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Send blood annually for measurement of creatinine in all patients at increased risk discount caverta 100 mg line. If proteinuria persists quantify protein with a spot urine protein creatinine ratio discount caverta 100 mg with mastercard. Patients who might qualify for dialysis and transplantation or who have complications should be referred early to ensure improved outcome and survival on dialysis, i. Where adequate laboratory and clinical resources exists, management according to the hospital level guidelines may be instituted. Differentiation of upper from lower urinary tract infection in young children is not possible on clinical grounds. Features of urinary tract infections in children Signs and symptoms are related to the age of the child and are often non-specific. Neonates may present with: » fever » hypothermia » poor feeding » sepsis » vomiting » prolonged jaundice » failure to thrive » renal failure Infants and children may present with: » failure to thrive » frequency » persisting fever » dysuria » abdominal pain » enuresis or urgency » diarrhoea In any child with fever of unknown origin, the urine must be examined, to assess whether a urinary tract infection is present. If a bag specimen reveals the following, a urine specimen must be collected aseptically for culture and sensitivity: » positive leukocytes or nitrites on dipstix in freshly passed urine » motile bacilli and increased leukocytes or leukocyte casts on urine microscopy Urine dipstix should be performed on a fresh urine specimen. For pregnant women and adolescents:  Amoxicillin/clavulanic acid 875/125 mg, oral, 1 tablet 12 hourly for 7 days. Acute pyelonephritis Outpatient therapy is only indicated for women of reproductive age, who do not have any of the manifestations requiring referral (see referral criteria below). Ill patients awaiting transfer » Ensure adequate hydration with intravenous fluids. Non-urgent » All children for urinary tract investigations after completion of treatment. Clinical features include: » perineal, sacral or suprapubic pain » dysuria and frequency » varying degrees of obstructive symptoms which may lead to urinary retention » sometimes fever » acutely tender prostate on rectal examination The condition may be chronic, bacterial or non-bacterial, the latter usually being assessed when there is failure to respond to antibiotics. Glomerular disease is suggested if proteinuria, red blood cell casts and/or dysmorphic red blood cells are present on microscopy. Note: The presence of blood on the urine test strips does not indicate infection and should be investigated as above. If haematuria does not resolve rapidly after treatment referral for formal investigation will be required, i. May be associated with both obstructive (weak, intermittent stream and urinary hesitancy) and irritative (frequency, nocturia and urgency) voiding symptoms. Urinary retention with a distended bladder may be present in the absence of severe symptoms, therefore it is important to palpate for an enlarged bladder during examination. For patients presenting with urinary retention, insert a urethral catheter as a temporary measure while patient is transferred to hospital. As the axial skeleton is the most common site of metastases, patients may present with back pain or pathological spinal fractures. It is important, however, to differentiate between nocturnal enuresis and daytime wetting with associated bladder dysfunction. Secondary causes of enuresis include: » diabetes mellitus » urinary tract infection » physical or emotional trauma Note: » Clinical evaluation should attempt to exclude the above conditions. Clinical features of obstructing urinary stones may include: » sudden onset of acute colic, localized to the flank, causing the patient to move constantly, » nausea and vomiting, » referred pain to the scrotum or labium on the same side as the stone moves down the ureter. Antimicrobial resistance patterns in outpatient urinary tract infections--the constant need to revise prescribing habits. Antimicrobial susceptibility patterns of Escherichia coli strains isolated from urine samples in South Africa from 2007-2011. Antimicrobial susceptibility of organisms causing community-acquired urinary tract infections in Gauteng Province, South Africa. A meta-analysis of randomized, controlled trials comparing short- and long-course antibiotic therapy for urinary tract infections in children. The Urinary Tract Subcommittee of the American Academy of Pediatrics Committee on Quality Improvement. Intensive Care Unit, Royal Children’s