影响高血压患者服药依从性因素调查

目的　了解高血压患者的服药依从率及影响服药依从性的原因。方法　采用自编问卷对 2 17名高血压患者进行了调查。结果　平均服药依从率为 3 2 71% ,不同年龄间依从性有差别 (P <0 0 0 1) ,性别、职业、文化水平、经济状况和有无家族史等都不是影响依从性的主要因素。服药依从性不佳为 67 2 9% ,其中 58 9%的患者不依从是认为疾病治愈 ,18 49%是无服药习惯 ,12 3 3 %归因于药物的副作用。结论　年龄对服药的依从性有影响 ,高血压患者服药不依从的主要原因是自认为疾病治愈和服药的习惯问题     

Opioid contracts in chronic nonmalignant pain management: objectives and uncertainties

In this article, we review the principal objectives and ideal elements of opioid contracts, as articulated by proponents of the practice. We examine the limited empirical evidence for the effectiveness of opioid contracts in achieving their intended objectives and identify areas of uncertainty and of ethical concern regarding their implementation. We argue that the challenge in deciding about implementing opioid contracts in clinical practice relates to the multiplicity of potential objectives they might serve, to a lack of empirical evidence regarding their effectiveness, and to ethical concerns over their implementation. Specialty and primary care clinicians contemplating the use of opioid contracts in treating patients with chronic nonmalignant pain need to be sensitive to these considerations, and further debate and research is necessary to establish the proper objectives, elements, effectiveness, and ethical justifications of opioid contracts in clinical practice.     

Elucidating Risk Factors for Androgen Deficiency Associated with Daily Opioid Use

Background

Opioids can suppress testosterone in men, which can lead to extensive morbidity. Identifying risk factors for androgen deficiency in men using daily opioids could improve monitoring and safety.

Methods

In a retrospective cohort study, we used Kaiser Permanente Northern California databases to identify men on stable doses of opioids. These subjects had no diagnoses of cancer or endocrine disorders except treated primary hypothyroidism. Subjects were divided into those using long-acting opioids and short-acting opioids. Total testosterone was measured in blood drawn in the morning while the subjects were on their regular dose of opioid. The association between opioid duration of action and androgen deficiency, controlling for dose, body mass index, age, diabetes, hyperlipidemia, and hypertension, was assessed using logistic regression.

Results

The study included 1585 men. Men on long-acting opioids were more likely to be androgen deficient than men on short-acting opioids (57% vs 35%, P < 0.001; odds ratio [OR] 3.39; 95% confidence interval [CI], 2.39-4.77). As dose increased, the odds of androgen deficiency increased; however, dose was more strongly associated with androgen deficiency in men on short-acting opioids (OR 1.16; 95% CI, 1.09-1.23, for each 10-mg increase in dose) than in men on long-acting opioids (OR 1.01; 95% CI, 1.01-1.02).

Conclusion

Use of long-acting opioids is a key risk factor in the development of androgen deficiency. Dose was significantly associated with androgen deficiency, but more so for men on short-acting than on long-acting opioids.     

Cannabis use history is associated with increased prevalence of ascites among patients with nonalcoholic fatty liver disease: A nationwide analysis

BACKGROUNDRecent studies have revealed the endocannabinoid system as a potential therapeutic target in the management of nonalcoholic fatty liver disease (NAFLD). Cannabis use is associated with reduced risk for NAFLD, we hypothesized that cannabis use would be associated with less liver-related clinical complications in patients with NAFLD.AIMTo assess the effects of cannabis use on liver-related clinical outcomes in hospitalized patients with NAFLD.METHODSWe performed a retrospective matched cohort study based on querying the 2014 National Inpatient Sample (NIS) for hospitalizations of adults with a diagnosis of NAFLD. The NIS database is publicly available and the largest all-payer inpatient database in the United States. The patients with cannabis use were selected as cases and those without cannabis were selected as controls. Case-control matching at a ratio of one case to two controls was performed based on sex, age, race, and comorbidities. The liver-related outcomes such as portal hypertension, ascites, varices and variceal bleeding, and cirrhosis were compared between the groups. RESULTSA total of 49911 weighed hospitalizations with a diagnosis of NAFLD were identified. Of these, 3820 cases were selected as the cannabis group, and 7625 non-cannabis cases were matched as controls. Patients with cannabis use had a higher prevalence of ascites (4.5% vs 3.6%), with and without cannabis use, P = 0.03. The prevalence of portal hypertension (2.1% vs 2.2%), varices and variceal bleeding (1.3% vs 1.7%), and cirrhosis (3.7% vs 3.6%) was not different between the groups, with and without cannabis use, all P > 0.05. Hyperlipidemia, race/ethnicity other than White, Black, Asian, Pacific Islander or Native American, and higher comorbidity score were independent risk factors for ascites in the cannabis group. Among non-cannabis users, obesity and hyperlipidemia were independent protective factors against ascites while older age, Native American and higher comorbidity index were independent risk factors for ascites. CONCLUSIONCannabis was associated with higher rates of ascites, but there was no statistical difference in the prevalence of portal hypertension, varices and variceal bleeding, and cirrhosis.     

