Suchergebnisse

The present report concerns a case of pulmonary nocardiosis in an immunocompetent host. This patient was diagnosed as having smear positive pulmonary tuberculosis and received supervised antitubercular treatment for 6 months from a government run tuberculosis centre (Directly Observed Therapy, Short-Course (DOTS) centre). At 3 months after completion of treatment, she presented with fever and cough with posterior–anterior (PA) view chest x ray showing a cavitary lesion on left upper zone. She was subsequently diagnosed as having a case of pulmonary nocardiosis and responded to oral cotrimoxazole.

Background UK NHS Stop Smoking Services provide cost effective smoking cessation interventions but, as yet, there has been no assessment of their provision of relapse prevention interventions. Methods Electronic questionnaire survey of 185 UK Stop Smoking Services Managers. Results Ninety six Stop Smoking Service managers returned completed questionnaires (52% response rate). Of these, 58.3% (n = 56) ran NHS Stop Smoking Services which provided relapse prevention interventions for clients with the most commonly provided interventions being behavioural support: telephone (77%), group (73%), and individual (54%). Just under half (48%, n = 27) offered nicotine replacement therapy (NRT), 21.4% (n = 12) bupropion; 19.6% (n = 11) varenicline. Over 80% of those providing relapse prevention interventions do so for over six months. Nearly two thirds of all respondents thought it was likely that they would either continue to provide or commence provision of relapse prevention interventions in their services. Of the remaining respondents, 66.7% (n = 22) believed that the government focus on four-week quit rates, and 42.9% (14 services) believed that inadequate funding for provision of relapse prevention interventions, were major barriers to introducing these interventions into routine care. Conclusions Just over half of UK managers of NHS Stop Smoking Services who responded to the questionnaire reported that, in their services, relapse prevention interventions were currently provided for clients, despite, at that time, there being a weak evidence base for their effectiveness. The most commonly provided relapse prevention interventions were those for which there was least evidence. If these interventions are found to be effective, barriers would need to be removed before they would become part of routine care.

Recently, a high proportion of patients with late-stage Trypanosoma brucei gambiense trypanosomiasis, who had been treated with melarsoprol in some disease-endemic areas, subsequently relapsed. To determine whether the frequency of postmelarsoprol relapses increased over time, we reviewed data from 2,221 trypanosomiasis patients treated with melarsoprol during this period in Nioki, Democratic Republic of Congo, from 1982 to 2001. The frequency of relapses was 5.6%(31/553), 6.8%(35/512), 4.5%(18/398), 11.4%(34/299), and 5.0%(17/343) for those treated from 1982 to 1985, 1986 to 1989, 1990 to 1993, 1994 to 1997, and 1998 to 2001, respectively. The higher frequency of relapses in 1994 to 1997 was associated with an incremental dosage regimen of melarsoprol. In multivariate analysis, after adjustment for treatment regimen, sex, residence, and trypanosomes in cerebrospinal fluid, postmelarsoprol relapses did not increase in Nioki, perhaps because 1) little drug pressure exists; 2) subtherapeutic doses have rarely been administered; 3) little potential exists for the preferential transmission of melarsoprol-resistant strains.

Abstract Background The purpose of this study was to determine the direct medical US cost of managing multiple sclerosis relapses. Methods Direct data analysis and cost modeling were employed to derive typical resource use profiles and costs in 2002 US dollars, from the perspective of a third-party payer responsible for comprehensive health-care. The location and scope of health care services provided over a 90-day period were used to define three levels of relapse management. Hospitalization and resulting subsequent care was defined as high intensity management. A medium level of intervention was defined as either use of the emergency room, an observational unit, or administration of acute treatments, such as intravenous methylprednisolone in an outpatient or home setting. The lowest intensity of care comprised physician office visits and symptom-related medications. Data were obtained from many sources including all payer inpatient, ambulatory and emergency room databases from several states, fee schedules, government reports, and literature. All charges were adjusted using cost-to-charge ratios. Results Average cost per person for high management level was $12,870, based on analysis of 4,634 hospital cases (mean age 48 years, 73% female). Hospital care comprised 71% of that cost. At discharge, 36% required inpatient sub-acute care, rehabilitation or home care. The typical cost per moderate episode was $1,847 and mild episode $243. Conclusions Management strategies leading to a reduction in the frequency and severity of a relapse, less reliance on inpatient care, or increased access to steroid infusions in the home, would have a substantial impact on the economic consequences of managing relapses.