Hospital, Parkville, Victoria 3052, Australia. Antibiotic treatment for pyelonephritis in children: multicentre randomised controlled non-inferiority trial. Treatment targets Additional Parameter Optimal Acceptable action suggested Finger-prick blood glucose values:  fasting (mmol/L) 4–7 <8 >8  2-hour post-prandial (mmol/L) 5–8 8–10 >10 Glycosylated haemoglobin (HbA1c) (%) <7 7–8 >8 Blood pressure Systolic <140 mmHg Diastolic <90 mmHg i LoE:I The increased risk of hypoglycaemia must always be weighed against the potential benefit of reducing microvascular and macrovascular complications. Insulin regimens Basal bolus regimen All type 1 diabetics should preferentially be managed with the “basal bolus regimen” i. This consists of pre-meal, short-acting insulin and bedtime intermediate-acting insulin not later than 22h00. The total dose is divided into: o 40–50% basal insulin o The rest as bolus insulin, split equally before each meal. It is a practical option for patients who cannot monitor blood glucose frequently. Drawing up insulin from vials » Clean the top of the insulin bottle with an antiseptic swab. In thin people it may be necessary to pinch the skin between thumb and forefinger of one hand. Prefilled pens and cartridges In visually impaired patients and arthritic patients, prefilled pens and cartridges may be used. However, an increasing number of adolescents are being diagnosed with type 2 diabetes mellitus. Criteria for screening for diabetes in children th » Body mass index > 85 percentile for age and sex. It is difficult to distinguish type 2 from type 1 diabetes mellitus, as many type 1 diabetics may be overweight, or have a family history of type 2 diabetes mellitus, given the increasing prevalence of both obesity and type 2 diabetes mellitus. The diagnosis of type 2 diabetes mellitus in adolescents should be made in consultation with a specialist. Most adults with type 2 diabetes mellitus are overweight with a high waist to hip ratio. In adults the condition might be diagnosed only when presenting with complications, e. Suspect type 1 diabetes mellitus among younger patients with excessive weight loss and/or ketoacidosis. Treatment targets Additional Parameter Optimal Acceptable action suggested Finger prick blood glucose values:  fasting (mmol/L) 4–7 <8 > 8  2-hour post-prandial (mmol/L) 5–8 8–10 > 10 Glycosylated haemoglobin (HbA1c) (%) < 7 7–8 > 8 Blood pressure Systolic < 140 mmHg Diastolic < 90 mmHg » In the elderly, the increased risk of hypoglycaemia must be weighed against the potential benefit of reducing microvascular and macrovascular complications. For treatment of hypertension and dyslipidaemia after risk-assessment, see Section 4. Diet » Consider the following for a person-centred approach to diet therapy:  Weight. These foods are digested slowly resulting in a slow and steady rise in blood glucose concentrations. Fruit and vegetables » Eat a variety of fruit and vegetables – 4 to 5 portions on a daily basis. Insulin type Starting dose Increment Add on 10 units in the evening before If 10 units not effective: therapy: bedtime, but not after 22h00. Risk factors include age < 6 years of age, low HbA1c and longer duration of diabetes. Hypoglycaemia in diabetic patients can be graded according to the table below: Mild/moderate hypoglycaemia Severe hypoglycaemia » Capable of self-treatment*. Autonomic symptoms/signs Neurological symptoms/signs » Tremors » Headache » Palpitations » Mood changes » Sweating » Low attentiveness » Hunger » Slurred speech » Fatigue » Dizziness » Pallor » Unsteady gait » Depressed level of consciousness/ convulsions *Note: » Children, particularly < 6 years of age, generally are not capable of self- management and are reliant on supervision from an adult. If a diabetic patient presents with an altered level of consciousness and a glucometer is not available, treat as hypoglycaemia. Conscious patient, not able to feed without danger of aspiration Administer via nasogastric tube:  Dextrose 10%, 5 mL/kg o Add 1 part 50% dextrose water to 4 parts water to make a 10% solution. Do not give excessive volumes of fluid: usually can keep line open with 2mL/kg/hour. They play an important role in the morbidity and mortality suffered by people with diabetes. Pain:  Amitriptyline, oral, 10–25 mg at night increasing to 100 mg, if necessary. Ulcers can be secondarily infected by staphylococci, streptococci, coliforms, and anaerobic bacteria which can lead to cellulitis, abscess formation, and osteomyelitis. In those with type 1 diabetes, triglycerides, and to a lesser extent cholesterol concentrations, are usually increased.

