Paracetamol-related deaths in Scotland, 1994-2000

AIMS: To investigate the death rate due to paracetamol poisoning in Scotland and what effect the reduction in over-the-counter paracetamol pack sizes in 1998 had on the death rate. METHODS: Records from 1994 to 2000 were examined to identify the number and annual incidence of paracetamol-related deaths. Numbers of deaths before and after the pack size reduction were compared. RESULTS: No significant differences were shown due to the pack size reduction. The Scottish paracetamol-related death rate was twice as high as in England and Wales. CONCLUSIONS: Further measures to reduce paracetamol-related morbidity and mortality in Scotland should be considered.     

Screening for illicit heroin use in patients in a heroin-assisted treatment program

The aim of this study was to investigate the use of illicit heroin among patients in a heroin-assisted treatment program. In this program, pharmaceutical-grade heroin was administered to heroin-addicted patients. Monitoring of illicit heroin use was considered important for the evaluation of this treatment program. Acetylcodeine and codeine, common adulterants of "street" heroin, were used as markers for illicit heroin. A liquid chromatography method with tandem mass spectrometric detection (LC-MS-MS) was developed, for quantitative analysis of heroin and methadone, their metabolites, and the simultaneous detection of acetylcodeine. One-hundred patients in a heroin-assisted treatment program were screened for acetylcodeine in plasma. Furthermore, patients were interviewed about illicit heroin use, and they were tested for alcohol and cocaine use. In plasma samples of 16% of the patients, acetylcodeine was detected. Overall agreement between self-report and plasma samples was 95% (kappa: 0.81). Patients who tested positive for acetylcodeine had visited the outpatients' clinics significantly less frequently than the patients who tested negative. Alcohol and cocaine use was more common in patients who tested positive for acetylcodeine. Illicit heroin use was observed in a limited percentage of patients. Overall agreement between self-report and markers of illicit heroin use was good.     

Public opinion towards supervised injection facilities and heroin-assisted treatment in Ontario, Canada

In recent years, controversial interventions such as 'heroin-assisted treatment' (HAT) and 'supervised injection facilities' (SIFs) have been established in attempts to minimise the high morbidity and mortality consequences of illicit drug use. This paper examines public opinion towards HAT and SIF using data from the 2003 Centre for Addiction and Mental Health (CAMH) Monitor, a representative population survey conducted among adults residing in Ontario, Canada. Data relating specifically to SIFs and HAT were isolated from the main database (n=885); agreement scores were collapsed to create a scale and analysed using independent sample t-tests and ANOVAs. Results revealed that 60 percent (n=530) of the sample agreed that SIFs should be made available to injection drug users, while 40 percent (n=355) disagreed. When asked about the provision of HAT, a similar pattern emerged. Variables significantly associated with positive opinions toward SIFs and HAT were: income; higher education; the use of cocaine or cannabis within the last 12 months; being in favour of cannabis decriminalisation; support of needle exchange in prison; view of illicit drug users as ill people; and agreement that drug users are in need of public support. Given the current political climate and the tentative position of SIFs and HAT in Canada, understanding the public's opinion is crucial for the feasibility and long-term sustainability of these interventions.     

Deaths of clients in methadone treatment in Texas: 1994-2002

This study analyzes causes of deaths of 766 patients who died while in methadone treatment in Texas between 1994 and 2002. Compared with deaths in the general population of Texas, deaths of clients in methadone treatment were 4.6 times more likely to be from a drug overdose, 3.4 times more likely to be from liver disease, 1.7 times more likely to be from a respiratory disease, 1.5 times more likely to be from a homicide and 1.4 times more likely to be from AIDS, but less likely to be from suicide, motor vehicle accidents, cardiovascular diseases or cancer. Of the clients, 20% died of liver disease, 18% of cardiovascular disease and 14% of drug overdose. An older cohort had been in treatment longer, had more take-homes, were on higher doses and tended to die of chronic diseases. A younger cohort tended to die from traumas, including drug overdose. Time in treatment was 43.3 months; mean daily dose was 77.3mg; number of days/month dosed in the clinic was 13.9. Given these rates, the scope of services should include on-site treatment for other medical conditions and staff should be educated about and counsel about the risk of death for new patients.     