Background UK NHS Stop Smoking Services provide cost effective smoking cessation interventions but, as yet, there has been no assessment of their provision of relapse prevention interventions. Methods Electronic questionnaire survey of 185 UK Stop Smoking Services Managers. Results Ninety six Stop Smoking Service managers returned completed questionnaires (52% response rate). Of these, 58.3% (n = 56) ran NHS Stop Smoking Services which provided relapse prevention interventions for clients with the most commonly provided interventions being behavioural support: telephone (77%), group (73%), and individual (54%). Just under half (48%, n = 27) offered nicotine replacement therapy (NRT), 21.4% (n = 12) bupropion; 19.6% (n = 11) varenicline. Over 80% of those providing relapse prevention interventions do so for over six months. Nearly two thirds of all respondents thought it was likely that they would either continue to provide or commence provision of relapse prevention interventions in their services. Of the remaining respondents, 66.7% (n = 22) believed that the government focus on four-week quit rates, and 42.9% (14 services) believed that inadequate funding for provision of relapse prevention interventions, were major barriers to introducing these interventions into routine care. Conclusions Just over half of UK managers of NHS Stop Smoking Services who responded to the questionnaire reported that, in their services, relapse prevention interventions were currently provided for clients, despite, at that time, there being a weak evidence base for their effectiveness. The most commonly provided relapse prevention interventions were those for which there was least evidence. If these interventions are found to be effective, barriers would need to be removed before they would become part of routine care.

Abstract Background UK NHS Stop Smoking Services provide cost effective smoking cessation interventions but, as yet, there has been no assessment of their provision of relapse prevention interventions. Methods Electronic questionnaire survey of 185 UK Stop Smoking Services Managers. Results Ninety six Stop Smoking Service managers returned completed questionnaires (52% response rate). Of these, 58.3% (n = 56) ran NHS Stop Smoking Services which provided relapse prevention interventions for clients with the most commonly provided interventions being behavioural support: telephone (77%), group (73%), and individual (54%). Just under half (48%, n = 27) offered nicotine replacement therapy (NRT), 21.4% (n = 12) bupropion; 19.6% (n = 11) varenicline. Over 80% of those providing relapse prevention interventions do so for over six months. Nearly two thirds of all respondents thought it was likely that they would either continue to provide or commence provision of relapse prevention interventions in their services. Of the remaining respondents, 66.7% (n = 22) believed that the government focus on four-week quit rates, and 42.9% (14 services) believed that inadequate funding for provision of relapse prevention interventions, were major barriers to introducing these interventions into routine care. Conclusions Just over half of UK managers of NHS Stop Smoking Services who responded to the questionnaire reported that, in their services, relapse prevention interventions were currently provided for clients, despite, at that time, there being a weak evidence base for their effectiveness. The most commonly provided relapse prevention interventions were those for which there was least evidence. If these interventions are found to be effective, barriers would need to be removed before they would become part of routine care.

