The use of record linkage to examine illicit drug use in pregnancy

AIMS: To examine the obstetric and perinatal outcomes for women with a drug-related hospital admission during pregnancy. DESIGN: Antenatal and birth admissions to New South Wales (NSW) hospitals from the NSW Inpatient Statistics Collection were linked to birth information from the NSW Midwives Data Collection over a 5-year period (1998-2002). MEASUREMENTS: Birth admissions were flagged as positive for drug use where a birth admission or any pregnancy admission for that birth involved an opioid, cannabis or stimulant-related International Classification of Diseases version 10 Australian modification (ICD-10AM) code. FINDINGS: A total of 416 834 live births were analysed over a 5-year period (1998-2002). Of these, 1974 pregnancies had an opioid ICD-10AM diagnosis recorded, 552 a stimulant-related ICD-10AM and 2172 a cannabis ICD-10AM diagnosis. Births in each of the drug groups were to women who were younger, had a higher number of previous pregnancies, were indigenous, smoked heavily and were not privately insured. These women also presented later in their pregnancy to antenatal services and were more likely to arrive at hospital unbooked. Neonates born to women in each of the drug groups were more likely to be premature and were admitted to neonatal intensive care and special care nursery more often, with neonates born to women in the opioid group admitted most often. CONCLUSIONS: Linked population level administrative data is a powerful method for examining the maternal and neonatal outcomes associated with the use of specific illicit drugs during pregnancy.     

Substance use associated with unintended pregnancy outcomes in the National Longitudinal Survey of Youth

Abortion is known to be associated with higher rates of substance abuse, but no studies have compared substance use rates associated with abortion compared to delivery of an unintended pregnancy. This study examines data for women in the National Longitudinal Survey of Youth whose first pregnancy was unintended. Women with no pregnancies were also used as a control group. Use of alcohol, marijuana, cocaine, and behaviors suggestive of alcohol abuse were examined an average of four years after the target pregnancy among women with prior histories of delivering an unintended pregnancy (n = 535), abortion (n = 213), or those who reported no pregnancies (n = 1144). Controls were instituted for age, race, marital status, income, education, and prepregnancy self-esteem and locus of control. Compared to women who carried an unintended first pregnancy to term, those who aborted were significantly more likely to report use of marijuana (odds ratio: 2.0), with the difference in these two groups approaching significance relative to the use of cocaine (odds ratio: 2.49). Women with a history of abortion also reported more frequent drinking than those with a history of unintended birth. With the exception of less frequent drinking, the unintended birth group was not significantly different from the no pregnancy group. Resolution of an unintended pregnancy by abortion was associated with significantly higher rates of subsequent substance use compared to delivering an unintended pregnancy. A history of abortion may be a useful marker for identifying women in need of counseling for substance use.     

Comparing two different approaches to measuring drug use within the same survey

Respondents to the National Population Health Survey in Canada (1996 97) were asked two types of questions about drug use that allowed a comparison of the responses. The first question was about self-reported drug use categories: "In the past month, did you take [e.g., antidepressants]?" The second asked about specific drugs: "What specific medications did you take over the last two days?" Responses to the latter were coded according to the main chemical entity and then grouped in specific drug product categories similar to the first question's self- reported categories. The two sets of drug use categories were cross-tabulated for the 62,588 respondents who were 20 years of age and older. The proportion of persons who reported taking specific drugs who had not previously answered "yes" to the question related to the corresponding self-reported drug use category ranged from a low of 4.8% for insulin/oral hypoglycemics to a high of 43.7% for narcotic analgesics. Various reasons for these discrepancies are discussed. A series of logistic regression models relating the discrepancies to respondent characteristics shows that there is no clear pattern of variables associated with the discrepancies. These results show that surveys should be carefully planned to reflect the type of information needed.     

The epidemiology of drug use during pregnancy.

It is posited that drug-taking behaviors related to pregnancy are socially conditioned patterns and are subject to reeducation. Drug-taking behaviors of pregnant women are reviewed. It is uniformly found that multiple drug agents are consumed by the average pregnant woman during the gestation period. The unique vulnerability of the fetus and the teratogenic potential of numerous drugs are discussed. Recommendations are offered for the judicious use of drugs during pregnancy.     

