The attached PDF is: Reducing Alcohol-Exposed Pregnancies: A Report of the National Task Force on FAS and Fetal Alcohol Effect, DHHS, 2009

The current (2008) "company line" - the current ruling dogma: "Studies of the long-term course of alcoholism indicate that most individuals are unable to maintain controlled drinking (Vaillant 1996). Studies of effects of cognitive-behavioural therapy (CBT)-focused, self control training in patients with limited alcohol problems show some positive effects in comparison with no treatment (for a review, see Berglund et al. 2003), but the effect in alcohol-dependent individuals remains controversial. Following a harm reduction strategy for patients not motivated for abstinence-oriented interventions to promote a reduction in drinking is acceptable in such situations (Good Clinical Practice), but abstinence from alcohol remains the primary long-term goal for moderate-to-severe alcohol dependence." - pg 12 "Nonetheless, comprehensive reviews of treatment studies (see Holder et al. 1991, 2000; Miller 1992; Miller et al. 1995; Berglund et al. 2003) reveal that, generally speaking, alcohol treatment is more effective than no treatment." - pg 13 "Pharmacotherapy can be used in conjunction with psychosocial treatment to increase abstinence rates or reduce relapse rates, treat other alcohol-related disorders (see above), or treat comorbid psychiatric disorders. In this context, psychotherapeutic or psychosocial interventions have been used to increase motivation for abstinence, improve motivation for medication compliance, and to enhance outcomes generally." - pg 13 "Poor adherence is a major problem with disulfiram treatment; most patients discontinue treatment within a few months (Azrin et al. 1982). Therefore, the use of supervised disulfiram treatment has been advocated. A comprehensive review of 13 controlled and five uncontrolled studies of the drug concluded that supervised disulfiram reduced drinking and improved the rate of retention in treatment compared with unsupervised disulfiram or a no-disulfiram control group (Brewer et al. 2000). Disulfiram is best considered a second-line medication in relapse prevention, which can be combined with either acamprosate or naltrexone." - pg 15

Trypanosoma brucei, the causative agent of African sleeping sickness, has three nearly identical genes encoding cysteine homologues of classical selenocysteine-containing glutathione peroxidases. The proteins are expressed in the mammalian and insect stages of the parasite. One of the genes, which contains a mitochondrial as well as a glycosomal targeting signal has been overexpressed. The recombinant T. brucei peroxidase has a high preference for the trypanothione/tryparedoxin couple as electron donor for the reduction of different hydroperoxides but accepts also T. brucei thioredoxin. The apparent rate constants k(2)' for the regeneration of the reduced enzyme are 2 x 10(5) m(-1) s(-1) with tryparedoxin and 5 x 10(3) m(-1) s(-1) with thioredoxin. No saturation kinetics was observed and the rate-limiting step of the overall reaction is reduction of the hydroperoxide. With glutathione, the peroxidase has marginal activity and reduction of the enzymes becomes limiting with a k(2)' value of 3 m (-1) s(-1). The T. brucei peroxidase, in contrast to the related Trypanosoma cruzi enzyme, also accepts hydrogen peroxide as substrate. The catalytic efficiency of the peroxidase studied here is comparable with that of the peroxiredoxin-like tryparedoxin peroxidases, which shows that trypanosomes possess two distinct peroxidase systems both dependent on the unique dithiol trypanothione.

The National Heart, Lung, and Blood Institute's National Cholesterol Education Program 2001 Adult Treatment Panel III report defined the metabolic syndrome as having at least 3 of the following 5 criteria: abdominal obesity, elevated triglyceride levels, low high-density lipoprotein cholesterol levels, an elevated blood pressure, and an elevated fasting glucose. Evidence is accumulating to suggest that the metabolic syndrome predisposes to cardiovascular disease (CVD). End-stage kidney disease (ESKD) patients requiring dialysis have a substantially elevated risk of CVD morbidity and mortality. Dialysis patients' increased risk can be partially explained by traditional and nontraditional risk factors. The prevalence of the metabolic syndrome in dialysis patients is unknown. This retrospective, cross-sectional study of 202 incident dialysis patients examined the prevalence of the metabolic syndrome at the time of renal replacement therapy initiation. The study group was compared with all incident dialysis patients in 2002 on file with the U.S. Renal Data System. Females represented 39.1% of the study population. Blacks composed 34.7% of the study group. Diabetes was the etiology of ESKD in 44.6% of our patients. Surrogate criteria were used for the Adult Treatment Panel III risk factors of abdominal obesity and elevated fasting glucose levels. Overall, the prevalence of the metabolic syndrome was 69.3% in our population and was especially prevalent among diabetic, female, and white ESKD patients. Study limitations included the use of surrogate markers for 2 criteria of the metabolic syndrome and dependence on the Medical Evidence Report (Form 2728) for baseline characteristics. In summary, the metabolic syndrome is highly prevalent in incident dialysis patients.

AIMS: Kidney transplant units in Australia are confined to large hospitals in major metropolitan areas, yet this may limit access and diminish outcomes in people who do not live in these large centres. The authors examined the viability of a kidney transplant unit located in northern Australia (NA), with particular emphasis on recipient outcomes and the number of donors. METHODS: 'Northern Australia' was arbitrarily defined as 'north of the tropic of Capricorn' for Queensland and Western Australia and included the entire Northern Territory. Data on donors and transplant recipients were provided by ANZDATA and ANZOD registries, identified by postcode. RESULTS: Between 1998 and 2004 in NA there were 163 deceased donor kidneys and 97.5% of available organs were transplanted. There were no Aboriginal/Torres Strait Islander (ATSI) donors from NA. Recipients from NA in this time included 55 patients receiving living grafts and 156 receiving deceased donor grafts, of whom 36% were ATSI, making up half of the total ATSI transplanted in Australia during this time period. Compared with the rest of Australia, NA recipients were older, waited longer on dialysis, had longer ischaemic times and a greater number of human leucocyte antigen mismatches, and were more likely to be diabetic and obese. Despite the longer cold ischaemic time in NA recipients, no difference in immediate graft function was seen. ATSI recipients in NA, when compared with their southern Australian counterparts, had poorer patient survival (HR=3.19, 95% CI 1.44-7.08, P<0.001), but equivalent graft survival (HR=1.67, 95% CI 0.95-2.95, P=not significant) on multivariate analysis. Key factors that would influence feasibility of a Northern Australian transplant unit include adequate staffing, and support services in addition to currently available resources. CONCLUSION: Current donor numbers in NA are adequate for past recipients of kidney transplant, but may not cover future needs without a significant increase in donor rate. A transplant unit situated in northern Australian would require significant resources to ensure long-term viability and its effect on outcomes is uncertain.