Patterns in use: a study on routes of administration of Asian drug users

Current evidence suggests that more people from ethnic minorities are accessing substance misuse services than before. However, research in this area is sparse and much of the work has been done outside London. Data gathered from the Thames regional database (1999) would suggest that the Asian community is an emerging sub-group that is accessing drug services. Anecdotal evidence suggests that the assessment process demonstrates marked differences when comparing data of Asian drug users with those of white users, the main differences being length of drug-using history, route of administration and amount of heroin being used. The drug of choice of the Asian community was heroin and their route of administration was by smoking (95% had never injected). In comparison, the British white population has a history of injecting drug use (95%). An audit was completed in Brent to verify the anecdotal evidence mentioned above. This audit was repeated in South Camden, where there is a similar Asian client group who are accessing the specialist service, to see if similar patterns in route of administration, length of drug history and amount of heroin used emerged. The audit was completed for 500 clients, with the two services provided approximately 250 clients each for the audit. The main evidence found differences in length of use, drug of choice, route of administration, age, social class and gender. The next step is to design suitable research to look at the possible reasons for this difference upon presentation, and whether this should shape drug service provision.     

Age Differences in Risk Behavior Among Incarcerated Substance-Abusing Women

Female substance abusing offenders are likely to need treatment due to their risky lifestyles. It is unknown if or how treatment could be different for women in different age groups. Given the special needs associated with substance abuse among women, examining potential differences in substance use and risky sexual behaviors between older and younger women is potentially important in order to target interventions. This study examines age differences in drug use, sexual activity, and criminal justice involvement between older (aged 35-56) and younger (aged 21-34) incarcerated female substance abusers. This study is part of a larger project focused on health service utilization among incarcerated substance abusers, which is funded by the National Institutes of Health. Data were collected from 60 incarcerated women. Participants were interviewed face-to-face regarding their drug use, sexual activity, and criminal justice involvement. It was hypothesized that older women would report decreased drug and alcohol use and decreased patterns of risky sexual activity than the younger women. The findings indicated that few differences in drug use and sexual activity exist between the different age groups. In addition, there were few differences in criminal justice involvement except for age of first arrest. These findings were unexpected. The lack of significant results in this study could possibly be explained by considering substance use as a life long process for those who become addicted. In this group of female drug users, it appears that patterns of risk behavior for some women are stable over time.     

Hospital inpatient admissions and past heavy drinking

Objective: To investigate if past heavy drinking is predictive of later hospital inpatient service usage.

Design: Drawn from a longitudinal study of untreated heavy drinking in the community, the relevant data were collected via an interviewer‐administered computerized questionnaire. Data collection was repeated at 2‐year intervals (1997, 1999 and 2001). Alcohol consumption, smoking, body mass index (BMI), sex, age and occupational social class for 1997 and 1999 were all tested as predictors of hospital inpatient service usage as reported at 2001.

Participants: A cohort of 340 (243 men and 97 women) untreated heavy drinkers recruited from the West Midlands.

Main outcome measure: Categorical (yes/no) use of hospital inpatient services in the previous 12 months. Secondary outcome measures included number of times admitted to hospital and total number of nights spent in hospital in the previous 12 months.

Results: Greater UK alcohol units consumed 3–4 years prior to admission to hospital and being female were found significantly to predict increased likelihood of admission to hospital. More recent measures of alcohol, smoking and BMI and health‐related demographic variables (age, occupational social class) were excluded from the logistic regression model as non‐significant predictors. Furthermore, greater consumption of alcohol units in 1997 was found to be significantly associated with the number of admissions reported in 2001, and both 1997 alcohol consumption and 1997 greater BMI were found to be predictive of nights spent in hospital.

Conclusions: Past alcohol consumption has greater utility than concurrent consumption levels in the prediction of hospital inpatient usage by heavy drinkers.     

Alcohol consumption and the risk of Barrett's esophagus:A meta-analysis

AIM: To evaluate the possible association between alcohol consumption and Barrett's esophagus(BE).METHODS: We performed a systematic literature search of multiple online electronic databases.Inclusion criteria entailed studies about alcohol and BE.Metaanalysis was conducted to evaluate odds ratio(OR) and95%CIs for the association between alcohol consumption and BE.RESULTS: Twenty studies comprising 4758 patients with BE were included in the meta-analysis.The risk of BE in patients with alcohol consumption was increasedcompared with control groups(OR = 1.01; 95%CI: 1.00-1.02),especially in case-control and cohort,European and Asian,and hospital studies,but there was a decreased risk of BE associated with alcohol consumption from American studies(OR = 0.86; 95%CI: 0.77-0.96).At the same time,there was no significant association between BE and alcohol consumption in community studies(OR = 0.97; 95%CI: 0.84-1.12) and the type of alcohol(wine,beer and liquor) studies.CONCLUSION: Our meta-analysis found that alcohol consumption was associated with an increased risk of BE,especially for European and Asian drinkers.     