Risk of unintended pregnancy among women with systemic lupus erythematosus

OBJECTIVE: It is recommended that women with systemic lupus erythematosus carefully time their pregnancies, but little is known about use of contraception and risk of unintended pregnancy in this population. The goal of this study was to estimate the proportion of women with lupus at risk for unintended pregnancy. METHODS: We surveyed 309 women with lupus, ages 18-50 years, seen at the University of Pittsburgh lupus center between January and May 2007. RESULTS: Of the women surveyed, 212 (69%) completed the survey. In the past 3 months, 97 (46% of 212) had faced some risk of unintended pregnancy. Of these, 53 (55% of 97) reported >or=1 occasion on which they had unprotected sex and 22 (23% of 97) reported that in the last 3 months they had unprotected sex "most of the time." No women reported having used emergency contraception after unprotected sex. A desire to "discuss birth control with a health care provider at the lupus center" was reported by 22 (10% of 212) respondents and 16 (17% of 94) women 相似文献   

The effect of matching comprehensive services to patients' needs on drug use improvement in addiction treatment

AIMS: To examine whether need-service matching in addiction treatment leads to improvements in drug use, and whether treatment duration mediates those improvements. DESIGN, PARTICIPANTS, MEASUREMENTS: This analysis utilizes prospective data from a US cohort of addiction treatment patients who reported service needs beyond core rehabilitative services (n = 3103). 'Drug use improvement' is the difference between the patient's peak drug use frequency (in days per month) in the year before intake and in the year after treatment. Overall and primary use of the major illicit drugs (heroin, powder or crack cocaine and marijuana) are considered separately. 'Need-service match' means that a patient rated a service as important at intake and reported its receipt during treatment. 'Percentage of needs matched' indicates the proportion of five service domains (medical, mental health, family, vocational and housing) so matched. FINDINGS: In mixed regression models controlling for multiple factors, a greater percentage of needs matched tended to improve primary (beta = 0.028, P = 0.09) and overall (beta = 0.049, P = 0.05) drug use in the follow-up year. Exclusion of treatment duration as a covariate doubled the magnitude of these coefficients. The benefits of matching were concentrated among the half of patients reporting needs in four to five rather than one to three domains, and were strongest among patients in long-term residential facilities. Addressing vocational and housing needs exerted the greatest effects. CONCLUSIONS: Matching comprehensive services to needs is a useful addiction treatment practice, especially for high-need patients. Treatment duration might partially mediate its effect.     

Comprehensive approaches to tobacco use control

This essay suggests approaches to two issues of importance to the future of tobacco use control research. First, there is need to identify those areas of tobacco use prevention and cessation research which have evolved to the point where additional investigation would only bring incremental gains. The reduction potential of this research should then be consolidated by applying existing, effective interventions widely and systematically. Conversely, there is need to identify those areas in which additional research is necessary. Second, the most logical way to reach agreement on those areas which are ready to move from research to applications-of-research is, with the co-operation and advice of the research community, through the large funding organizations which have supported this research over the past 2 decades. It is these organizations which, once the most effective interventions are identified, are capable of supporting the centrally-planned, consensus-driven, comprehensive approaches to tobacco use control which will be necessary to continued success in reducing tobacco-related morbidity and mortality in the industrialized world and to begin addressing the growing problems of tobacco use in the developing world.     

Current approaches to drug treatment of ventricular arrhythmias

Ventricular arrhythmias are common and cause serious problems, ranging from symptom aggravation to sudden cardiac death. New knowledge about arrhythmias and new antiarrhythmic drugs provide greater opportunities for treatment choice and evaluations. A prognostic classification of ventricular arrhythmias helps to focus management. For benign ventricular arrhythmias, the objective of drug treatment is alleviation. The best management approach to potentially malignant ventricular arrhythmias, however, is not yet known, and data from ongoing clinical studies continue to accrue, developing the knowledge base needed to devise better regimens. Symptomatic patients can be managed either by symptom alleviation, as in benign arrhythmia, or more aggressively, as in malignant ventricular arrhythmia. Treatment is not mandatory for asymptomatic patients with potentially malignant ventricular arrhythmias, because there is no evidence that reducing arrhythmia prolongs life or effectively prevents symptomatic disease. Also, antiarrhythmic drugs have the potential for causing adverse effects, even lethal ones. For malignant ventricular arrhythmia, the objective of treatment is prevention of symptomatic ventricular arrhythmia and sudden cardiac death. Effective new methods predictive of successful drug treatment in individual patients are available; these methods remove much of the empiricism from management of patients with malignant ventricular arrhythmia. Treatment deemed effective by rigorous noninvasive evaluation or by electrophysiologic studies has a high probability of success in the long term. Drug management of malignant ventricular arrhythmia should become more effective in the future as a result of newly developing approaches to drug evaluation.     

