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Directly age-standardized rates of out-patient utilization ofantihypertensive drugs (antihypertensives, diuretics and beta-blockers)and stroke mortality in men and women (40–79 years ofage) were compared over 4 years (1987–1990) in a midwestern(Värmland) and a southern (Skäne) province of Swedenand in their 49 (16 + 33) municipalities. In both genders, thestroke mortality and utilization rates of the 3 antihypertensivedrug groups, both combined and separate, were higher in Värmlandand there were positive correlations between these rates whenall 49 municipalities were compared. On the other hand, foreach province and each drug group there were municipalitieswith every possible combination of stroke mortality and antihypertensivedrug utilization rates. In addition, antihypertensive drug utilizationrates were similar in men and women even though the stroke mortalityrates were much lower among the latter. The findings cast doubton the effectiveness of antihypertensive drug treatment in commonpractice.  相似文献   
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在美国,每年有超过40万的人死于吸烟、暴饮暴食、物质滥用以及意外事故和自杀。此外,合并有精神疾病的成瘾者(双重诊断)相当普遍。约29%患有精神疾病的人和一半左右患严重精神疾病(如精神分裂症)的人有成瘾史。因此,成瘾相关的预防、研究及治疗依然是精神病学领域关注的重点。我们将回顾2008 -2009年在药物滥用、食物和其他成瘾方面的研究。在药物试验、药物的选择、成瘾易感性、干预的预后以及复吸的可能性方面存在明显的个体差异。在过去的几十年中,在成瘾的认定、预防和治疗方面取得的成绩是有目共睹的。例如,虽然直到DSM-ⅡI修订版出台才将可卡因列为有滥用潜力的物质,但这一发现拓展了以往局限于对成瘾躯体戒断症状的研究、治疗的范围。最近在动物模型方面已有所突破,目前正在进行有关成瘾大鼠的研究。此外,神经生物学、影像学、蛋白质组学、纳米技术、药理学以及行为科学研究方面的进展也对成瘾领域的研究产生影响。本文综述了我们在成瘾研究中的部分工作以及其他成瘾研究方面取得的进展。  相似文献   
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Many biological and psychological factors induce haemodynamicand extra-cardiovascular functional changes mediated by theautonomic nervous system. Pharmacological blood pressure reduction,as a neurovegetative stimulus, can change the arousal of thesympathetic nervous system. We evaluated the effects of twocalcium channel blockers, verapamil and amlodipine, both administeredas monotherapies, upon the sympathetic stress response in 23randomized mild-to-moderate essential hypertensives (161 ±2198 ± 1 mmHg). Patients performed four stress tests (mental arithmetic, colourword Stroop, cold pressor and handgrip) while extracardiovascularand haemodynamic functions were assessed non-invasively at everyheart beat, during baseline, stress and recovery phases. Thesympathetic response was evaluated by computing the ‘area-under-the-curve’(value x time) measured during the psychophysiological session.The session was repeated at run-in, after placebo and duringtreatment. After one month's treatment, baseline blood pressure was significantlyreduced in patients treated with amlodipine (139 ± 1184± 1 mmHg; P<0.001) and verapamil (140 ± 2185±1 mmHg; P<0.001). The emotional arousal (frontalismuscular contraction, skin conductance) was unchanged, but thecutaneous vascular response was reduced (P<0.05) in patientstreated with verapamil. No changes in systolic or diastolicblood pressure were detectable, but amlodipine increased theheart rate response (P<0.05). In contrast, verapamil reducedthe heart rate (P<0.05) without depressing the cardiac outputresponse, which was increased with amlodipine (P<0.05). Totalvascular resistance was significantly (P<0.001) reduced withboth the treatments. Consequently, functional cardiac load,expressed by pressure-rate product and cardiac power, was significantlyenhanced with amlodipine and reduced with verapamil. In conclusion, the abnormal sympathetic stress response, whichcharacterizes the hypertensive patient, might be affected bythe choice of medication. Verapamil in particular, moderatedemotional arousal, the vasoconstrictive response and reducedcardiac load without lowering cardiac output demands. In contrast,in patients treated with amlodipine, in whom the cardiac outputresponse was increased, the pattern was reversed and the functionalcardiac load was also increased.  相似文献   
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Summary. Between 1970 and 1979, 103 women below 35 years of age with invasive cervical cancer were treated at the First Obstetrics and Gynaecology Clinic of the University of Milan. Nine patients were pregnant or less than 3 months postpartum. Estimated 10–year disease–free survival, determined by the life–table method, was 100% in stage IA (37 patients), 79% in stage IB (45 patients), 67% in stage 11 (15 patients), 0% in stages III (5 patients) and IV (1 patient). Prognosis was also strongly associated with lymph–node involvement, 10–year actuarial survival decreasing from 93% in lymph–node–negative to 44% in lymph–node– positive patients ( P 相似文献   
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A representative sample of 68 year old men living in Malmö,Sweden, was investigated concerning use of anxiolytic-hypnoticdrugs. The subjects were psychometrically tested using the synonyms,Koh's block design, paired associates, visual retention, anddigit symbol tests. Subjects with continuous use of anxiolytics,the vast majority of which consisted of benzodiazepines, hadan increased risk of impaired cognitive function (RR=3.2 andp=0.008). Multivariate adjustments for differences in education,alcohol habits, exposure to organic solvents and stroke betweenusers and non-users of anxiolytics did not reduce the estimateof risk (RR adj =3.4; 95% confidence interval: 1.3–8.9).Adjusting for differences in the number of subjects with a historyof depression reduced the risk estimate slightly (RR adj =2.7;95% confidence interval: 1.0–7.7) but adjustments fordifferences in anti-hypertensive and anti-diabetic medicationhad no influence. Subjects with occasional use of anxiolyticsand subjects with occasional or continuous use of hypnoticsshowed no risk increase. Neither selection bias nor informationbias appeared to explain the findings. Accordingly, increasedcaution is warranted when prescribing benzodiazepines for regularanxiolytic use.  相似文献   
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