Muscle strength in healthy white and Asian subjects: the relationship of quadriceps maximum voluntary contraction to age, sex, body build and vitamin D

1. The maximum voluntary isometric contraction (MVC) of the dominant quadriceps muscle was measured in 136 healthy White and 172 healthy Hindu Asian subjects resident in London, using a specially designed chair equipped with a force measuring load cell. 2. Males were stronger than females, and for both sexes MVC declined with age. From age 20 to 60 the annual decline in MVC ranged from 0.56% in White males to 1.5% in female Asians. 3. White subjects were stronger than Asian subjects even after correcting for the effect of age, height, weight and sex in a multi-factorial analysis. 4. Only in males did MVC correlate with height and weight. Asian women were more obese than any other group, and showed an increase in body mass index with age. 5. Twenty-two per cent of Asian subjects had marked vitamin D deficiency (plasma 25-hydroxycholecalciferol less than 10 nmol/1). There was no correlation between MVC, and plasma 25-hydroxycholecalciferol.     

Kokainmissbrauch in Wien und in europäischen Metropolen – eine multizentrische Studie

INTRODUCTION: As cocaine consumption seems to have increased over the last decades, the EU has funded this multi-center, cross-sectional survey to investigate cocaine consumption in three different target groups. The study was conducted by the Addiction Clinic, Department of Psychiatry, Medical University Vienna and other nine European cities. METHODS: Data were collected by structured face-to-face interviews. The sample was composed of 211 cocaine abusers out of three target groups: (1) treatment group undergoing opioid maintenance therapy, (2) marginalized scene group and (3) integrated party group. Sociodemographic data such as age, education, employment, monthly expenses on cocaine/crack, data on consumption patterns, physical and mental health and personal needs regarding cocaine consumption were evaluated. Urine toxicology results for cocaine in the treatment group completed the analysis. RESULTS: The marginalized scene group was the oldest with a mean age of 29.35 years, with the highest unemployment rate (mean 25.11 days) and the longest duration of cocaine consumption (mean 5.80 years). They had the highest cocaine consumption pattern with a mean of 22.32 days within the last month. On average 1969 Euros/months was spent for their addiction. The treatment group had the lowest school education with a mean of 10.36 years, but showed a sufficient insight in their cocaine problem. However, the party group (with the lowest mean age, 25.64 years) highly underestimated their drug problem, the mean amount of money they spent for their addiction was 588.99 Euro/months. Structured urine toxicology between 1996 and 2002 in patients undergoing opioid maintenance therapy ("treatment group") revealed a significant increase of concomitant cocaine consumption (1996: 33.1%; 2002: 40.2%; p = 0.044). DISCUSSION: The European trend of increased cocaine use could also be observed in Vienna. One of the greatest barriers for establishing adequate treatment settings for this target group is the difficulty to reach this population. In addition, multiple substance abuse seems to be one of the predominating patterns of cocaine consumption and this aspect should be integrated within treatment (in the treatment and scene groups additional heroin and benzodiapzepines abuse is observed, in the party group intensive alcohol consumption). The Viennese results are in line with those of the other European cities; however, it could not be confirmed that consumption of crack cocaine and binge play a similarly significant role as in cities such as Hamburg or London.     

Alcohol consumption and the risk of Barrett’s esophagus: A meta-analysis

AIM: To evaluate the possible association between alcohol consumption and Barrett’s esophagus (BE). METHODS: We performed a systematic literature search of multiple online electronic databases. Inclusion criteria entailed studies about alcohol and BE. Meta-analysis was conducted to evaluate odds ratio (OR) and 95%CIs for the association between alcohol consumption and BE. RESULTS: Twenty studies comprising 4758 patients with BE were included in the meta-analysis. The risk of BE in patients with alcohol consumption was increased compared with control groups (OR = 1.01; 95%CI: 1.00-1.02), especially in case-control and cohort, European and Asian, and hospital studies, but there was a decreased risk of BE associated with alcohol consumption from American studies (OR = 0.86; 95%CI: 0.77-0.96). At the same time, there was no significant association between BE and alcohol consumption in community studies (OR = 0.97; 95%CI: 0.84-1.12) and the type of alcohol (wine, beer and liquor) studies. CONCLUSION: Our meta-analysis found that alcohol consumption was associated with an increased risk of BE, especially for European and Asian drinkers.     