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Rituxan-induced infusion reactions and sequelae include urticaria buy caverta 100mg with visa, hypotension safe caverta 100 mg, angioedema, hypoxia, bronchospasm, pulmonary infiltrates, acute respiratory distress syndrome, myocardial infarction, ventricular fibrillation, cardiogenic shock, anaphylactoid events, or death. Depending on the severity of the infusion reaction and the required interventions, temporarily or permanently discontinue Rituxan. Closely monitor the following patients: those with pre-existing cardiac or pulmonary conditions, those who experienced prior cardiopulmonary adverse reactions, and those with high numbers of circulating malignant cells 3 (≥25,000/mm ). These reactions include paraneoplastic pemphigus, Stevens-Johnson syndrome, lichenoid dermatitis, vesiculobullous dermatitis, and toxic epidermal necrolysis. The onset of these reactions has been variable and includes reports with onset on the first day of Rituxan exposure. The safety of readministration of Rituxan to patients with severe mucocutaneous reactions has not been determined. Reactivation also has occurred in patients who appear to have resolved hepatitis B infection (i. The patients with autoimmune diseases had prior or concurrent immunosuppressive therapy. Correct electrolyte abnormalities, monitor renal function and fluid balance, and administer supportive care, including dialysis as indicated. Infections have been reported in some patients with prolonged hypogammaglobulinemia (defined as hypogammaglobulinemia >11 months after rituximab exposure). New or reactivated viral infections included cytomegalovirus, herpes simplex virus, parvovirus B19, varicella zoster virus, West Nile virus, and hepatitis B and C. Discontinue Rituxan for serious infections and institute appropriate anti-infective therapy. Perform cardiac monitoring during and after all infusions of Rituxan for patients who develop clinically significant arrhythmias, or who have a history of arrhythmia or angina. Monitor closely for signs of renal failure and discontinue Rituxan in patients with a rising serum creatinine or oliguria. Evaluate if symptoms of obstruction such as abdominal pain or repeated vomiting occur. Most patients in the Rituxan-treated group had B-cell counts below the lower limit of normal at the time of immunization. The duration of cytopenias caused by Rituxan can extend months beyond the treatment period. The safety and efficacy of retreatment with Rituxan have not been established [See Dosage and Administration (2. The data described below reflect exposure to Rituxan in 2783 patients, with exposures ranging from a single infusion up to 2 years. Infusion reactions typically occurred within 30 to 120 minutes of beginning the first infusion and resolved with slowing or interruption of the Rituxan infusion and with supportive care (diphenhydramine, acetaminophen, and intravenous saline). The incidence of infusion reactions was highest during the first infusion (77%) and decreased with each subsequent infusion. For Cycles 2-8, the incidence of Grade 3-4 infusion reactions on the day of or day after the 90-minute infusion, was 2. The overall incidence of infections was 31% (bacterial 19%, viral 10%, unknown 6%, and fungal 1%). In diffuse large B-cell lymphoma patients, viral infections occurred more frequently in those who received Rituxan. These included lymphopenia (40%), neutropenia (6%), leukopenia (4%), anemia (3%), and thrombocytopenia (2%). The median duration of lymphopenia was 14 days (range, 1−588 days) and of neutropenia was 13 days (range, 2−116 days). A single occurrence of transient aplastic anemia (pure red cell aplasia) and two occurrences of hemolytic anemia following Rituxan therapy occurred during the single-arm studies. Prolonged neutropenia is defined as Grade 3-4 neutropenia that has not resolved between 24 and 42 days after the last dose of study treatment. Late-onset neutropenia is defined as Grade 3-4 neutropenia starting at least 42 days after the last treatment dose. In patients who did not have prolonged neutropenia, the frequency of late-onset neutropenia was 14. In patients who did not have prolonged neutropenia, the frequency of late-onset neutropenia was 