Background Reducing smoking is a chief priority for governments and health systems like the UK National Health Service (NHS). The UK has implemented a comprehensive tobacco control strategy involving a combination of population tobacco control interventions combined with treatment for dependent smokers through a national network of NHS Stop Smoking Services (NHS SSS). Objectives To assess the effectiveness and cost-effectiveness of relapse prevention in NHS SSS. To (1) update current estimates of effectiveness on interventions for preventing relapse to smoking; (2) examine studies that provide findings that are generalisable to NHS SSS, and which test interventions that might be acceptable to introduce within the NHS; and (3) determine the cost-effectiveness of those relapse preventions interventions (RPIs) that could potentially be delivered by the NHS SSS. Data sources A systematic review of the literature and economic evaluation were carried out. In addition to searching the Cochrane Tobacco Addiction Group register of trials (2004 to July 2008), MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, PsycINFO, the Science Citation Index and Social Science Citation Index were also searched. Review methods The project was divided into four distinct phases with different methodologies: qualitative research with a convenience sample of NHS SSS managers; a systematic review investigation the efficacy of RPIs; a cost-effectiveness analysis; and a further systematic review to derive the relapse curves for smokers receiving evidence-based treatment of the type delivered by the NHS SSS. Results Qualitative research with 16 NHS SSS managers indicated that there was no shared understanding of what relapse prevention meant or of the kinds of interventions that should be used for this. The systematic review included 36 studies that randomised and delivered interventions to abstainers. 'Self-help' behavioural interventions delivered to abstainers who had achieved abstinence unaided were effective for preventing relapse to smoking at long-term follow-up [odds ratio (OR) 1.52, 95% confidence interval (CI) 1.15 to 2.01]. The following pharmacotherapies were also effective as RPIs after their successful use as cessation treatments: bupropion at long-term follow-up (pooled OR 1.49, 95% CI 1.10 to 2.01); nicotine replacement therapy (NRT) at medium- (pooled OR 1.56, 95% CI 1.16 to 2.11) and long-term follow-ups (pooled OR 1.33, 95% CI 1.08 to 1.63) and one trial of varenicline also indicated effectiveness. The health economic analysis found that RPIs are highly cost-effective. Compared with 'no intervention'; using bupropion resulted in an incremental quality-adjusted life-year (QALY) increase of 0.07, with a concurrent NHS cost saving of 68 pounds; for NRT, spending 12 pounds resulted in a 0.04 incremental QALY increase; varenicline resulted in a similar QALY increase as NRT, but at almost seven times the cost. Extensive sensitivity analyses demonstrated that cost-effectiveness ratios were more sensitive to variations in effectiveness than cost and that for bupropion and NRT, cost-effectiveness generally remained. Varenicline also demonstrated cost-effectiveness at a 'willingness-to-pay' threshold of 20,000 pounds per QALY, but exceeded this when inputted values for potential effectiveness were at the lower end of the range explored. For all drugs, there was substantial relapse to smoking after treatment courses had finished. Quit attempts involving NRT appeared to have the highest early relapse rates, when trial participants would be expected to still be on treatment, but for those involving bupropion and varenicline little relapse was apparent during this time. Limitations The qualitative research sample was small. Conclusions Based on the totality of evidence, RPIs are expected to be effective and cost-effective if incorporated into routine treatment within the NHS SSS. While staff within the NHS SSS were largely favourably inclined towards providing RPIs, guidance would be needed to encourage the adoption of the most effective RPIs, as would incentives that focused on the importance of sustaining quit attempts beyond the currently monitored 4-week targets.

