Perfil lipoproteico de riesgo en pacientes con diabetes mellitus tipo 1 / Risk lipoprotein profile in patients with type 1 diabetes mellitus

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Heavy metal distribution and bioaccumulation in Chihuahuan Desert Rough Harvester ant (Pogonomyrmex rugosus) populations.

Heavy metal contamination can negatively impact arid ecosystems; however a thorough examination of bioaccumulation patterns has not been completed. We analyzed the distribution of As, Cd, Cu, Pb and Zn in soils, seeds and ant (Pogonomyrmex rugosus) populations of the Chihuahuan Desert near El Paso, TX, USA. Concentrations of As, Cd, Cu, and Pb in soils, seeds and ants declined as a function of distance from a now inactive Cu and Pb smelter and all five metals bioaccumulated in the granivorous ants. The average bioaccumulation factors for the metals from seeds to ants ranged from 1.04x (As) to 8.12x (Cd). The findings show bioaccumulation trends in linked trophic levels in an arid ecosystem and further investigation should focus on the impacts of heavy metal contamination at the community level.

Chemically dependent patients in recovery: roles for the family physician.

Successful recovery from chemical dependency usually requires at least two years of abstinence and has complex medical, psychologic, and social aspects. In addition to the multiple medical problems associated with substance abuse, patients are at risk for conditions resulting from impaired judgment during addiction, including sexually transmitted diseases. In addition, therapeutic doses of ongoing medications (e.g., antihypertensive agents) may need to be reestablished because of the physiologic changes that occur during recovery. Patient attitudes toward physicians and medications may range from overuse to avoidance, depending on personal experiences and vulnerabilities. These factors may also influence the efforts of physicians, family members and support groups who are trying to help recovering patients. Twelve-step programs, supportive medical follow-up and the judicious use of medications in specific circumstances can greatly increase the probability of successful and sustained recovery for previously addicted patients.

New dimensions in behavioral health/primary care integration.

The case is made for the integration of primary care and behavioral health services in the HMO. Key features of a successfully integrated behavioral health service are offered, along with brief reports of integration efforts at a number of HMOs across the United States. The author believes that better value and cost efficiencies result from integration.

A new approach to alcoholism detection in primary care.

This article describes a model that brings together the chemical dependency, mental health, and primary care services of a staff model HMO for the purpose of establishing a primary care clinic-based program to assist physicians in early detection of chemical dependency and frequent psychiatric disorders. The model creates a partnership between a master's-level professional social worker (MSW) and a designated family physician from the clinic. Their focus is on provider education, consultation, and on assisting patients with referrals to the appropriate services. Parameters of success include changes on referral patterns, use of the MSW's services, and clinic satisfaction. In addition, there are indications that early intervention has had a positive impact on subsequent use of other health care system's resources.

Designing chemical dependency programs in HMOs.

This article is a description of an existing chemical dependency treatment program in an HMO, Group Health Cooperative of Puget Sound, a consumer-owned and governed staff model organization. It presents the various issues that were considered before deciding to develop an in-house program and the variety of different services offered. The Alcohol and Drug Abuse Program of Treatment (ADAPT) is a comprehensive model offering both inpatient and outpatient detoxification and rehabilitation services to an enrollment base of approximately 350,000 subscribers. This article, written from a practical "nuts and bolts" perspective, should benefit other HMO providers who are considering development of their own in-house program.