What heroin users tell us about overdose

This study describes overdose experiences of heroin users, both the overdoses they themselves experienced, as well as those that they witnessed. A structured interview was performed with 101 current heroin users in Albuquerque, New Mexico from January 7, 2002 to February 26, 2002. Heroin-related overdoses were found to be common in this sample of heroin users. Three or more persons were reported to be present during 80 of the 95 most recently witnessed overdoses. An ambulance was called in only 42 of the 95 witnessed overdoses. Seventy-five percent of the respondents who witnessed an overdose stated concern over police involvement was an important reason for delay or absence of a 911 call for help. One hundred of the 101 respondents reported willingness, if trained, to use rescue breathing and to inject naloxone to aid an overdose victim. New methods need to be found to reduce heroin overdose death. Scientific studies are needed on the efficacy of take-home naloxone.     

What do epidemiologic findings tell us about health effects of environmental aerosols?

In the last 10 years there has been an abundance of new epidemiological studies on health effects of particulate air pollution. The overall evidence suggests that fine particulate pollution can be an important risk factor for cardiopulmonary disease. Long-term, repeated exposure to fine particulate air pollution may increase the risk of chronic respiratory disease and the risk of cardiopulmonary mortality. Short-term exposures exacerbate existing cardiovascular and pulmonary disease and increase the risk of becoming symptomatic, requiring medical attention, or even dying. This paper outlines the results of the basic epidemiologic studies and briefly reviews and discusses recent studies that have looked at specific physiologic health endpoints in addition to lung function. A few recent, mostly exploratory pilot studies, have observed particulate pollution associations with blood plasma viscosity, heart rate, heart rate variability, and indicators of bone marrow stimulation. A systemic response to particulate-related pulmonary inflammation remains somewhat speculative. The epidemiologic evidence, nevertheless, seems consistent with the hypothesis that particle-induced pulmonary inflammation, cytokine release, and altered cardiac autonomic function may be part of the pathophysiological mechanisms or pathways linking particulate pollution with cardiopulmonary disease.     

Putative endogenous ligands to the benzodiazepine receptor: What can they tell us?

The endogenous ligand for the benzodiazepine receptor has not been convincingly demonstrated, nor is it clear what role this drug receptor actually plays in brain function. A number of putative endogenous ligands for the benzodiazepine receptor have been identified and reported in the literature. These putative ligands, at various stages of purification, have been typically identified by their ability to displace ³H-diazepam in a radioreceptor binding assay. Taken together, these studies provide useful information on the role that the benzodiazepine receptor and its ligand might play in brain function. The purpose of this paper is to review this area of research and attempt to provide a unifying hypothesis. In summary, calling this bioactive site the benzodiazepine receptor may be a misnomer, as it appears to effect both anxiogenic and anxiolytic activities involved in the maintenance of homeostatic levels of vigilance. Moreover, it can be suggested that endogenous ligands of reciprocal action could exist, mediating each function (relaxation and vigilance) and, thereby, maintain a balance of neural activity.     

Drug treatment outcomes in the criminal justice system: What non-self-report measures of outcome can tell us

Coerced drug treatment has become a common route for drug users to enter drug treatment in the UK and has been shown to be effective in reducing drug use and offending. This article presents the non-self-report measures of offending and drug use for one such treatment. The results support the findings of other studies in that those with lower offending rates prior to starting treatment and lower drug use during treatment show reduced offending following treatment commencement. More serious drug-using offenders showed limited changes in their offending following drug treatment. Possible explanations for this are discussed.     

What Oregon's parity law can tell us about the federal Mental Health Parity and Addiction Equity Act and spending on substance abuse treatment services

Background

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires commercial group health plans offering coverage for mental health and substance abuse services to offer those services at a level that is no more restrictive than for medical-surgical services. The MHPAEA is notable in restricting the extent to which health plans can use managed care tools on the behavioral health benefit. The only precedent for this approach is Oregon's 2007 state parity law. This study aims to provide evidence on the effect of comprehensive parity on utilization and expenditures for substance abuse treatment services.

Methods

A difference-in-difference analysis compared individuals in five Oregon commercial plans (n = 103,820) from 2005 to 2008 to comparison groups exempt from parity in Oregon (n = 19,633) and Washington (n = 39,447). The primary outcome measures were annual use and total expenditures.

Results

Spending for alcohol treatment services demonstrated statistically significant increase in comparison to the Oregon and Washington comparison groups. Spending on other drug abuse treatment services was not associated with statistically significant spending increases, and the effect of parity on overall spending (alcohol plus other drug abuse treatment services) was positive but not statistically significant from zero.

Conclusions

Oregon's experience suggests that behavioral health insurance parity that places restrictions on how plans manage the benefit may lead to increases in expenditures for alcohol treatment services but is unlikely to lead to increases in spending for other drug abuse treatment services.     

What can the use of unmetabolizable lipophilic compounds tell about the importance of drug metabolism?

