论女性在预防吸毒和控制艾滋病的蔓延中的作用

近年来女性吸毒与感染艾滋病病毒(HIV)的人数不断地增加,影响和危害日益严重.据世界卫生组织的统计,截止2002年底,全世界已有4200万人感染HIV或罹患艾滋病,其中43%为妇女,在世界许多地区,艾滋病已成为年轻妇女和儿童的主要死亡原因之一.我国艾滋病发病率呈几何级数急剧上升,到2003年HIV感染者达到84万人[1],注射吸毒感染是主要的传播途径,约占63%左右[2],经采血途径和性传播途径次之.在吸毒者中女性所占的比例约为20%左右,比十年前增长了近一倍[3].女性吸毒者比例的增高预示着毒品蔓延速度的加快,这是一个值得警惕的信号.女性吸毒还引起了许多社会及公共卫生问题,尤其以卖淫、传播性病及艾滋病等问题最为严重[4].     

Pharmacists and HIV/AIDS prevention: Review of the literature

ObjectivesTo provide a summary of the available literature on pharmacists' participation in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) prevention efforts, excluding needle exchange programs or highly active antiretroviral therapy (HAART) education, and to offer strategies based on the literature to expand pharmacists' roles in HIV/AIDS prevention efforts.Data sourcesData were collected from published reports indexed from database inception through December 2008 and identified through the Centers for Disease Control and Prevention's Prevention Research Synthesis database, Ovid, PubMed, Embase, and Cochrane Library. Search terms used were pharmacist or pharmacy and HIV and/or prevention or counseling or testing or screening.Study selectionOnly English language reports were included; studies that focused on needle/syringe exchange programs and HAART therapy education and adherence counseling were excluded.Data synthesis13 reports were identified. The majority of articles were from international sources, and all focused on pharmacists and pharmacies as HIV/AIDS information resources.ConclusionFindings from the available literature showed that most pharmacists served in treatment and prevention information resource roles but were interested in expanding their roles into other prevention efforts, including HIV testing with additional training. Pharmacists described in the reports expressed a need for specific training regarding HIV/AIDS knowledge and transmission.     

监管条件下HIV/AIDS的防制与管理

本文通过对某劳教所143名艾滋病病毒(HⅣ)感染者的高危生活行为方式的调查,分析并探讨在监管条件下HⅣ/AIDS的预防与控制策略.     

Medication management during pregnancy: role of the pharmacist

A community pharmacist is frequently the first healthcare professional who is asked to give advice regarding medication use during pregnancy. As 50% of pregnancies are unplanned, a woman often discovers she is pregnant while already taking a medication and visits a pharmacy which is easily accessible, to enquire if she has harmed her baby by this action. Following a review of the literature, of which there is a paucity on this topic, we found that pharmacists often do not feel equipped to dispense teratology information and frequently refer the woman to her attending physician, without giving any information. In addition, it was clear that even when they did give information, it was not necessarily evidence-based and at times, inaccurate and based on their own opinions. In this article, we have attempted to make pharmacists aware of all the sources that are available, to enable them to perform this important role as a member of the health care team. These include websites, texts, evidence-based literature, teratogen information services and more. With the knowledge extracted from various resources, following critical appraisal of the data, they should be more comfortable and feel better equipped to transfer this information to a pregnant woman. In conclusion, while there may be a lack of adequate information regarding use of certain medications during pregnancy, pharmacists should be able to integrate available information with their medication expertise, to make appropriate individual risk/benefit decisions. This requires active engagement with pregnant women, rather than automatically referring them to their physician, thus establishing the pharmacist role as an essential member of the health care team.     

