药物依赖与帕金森病的相关性研究

药物依赖或成瘾,是一种慢性脑疾病。依赖性药物包括精神兴奋剂(可卡因、苯丙胺等)、阿片类药物(吗啡、海洛因等)、致幻剂以及大麻类等。中脑边缘多巴胺系统(mesolimbic dopamine system,MLDS)被认为是这些药物导致成瘾的关键环路[1]。帕金森病(Parkinson’s disease,PD)是一种常见的中老年人神经系统变性疾病,60岁以上人群中患病率为1%,并随年龄增长而增高。本病的病理基础是黑质致密部的多巴胺(dopamine,DA)神经元进行性变性、死亡,从而失去了黑质纹状体DA通路对运动系统的控制能力,进而出现了以静止性震颤、运动迟缓、肌强直和姿势步…     

无铅汽油推广使用以来儿童铅暴露对智力影响的疾病负担变化趋势分析研究

目的探讨使用无铅汽油以来铅暴露对儿童智商影响的疾病负担。方法通过文献检索收集国内1998~2006年公开发表的儿童血铅研究论文,采用WHO环境铅疾病负担的评估方法,对推广无铅汽油后儿童血铅水平进行分析,并估评儿童铅暴露引起的轻度智力低下(MMR)的疾病负担(DALYs)。结果推广无铅汽油9年后儿童血铅水平(几何平均浓度)由8.3μg/dl下降至2.99μg/dl,下降了64%,每1000名儿童发生的MMR减少了2.08例,每1000名儿童的疾病负担损失减少了22.3DALYs。推广无铅汽油9年后,估计可以减少MMR发病656例,同时可减少因铅暴露所致MMR的疾病负担损失近7000DALYs。结论无铅汽油的推广使用可明显降低由铅暴露对儿童智力影响的疾病负担。     

药物成瘾的机制

药物成瘾是一种反复发作的慢性疾病,尽管有严重不良后果,仍持续地强迫性觅药和用药.成瘾性物质可引起愉悦状态(最初阶段则为欣快)或缓解痛苦.持续用药引起中枢神经系统的适应性改变,导致耐受、躯体依赖、敏化、渴求和复吸.这里所讨论的成瘾性药物是指阿片、大麻、酒精、可卡因、苯丙胺和尼古丁.     

1990-2019年中国乙型肝炎疾病负担分析及趋势预测

目的 了解2019年中国乙型肝炎的疾病负担情况并对2020—2030年乙型肝炎的疾病负担发展趋势进行预测。方法 在2019全球疾病负担研究数据库（Global Burden of Disease 2019,GBD 2019）中下载中国乙型肝炎数据。利用患病率、发病率、死亡率、伤残调整寿命年（disability-adjusted life year,DALY）、早死损失寿命年（years of life lost,YLL）、伤残损失寿命年（years lived with disability,YLD）及年龄标化率等指标描述2019年中国乙型肝炎的疾病负担情况，利用估计年百分比变化（estimated annual percentage change,EAPC）描述中国乙型肝炎疾病负担1990—2019年的变化趋势。采用R4.2.1构建贝叶斯年龄-时期-队列模型对2020—2030年中国乙型肝炎总体发病、死亡、DALY和YLD情况进行预测。结果 1990—2019年中国乙型肝炎的总体疾病负担呈下降趋势，中国乙型肝炎的总体标化患病率为6 566.1/10万、标化发病率为1 397.3/1...     

我国结核病的疾病负担研究

目的全面评估结核病对国人的健康危害。方法采用文献调研的方法，使用世界卫生组织的推荐的伤残调整生命年的方法，计算出2003年我国结核病的疾病负担。结果2003年我国结核病所导致的损失为833367个DALYs，即损失健康生命年为833367人年，疾病负担强度为0．6449DALYs／1000人。结论以伤残调整生命年测量出的结核病的负担比以传统指标衡量的负担要包含更丰富的信息，应逐步将DALY的测算纳入常规疾病监测体系。     

对2015年全球疾病负担研究及我国现状的系统分析——Lancet全球疾病负担研究摘译

1 全球疾病负担研究 1.1 背景:为了改善全球人口的生存状况、延长人口寿命,我们需要及时、准确的各地死亡率水平和趋势的数据.然而,有意义的死亡率比较,需要解决许多数据和评估方法相关的挑战,具体如下:1)调整死亡分类原因在时间和人群中的明显差异;2)调整生命注册系统数据的覆盖面和质量问题;3)从原因特异性来源(如癌症登记)和死亡识别工具的替代原因(如口头尸检)合理地合成死亡率数据;4)制定健全的分析策略,以期在稀疏数据中估计原因特异性死亡.全球疾病负担研究(the global burden of disease,GBD)为解决这些问题提供了一种标准化方法,从而提高了根据年龄、性别、原因、时间和地域进行有意义比较的能力.     