Effects of alcohol consumption on hepatocellular injury in Japanese men

To clarify the effects of alcohol consumption on hepatocellular injury, we examined aspartate and alanine aminotransferases (AST and ALT), and gamma-glutamyltransferase (GGT), together with weekly alcohol consumption calculated from a self-rating questionnaire, in 1113 Japanese salesmen. The thresholds of associations between alcohol consumption and liver markers were estimated by the benchmark dose (BMD) method. The AST, ALT and GGT were positively correlated with alcohol intake (p<0.001), as well as age and body mass index (BMI); the relations to alcohol were statistically significant even when controlling for age, BMI and smoking habit. Although the AST and GGT were associated with four types of alcoholic beverage (p<0.01), it was only whiskey that had close relation to the ALT (p<0.05). The thresholds of alcohol consumption (ethanol g/week), i.e., 95% lower confidence limits of the BMD, were 362 for AST, 660 for ALT, and 252 for GGT. The thresholds for GGT and AST in Japanese men seem to be somewhat higher than those reported in Western countries. It is suggested that hepatocellular injury (i.e., AST elevation) in Japanese men may emerge at the ethanol level of more than 50 g/day.     

Paracetamol hepatotoxicity and alcohol consumption in deliberate and accidental overdose

We studied the relationship between alcohol consumption and hepatotoxicity related to paracetamol ingestion both in cases of overdose with suicidal intent and in cases where paracetamol was apparently taken for therapeutic reasons. In a retrospective study of 553 patients admitted to a specialist liver unit between January 1987 and December 1993 with paracetamol-induced hepatotoxicity, there was no difference in the severity of the hepatotoxicity following either a deliberate or an inadvertent overdose. Heavy alcohol consumption was more common in males than females and more commonly associated with deliberate overdoses of >15 g. There was no correlation between alcohol consumption and severity of hepatotoxicity (mean INR and the serum creatinine levels over the first 7 days after the overdose). The significantly lower platelet count in heavy drinkers was probably the consequence of direct alcohol toxicity to the marrow. Overall there was a greater incidence of heavy alcohol consumption amongst therapeutic misadventure compared to deliberate overdose cases, but there was no difference between the two groups when amounts of <10 g/day were involved. Eleven (29%) patients in the therapeutic misadventure group were depressed, 10 of whom had previously attempted suicide. In conclusion, we were unable to demonstrate that heavy drinkers develop more severe hepatotoxicity following paracetamol overdose than non-drinkers, and from the material reported in this study, accidental overdose is a better defining term than therapeutic misadventure.     

丙泊酚/咪达唑仑新用法在ICU患者长时间镇静中的效价比特点

目的 观察丙泊酚间断诱导、咪达唑仑持续静脉滴注对意识清醒、需长时间气管插管ICU患者的镇静效果、抗耐药性及效价比等.方法 选择急诊ICU内意识清醒、行气管插管且预计镇静超过72h的患者49例,随机分为四组,即丙泊酚组(A组,n=11)、咪达唑仑组(B组,n=14)、咪达唑仑-丙泊酚联合组(C组,n=10)和丙泊酚诱导-咪达唑仑维持组(D组,n=14).A、B、C组行既往常规镇静方法,分别给予负荷量的丙泊芬、咪达唑仑或二者联合静脉推注,随即以相同药物持续静脉滴注维持;D组为新方法,以丙泊酚间断静脉推注诱导镇静,而以咪达唑仑持续静脉滴注维持.使用Richmond躁动-镇静(RASS)评分系统评价镇静效果,RASS评分-1～-3分为成功镇静;记录人均每日用药量及用药费用.结果 四组方法均可达到满意的镇静效果;用药超过72h后,A、B、C组每日用药量较首日用药量明显升高(P<0.05),而D组则无明显变化(P>0.05);D组人均每日镇静药消费低于A、B、C组,超过72h后尤为明显.结论 新方法较常规方法镇静效果相同,但具有明显的抗耐药性,且效价比最高.     

