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A follow-up study of heroin addicts (VEdeTTE2): study design and protocol

Then, get ready to escape the ordinary and experience an hour, day or week of complete pleasure, intimacy and companionship with one of the most desirable escorts in Grugliasco A sample size of is required to find a statistically significant Relative Risk of 1. Forensic Science International.

The assessment of long-term outcomes other than mortality involves tracing patients and obtaining their consent again, which requires good study design Prostitutes Grugliasco well-organized field work. Moreover, in conducting a follow-up study several critical methodological issues must be considered, such as attrition and the accuracy of self-reported drug use.

Prostitutes Grugliasco evaluate the feasibility of the VEdeTTE2 study and to ensure the quality of follow-up procedures, a pilot study Prostitutes Grugliasco conducted in The purpose of Prostitutes Grugliasco paper is to describe the VEdeTTE2 study design and protocol, and to Prostitutes Grugliasco the results of the pilot study and the improvements to the protocol implemented in consequence of the pilot study. The study population of the VEdeTTE2 study consist of a sample of patients enrolled in the VEdeTTE1 cohort between September and March all new patients and a random sample of re-entry and prevalent patients.

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A sample size of is required to find a statistically significant Relative Risk of 1. However, based on available funds, it was decided to follow-up 2, patients. All procedures and instruments were approved by the Ethical Committee. A telephone number to contact the Ethical Committee is specified on the written consent form, a copy of which is given to the patient at the time of enrolment.

Precautions are taken to guarantee data confidentiality. Data are identified using the same anonymous code assigned to the patient upon enrolment in VEdeTTE1. The possibility of matching the anonymous code with patient identity is restricted to Prostitutes Grugliasco NHS treatment centres and the Regional Coordinating Centres.

Moreover, patients are assigned to interviewers whom they have never met before, and they have the choice of being interviewed outside the Prostitutes Grugliasco treatment centre. Finally, only aggregate results will be communicated to NHS treatment centres. To minimize attrition and achieve a good contact rate, detailed procedures were devised. First of all, a reward is given to participating patients, as suggested in the international literature [ 27Prostitutes Grugliasco ].

Patients are given 15 euro for the interview and 37 euro for the biological sample. Secondly, the interviewers are either external interviewers or NHS Prostitutes Grugliasco centre personnel; they are trained in a one-day training session, Prostitutes Grugliasco paid euro for each interview and 15 euro for each refusal or drop-out.

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Thirdly, accurate tracing procedures were implemented. For patients still attending NHS treatment centres, the interviewer is introduced to the patient by a clinician at the Prostitutes Grugliasco centre.

A pilot phase was planned and carried out on 60 patients.

For patients no longer attending the drug treatment centre, the interviewer contacts the patient with the help of treatment centre personnel. In the case of failure, life status and home address are obtained at the General Registry Office and, whenever possible, a phone number from the patient's acquaintances.

Finally, a maximum of three attempts are made to contact the patient by letter sent to the last known address. Participants are required to complete a questionnaire administered by an interviewer. The questionnaire consists of eleven sections: 1 civil status, educational level, accommodation, job to be completed for refusals and drop-outs only ; 2 HIV, HBV and HCV test results, other pathologies recorded Prostitutes Grugliasco the case history; 3 changes in civil status, educational level and life events since the VEdeTTE1 interview e.

The Prostitutes Grugliasco section for refusals and drop-outs is Prostitutes Grugliasco from information in the Prostitutes Grugliasco records.

Most of the above items were Prostitutes Grugliasco in the interview upon enrolment in the VEdeTTE1 cohort, thereby allowing Prostitutes Grugliasco comparison to be made between the social and health status of the patients in the two time periods. Information on treatment is collected from clinical records and recorded on a specific Registration Form beginning with the first treatment received during the VEdeTTE1 study period until the end of the VEdeTTE2 study.

Details are collected on each treatment: Prostitutes Grugliasco, dose, start and end dates. All types of treatment used in the NHS treatment centres are recorded: pharmacological treatments methadone and buprenorphine maintenance or detoxification, Prostitutes Grugliasco drugs, naltrexone, detoxification with non-opiate drugspsychosocial treatments counselling, social advice, psychotherapy, job guidancein-patient detoxification, semi-residential treatment and residential therapeutic community.

Participating patients are also required to provide a sample of nape, axillary or pubic hair. Hair analysis is performed to ascertain the reliability of self-reported drug use [ 29 - 34 ]. In Prostitutes Grugliasco to have information on drug use in the last 30 days, and as hair grows between 0.

Morphine and 6-monoacetylmorphine are examined as markers of heroin use; cocaine and its metabolite benzoylecgonine are the markers of cocaine use [ 3536 ]. To give a reliable estimate of the last 30 days use, both the length of the sample Prostitutes Grugliasco the site of the body from Prostitutes Grugliasco hair is collected will be taken into account at the statistical analysis stage.

A pilot study was carried out to verify the feasibility Prostitutes Grugliasco the follow-up procedures. The specific objectives of the pilot study were:.

The pilot study was carried out in the Piedmont region between April and Juneinvolving 10 NHS drug abuse treatment centres. From these 1, patients, 60 were selected for the pilot study: all new patients and a random sample of Prostitutes Grugliasco and prevalent patients.

To assess the difference Prostitutes Grugliasco contact rate, patients were randomly assigned to three external interviewers 29 patients and three NHS treatment centre personnel 31 patients. Of the nine patients no longer attending treatment centres, only one The proportion not traced among Prostitutes Grugliasco no longer attending NHS treatment centres Five of the six patients living in Prostitutes Grugliasco therapeutic community were interviewed.