38. In these single-arm Rituxan studies, bronchiolitis obliterans occurred during and up to 6 months after Rituxan infusion. In Study 5, detailed safety data collection was limited to serious adverse reactions, Grade ≥ 2 infections, and Grade ≥ 3 adverse reactions. In patients receiving Rituxan as single-agent maintenance therapy following Rituxan plus chemotherapy, infections were reported more frequently compared to the observation arm (37% vs. Grade 3-4 adverse reactions occurring at a higher incidence (≥ 2%) in the Rituxan group were infections (4% vs. Neutropenia was the only Grade 3 or 4 adverse reaction that occurred more frequently (≥2%) in the Rituxan arm compared with those who received no further therapy (4% vs. Detailed safety data collection in these studies was primarily limited to Grade 3 and 4 adverse reactions and serious adverse reactions. In Study 8, a review of cardiac toxicity determined that supraventricular arrhythmias or tachycardia accounted for most of the difference in cardiac disorders (4. Detailed safety data collection in Study 11 was limited to Grade 3 and 4 adverse reactions and serious adverse reactions. Infusion-related adverse reactions were defined by any of the following adverse events occurring during or within 24 hours of the start of infusion: nausea, pyrexia, chills, hypotension, vomiting, and dyspnea. Among all exposed patients, adverse reactions reported in greater than 10% of patients include infusion-related reactions, upper respiratory tract infection, nasopharyngitis, urinary tract infection, and bronchitis. In placebo-controlled studies, patients received 2 x 500 mg or 2 x 1000 mg intravenous infusions of Rituxan or placebo, in combination with methotrexate, during a 24-week period. From these studies, 938 patients treated with Rituxan (2 x 1000 mg) or placebo have been pooled (see Table 2). Adverse reactions reported in ≥ 5% of patients were hypertension, nausea, upper respiratory tract infection, arthralgia, pyrexia and pruritus (see Table 2). The rates and types of adverse reactions in patients who received Rituxan 2 x 500 mg were similar to those observed in patients who received Rituxan 2 x 1000 mg. The incidence of adverse reactions during the 24-hour period following the second infusion, Rituxan or placebo, decreased to 11% and 13%, respectively. Acute infusion reactions (manifested by fever, chills, rigors, pruritus, urticaria/rash, angioedema, sneezing, throat irritation, cough, and/or bronchospasm, with or without associated hypotension or hypertension) were experienced by 27% of Rituxan-treated patients following their first infusion, compared to 19% of placebo-treated patients receiving their first placebo infusion. The incidence of these acute infusion reactions following the second infusion of Rituxan or placebo decreased to 9% and 11%, respectively. Serious acute infusion reactions were experienced by <1% of patients in either treatment group. Acute infusion reactions required dose modification (stopping, slowing, or interruption of the infusion) in 10% and 2% of patients receiving rituximab or placebo, respectively, after the first course. The proportion of patients experiencing acute infusion reactions decreased with subsequent courses of Rituxan. The administration of intravenous glucocorticoids prior to Rituxan infusions reduced the incidence and severity of such reactions, however, there was no clear benefit from the administration of oral glucocorticoids for the prevention of acute infusion reactions. Patients in clinical studies also received antihistamines and acetaminophen prior to Rituxan infusions. Infections In the pooled, placebo-controlled studies, 39% of patients in the Rituxan group experienced an infection of any type compared to 34% of patients in the placebo group. The most common infections were nasopharyngitis, upper respiratory tract infections, urinary tract infections, bronchitis, and sinusitis. The incidence of serious infections was 2% in the Rituxan-treated patients and 1% in the placebo group. Rates of serious infection remained stable in patients receiving subsequent courses. Cardiac Adverse Reactions In the pooled, placebo-controlled studies, the proportion of patients with serious cardiovascular reactions was 1.