安全用药之我见--评药物患者和医师

中国医学论坛报于2005年3月24日至4月21日连续五期发表了题为“安全用药,临床实践的永恒主题——由COX-2特异性抑制剂引发的争论”的纪要和文章。尽管这些报道的起因源自新一代抗炎药罗非昔布和塞来昔布在防治结、直肠腺瘤样息肉的长疗程中引发的心脑血管事件,而它给人们的忠告则说明,在临床上使用任何药物都必须以安全为前题而不应给患者带来伤害。因此,安全用药应成为临床治疗的出发点和归宿。但是,如何做到安全用药?如何在安全用药的前题下最大限度地发挥药物的疗效及将药物的不良反应降到最低?或者简单地说,如何做到取药物之利防药物…     

Rheumatoid arthritis and pregnancy: evolution of disease activity and pathophysiological considerations for drug use

It has long been known that pregnancy and childbirth have a profound effect on the disease activity of rheumatic diseases. For clinicians, the management of patients with RA wishing to become pregnant involves the challenge of keeping disease activity under control and adequately adapting drug therapy during pregnancy and post-partum. This article aims to summarize the current evidence on the evolution of RA disease activity during and after pregnancy and the use of anti-rheumatic drugs around this period. Of recent interest is the potential use of anti-TNF compounds in the preconception period and during pregnancy. Accumulating experience with anti-TNF therapy in other immune-mediated inflammatory diseases, such as Crohn's disease, provides useful insights for the use of TNF blockade in pregnant women with RA, or RA patients wishing to become pregnant.     

Current approaches to drug therapy for the hypercholesterolemic patient

CAD is a complex disease with multiple etiologies and aggravating events. Yet, elevated plasma cholesterol levels, chiefly in the form of LDL, are essential for the progression of the atherosclerotic lesion. Any total plasma cholesterol level above an ideal of 180 mg/dl (and an LDL cholesterol level of 100 mg/dl) must be considered atherogenic in the presence of other risk factors. In patients at high risk for death from CAD, combined diet and drug therapy should have as a goal the attainment of ideal lipoprotein values. Drug therapies are now available that make it possible to substantially lower elevated LDL levels in almost all patients and even to achieve ideal levels in those at highest risk.     

Innovative approaches to comprehensive cardiovascular disease risk reduction in clinical and community-based settings

We have developed, tested, and successfully implemented an affordable, evidence-based, comprehensive cardiovascular disease risk-reduction program for use in primary and secondary prevention settings. The program is administered at hospitals, physician practices, cardiac rehabilitation programs, work sites, shopping malls, and health clubs. The program is also delivered from a call center using the telephone and the Internet. Program staff are guided by a computerized participant management and tracking system. Lifestyle management interventions are based on several behavior change models, primarily social learning theory, the stages of change model, and single concept learning theory. Typically, the program is administered entirely by non-physician healthcare professionals whose services are integrated with the care provided by the participants’ physicians. Outcome data have documented the clinical effectiveness of this innovative approach.     

如何安全应用抗心律失常药物

心律失常是引起各种心脏病病死的主要原因之一,尤其在心力衰竭、心肌缺血或心肌梗死时,心律失常的发生率、病死率更高.因此欲使心血管疾病总的病死率下降,必须降低心律失常的病死率.     

Youthful drug use and drug subcultures

Drug involvement is such an intensely social behavior that it lends itself to the notion of a subcultural existence. The social aspects of drug involvement generate a value system that is different from the dominant order. Using a longitudinal sample of college students, the findings indicate two distinctively different types of drug use, marijuana-only versus illicit drug involvement, that correspond to a subcultural or contracultural phenomenon. The elements of a subculture or contraculture are amenable to empirical measurement and can be differentiated from the dominant value system. Marijuana use reflects a type of subculture activity that maintains ties to the conventional order. Illicit drug use, on the other hand, is a contracultural activity, representing a pronounced break with the dominant culture.