Abstract Background NHS Stop Smoking Services in the UK provide cost effective smoking cessation interventions, but approximately 75% of smokers who are abstinent at 4 weeks relapse to smoking by 12 months. This study aimed to explore health professionals' understanding of relapse prevention interventions (RPIs), the feasibility of offering such support and whether and how these are currently used in UK NHS Stop Smoking Services. Methods Sixteen health professionals working in UK NHS Stop Smoking Services, selected from those attending a national conference were interviewed and Framework Analysis was used to identify recurrent key themes and concepts in their perceptions and experiences of providing relapse prevention interventions (RPIs). Results Interviewees had diverse perceptions of relapse prevention as a concept. Whilst relapse prevention was largely seen as support to prevent abstinent smokers from relapsing to smoking, some interviewees stated that RPIs were being delivered to lapsed or relapsed smokers. Current provision of RPIs was most commonly described as behavioural counselling being offered predominantly after completed cessation treatment, often in the format of 'rolling groups' which the client was encouraged to attend. Commonly identified barriers to the introduction of RPIs were funding and government targets focussed on short term cessation, smokers' low uptake of offered RPIs and an uncertain evidence base for their effectiveness. Interviewees were positive about the potential use of pharmacotherapy for relapse prevention, but were negative about the possibility of introducing proactive telephone counselling for this purpose. Conclusion There is currently no shared understanding of the concept of relapse prevention amongst this sample of health professionals working in UK NHS Stop Smoking Services. For RPIs to be systematically delivered via these services, a commonly-held, widely-accepted and understood definition of relapse prevention would be needed. Other barriers towards introducing RPIs, such as their weak evidence and the short term cessation-focussed targets against which UK stop smoking services are measured, would also need addressing and interventions which are acceptable to abstinent smokers would need to be developed.

I propose to remember in a form what for specialists in the 'intellectual' problem are certainly common places, critic and historiographic budgets for the subject (I refer to the collective nature of the concept, two of its properties — responsibility and representation — and one of its traditions closest to us, that of 'the legal city').From that review, I attempt to outline some conjectures of some of the most or less located conjectures concerning an episode and a book produced by Cuba and the Cuban Revolution, I refer to the Library of the Library of the 2002. Faculty of Humanities and Education Sciences ; Me propongo recordar de modo formulario lo que para especialistas en el problema "intelectuales" son seguramente lugares comunes, presupuestos crítico-historiográficos del tema (me refiero al carácter colectivo de la noción, a dos de sus propiedades –responsabilidad y representación– y a una de sus tradiciones más próximas a nosotros, la de "la ciudad letrada").A partir de ese repaso, intento esbozar algunas conjeturas más o menos situadas a propósito de un episodio y de un libro imantados por Cuba y la Revolución Cubana (me refiero al ensayo de Jean Franco de 2002, y a la ruptura del Consejo Editor de Punto de vista en 2004) Documento incorporado en 2018 en el marco del "Programa de becas de experiencia laboral" de la Biblioteca Profesor Guillermo Obiols para estudiantes de Bibliotecología, a partir de un procedimiento técnico de captura de datos desarrollado por el personal del IdIHCS. Facultad de Humanidades y Ciencias de la Educación

