated with NPSS. Telephone and in-person interviews were conducted in Los Angeles (LA) and San Francisco (SF) with 238 pharmacies in 2007 (n = 67 in SF; n = 171 in LA). Quantitative survey items captured pharmacy registration with the county, pharmacy policies/practices, episodes and conditions of NPSS and refusals to sell, potential negative consequences of NPSS, and staff attitudes regarding HIV and HCV prevention for IDUs. Overall, 42% of pharmacies reported NPSS (28% in LA and 81% in SF), although only 34% had registered with the county (17% in LA and 76% in SF). Many pharmacies required proof of a medical condition (80% in LA and 30% in SF) and refused NPSS if the customer was a suspected IDU (74% in LA, 33% in SF). Few negative consequences of NPSS were reported. In multivariate logistic regression analysis, we found that the odds of NPSS were significantly higher among pharmacists who thought syringe access was important for preventing HIV among IDUs [adjusted odds ratio (AOR) = 2.95; 95% confidence interval (CI) = 1.10-7.92], were chain pharmacies (AOR = 12.5; 95% CI = 4.55-33.33), and were located in SF (AOR = 4.88; 95% CI = 1.94-12.28). These results suggest that NPSS were influenced by pharmacists' perception. NPSS might be increased through greater educational efforts directed at pharmacists, particularly those in non-chain pharmacies.

Further development of the Multiple Errands Test: standardized scoring, reliability, and ecological validity for the Baycrest version.

OBJECTIVES: (1) To determine the summary scores on the Baycrest Multiple Errands Test (BMET) that best discriminate between community dwelling people with traumatic brain injury or stroke and matched controls; (2) to determine interrater reliability; (3) to evaluate further the ecological validity. DESIGN: Case-control. SETTING: Large, university-affiliated health care center and participants' homes. PARTICIPANTS: People with acquired brain injury (n=27) and healthy matched controls (n=25). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: (1) BMET; (2) performance-based measure of instrumental activities of daily living: the Assessment of Motor and Process Skills; (3) self-report and significant other report of daily life function, the Dysexecutive Questionnaire, the Sickness Impact Profile, and the Mayo-Portland Adaptability Inventory. RESULTS: Performance on the BMET was significantly different between people with acquired brain injury and controls (P<.05); good to strong correlations (>.50) were found in more than one third of the correlations between the BMET and measures of IADL and everyday function. Interclass correlation coefficients (ICCs) on BMET summary scores were high (ICC=.71-.88), illustrating very good interrater reliability. CONCLUSIONS: This study extends the psychometric findings of the Multiple Errands Test, thus further confirming its value for clinical and research purposes. It is a reliable and ecologically valid assessment that provides a standard way of categorizing executive performance errors in a naturalistic environment.

Glycopyrrolate for treatment of clozapine-induced sialorrhea in three adolescents.

OBJECTIVE: The aim of this case study was to report preliminary data on the effectiveness and tolerability of glycopyrrolate for the treatment of clozapine-induced sialorrhea, or excessive flow of saliva, in an adolescent population. METHOD: Three adolescent females (age 13-16), who developed sialorrhea secondary to clozapine treatment, received an open-label trial of glycopyrrolate (4-8 mg) during inpatient hospitalization for treatment-resistant psychotic illness. RESULTS: The target symptom of sialorrhea was improved in all three cases, with patient self-reports of decreased production of saliva confirmed by staff observation. Glycopyrrolate was generally well tolerated by the patients. One patient reported constipation, which improved with symptomatic treatment. A second patient reported dry mouth, which improved with a reduction in dose of glycopyrrolate. CONCLUSIONS: These three cases provide support for the potential effectiveness and tolerability of glycopyrrolate for clozapine-induced sialorrhea in adolescents. Further controlled studies are required to determine the safety, efficacy and tolerability of glycopyrrolate in this age group and in adults for clozapine-induced sialorrhea.

Compulsory substance abuse treatment: an overview of recent findings and issues.

An overview of research trends and issues in the area of compulsory substance abuse treatment is presented, using a sample of 170 English-language articles obtained from a search of 4 databases (Medline, PubMed, Embase, PsychINFO, supplemented by a manual search). About half (51%) of these articles were non-empirical (i.e. literature reviews, policy proposals, legal and ethical commentaries on compulsory treatment). A subsample of empirical studies published since 1988 (n = 71) was coded to summarize research trends in relation to 3 key issues: (1) how compulsory treatment was studied (country of origin; type of compulsory treatment; treatment population), (2) the evidence base for judging effectiveness of compulsory treatment (research design; sampling; type, timing and results of outcome measures), and (3) the relationship between compulsory treatment and coercion (measurement strategies). Directions for future research are discussed.