Circumstances preceding the suicide of Asian Pacific Islander Americans and White Americans

This study examined the circumstances preceding suicide among Asian and Pacific Islander Americans (APIAs) and White American decedents using data from the National Violent Death Reporting System in the United States. After controlling for gender and age, APIAs had lower rates of recent disclosure of suicide ideation, recent mental health treatment, recent mental health problems, and intimate partner problems, but higher rates of school problems than White Americans. There were also significant Race?×?Age moderation effects for recent mental health, financial, and school problems and a significant Race?×?Gender moderation effect for intimate partner problems.     

Does alcohol contribute to accident and emergency department attendance in elderly people?

OBJECTIVE: To evaluate the possible contribution of alcohol to presentation of elderly subjects at a hospital accident and emergency (A&E) department. METHODS: 105 patients aged 70 years and over who attended the department were interviewed by a single observer using a structured questionnaire based on previously validated general population surveys. Details of alcohol consumption within the previous 24 hours were recorded. Usual consumption of alcohol in the preceding 12 months was estimated by the quantity frequency method. Alcohol dependence was screened for by the CAGE questionnaire. An assessment of disability was made using the Barthel index. Breath alcohol was measured. RESULTS: In only 2% of attenders was alcohol thought to be a contributory factor. Breath alcohol measurements were technically unsatisfactory in this age group. Regular drinkers were functionally and socially more independent than non-regular drinkers. Drinking patterns in this age group may partly be determined by the physical ability to obtain alcohol. CONCLUSIONS: Alcohol was not found to be a major factor in A&E attendance in elderly people.     

感染性高热病人不同降温方法效果观察

目的观察感染性高热病人不同降温方法的退热效果。方法将90例高热病人按抽签的方法随机分为3组,物理降温组30例,药物降温组30例,药物辅以物理降温组30例,比较各种降温方法的降温效果。结果使用降温措施0.5h后,3组病人降温有效率经卡方检验,有显著性差异(P<0.001),物理降温组和药物辅以物理降温组降温有效率明显高于药物降温组;4h内3组病人体温回升率经卡方检验,有显著性差异(P<0.001),药物降温组和药物辅以物理降温组体温回升率明显低于物理降温组。结论物理降温退热迅速、安全,但欠持久;药物降温退热持久有效、安全,但不迅速;药物辅以物理降温迅速、有效、安全、持久地达到退热目的,未见不良反应发生。     

Alternate oucher form testing: Gender,ethnicity, and age variations

This study was part of a project to improve pain assessment and management for a multiethnic group of children. Based on its visual appeal for the clinical team, the Oucher was selected for trial. A reduced size and shortened screening technique were introduced. Children (N = 79) aged 3 to 12 years were randomly assigned to use the original or a reduced-size Oucher first. Scale scores were highly correlated regardless of size or presentation order. There were no differences attributable to age, gender, or ethnicity (Black, White, Hispanic). There is preliminary support for using the more convenient size and screening process.     

饮酒对血压的影响

摘要 目的：通过大样本的流行病学调查及横断面研究，进一步探讨饮酒对血压的影响；方法：资料来自2006年7月至12月开滦唐家庄矿职工查体资料。资料用Excel 2003建库，SPSS 13.0统计软件处理数据。结果：1 在调整年龄、体重指数、有无吸烟史及文化程度的差异后，男性饮酒组收缩压和舒张压均高于不饮酒组和戒酒组(P < 0.05) 。男性饮酒量与收缩压和舒张压正相关，收缩压及舒张压随饮酒量的增加呈线性增加(P<0.01)。饮酒是高血压的独立危险因素(P < 0.05)。2 高血压相关危险因素的多因素非条件回归分析结果显示年龄、BMI、 腰围、肌酐、尿素氮、血尿酸、文化程度和饮酒是高血压的危险因素。结论 :男性饮酒量与收缩压和舒张压呈正相关，收缩压及舒张压随饮酒量的增加而增加。饮酒是高血压的危险因素。     

老年脂肪肝临床分析及饮食治疗

目的分析老年脂肪肝形成病因,寻求合理饮食治疗。方法 选择年度干部体检中624名作为考察源(平均年龄67±9岁),超声诊断判定脂肪肝者,选择其中180名非脂肪肝者作力对照者,测定两组血清甘油脂(TG)、血清总胆醇(TC)和高密度脂蛋白(HDL-C),并考察脂肪肝者肥胖及嗜酒程度。结果 诊断为脂肪肝者为156名(25％),脂肪肝者中患有肥胖症为87名(54.4％),嗜酒者109名(69.8％);脂肪肝者TG明显高于对照组(P<0.01),HDL-C低于对照组(P<0.01),TC无显著差异(P>0.05)。结论 营养失调、乙醇过量和肥胖病等是形成脂肪肝的常见原因,适度减少营养摄人,尽量减少饮酒或禁酒,同时配合中等量的有氧运动,可望获得良好的综合调脂效果。     