老年性黄斑变性的性别相关性全球疾病负担

目的 利用伤残调整生命年(disability-adjusted life yearDALY,DALY)探索性别与老年性黄斑变性(senile macular degeneration,SMD)全球疾病负担的关系及其对公共卫生政策的意义.方法 通过进行一项国际性数据库观察研究,从全球健康数据交换(data exchange)数据库发表的"2018年全球疾病负担研究"中提取了1990年至2017年全球性别特定性SMD的疾病负担数值、粗略的疾病负担率和年龄标准化的疾病负担率,从而分析比较社会经济相关的性别差异对SMD疾病负担的影响.结果 SMD引起的所有年龄段性别特异性全球疾病负担—伤残调整生命年数和伤残调整生命年率从1990—2017年处于上升趋势,其中女性的伤残调整生命年数由1990年的151958.39(95％UI:208911.03～102688.65)增加到2017年的307576.72(95％UI:421655.58～209694.25),男性的从1990年的102999.44(95％UI:142727.58～69913.40)到2017年的223157.46(306692.81～153280.42);女性的伤残调整生命年率为1990年5.68(95％UI:7.80～3.84)至2017年8.08(95％UI:11.08～5.51),男性为1990年3.79(95％UI:5.25～2.57)至2017年5.82(95％UI:8.00～4.00);女性年龄标准化的伤残调整生命年率从1990年的7.28(95％UI:10.00～4.92)下降到2017年7.16(95％UI:9.81～4.88),然而男性SMD的年龄标准化的伤残调整生命年率从1990年6.13(95％UI:8.47～4.15)到2000年出现短暂波动后,最终在2017年升高到6.26(95％UI:8.64～4.31).曼—惠特尼检验显示,三者均呈现性别差异(P<0.01).结论 在过去的28年中,SMD导致的疾病负担总体处于上升趋势,女性的疾病负担比男性更大.本研究的发现有助于提高公共卫生部门对SMD全球疾病负担的关注,制定更优化的政策应对SMD的治疗.     

药物滥用的性别差异及神经生物学机制

<正>精神兴奋剂(可卡因、苯丙胺等)、阿片类药物(海洛因、阿片、吗啡等)、致幻剂和大麻类等毒品都具有强烈的成瘾性。女性滥用海洛因与其他成瘾性药物已成为当今世界的严峻社会问题。1994年调查发现,香港地区精神药物滥用人数有2328人,到2001年已增加到6022人,其中男性占82.3%,女性占17.7%[1]。截至2009年6月底,我国登记在册的吸毒人员为121万人,其中女性占19.9%[2]。     

NMDA受体数量在吗啡增敏、耐受和依赖形成过程中的重要性

阿片受体激动剂可使阿片受体下调,而其拮抗剂则可使阿片受体上调,此上调与阿片药物作用增敏有关,因此阿片受体拮抗剂可用于防治阿片类药物所致耐受。近年来还发现NMDA受体拮抗剂可减轻或逆转耐受及依赖程度;相反,预先用NMDA受体拮抗剂则可加重耐受,表明NMDA受体在阿片类药物耐受形成过程中有作用。本文旨在研究纳曲酮和NMDA受体拮抗剂地佐环平(dizocilpine,MK801)在吗啡所致耐受和依赖过程中的作用以及对脑NMDA受体动力学(Kd,Bmax)的影响。方法　将大鼠随机分为6组:盐水-盐水组、盐水-吗啡组、纳曲酮-盐水组、纳曲酮-吗啡组、地佐…     

苯丙胺类依赖的药物治疗现状和展望

苯丙胺类药物是国内第二大成瘾性药物,苯丙胺类依赖是一个重要的公共健康问题,但至今尚未发现有效的治疗药物。本文首先介绍了苯丙胺类依赖形成的多巴胺和非多巴胺机制,并对多巴胺转运体抑制剂、多巴胺受体部分激动剂及拮抗剂、谷氨酸受体拮抗剂、乙酰胆碱酯酶抑制剂、γ-氨基丁酸受体激动剂、5-羟色胺转运体抑制剂以及阿片受体拮抗剂等已用于苯丙胺类依赖治疗实践的药物进行了系统综述,并展望了苯丙胺类依赖治疗药物的研究方向。     