Trends of Cannabis Use Disorder in the Inpatient: 2002 to 2011

Objectives

The nationwide prevalence of cannabis use/abuse has more than doubled from 2002 to 2011. Whether the outpatient trend is reflected in the inpatient setting is unknown. We examined the prevalence and incidence of cannabis abuse/dependence as determined by discharge coding in a 10-year (2002-2011) National Inpatient Sample, as well as various trends among demographics, comorbidities, and hospitalization outcomes.

Does Spatial Accessibility of Pharmacy Services Predict Compliance with Long-Term Control Medications?

Background: Disadvantaged urban children with asthma are at high risk for undermanagement of their disease and poor compliance with inhaled corticosteroids (ICS). Objective: To determine whether spatial accessibility (SA) of retail pharmacy services is associated with ICS compliance. Methods: Caregivers of 137 urban high-morbidity asthmatic children attended a comprehensive intervention to improve asthma care and outcomes. Subsequent ICS compliance was determined at 1, 3, and 6 months. We modeled 18 measures of SA to 339 pharmacies using logistic regression and adjusting for numerous covariates. Results: No relationships between SA and compliance were found. Conclusions: In this group of disadvantaged urban children with severe asthma, compliance with ICS was not significantly associated with SA of retail pharmacy services.     

Does Spatial Accessibility of Pharmacy Services Predict Compliance with Long-Term Control Medications?

Background: Disadvantaged urban children with asthma are at high risk for undermanagement of their disease and poor compliance with inhaled corticosteroids (ICS). Objective: To determine whether spatial accessibility (SA) of retail pharmacy services is associated with ICS compliance. Methods: Caregivers of 137 urban high-morbidity asthmatic children attended a comprehensive intervention to improve asthma care and outcomes. Subsequent ICS compliance was determined at 1, 3, and 6 months. We modeled 18 measures of SA to 339 pharmacies using logistic regression and adjusting for numerous covariates. Results: No relationships between SA and compliance were found. Conclusions: In this group of disadvantaged urban children with severe asthma, compliance with ICS was not significantly associated with SA of retail pharmacy services.     

高血压病患者大血管顺应性变化及其对降压的反应

应用颈动脉搏动图(CPT)反应高血压(EH)病人大血管的顺应性及功能变化。结果显示:EH病人大血管阻力指数增加、顺应性下降。顺应性的改变与细胞内Na~+浓度(Na~+_1)异常有关,降压治疗可通过降低Na~+_1,改善EH的血管顺应性     

Combined Therapy with Interferon and Ribavirin in Chronic Hepatitis C Does Not Affect Serum Quasispecies Diversity

Our aim was to investigate if interferon plus ribavirin has any effect on serum HCV quasispecies distribution and the relationship between diversity of HCV quasispecies and treatment response. In all, 21 patients were treated with interferon plus ribavirin for 48 weeks. The presence of HCV quasispecies was determined in serum samples at baseline and at the fourth week of treatment by SSCP analysis of the hypervariable region. SSCP pattern was defined as single or multiple band. A single band was found in six patients and multiple bands in nine. No significant difference was found between SSCP pattern in pretreatment samples and response to the therapy. In none of the patients were observed changes in number of SSCP bands between samples taken at baseline and in the fourth week of the therapy. In conclusion, the complexity of HCV quasispecies before the therapy was not related to treatment response; combined therapy did not affect serum HCV quasispecies.     

A Patient's Race/Ethnicity Does Not Explain the Underuse of Appropriate Adjuvant Therapy in Colorectal Cancer