Disturbing TrendsThe Epidemiology of Pediatric Emergency Medical Services Use

OBJECTIVE: To compare pediatric ambulance patients transported for chief complaints of suicide, assault, alcohol, and drug intoxication (SAAD) with pediatric patients transported for all other chief complaints. METHODS: An out-of-hospital database for the primary transporting service in an urban area was analyzed for patients 0-20 years of age from 1992 to 1995. Chief complaints by age, gender, and billing status were analyzed. RESULTS: There were 17,722 transports. The SAAD group comprised 14.9% of all transports (suicide attempt 1.6%, assault 5.9%, alcohol intoxication 3.2%, and drug abuse 4.2%). The proportion of transports due to SAAD increased with age: 0-11-year-olds (4.2%); 11-16-year-olds (17.5%); and 17-20-year-olds (20.3%) (p = 0.0001). Genders were equally represented in the overall group, while males comprised 52.6% of the SAAD transports (p = 0.032). In the SAAD group, the majority of transports for assaults (55.9%) and alcohol (58.8%) involved males, while females were the majority in transports for suicide (52.3%) and drug abuse (66%) (p = 0.0001). Reimbursement sources differed, with those in the SAAD group less likely to be reimbursed by private or public (Medicaid, government) insurance (p < 0.0001) compared with the overall group. CONCLUSIONS: A substantial proportion of pediatric emergency medical services transports are for high-risk conditions. This patient population differs from the overall group by age distribution and reimbursement source.     

自知力教育对门诊精神分裂症患者自知力及服药依从性的影响

目的探讨自知力教育对门诊精神分裂症患者自知力恢复及服药依从性的影响.方法将60例首次门诊治疗精神分裂症患者随机分为对照组及观察组各30例,对照组常规药物治疗,观察组在常规药物治疗基础上进行自知力教育.分别于首次就诊时、2周、4周、8周复诊时进行简明精神病评定量表（BPRS）,自知力与治疗态度问卷表（ITAQ）测定以及服药依从性评定.结果首次就诊和2周、4周复诊时2组BPRS量表,ITAQ及服药依从性差异无显著性（P〉0.05）,门诊治疗8周后观察组ITAQ评分显著高于对照组,BPRS评分显著低于对照组,服药依从性明显提高,差异有显著性意义（P〈0.05）;ITAQ与服药依从性,BPRS评分呈显著负相关.结论对门诊精神分裂症患者进行自知力教育可以有效恢复患者自知力,提高服药依从性,促进疾病恢复.     

Primary glomerulonephritis and hydrocarbon exposure: a case-control study and literature review.

A case-control study was undertaken to investigate the possible role of chronic hydrocarbon exposure and tobacco and alcohol consumption in the causation of primary glomerulonephritis. Exposure to hydrocarbons and the consumption of tobacco and alcohol were assessed blindly by telephone interview and questionnaire in 55 patients with end-stage renal disease due to biopsy-proven primary glomerulonephritis in whom there had been no evidence of systemic disease. This was compared with 55 normal subjects matched for age, sex, social class and residential area and a comparable internal control group of 45 patients with end-stage renal disease secondary to systemic disease, diabetic nephropathy or chronic pyelonephritis. Hydrocarbon exposure scores derived from the results of the questionnaires were significantly higher (p < 0.001) in the patients with primary glomerulonephritis than in the normal subjects and the internal control group. Moreover, more detailed assessment of the type of hydrocarbon exposure showed significantly greater exposure of patients with glomerulonephritis to petroleum products (p < 0.001), greasing/degreasing agents (p < 0.01) and paints/glue (p < 0.05), and a resulting estimated relative risk of developing glomerulonephritis with each type of hydrocarbon exposure of 15.5, 5.3 and 2.0. Those patients with heavy hydrocarbon exposure (hydrocarbon score > 25,000) had a significantly higher serum creatinine at presentation than those with mild to moderate exposure, suggestive of more advanced renal disease. However, there was no significant difference in tobacco and alcohol consumption among subjects in different groups. We conclude that occupational exposure to hydrocarbon is likely to play a role in the pathogenesis of primary glomerulonephritis and that the risk of developing glomerulonephritis is greatest in those subjects exposed to petroleum products.