Contingency Management Incentives

Research shows the effectiveness of treatment approaches that use contingency management principles, which involve giving patients in drug treatment the chance to earn incentives in exchange for urine samples that are free from drugs. These incentives include prizes or vouchers exchangeable for food items, movie passes and other personal goods. Studies conducted in both methadone programs and psychosocial counseling treatment programs demonstrate that interventions that involve incentives are highly effective in increasing treatment retention and promoting abstinence from drugs like alcohol, stimulants, opioids, marijuana and nicotine. Some people think that a contingency management intervention with prizes could promote gambling as it contains an element of chance and because pathological gambling and substance use disorders can exist together. However, studies show that contingency management procedures with prizes do not promote gambling behavior.

Nummular Dermatitis

Nummular dermatitis, also known as nummular eczema, is one of the many forms of dermatitis. Also known as discoid dermatitis, it presents as round or oval-shaped itchy lesions. The coin-shaped patches can affect any part of the body, but the legs and buttocks are the most common areas. Flare-ups are associated with dry skin, so the winter season is a particularly bad time for those with this condition. The disorder is recurrent and chronic, and may appear at any age, although it is most common in people in their 60s. Nummular dermatitis does not appear to be a genetic condition, related food allergies or contagious.

Personalized Medicine

Personalized medicine is a medical model emphasizing the systematic use of information about an individual patient to select or optimize that patient's preventative and therapeutic care. Personalized medicine is the products and services that leverage the science of genomics and proteomics and capitalize on the trends toward wellness and consumerism to enable tailored approaches to prevention and care. Over the past century, medical care has centered on standards of care based on epidemiological studies of large cohorts. Personalized medicine seeks to provide an objective basis for consideration of such individual differences. Traditionally, personalized medicine has been limited to the consideration of a patient's family history, social circumstances, environment, and behaviors in tailoring individual care. Personalized medicine uses new methods of molecular analysis to manage a patient’s disease or predisposition toward a disease. It aims to achieve optimal medical outcomes by helping physicians and patients choose the disease management approaches likely to work best in the context of a patient’s genetic and environmental profile. Such approaches may include genetic screening programs that more precisely diagnose diseases and their sub-types, or help physicians select the type and dose of medication best suited to a certain group of patients. Personalized medicine is an extension of traditional approaches to understanding and treating illness. Since the beginning of the study of medicine, physicians have employed evidence found through observation to make a diagnosis or to prescribe treatment. In the modern concept of personalized medicine, the tools provided to the physician are more precise, probing not just the obvious, such as a tumor on a mammogram or cells under a microscope, but the very molecular makeup of each patient. Looking at the patient on this level helps the physician get a profile of the patient’s genetic distinction, or mapping. By investigating this genetic mapping, medical professionals are then able to profile patients, and use the found information to plan a course of treatment that is much more in step with the way their body works. Genomic medicine and personalized medicine use genetic information to prevent or treat disease in adults or their children. Having a genetic map or a profile of a patient’s genetic variation can then guide the selection of drugs or treatment processes. This can minimize side effects or to create a strategy for a more successful outcome from the medical treatment. Helping the physician cover all the bases is imperative. Genetic mapping can also indicate the propensity to contract certain diseases before the patient actually shows recognizable symptoms, allowing the physician and patient to put together a plan for observation and prevention. Personalized medicine, when coupled with personal pharmacogenetics, is a unique approach that may be well suited for the health challenges we face in the new millennium. Although the medical and scientific communities, through research and discovery, got the upper hand over many of the diseases we have encountered since the advent of advanced medicine, many diseases that are more complicated. Diseases like diabetes, heart disease, cancer, and Alzheimer’s are caused by a combination of genetic and other factors. Coupled with the fact that they tend to be chronic, they place a significant burden on not only the patient, but on the healthcare system as a whole. Personalized medicine aims to provide the tools and knowledge to fight chronic diseases and treat them more effectively than ever before. Genetic profiles can help physicians to better discern subgroups of patients with various forms of cancer, in addition to other complex diseases, helping to guide doctors with accurate forms of predictive medicine and preventative medicine. With personalized medicine, the physician is intending to select the best treatment protocol or even, in many cases, avoid passing the expense and risks of unnecessary medical treatments on to the patient altogether. In addition, personalized medicine, when used correctly, aims to guide tests that detect variation in the way individual patients metabolize various pharmaceuticals. Personalized medicine is working to help determine the right dose for a patient, helping to avoid hazards based on familial history, environmental influences, and genetic variation.

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Metabolic Syndrome and Weight

The metabolic syndrome is a group of risk factors related to obesity for coronary heart disease and diabetes. A person has the metabolic syndrome if he or she has three or more of the following risk factors: A large waistline. For men, this means a waist measurement of 40 inches or more and for women, it means a waist measurement of 35 inches or more; high triglycerides or taking medication to treat high triglycerides. A triglyceride level of 150 mg/dL or higher is high; Low levels of HDL good cholesterol or taking medications to treat low HDL. For men, low HDL cholesterol is below 40 mg/dL. For women, it is below 50 mg/dL; High blood pressure or taking medications to treat high blood pressure. High blood pressure is 130 mm Hg or higher for systolic blood pressure the top number or 85 mm Hg or higher for diastolic blood pressure the bottom number; High fasting blood glucose sugar or taking medications to treat high blood sugar. This means a fasting blood sugar of 100 mg/dL or higher.
A person with metabolic syndrome has approximately twice the risk for coronary heart disease and five times the risk for Type 2 diabetes. It is estimated that 27 percent of American adults have the metabolic syndrome.
The metabolic syndrome relates to obesity, especially abdominal obesity. Other risk factors that affect metabolic syndrome are physical inactivity, insulin resistance, genetics and old age.
Obesity is a risk factor for the metabolic syndrome because it raises blood pressure and triglycerides, lowers good cholesterol and contributes to insulin resistance. Excess fat around the abdomen carries even higher risks.
It may be possible to prevent the metabolic syndrome with weight management and physical activity. For patients who already have the syndrome, losing weight and being physically active may help prevent or delay the development of diabetes, coronary heart disease or other complications.
Individuals who are overweight or obese and who have the metabolic syndrome should aim to lose 10 percent of their body weight and do at least 30 minutes of moderate-intensity physical activity every day. Doctors also advise that people quit smoking, eat healthfully and take prescription medications for conditions such as high blood pressure or low HDL cholesterol.