Trends in malaria chemoprophylaxis prescription in South Africa 1994 to 2000

The World Health Organization estimates that more than 300 million cases of malaria exist worldwide each year, resulting in more than 3 million deaths, with more than 1 million deaths of children in sub-Saharan Africa alone. Malaria is also a reemerging disease in some parts of Africa, including South Africa. Malaria prevention is multi-faceted with no single precaution offering complete protection. Taking chemoprophylaxis decreases the severity and frequency of death from malaria due to Plasmodium falciparum when compared with taking no chemoprophylaxis.     

New trends in clinical and experimental immunosuppression--fourth international conference. 17-20 February 2000, Geneva, Switzerland

The meeting covered several aspects of currently used immunosuppressive drugs, but focused on tolerance induction strategies in the treatment of both allograft rejection and autoimmune diseases. Topics discussed included: clinical trials with anti-CD3 in recently-diagnosed insulin-dependent diabetes mellitus (IDDM) patients; Tr1 cells in bone-marrow transplantation; and, 1 alpha,25-dihydroxyvitamin D3-associated with mycophenolate mofetil and anti-CD25 in islet transplantation. In addition, malononitrilamides, an emerging class of novel immunosuppressants, were discussed in depth.     

Consideration of a North American heroin-assisted clinical trial for the treatment of opiate-dependent individuals

Untreated opiate addiction remains a major public health problem in North America (US and Canada). Increased morbidity and mortality as well as criminal behavior related to untreated opiate dependence constitute significant social and economic burdens. While the principal treatment modality to opiate addiction in North America has been methadone treatment since the 1960s, its reach and effectiveness has been limited; at any given time, only about 25% (US) and 15-20% (Canada) of all opiate addicts are in methadone treatment. Reasons for low levels of treatment participation among this subset of users include perceptions among users that treatment programs are punitive and that the medication is fraught with side effects. In the meantime, alternatives to methadone have been recently approved or are in development, including levo-alpha acetylmethadol and buprenorphine. However, the extent to which they will solve the current problem is still unknown, and therefore development of additional treatment strategies needs to continue. Recent studies of heroin-assisted treatment in Europe (Switzerland, the Netherlands and Great Britain) produced preliminary yet encouraging results in attracting and retaining long-term, treatment-resistant addicts in treatment, as well as improving treatment outcomes. However encouraging, the North American context differs from Europe. A study performed in North America would provide critical information on whether utilizing injectable opiates enhances the overall therapeutic attractiveness and effectiveness of substance abuse treatment to a subset of recalcitrant users. Implications of positive results would expand the continuum of effective interventions in the US and Canada, and increase the number of long-term, treatment-resistant opiate addicts in treatment.     

Spectrum and antibiotic resistance of uropathogens from hospitalized patients with urinary tract infections: 1994-2000

During the period 1994–2000 all uropathogens cultured from urine of hospitalized urological patients were identified and susceptibility was tested against 11 antibacterials. Duplicated isolates were eliminated. There was no general trend of increased of resistance apart from E. coli to ciprofloxacin (10.4% in 2000). Vancomycin-resistant staphylococci or enterococci was not significant. The lowest overall rates of resistance were found with piperacillin/tazobactam followed by ciprofloxacin and trimethoprim/sulphamethoxazole. Ciprofloxacin was the best oral antibiotic for the empirical treatment of urinary tract infection (UTI) due to Gram-negative rods and ampicillin/sulbactam for the treatment of UTI with Gram-positive cocci.     