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Lack of saliva increases the risk of developing caries (particularly athe cervi- cal and rooareas of the eth) generic caverta 50mg line, enamel erosions and periodontal diseases [1 discount 50mg caverta amex,2,33]. Early de- ction and treatmenof hyperglycemia and hyposalivation may provide a useful 77 Rad 514 Medical Sciences, 38(2012) : 69-91 M. Mravak-Stipetic: Xerostomia - diagnostics and treatmenstragy for preventing the dental complications of diabes and promoting oral he- alth in this population. Oral fungal infection (candidosis) and enlargemenof salivary glands from si- aladenitis are seen commonly in patients with modera-to-severe salivary gland hypofunction [2,20]. The risk of infection is increased in people who wear dentures, smokers and diabetics; in patients with Sjogren�s syndrome and connective tissue diseases tread with corticosroids or other immunosuppressants. These drugs also contribu to candidiasis because they reduce the natural resistance of the mucosa. Lack of saliva creas difculties in wearing dentures while promoting the developmenof denture stomatitis [1,2]. In cases when there is still some residual salivary function iwas shown thasaliva stimulans (local or sysmic stimulation of secretory gland) produce grear relief than saliva substitus. When salivary glands are irreversible dama- 78 Rad 514 Medical Sciences, 38(2012) : 69-91 M. Mravak-Stipetic: Xerostomia - diagnostics and treatmenged and withoucapability to produce saliva, as is in the cases of head and neck ra- diotherapy or advanced sysmic disease (e. When salivary function is preserved stimulation of salivary glands aimed to increase the salivary output, include: 1. Local stimulation The combination of chewing and acidic tas, as provided by chewing gums or solid food or fruits, preferentially acidic (apple, pinneapple, carrots etc. Patients with dry mouth musbe told noto use sweets, sweener in food and drink and various other sugar products due to the increased risk for dental caries. Use of acupuncture in the treatmenof xerostomia have focused earlier mainly on a curative approach when the salivary gland tissues are already damaged and xerostomia is present. Electrical stimulation has also been used as a therapy for salivary hypofunction buhas been inadequaly investigad clinically. A device thadelivers a verylow- voltage electrical charge to the tongue and pala has been described although its efecwas modesin patients with dry mouth [16]. Sysmic stimulation Any agenthahas the ability to infuence salivary glands to increase production of saliva is rmed a secretagogue. The mechanism of action for salivary stimulation of a mucolytic agenbromhexine and anetholetrithione is nofully understood. No proven benefto salivary function 79 Rad 514 Medical Sciences, 38(2012) : 69-91 M. Mravak-Stipetic: Xerostomia - diagnostics and treatmenhas been shown for bromhexine yeimay stimula lacrimal function in patients with Sjogren�s syndrome although this is controversial. Ihas been suggesd thaanetholetrithione may up-regula muscarinic receptors and increased saliva fow in patients with mild salivary gland hypofunction, buwas inefective in patients with marked salivary gland hypofunction. As a parasympathomimetic agenicauses stimulation of cholinergic receptors on the surface of acinar cells. Pilocar- pine increases salivary output, stimulating any remaining gland function. Currenindications are for patients following radiotherapy and for those with Sjogren�s syn- drome. In doses of up to 15 mg/day, iincreases secretion of saliva, and for optimal results patients should be tread during 8-12 week. Afer the administration of pilocarpine, salivary outpuincreases rapidly, usually reaching a maximum within 1 hour. Stimulation of the salivary glands during radiation therapy has been suggesd as a possible means of reducing damage to the glands. The synergistic efecof anetholetrithione in combination with pilocarpine was shown [20]. The mechanism of action of anetholetrithione may be to increase the number of cell surface receptors on salivary acinar cells and pilocarpine stimulas the receptors thus, in combination, these drugs have synergistic efec[20]. Pilocar- pine is contraindicad in patients with pulmonary disease, asthma, cardiovascular disease, gastroinstinal diseases and glaucoma [20]. Cevimeline is another parasympathomimetic agonisthahas been recently approved for the treatmenof oral dryness in patients with Sjogren�s syndrome. Due to similar side efects as to those of pilocarpine imusbe prescribed with caution. Symptomatic approach Palliative treatmenremains as only choice in cases when there is no functio- nally salivary tissue