The problem under study. The problem of efficiency of alternative to imprisonment (non-custodial) sanctions is investigated in the present study. The fundamental advantage of this kind of punishment is the possibility to control offenders' behavior in the community. This idea is based on the personal ability to change, which depends on an offender's will and efforts to change himself and to start solving the problems, which have caused the offending behavior (motivation to change). Therefore, imposed alternative sanctions should affect the changes in offenders' behavior. The individual conditions (obligation and/or restrictions) of the sanction, imposed by a court, should direct an offender's efforts to change. The problem of efficiency of alternative sanctions is discovered, while studying, how the conditions of imposition and execution of these sanctions could affect the criminogenic factors and, therefore, could reduce recidives of crime. Analyzing these aspects we can observe the problem of individualization of punishment, or finding the appropriate sanction, and the problem of coherent application of the sanction. A court, imposing non-custodial sanction, should not only state a term of its application, but also should decide, if the imposed obligations (their amount and character) are sufficient to supervise the offender in the community. The imposition of non-custodial sanctions to a great extend determs the process of execution of it. Particularly, if the conditions of imposed sanction do not determine the offender to change and to solve the problems, related with offending behavior, then the control of their execution cannot affect the recidive of offending. The practical efficiency of these sanctions is determed by selection of the appropriate sanction; by sufficiency and practical useness of requirements, applied to offender in the process of execution; and by evaluation of the execution. The relevance of the study. The Commettee of Ministers of The Council of Europe, solving the problem of overcrowdedness of prisons, recommended to the member-states to deliver the plan to solve this problem, which would be based on the priorities of punishment, the public opinion, and the analysis of present practice of punishment. The program of the Government of the Republic of Lithuania of years 2000 – 2004 contains the intention to modify partially the system of punishment; to state the adequate punishment to the violations of law, to reduce the repressive effect of sanctions, to seek the social integration of the persons, having served the sentence. In this program there was presumed "the principle of economy of punishment" – the least sanction, which would be enough to affect the offender and stimulate him to change; confirmed the intention to apply community service, material sanctions and other non-custodial sanctions rather than penal measures. The legislative directions, contained in these documents, allowed to extend the application of alternative sanctions in the Penal Code, which came into effect on 1 May 2003. These measures were supposed to reduce the number of imprisoned and to become an efficient alternative to custodial sanctions. One of the conditions of efficiency of alternative sanctions is a systematic analysis and evaluation, if its application helps to reach the planned results. After more than five years since new Penal Code came into effect, we have some expirience of application of alternative sanctions, which would need a revision. Observing the functioning of the system of these sanction we can note, that the sanctions are being imposed and executed chaotically. This primary overview determs the relevance of theoretical and practical study of alternative sanctions. The law acts of the Republic of Lithuania forms the need to create an efficient model of probation. The program of the Government of the Respublic of Lithuania of the years 2004 – 2008 foresees to develop the model of probation (suspended sentence, early discharge from punishment), which would be conform to international legal acts and would stimulate offenders not to offend in the future. The activity program of the Government of the year 2009 foresees to extend the efficient probation (including suspended sentence) system, which is oriented towards management of the risk of repeated offending behavior, which would create the conditions for social security, for reducing the recidives of crime, and particularly for reducing the number of imprisoned people. The mentioned program contains the intention to direct the work of correctional inspections toward social aid to convicts, not only toward the control of their behavior. Development of the model for probation is also approved in the Conception of probation system in Lithuania. In order to achieve these aims, it is necessary to explore the problems of the existing system of alternative sanctions and to state practice-based criteria, which the efficiency of the sanctions depends on. The object of the study. In this dissertation study there is investigated theorical and practical aspects of conditions of imposition and execution of community service, limitation of freedom and suspended sentence, in the terms of rational usage of resources and reducing of recidives. The aim of the study. The aim of this dissertation study is to state the shortcomings of application of alternative sanctions and to formulate the criteria of efficiency, on the base of theoretical knowledge and collected practical data. The tasks of the study: 1) To present theorical analysis of the system of alternative sanctions (probation); 2) To analize the criteria, which efficiency of the system of alternative sanctions depends on; 3) To analize, if the existing reglamentation of sanction imposition allows to a court to select the appropriate alternative sanction; 4) To investigate the concept of offender's personality and his dangerness, formed in the Lithuanian penal law; 5) To state, if the structure of evaluation of personality and dangerness ensures elimination of the criminogenic factors; 6) To state the main practical problems of imposition of alternative sanctions; 7) To investigate the process of execution of alternative sanctions, to explore its main shortcomings and to state the criteria of its efficiency. The scientific recency of the study. The legal and social criteria of efficiency of non-custodial sanction have not been yet researched in Lithuania. This dissertation study presents the complex research of the presumptions of efficiency of these sanctions.The study contains analysis of the national system of alternative sanctions, in the context of reglamentation of this system by international legal acts and reglamentation of national systems in such countries, as the United Kingdom, Sweden and others. The area of present research also comprises the examination of scientific substantiation of the national system in the context of concepts of efficiency, approved in these countries. The author of the study argues the significant role of scientific approach, based on practical research, in the formation of the efficient system of alternative sanctions. The study contains the description of the scientific and practical researches, which allowed to comprehend the link between the structured evaluation of offender's personality and the selection of a proper sanction. In the study there are also argued the significant role of proper evaluation of the social factors in realization of alternative sanctions. The analysis comprises not only theoretical conception of efficiency, but also the evaluation of expirience of application of the sanctions in Lithuania. This study presents the new approach to the problems of the discretion of sanction imposition and the evaluation of offender's personality. The significance of the work. One of the significant aspect of the present research is the analysis of some years of the practice in application of alternative sanction in Lithuania. On the basis of complex research we have tried to state the criteria of efficiency of alternative sanctions. These criteria could be used improving the legal acts on the imposition and execution of alternative sanctions. The hypothesis of the study. The existing mechanism of imposition and execution of alternative sanctions is not efficient, since its affection to recidive of crime is not based on the measures, oriented towards elimination or correction of criminogenic factors. The maintained statements of the dissertation study: 1. The possibility to control (supervise) a convict in the community depends on his motivation, which is expressed by his consent (agreement) to fulfil the requirements of imposed obligation. 2. The rules of imposition of alternative sanctions should be oriented to the certain groups of offenders (for example, substances addicted persons). 3. Since a court has extensive discretion in selection of the type of alternative sanction, the main reason for the selection is evaluation of information about an offender. 4. Subjectivity in evaluation of personality of offender and his dangerness determs eclecticism in the practice of imposition of alternative sanctions. 5. Imposition and execution of alternative sanctions should be oriented to change offender's social behavior and to eliminate criminogenic factors (substance addictment, alcohol drinking, etc.), which have been resulted in offence. 6. If substance addictment was a significant factor in making an offence, imposed to the offender alternative sanction should also contain the obligation to undergo treatment course. 7. The present reglamentation of application of alternative sanctions doesn't contribute to offenders' social progress and to their rehabilitation. 8. The present reglamentation determs only nominal approach to execution of obligation by convicts and to assessment of that execution. 9. The obligation to undergo the treatment course should