Mortality attributable to harmful drinking in the United States, 2000

OBJECTIVE: Although alcohol has been associated with death from a variety of causes, there are no recent data on the number of deaths in the United States attributable to harmful alcohol use. This study provides updated information on the number of deaths in the United States attributable to harmful drinking. METHOD: We used the etiologic-fraction method to calculate alcohol-related mortality by cause of death, using U.S. mortality data for 2000, the most recent year available. Prevalence of alcohol use was estimated from the Behavioral Risk Factor Survey and from the National Household Survey on Drug Abuse. Medium and high levels of regular drinking or heavy episodic drinking were defined as harmful drinking. RESULTS: An estimated 63,718 deaths were attributable to harmful drinking in the U.S. in 2000. Of these, an estimated 45,988 were in men and 17,730 in women, accounting for 4% of all deaths among men and 1.5% among women. Among men, 47.6% were due to medium and high levels of regular drinking, and 52.4% due to heavy episodic drinking, whereas among women these proportions were 54.2% and 45.8%. CONCLUSIONS: Harmful drinking accounts for a substantial number of deaths each year in the United States. Prevention of this underlying cause of mortality must be a public health priority.     

Exchanging expertise and constructing boundaries: The development of a transnational knowledge network around heroin-assisted treatment

Over the last 20 years, supervised injectable and inhalable heroin prescribing has been developed, tested and in some cases introduced as a second line treatment for limited groups of entrenched heroin users in a number of European countries and Canada. Based on documentary analyses and eleven key informant interviews, this paper investigates the growth of ‘expertise’ and the sharing of knowledge between scientific stakeholders from different countries involved in researching and developing this area of treatment. Drawing on Stone's concept of the ‘knowledge network’ (Stone, 2013) and Gieryn's theory of ‘boundary-work’ (Gieryn, 1983), the analysis demonstrates the collective power of this group of scientists in producing a particular form of knowledge and expertise which has accrued and been exchanged over time. It also illustrates the ways in which this type of science has gained credibility and authority and become legitimised, reinforced and reproduced by those who employ it in both scientific and political debates. Boundaries were constructed by the knowledge network between different types of professions/disciplines, different forms of science and between the production of science and its consumption by non-scientists. The uniformity of the knowledge network in terms of their professional and disciplinary backgrounds, methodological expertise and ideological perspectives has meant that alternative forms of knowledge and perspectives have been neglected. This limits the nature and scope of the scientific evidence on which to base policy and practice decisions impacting on the work of policy makers and practitioners as well as the experiences of those in treatment who are most affected by this research and policy development.     

Methadone treatment in Spain, 1994.

The objective of this study was to describe the methadone treatment (MT) network in Spain, and to evaluate compliance with criteria known to influence the spread of human immunodeficiency virus (HIV). During the last 3 months of 1994, a mailed questionnaire was sent to the coordinators of all methadone treatment centers in Spain. A total of 224 centers completed the questionnaire (90% response rate). The total number of patients receiving MT in the studied centers was 13,402. Their mean age was 29 years, 79% were male, and approximately 60% were HIV positive. The rate of patients in MT varied by Region (mean: 6.7 patients in MT per 10,000 inhabitants). Although the global mean of reported daily dose of methadone was 60 mg, in 44% of the centers it was lower than that. Despite the high number of centers involved with MT in Spain, the coverage by regions is unequal. Studied centers revealed only a moderate adherence to procedures considered to be effective in HIV prevention. Given the magnitude of HIV infection in Spain, there is a clear need for improvement.     

1994—1999年上海市抗生素用量分析

目的 :了解上海市抗生素用量的变化趋势。方法 :选取 1994- 1999年上海市医院用药分析系统中的抗生素类药品数据资料 ,将每种抗生素的用量折算成 DDDS/人×年 ,以年为时间单位 ,以 1994年为基准年 ,分析抗生素用量的变化。结果 :上海市抗生素总量用呈逐年增长趋势。从用量构成比来看 ,以头孢菌素类为最大 ,其中以头孢拉定用量最多。从用量增长率来看 ,以青霉素复合制剂为最高 ,青霉素类次之 ,青霉素复合制剂中的羟氨苄青霉素克拉维酸盐增长率最高。结论 :上海市抗生素总用量呈上升趋势 ,应用最多的是中等价格的头孢菌素类药 ,增长最快的是高价青霉素复合制剂 ,这是造成抗生素药品费用上升的主要原因