presenas is in the disorders of irreversible damage of salivary secretory cells (such as in radiation-induced xerostomia). Mosremedies available today for patients with dry mouth are only symptomatic and aimed to avoid or alle- via discomforand pain as well as to prevencomplications of xerostomia. A number of saliva substitus have been developed for the palliative care of patients with salivary hypofunction to supplementhe saliva and allevia oral symptoms of dryness. These agents, in liquid, spray, or gel form have moisning and lubricating properties, and their purpose is to provide prolonged wetness of the oral mucosa. Commercial artifcial saliva should resemble normal saliva in its 80 Rad 514 Medical Sciences, 38(2012) : 69-91 M. Preetha and Banerjee [60] compared artifcial saliva based on carboxymethylcellulose and the xanthan gum and found thathe examined sub- stitus fall shorof required biophysical criria and modifcations are required to improve them. The advantages of saliva substitus or artifcial saliva are in the coating and moisturizing oral mucosa and eth, and disadvantages are their short-rm acti- vity withoupreventive efecon oral tissue. Commercialy available alcohol contai- ning oral rinses should be avoided due to their drying efect. Patients with irreversible xerostomia should be instrucd to maintain proper hydration of the oral cavity by taking plenty of fuids throughouthe day and kee- ping the mouth moist, and using artifcial saliva preparations. Frequensips of wa- r throughouof day and during the meals will facilita chewing and swallowing and may also improve the tas of food. The use of bedside humidifers may lessen discomforof dryness, especially anighduring sleep when any residual salivary secretion is physiologically decreased. Patients should avoid any cafeinad drinks (a, cofee) and sof drinks and alcohol, as well as smoking and alcohol-containing mouthwases to prevenfurther desiccation. Special denture adhesives for individuals with xerostomia also may provide some rention aid for removable dentures. Peri- odontal diseases may be prevend by using an alcohol-free, antibacrial mouth rinse, such as chlorhexidine. Professional oral hygiene procedures and instructions in home care as well as di- ligenand meticulous oral hygiene are crucial to reduce the bacrial load in the oral cavity and thus the risk for halitosis and oral infection. Mravak-Stipetic: Xerostomia - diagnostics and treatmenDecreasing dosage of psychopharmaca could be atained by psychotherapy or adding a lighxercise regimen to the patient. For a patienwith uncontrolled type 2 diabes, regular glycemic control (using modifcations of diet, exercise, and possibly oral anti-diabetic medication or insu- lin), may eliminas the hypo-salivation. Xerostomia being caused by uncontrolled diabes, can be cured by bringing diabes under control. Hydroxychloroquine is classifed as an anti-malarial medi- cation and is also used to decrease infammation in sysmic lupus erythematosus as well as rheumatoid arthritis and Sjogren�s Syndrome (all rheumatic disorders) [62]. This therapeutic approach focuses the ra- diation beams to the targetumour tissue with aim to avoid unnecessary radiation of sourrounding salivary gland. The compur-driven chnology generas dose distribu- tions thasharply conform to the tumor targewhile minimizing the dose delivered to the surrounding or contralaral normal gland tissues. Multiple studies have demonstrad thathe parotid gland sparing efecof this tre- atmenmodality resuld in signifcanobjective and subjective improve- menof xerostomia. However, in patients who have tumours thaorigina from the midline or thacross the midline, or in patients with contralaral lymph node metastais iis nopossible to use this chnique [54,63]. However, a high ra of serious adverse events, including hyponsion and ga- stroinstinal disturbances, results in discontinuation of amifostine and limits its use. Caries Fluoride preparations for control of dental caries should be prescribed to all individuals who have natural eth. Patients with signifcanxerostomia should be closely monitored for the developmenof dental caries, which may be prevend by the daily use of 1. Application of fu- oride should be adjusd accordingly to the severity of the gland dysfunction, the degree of developmenof caries and the underlying disease or the cause thaled to the dryness of the mouth. Studies have demonstrad thafuoride preparations alone are nosufciento prevencaries and remineralization of damaged eth, particularly in patients with dry mouth who underwenradiation therapy [65-67]. A study evaluad the use of calcium phospha supersaturad remineralizing rinse in 84 Rad 514 Medical Sciences, 38(2012) : 69-91 M.