The problem under study. The problem of efficiency of alternative to imprisonment (non-custodial) sanctions is investigated in the present study. The fundamental advantage of this kind of punishment is the possibility to control offenders' behavior in the community. This idea is based on the personal ability to change, which depends on an offender's will and efforts to change himself and to start solving the problems, which have caused the offending behavior (motivation to change). Therefore, imposed alternative sanctions should affect the changes in offenders' behavior. The individual conditions (obligation and/or restrictions) of the sanction, imposed by a court, should direct an offender's efforts to change. The problem of efficiency of alternative sanctions is discovered, while studying, how the conditions of imposition and execution of these sanctions could affect the criminogenic factors and, therefore, could reduce recidives of crime. Analyzing these aspects we can observe the problem of individualization of punishment, or finding the appropriate sanction, and the problem of coherent application of the sanction. A court, imposing non-custodial sanction, should not only state a term of its application, but also should decide, if the imposed obligations (their amount and character) are sufficient to supervise the offender in the community. The imposition of non-custodial sanctions to a great extend determs the process of execution of it. Particularly, if the conditions of imposed sanction do not determine the offender to change and to solve the problems, related with offending behavior, then the control of their execution cannot affect the recidive of offending. The practical efficiency of these sanctions is determed by selection of the appropriate sanction; by sufficiency and practical useness of requirements, applied to offender in the process of execution; and by evaluation of the execution. The relevance of the study. The Commettee of Ministers of The Council of Europe, solving the problem of overcrowdedness of prisons, recommended to the member-states to deliver the plan to solve this problem, which would be based on the priorities of punishment, the public opinion, and the analysis of present practice of punishment. The program of the Government of the Republic of Lithuania of years 2000 – 2004 contains the intention to modify partially the system of punishment; to state the adequate punishment to the violations of law, to reduce the repressive effect of sanctions, to seek the social integration of the persons, having served the sentence. In this program there was presumed "the principle of economy of punishment" – the least sanction, which would be enough to affect the offender and stimulate him to change; confirmed the intention to apply community service, material sanctions and other non-custodial sanctions rather than penal measures. The legislative directions, contained in these documents, allowed to extend the application of alternative sanctions in the Penal Code, which came into effect on 1 May 2003. These measures were supposed to reduce the number of imprisoned and to become an efficient alternative to custodial sanctions. One of the conditions of efficiency of alternative sanctions is a systematic analysis and evaluation, if its application helps to reach the planned results. After more than five years since new Penal Code came into effect, we have some expirience of application of alternative sanctions, which would need a revision. Observing the functioning of the system of these sanction we can note, that the sanctions are being imposed and executed chaotically. This primary overview determs the relevance of theoretical and practical study of alternative sanctions. The law acts of the Republic of Lithuania forms the need to create an efficient model of probation. The program of the Government of the Respublic of Lithuania of the years 2004 – 2008 foresees to develop the model of probation (suspended sentence, early discharge from punishment), which would be conform to international legal acts and would stimulate offenders not to offend in the future. The activity program of the Government of the year 2009 foresees to extend the efficient probation (including suspended sentence) system, which is oriented towards management of the risk of repeated offending behavior, which would create the conditions for social security, for reducing the recidives of crime, and particularly for reducing the number of imprisoned people. The mentioned program contains the intention to direct the work of correctional inspections toward social aid to convicts, not only toward the control of their behavior. Development of the model for probation is also approved in the Conception of probation system in Lithuania. In order to achieve these aims, it is necessary to explore the problems of the existing system of alternative sanctions and to state practice-based criteria, which the efficiency of the sanctions depends on. The object of the study. In this dissertation study there is investigated theorical and practical aspects of conditions of imposition and execution of community service, limitation of freedom and suspended sentence, in the terms of rational usage of resources and reducing of recidives. The aim of the study. The aim of this dissertation study is to state the shortcomings of application of alternative sanctions and to formulate the criteria of efficiency, on the base of theoretical knowledge and collected practical data. The tasks of the study: 1) To present theorical analysis of the system of alternative sanctions (probation); 2) To analize the criteria, which efficiency of the system of alternative sanctions depends on; 3) To analize, if the existing reglamentation of sanction imposition allows to a court to select the appropriate alternative sanction; 4) To investigate the concept of offender's personality and his dangerness, formed in the Lithuanian penal law; 5) To state, if the structure of evaluation of personality and dangerness ensures elimination of the criminogenic factors; 6) To state the main practical problems of imposition of alternative sanctions; 7) To investigate the process of execution of alternative sanctions, to explore its main shortcomings and to state the criteria of its efficiency. The scientific recency of the study. The legal and social criteria of efficiency of non-custodial sanction have not been yet researched in Lithuania. This dissertation study presents the complex research of the presumptions of efficiency of these sanctions.The study contains analysis of the national system of alternative sanctions, in the context of reglamentation of this system by international legal acts and reglamentation of national systems in such countries, as the United Kingdom, Sweden and others. The area of present research also comprises the examination of scientific substantiation of the national system in the context of concepts of efficiency, approved in these countries. The author of the study argues the significant role of scientific approach, based on practical research, in the formation of the efficient system of alternative sanctions. The study contains the description of the scientific and practical researches, which allowed to comprehend the link between the structured evaluation of offender's personality and the selection of a proper sanction. In the study there are also argued the significant role of proper evaluation of the social factors in realization of alternative sanctions. The analysis comprises not only theoretical conception of efficiency, but also the evaluation of expirience of application of the sanctions in Lithuania. This study presents the new approach to the problems of the discretion of sanction imposition and the evaluation of offender's personality. The significance of the work. One of the significant aspect of the present research is the analysis of some years of the practice in application of alternative sanction in Lithuania. On the basis of complex research we have tried to state the criteria of efficiency of alternative sanctions. These criteria could be used improving the legal acts on the imposition and execution of alternative sanctions. The hypothesis of the study. The existing mechanism of imposition and execution of alternative sanctions is not efficient, since its affection to recidive of crime is not based on the measures, oriented towards elimination or correction of criminogenic factors. The maintained statements of the dissertation study: 1. The possibility to control (supervise) a convict in the community depends on his motivation, which is expressed by his consent (agreement) to fulfil the requirements of imposed obligation. 2. The rules of imposition of alternative sanctions should be oriented to the certain groups of offenders (for example, substances addicted persons). 3. Since a court has extensive discretion in selection of the type of alternative sanction, the main reason for the selection is evaluation of information about an offender. 4. Subjectivity in evaluation of personality of offender and his dangerness determs eclecticism in the practice of imposition of alternative sanctions. 5. Imposition and execution of alternative sanctions should be oriented to change offender's social behavior and to eliminate criminogenic factors (substance addictment, alcohol drinking, etc.), which have been resulted in offence. 6. If substance addictment was a significant factor in making an offence, imposed to the offender alternative sanction should also contain the obligation to undergo treatment course. 7. The present reglamentation of application of alternative sanctions doesn't contribute to offenders' social progress and to their rehabilitation. 8. The present reglamentation determs only nominal approach to execution of obligation by convicts and to assessment of that execution. 9. The obligation to undergo the treatment course should