艾滋病患者常见机会性真菌感染的防治

艾滋病患者由于存在免疫缺陷而成为侵袭性真菌感染的高危人群,尽管高效抗反转录病毒联合治疗(HAART)在临床广泛使用,但机会性真菌感染仍是我国艾滋病患者常见的机会性感染和死亡原因,我国艾滋病患者常见的机会性真菌感染包括:口腔及食道念珠菌病、肺孢菌肺炎、隐球菌脑膜炎、曲霉病以及马尔尼菲青霉病等.机会性真菌感染的发生与艾滋病患者的细胞免疫状态有关,通过HAART提高患者CD4+T淋巴细胞计数以及针对高危人群采取预防性使用抗真菌药物是降低艾滋病患者机会性真菌感染的主要措施,但预防性用药有增加真菌耐药性产生的可能.对于艾滋病患者机会性真菌感染,在尽早使用敏感抗真菌药物的同时,适时给予抗HIV治疗有助于病情的恢复.对于临床治愈的患者,应根据患者细胞免疫状态,决定是否给予维持治疗以防止病情复发.新型高效广谱抗真菌药物不断出现,为艾滋病患者机会性真菌感染的防治提供了新的选择,但这些药物在艾滋病患者中的疗效和安全性有待进一步观察和研究.     

Expanding research on the role of alcohol consumption and related risks in the prevention and treatment of HIV/AIDS

This article is a review of some of the major epidemiological, behavioral, biological, and integrative prevention research issues and priorities in the area of HIV/AIDS and alcohol consumption. Drinking alcohol increases both the risk for infection with HIV and related illnesses and the morbidity and mortality of patients who progress to AIDS. New and improved measurement procedures have helped in assessment of the complex patterns of alcohol use, identification of intervening explanatory mechanisms for risk behaviors and contexts, and determination of intervention outcomes. Both the direct and indirect effects of alcohol misuse appear to be major contributors to both the risk for infection with HIV and the transmission of HIV/AIDS at the individual and population levels. There is increasing evidence that perhaps no level of alcohol consumption is "safe" for those who are HIV infected and receiving antiretroviral treatment. Interdisciplinary basic behavioral and biomedical research is needed to develop comprehensive culturally appropriate strategies for programs that can be effectively delivered in community contexts in the United States and abroad and that focus on the integration of our understanding of individual behaviors, high-risk group membership, biological mechanisms, and the social and physical environments that place individuals at risk for HIV infection. High-priority topics include improving adherence to antiretroviral medications, prevention of infection in young minority women in the United States, and treatment of HIV+ pregnant women who are alcohol abusers to prevent adverse fetal outcomes, which is an international focus in under-resourced settings in Africa.     

Patients' preferences for an increased pharmacist role in the management of drug therapy

Objectives This study investigated patients' preferences for an innovative combined prescribing‐and‐dispensing role for pharmacists in the management of drug therapies, compared to the more traditional dispensing‐only role. Methods The project was a cross‐sectional study. A structured self‐completed Discrete Choice Experiment questionnaire was administered to a sample of patients aged over 18 years waiting to see their doctor at the surgery. Respondents compared the proposed combined innovative service with both their ‘current’ service and a ‘dispensing‐only pharmacist’ service. Analyses were initially conducted for all respondents and then repeated excluding those with constant preferences (i.e. those who always chose the same option). The setting was two general practices in Aberdeen, Scotland. Key findings We approached 244 people and 204 returned an evaluable questionnaire. Everything else being equal, respondents preferred their ‘current’ service to either the proposed combined prescribing‐and‐dispensing role or a dispensing‐only service. However, those without constant preferences, who were mostly younger, preferred the combined service, where a pharmacist both prescribed and dispensed. Conclusions Patients value input from their pharmacists, but are resistant to change and prefer their current situation. However, younger people are more willing to trade between alternatives, and preferred the innovative combined prescribing‐and‐dispensing service. Changes in the pharmaceutical service could be supported by the public. The Discrete Choice Experiment approach is considered a useful tool for evaluating preferences for alternative pharmacy services.     