Introduction To improve colorectal cancer outcomes, appropriate adjuvant therapy (chemotherapy, radiation therapy) should be given. Numerous studies have demonstrated underuse of adjuvant therapy in colorectal cancer. The current study examines variables associated with underuse of adjuvant therapy. Methods Three population-based databases were linked: California Cancer Registry, California Patient Discharge Database, 2000 Census. All colorectal cancer patients diagnosed from 1994 to 2001 were studied. Patient characteristics (age, gender, race/ethnicity, comorbidities, payer, diagnosis year, socioeconomic status) were used in five multivariate regression analyses to predict receipt of chemotherapy for Stage III colon cancer, and receipt of chemotherapy and radiation therapy for Stages II, III rectal cancer. Results The overall cohort was 18,649 Stage III colon cancer and Stages II, III rectal cancer patients. Mean age was 68.9 years, 50 percent male, 74 percent non-Hispanic white, 6 percent black, 11 percent Hispanic, 9 percent Asian, and 65 percent had no significant comorbid disease. Receipt of chemotherapy was 48 percent for Stage III colon cancer, 48 percent for Stage II rectal cancer, and 66 percent for Stage III rectal cancer. Receipt of radiation therapy was 52 percent for Stage II rectal cancer and 66 percent for Stage III rectal cancer. In all five models, low socioeconomic status predicted underuse of chemotherapy or radiation therapy (P < 0.016). Race/ethnicity was not statistically associated with underuse in any of the models. Conclusions Most literature identifies race/ethnicity as the reason for disparate receipt of adjuvant therapy in colorectal cancer. Using a more robust database of three population-based sources, our analysis demonstrates that socioeconomic status is a more important predictor of (in)appropriate care than race/ethnicity. Explicit measures to improve care to the poor with colorectal cancer are needed. Supported by Limited Project Grant from The American Society of Colon and Rectal Surgeons; Asian American Network for Cancer Awareness, Research, and Training Grant from the National Cancer Institute (#5U01CA086322-06); and the Robert Wood Johnson Clinical Scholars Program at UCLA. Read at the meeting of The American Society of Colon and Rectal Surgeons, Philadelphia, Pennsylvania, April 30 to May 5, 2005; Recipient of the Piedmont Society of Colon and Rectal Surgeons Awards for Clinical Podium Presentation. Reprints are not available.     

Opioid treatment and hypoalbuminemia are associated with increased hospitalisation rates in chronic pancreatitis outpatients

Background/objectivesChronic pancreatitis (CP) is a complex and debilitating disease with high resource utilisation. Prospective data on hospital admission rates and associated risk factors are scarce. We investigated hospitalisation rates, causes of hospitalisations and associated risk factors in CP outpatients.MethodsThis was a prospective cohort study comprising 170 patients with CP. The primary outcome was time to first pancreatitis related hospitalisation and secondary outcomes were the annual hospitalisation frequency (hospitalisation burden) and causes of hospitalisations. A number of clinical and demographic parameters, including pain pattern and severity, opioid use and parameters related to the nutritional state, were analysed for their association with hospitalisation rates.ResultsOf the 170 patients, 57 (33.5%) were hospitalised during the follow-up period (median 11.4 months [IQR 3.8–26.4]). The cumulative hospitalisation incidence was 7.6% (95% CI; 4.5–12.2) after 30 days and 28.8% (95% CI; 22.2–35.7) after 1 year. Eighteen of the hospitalised patients (32%) had three or more admissions per year. High dose opioid treatment (>100 mg per day) (Hazard Ratio 3.1 [95% CI; 1.1–8.5]; P = 0.03) and hypoalbuminemia (<36 g/l) (Hazard Ratio 3.8 [95% CI; 2.0–7.8]; P < 0.001) were identified as independent risk factors for hospitalisation. The most frequent causes of hospitalisations were pain exacerbation (40%) and common bile duct stenosis (28%).ConclusionsOne-third of CP outpatients account for the majority of hospital admissions and associated risk factors are high dose opioid treatment and hypoalbuminemia. This information should be implemented in outpatient monitoring strategies to identify risk patients and improve treatment.     

Concomitant Irritable Bowel Syndrome Does Not Influence the Response to Antimicrobial Therapy in Patients with Functional Dyspepsia

Digestive Diseases and Sciences - Antimicrobial therapy improves symptoms in patients with irritable bowel syndrome (IBS), but the efficacy in functional dyspepsia (FD) is largely unknown. While FD...     

行为干预在社区老年高血压患者服药依从性中的应用研究

目的探讨行为干预在社区老年高血压患者服药依从性中的作用。方法随机选择2010年1-10月住院高血压患者172例,随机分为两组,行为干预组93例,对照组79例。对照组仅采用常规治疗和护理;行为干预组在常规治疗和护理基础上给予干预。6个月后对所有患者进行问卷调查。结果行为干预组高血压患者药物治疗依从性佳百分率为77.4%,对照组服药依从性佳百分率为54.4%,两者之间差异有统计学意义（2χ=12.9,P〈0.01）;行为干预组患者血压正常控制率为72.0%,而对照组血压正常控制率为44.3%,两者之间差异有统计学意义（χ2=15.9,P〈0.01）。结论行为干预可以明显提高老年患者服药依从性率,从而提高血压正常控制率。