OBJECTIVE—To examine the effect of a unique organisational smoking ban on female United States Navy recruits, a population with historically high smoking rates. SETTING AND DESIGN—Study participants were female recruits (n = 5503) entering the Navy recruit training command between March 1996 and March 1997 (12 consecutive months). Participants completed smoking surveys at entry to recruit training (baseline) and again at graduation from training after exposure to an eight week, 24 hour a day smoking ban. Effects of the ban on baseline to graduation changes in perceptions of being a smoker were examined, and relapse rates among baseline ever smokers was assessed three months after leaving recruit training. RESULTS—Among all recruits, 41.4% reported being smokers at entry (that is, reported any smoking in the 30 days before entering recruit training). As a result of the ban, there was a significant reduction (from about 41% to 25%, p < 0.001) in the percentage of all women recruits who reported themselves as smokers, a much larger change than expected had no ban been in place. Relapse at the three month follow up varied according to the type of smoker at entry into the Navy, with rates ranging from 89% relapse among baseline daily smokers to 31% among baseline experimenters. CONCLUSIONS—Findings suggest that the ban provides some smokers who desire to quit with an external impetus and support to do so. However, high relapse rates indicate that more than an organisationally mandated smoking ban during recruit training is needed to help younger smokers, more regular smokers, and those who intend to continue smoking to quit after joining the Navy. Keywords: military; women; smoking ban