The only patient in prison was declared a drop-out, as it was impossible to contact the patient, although many attempts had been made.

The two patients who had migrated to another Italian region were searched for by telephone and through their acquaintances; one of them was contacted but not interviewed, because of administrative problems. By the end of Prostitutes Grugliasco pilot study, 53 patients The median follow-up period at the time of the interview was 29 months.

All except one of the 41 patients interviewed provided a biological sample Prostitutes Grugliasco nape hair, 5 axillary hair, 2 pubic hair.

The axillary hair samples were not reliable: most of them were inadequate in quantity Prostitutes Grugliasco inhomogeneous in length.

Of the remaining 31 samples, For the biological sample, the acceptance rate was unexpectedly high The interviewer incentive scheme was successful. However, to encourage interviewers to obtain the consent of as many patients as possible and to avoid the temptation to contact only those patients still attending the NHS treatment centres, the interviewer reward was changed slightly in the Prostitutes Grugliasco study. As treatment centre personnel had a lower contact rate than external interviewers, it was decided that no more than half of the interviewers would be NHS treatment centre personnel, and that they would be assigned Prostitutes Grugliasco patients compared to external interviewers.

To overcome the difficulties encountered in contacting the patient in Prostitutes Grugliasco, a Prostitutes Grugliasco for official authorization was sent to the Ministry of Justice.

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The Ministry of Justice sent a statement of collaboration to all the prisons involved Prostitutes Grugliasco facilitate the work of the interviewers. Other changes were Prostitutes Grugliasco the monitoring forms were simplified accordingly to the comments provided by the interviewers; the sections in the questionnaire were re-ordered with questions about demographic characteristics at the beginning, and the more intrusive ones e.

Moreover, in order to deepen the investigation into illegal activity, a twelfth section was developed that included questions about criminal activity and prostitution.

This section was on a separate sheet, which was given to the patient to be completed and returned by regular mail. The Prostitutes Grugliasco was that this procedure would encourage patients to answer honestly, without fear of legal consequences.

This may be owing to the inconsistency between the length of the hair examined 2—4 cm corresponding Prostitutes Grugliasco 2—4 months and the recall period in the questionnaire 30 Prostitutes Grugliasco. Patients who had Prostitutes Grugliasco drugs two or three months prior to the interview but not within the last 30 days would have screened positive and given a negative response on the questionnaire.

This may be particularly relevant for cocaine use, which is sporadic compared to heroin dependence. On the other Prostitutes Grugliasco, the fact that two patients reported heroin use on the questionnaire but screened negative may suggest that the biological test lacks the power to detect sporadic drug use.

Moreover, even though all samples that screened positive were confirmed by gas chromatography-mass spectrometry, certain laboratory errors, such as false positives caused by contamination in the laboratory, could have been more thoroughly addressed had there been more specimens.

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This is unlikely to affect the final results in the VEdeTTE2 main study, as there Prostitutes Grugliasco a large number of samples. In order to improve the results in the main study, only the two centimetres of hair nearest the root was tested and patients were asked about Prostitutes Grugliasco drug use in the last two months.

In Italy, there have not been any large follow-up studies of heroin addicts evaluating rehabilitation outcomes in the long term. The scarcity of international data on long-term rehabilitation outcomes and the availability of a large sample such as the VEdeTTE1 cohort as a source of potential subjects were the reasons for undertaking the Prostitutes Grugliasco study.

Moreover, the VEdeTTE1 study, because of its study design, could investigate the effect of different treatments and combinations of treatments on retention and Prostitutes Grugliasco [ 38 ], but not on drug use.

The VEdeTTE2 follow-up study, which combines self-reported measures with the results of a biological sample, will provide a more reliable assessment of drug use and, therefore, is a good occasion for a thorough investigation into the effects of treatments on long-term Prostitutes Grugliasco use. The aim of this paper is to describe the VEdeTTE2 study design and protocol, and Prostitutes Grugliasco present the results of the pilot study underlining the changes to the instruments consequently implemented.

Moreover, the pilot phase was very Prostitutes Grugliasco in identifying possible causes of delays and attrition. For example, there were significant differences in the contact rates between the two types of interviewers, with more favourable results by external interviewers compared to treatment centre personnel.

This could be probably due to differences in the availability of dedicated time between the two categories of interviewers. Study instruments contained some flaws, identified by the interviewers, which were consequently modified. The self-reported drug use is a crucial item of a study aimed at measuring the use of substances.

For this reason, Prostitutes Grugliasco is generally recommended to collect Prostitutes Grugliasco biological sample in order to have a reliable measure of drug use. This result confirmed the need to obtain a hair sample from all patients. These results underline the importance of the pilot phase when planning a follow-up study, especially when Prostitutes Grugliasco addicted are Prostitutes Grugliasco.

FV-T and FM drafted the article and Prostitutes Grugliasco the statistical analysis in the pilot study. All authors provided comments to the draft and participated to the completion of the report.

Sergio Pellegrino for his comments on the description of the procedure for the hair sample analysis, and Dr. Sherri Pasian for her careful review of English. National Center for Biotechnology InformationU. Subst Abuse Treat Prev Policy. Published online Mar For instance, an agency escort might have limited services while independent escorts might even offer their clients an erotic massage.

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Table 2 Characteristics of the 41 patients interviewed for the Pilot Study. Apart from this live gallery, there are three cafes in the street.

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