昭通市艾滋病流行现状与防治策略

目的了解昭通市艾滋病流行特征,为制定有效的防治策略提供依据。方法回顾性分析昭通市1996～2010年艾滋病疫情、监测和流行病学资料。结果截至2010年12月底,昭通市累计报告HIV/AIDS共计1619例,其中AIDS患者309例,死亡报告186例;传播途径的构成中性传播占39.87%,注射吸毒39.57%,母婴传播1.09%,义务献血人群0.42%,不详19.06%;外出流动人口感染者占总数的44.09%。结论传播途径以性传播为首,艾滋病流行由高危人群向普通人群扩散,感染者以外出人群为主,提高外出流动人口对艾滋病的防护意识,切实加强外出流动人口高危行为干预措施是当前昭通市防治艾滋病主要策略。     

African-American injection drug users: tensions and barriers in HIV/AIDS prevention.

This exploratory study utilized a focus group methodology to explore tensions and barriers in HIV/AIDS prevention among African-American injection drug users. Participants discussed HIV infection risks, national/community HIV prevention effectiveness, prevention barriers, ideas on barrier removal, and the tensions which exist between users and the larger African-American community. Recognizing the inevitability of continued drug use for many injectors, participants requested basic harm-reduction supplies including condoms, needle exchange programs, additional drug user treatment services, and the use of culturally- and gender-matched peer-led prevention and treatment outreach. Preliminary recommendations are made for consideration in HIV/AIDS prevention among African-American IDUs.     

我国HIV/AIDS流行现状与防治对策

我国自1985年首次发现HIV感染者后,HIV/AIDS病例数逐年增长,传播途径由单一逐渐趋向多样化,通过性传播和母婴传播的HIV/AIDS病例日益增多,我国正面临着HIV/AIDS大流行的危险,当前是防御HIV/AIDS流行的关键时期. 1我国HIV/AIDS流行现况 据卫生部疾病控制司报告,1985年-2002年上半年全国累计报告HIV感染者26 058例,估计累计HIV感染者已增至近100万人,其中艾滋病患者1111例,死亡584例[1];HIV疫情涉及我国31个省、自治区、直辖市,但各地的流行严重程度不一,累计报告例数最多的是云南,其次是新疆、广西、河南、四川、广东和贵州[2];HIV的感染与发病年龄以20-39a的青壮年为主,尤以20-29a为最,分别占感染与发病人数的47.9%和36.4%[3];HIV/AIDS的传播以经血传播为主,其中注射毒品滥用者(IDU)感染人数占68.0%,经采供血途径占9.7%,输血和注射血液制品者占1.5%,经性途径占7.2%[4];已发现经母婴传播的病例.     

Contemporary management of transient ischemic attack: role of the pharmacist

Transient ischemic attacks (TIAs) have been redefined recently. The new tissue-based definition of TIA abandons the 24-hour restriction on symptom duration previously used to differentiate TIA from acute ischemic stroke and requires neuroimaging studies to identify the cause of the ischemia and to determine the presence and extent of brain injury. This new definition brings to light the need for urgent diagnostic testing and timely initiation of treatment, as well as secondary prevention measures to reduce the increased risk of stroke, cardiovascular complications, and death in the days and weeks after a TIA. Pharmacists play a key role in identifying patients at risk for a first or recurrent TIA or stroke, educating high-risk patients on the signs and symptoms of TIA or stroke and the need for urgent evaluation and treatment, overcoming barriers to timely diagnosis and treatment, and ensuring that appropriate primary or secondary prevention strategies are in place. Furthermore, studies have shown that pharmacist-led interventions can lead to significant improvements in modifiable risk factors, such as blood pressure and cholesterol levels, as well as drug adherence, and may reduce the occurrence of strokes. These interventions may also help maintain patients' health-related quality of life and improve patients' satisfaction with care.     

非政府组织参与我国艾滋病防治工作的法律政策环境演变

艾滋病是全球性重大公共卫生问题和社会问题,非政府组织(NGO)在艾滋病防治工作中发挥着不可替代的作用.在众多影响艾滋病防治领域NGO发展的因素当中,法律政策环境是对其发展影响最大的因素.本文将介绍NGO参与我国艾滋病防治工作的法律政策环境演变过程,以及在这一过程中我国艾滋病防治领域NGO的发展状况.