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Withdrawal A set of symptoms that are experienced when discontinuing use of a substance to which a person has become dependent or addicted caverta 50 mg sale, which can include negative emotions such as stress buy caverta 100 mg overnight delivery, anxiety, or depression, as well as physical effects such as nausea, vomiting, muscle aches, and cramping, among others. Wrap-Around Services Wrap -around services are non-clinical services that facilitate patient engagement and retention in treatment as well as their ongoing recovery. This can include services to address patient needs related to transportation, employment, childcare, housing, legal and fnancial problems, among others. Government reports, annotated bibliographies, and relevant books and book chapters also were reviewed. From these collective sources, a set of 600 core prevention programs was identifed for possible inclusion in this Report. Evaluation Criteria Programs were included only if they met the program criteria of the Blueprints for Healthy Youth Development listed below. The See Chapter 1 - Introduction and prevention effects described compare the group or Overview. The need for follow-up fndings was considered essential given the frequently observed dissipation of positive posttest results. Level of signifcance and the size of the effects are reported in Appendix B - Evidence-Based Prevention Programs and Policies. Programs that broadly affected other behavioral health problems but did not show reductions in at least one direct measure of substance use were excluded. Centered multiethnic (Grade 8), reduced (2001)11 Intervention schools; 576 risk of starting to use Furr-Holden, et students in other illegal drugs al. Treatment urban French effects on drinking (1996)17 Program Canadian to the point of being (Montreal) students in drunk at age 15. Grade 7 (high- risk subsample), primarily African American and Hispanic Study 2a: N = 758 Study 2a: At 1-year follow- Smith, et al. Health and secondary schools in up (after two years of (2000)26 and Alcohol Harm metropolitan Perth, intervention), reduced (2004)27 Reduction Australia; 2,300 weekly drinking (5%) and Project students aged 12 to harm from alcohol use. Selected as in (29% reduction), binge Study 1, lower risk drinking (43% reduction), sample = 1,433 and problem drinking students (29% reduction). Low risk students had lower quantity of drinking (29% reduction) and lower rates of binge drinking (35% reduction). Unplugged Universal School N = 170 schools in 7 At 18-month follow- Faggiano, et al. European countries; up, reductions in any (2010)33 7,079 students aged drunkenness (3. Families School/ Midwestern public up, lower lifetime alcohol (2001)39 Program: For Multicomponent schools; 667 use (50% vs. Choices Midwestern use initiation through (2009)41 schools; 883 high school and alcohol- students in Grade 7 related problems and illicit drug use through early adulthood. Strong African Universal Family N = 667 Southern At 2-year follow-up, slower Brody, et al. I Hear What Universal Family Study 1: N = 591 Study 1: At 1-year follow- Schinke, et al. You’re Saying (Mother- adolescent girls and up, reductions in use of (2009)50 Daughter) their mothers alcohol, marijuana, and prescription drugs. Study 2: N = 108 Study 2: At 2-year follow- Fang & Schinke Asian American up, reductions in use of (2013)51 girls and their alcohol, marijuana, and mothers (2007- prescription drugs. Unidas Hispanic students in up, lower substance use (2015)52 Brief Grade 8 initiation (28. Positive Selective Family N = 593 Grade 6-8 Lower rates of marijuana Véronneau, et Family urban youth and use through age 23. Study 2: N = Study 2: At 1-year follow- Larimer, et 159 Fraternity- up, reductions in average al. Study 3: N = 550 Study 3: At 1-year