Административный надзор милиции за лицами, освобожденными из мест лишения свободы, являлся составной частью системы предупреждения рецидивной преступности. В результате реформирования законодательства в 90-х годы прошлого века система предупреждения роста рецидивной преступности была разрушена. Проект Федерального закона имеет цель ее восстановления. Однако он несовершенен и, по мнению автора, не может быть одобрен в окончательном чтении. Автором предложен альтернативный проект Федерального закона. ; The administrative control to militias for persons, freed from places of the deprivation of the liberty, was shown by component part of system of the warning relapse to criminality. As a result reconstruction legislation in 90-h years past age system warning the growing relapse to criminality was ruined. The Project of the Federal law has a purpose of its reconstruction. However he imperfect and, in the opinion of author, can be not approved in final reading. The Author is offered alternative project of the Federal law.

A retrospective chart review of 4,925 human African trypanosomiasis patients treated with melarsoprol in 2001–2003 in Equateur Nord Province of the Democratic Republic of Congo showed a treatment failure rate of 19.5%. This rate increased over the 3 years. Relapse rates were highest in the central part of the province.

Brief hospitalization contributes to quicker and more effective recovery in psychiatric practice. It also leads to a progressive change in the pattern of mental morbidity. Two-year follow-up of patients treated with this technique indicates that recovery is sustained, and relapse/wastage rate is low. There is need for further research in this significant aspect of military medicine.