The burden of Alzheimer's disease

Alzheimer's disease (AD) imposes a severe burden upon patients and their carers. In particular, family carers of AD patients face extreme hardship and distress that represents a major but often hidden burden on healthcare systems. Carers often experience clinically significant alterations in physical and mental health, particularly depression. A number of individual features of the dementia syndrome that are known to be particularly burdensome to carers include the degree of cognitive impairment, amount of help required with activities of daily living, personality changes and the presence of psychiatric symptoms and behavioural disturbances. The neuropsychiatric features of AD patients can adversely impact the relationship between the patient and caregiver generating feelings of strain, burden and social isolation. Individual characteristics of the caregiver including personality, gender, degree of formal and informal support and physical and mental health, as well as attributional style ('coping style') and expressed emotion (critical or hostile attitudes), also dictate carer burden. As informal caregivers play such a crucial role in the care of AD patients, appropriate management strategies that incorporate interventions which address the specific burdens of the individual caregiver are essential. Reducing the burden of care can be achieved by the combination of a number of individual and general measures, including education, respite and emotion-focused interventions. These measures, accompanied by non-pharmacological strategies, are extremely important in the total care of the AD patient, with the emphasis on maintaining people in the community as long as possible.     

Alcohol and the burden of disease

World Health Organization (WHO) lists alcohol consumption as a leading risk to health, contributing 4% to the global burden of disease. This serves as justification for far-reaching preventive interventions. The purpose of this article is to recapitulate in narrative some of the assumptions upon which WHO conclusions rest and to interpret their validity accordingly. First, it may be misleading to include ‘alcohol use’ as a risk to health. As alcohol use has beneficial, protective as well as harmful properties, burden assessment should be based on harmful aspects only, e.g., ‘hazardous patterns of alcohol use’. Second, assessments of interventions aimed at reducing risks from alcohol use to disease burden should also consider such interventions’ impact on dimensions other than health or disease–in particular, psychosocial benefits of alcohol consumption. Third, the uncertainties associated with both the database and methodology for estimating the disease burden attributable to alcohol are high and need to be considered in the interpretation of findings.     

The increasing hospital disease burden of haemochromatosis in England

Background Hereditary haemochromatosis is a preventable cause of liver disease with an increasing disease burden. Aims To investigate time trends for hospital admission ascribed to haemochromatosis in England during the period from 1989/1990 to 2002/2003 and mortality from 1979 to 2005. Methods Hospital admission data, relating to both in‐patients and day‐cases, were obtained from the Hospital Episodes Statistics service. Mortality rates for England and Wales were provided by the Office for National Statistics. Results Haemochromatosis is an uncommon cause for hospital admission. Age‐standardized in‐patient admission rates increased over the study period by 269% in men and by 290% in women: (from 0.64 to 2.36 and from 0.21 to 0.81 per year per 100 000). The increase in age‐standardized day‐case admission rates was even higher (men: from 2.78 to 34.9 per year per 100 000, 1155%; women: from 0.58 to 11.67 per year per 100 000, 1924%). Haemochromatosis was recorded as an uncommon cause of death. Conclusions Hospital in‐patient and day case admissions for haemochromatosis increased markedly over the study period while mortality remained low. Both admission rates and mortality were higher in men than in women. The increase in admission rate may reflect improved recognition and diagnosis of iron overload disorders following identification of the HFE gene. Aliment Pharmacol Ther 31 , 247–252     

围手术期使用抗生素所致相关性肠炎的疾病负担

目的:初步查明某院围手术期抗生素相关性肠炎的疾病负担.方法:以使用了止泻药为线索,查阅手术科室相关病史,找出抗生素相关性肠炎,与对照组进行比较,统计不合理使用抗生素的发生率以及加重经济负担的量化指标.结果:从2007年1月-7月,共查阅相关科室4 278个围手术期病例,发现抗生素相关性肠炎38例,其不合理使用抗生素的发生率为42.1%,显著高于对照组,并且使住院总费用共增加489 022元.结论:腹泻前抗生素使用时间为抗生素相关性肠炎的诱发因素.围手术期抗生素相关性肠炎有较大的疾病负担,采取有效措施降低其发生率意义重大.