follow- Terlecki, et heavy drinking up, lower typical drinking al. Parent Universal College Study 1: N = 882 Study 1: At 8-month Ichiyama, et Handbook college-bound follow-up, females were al. Family Stress primarily White reduced number of drinks (2003)72 Project female secretarial per month. Computerized Universal Primary Care N = 771 Primary care At 1-year follow-up, Fink, et al. Project Share Selective Primary Care N = 1,186 Primary At 1-year follow-up, Ettner, et al. Six-year growth curve effects lower for marijuana, amphetamine use, and drunkenness. Project Star Universal School and N = 42 urban At 1-year follow-up, lower Report 1: (Midwestern Community/ public middle proportion of students Pentz, et al. Prevention Multicomponent and junior high reporting past-week and (1989)83 Project) schools in Kansas past-month use of alcohol. Report 2: City, Missouri Secondary prevention Pentz & and Indianapolis, effects on baseline users Valente Indiana; 3,412 were observed up to 1. Report 2: N = Report 2: At posttest, a Wagenaar, et 1,721-3,095 reduction in the number of al. Long-term effects of prenatal and infancy nurse home visitation on the life course of youths: 19-year follow-up of a randomized trial. Enduring effects of prenatal and infancy home visiting by nurses on children: follow- up of a randomized trial among children at age 12 years. Promoting positive adult functioning through social development intervention in childhood: Long-term effects from the Seattle Social Development Project. Effects of a universal classroom behavior management program in frst and second grades on young adult behavioral, psychiatric, and social outcomes. The distal impact of two frst-grade preventive interventions on conduct problems and disorder in early adolescence. Developmentally inspired drug prevention: Middle school outcomes in a school-based randomized prevention trial. Outcomes during middle school for an elementary school-based preventive intervention for conduct problems: Follow-up results from a randomized trial. Impact of early intervention on psychopathology, crime, and well- being at age 25. From childhood physical aggression to adolescent maladjustment: The Montreal Prevention Experiment. Preventing binge drinking during early adolescence: One-and two-year follow-up of a school-based preventive intervention. Effectiveness of a universal drug abuse prevention approach for youth at high risk for substance use initiation. Evaluation of Life Skills Training and Infused-Life Skills Training in a rural setting: Outcomes at two years. Randomized study of combined universal family and school preventive interventions: Patterns of long-term effects on initiation, regular use, and weekly drunkenness. Substance use outcomes 5½ years past baseline for partnership-based, family-school preventive interventions. Effectiveness of a selective, personality-targeted prevention program for adolescent alcohol use and misuse: A cluster randomized controlled trial. Effectiveness of a selective intervention program targeting personality risk factors for alcohol misuse among young adolescents: Results of a cluster randomized controlled trial. Beyond primary prevention of alcohol use: A culturally specifc secondary prevention program for Mexican heritage adolescents. The adolescents training and learning to avoid steroids program: Preventing drug use and promoting health behaviors. Randomized trial of brief family interventions for general populations: Adolescent substance use outcomes 4 years following baseline. Brief family intervention effects on adolescent substance initiation: School-level growth curve analyses 6 years following baseline. Longitudinal substance initiation outcomes for a universal preventive intervention combining family and school programs.

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