6-CB, a model compound which because of its lipophilicity cannot be excreted by the kidneys and is also unmetabolizable, shows an extreme type of pharmacokinetics. In rats given single doses the compound disappears with a half-life of half a life span by fecal excretion. If adipose tissue mass is allowed to increase, the 75% dose initially stored in adipose tissue does not decrease during 280 days. With repeated weekly administration each dose adds some 90% to the body burden. It is concluded that the old hypothesis of drug-metabolizing enzymes as a protective system preventing accumulation of naturally occurring lipophilic drugs is correct.     

Systematic review of national and international guidelines on attention-deficit hyperactivity disorder

During the last few years several clinical guidelines on attention-deficit hyperactivity disorder (ADHD) have been published by national and international medical societies. To systematically review and compare recommendations of selected ADHD guidelines, we performed a systematic search in online guideline databases and PubMed in order to retrieve guideline texts. Guidelines meeting inclusion criteria were reviewed and recommendations on assessment and treatment extracted. The AGREE instrument was used to assess methodological quality. Of the 26 guidelines identified, 13 were selected for further analysis: 11 guidelines deal with ADHD in childhood and adolescence and 5 guidelines cover transitional patients and/or ADHD in adults. The methodological quality of ADHD guidelines is moderate to good. They reflect similarities and differences of healthcare systems. Diagnosis throughout the lifespan is based on a detailed clinical history. There is greater agreement on evidence-based pharmacological treatment than on psychosocial interventions, reflecting the strength of evidence.     

急性重症胰腺炎患者的早期肠内营养现状

急性重症胰腺炎（Severe acute pancreatitis，SAP）是一种十分凶险的急症，占急性胰腺炎的20％-30％，其病死率在20％左右。由于胰腺释放多种消化酶和炎症介质．迅速介导金身系统性炎症反应综合征（Syste inflammatory reaction syndrome，SIRS）．可涉及邻近组织或远隔脏器．继发胰周及远隔部位的感染和脓毒血症，重者导致多脏器功能衰竭（Muhiorgans functional failure，MODF）。SAP患者始终处于高分解状态，绝大多数患者由于蛋白质、糖和脂肪的持续性、     

The possible harms of statins: What do product labels,patient package inserts,and pharmacy leaflets tell us?

Objectives

To evaluate the degree to which health care professionals and patients receive consistent messages regarding the possible harms of statins.

乌司他丁治疗94例急性胰腺炎临床分析

目的探讨微泵与非微泵静脉输注乌司他丁治疗重症老．性胰腺炎疗效的差异及乌司他丁的最佳用药剂量。方法将94例重症急性胰腺炎患者随机分为两组,实验组（46例）应用微泵静脉输注乌司他丁;对照组（48例）乌司他丁经静脉全身给药。比较两组临床症状体征、实验室数据及远期并发症的差异。结果①实验组腹痛、腹胀、压痛消失的时间均短于对照组（P〈005）,中转急诊手术率低于对照组。②实验组患者的第3天、第7天血淀粉酶、尿淀粉酶、血糖、白细胞亦均低于对照组（P〈0．05）。③并发症假性胰腺囊肿发生率两组无显著差异（P〉0．05）,与是否合用生长抑素密切相关（P〈0．05）。结论微泵静脉输注乌司他丁治疗重症急性胰腺炎疗效好、剂量小。远期并发症的防治建议联合应用生长抑素。     

肠外营养治疗重症急性胰腺炎探讨

1 慨述 重症急性胰腺炎(SAP)是临床常见危急重症,由胰酶激活而致消化胰腺本身引起的急性炎症.SAP属严重的消耗性疾病,患者由于必须禁食,导致营养摄人不足;患者常伴恶心、呕吐等导致营养物质丢失.     

A comparative review of pharmacoeconomic guidelines

We have reviewed 4 international sets of guidelines for the economic evaluation of pharmaceutical products-those of the Australian Pharmaceutical Benefits Advisory Committee, the Canadian Coordinating Office for Health Technology Assessment, the Ontario Ministry of Health, and the England and Wales Department of Health. Comparison of these guidelines reveals that there are a number of differences between them, including disparities in outcome selection, costs and perspectives. These observations were attributed to differences in study purpose, conceptual approach, measurement techniques and value judgements. Uniformity can be achieved only in conceptual approach and measurement technique. Guidelines should be flexible to accommodate differences in the study purposes and value judgements of the analysts.     

Protein kinase C isozyme selective peptides--a current view of what they tell us about location and function of isozymes in the heart

The identification of protein kinase C isozymes in distinct localities within the cell has led to the suggestion that each isozyme mediates a unique function. This has necessitated the development of methodologies that are capable of assigning specific function to an isozyme. For many years the location of individual isozymes in a particulate fraction was used to correlate specific isozymes with cellular function. More recently over-expression of selective isozymes and genetic knockouts have provided tissue-specific and developmentally regulated information on function. It is now known that specific proteins act as isozyme selective receptors for activated C kinase (RACKs) which determine subcellular localization of specific isozymes. As a result, peptides have been designed from the interaction site between the isozyme and its RACK that prevent the binding of isozymes to their respective RACKs. This has allowed the modulation of function of individual isozymes. This review will examine the development of the peptides as isozyme selective inhibitors or activators of PKC and its impact on understanding the role of isozymes in cellular function in the healthy and diseased heart. The possible development of isozyme-specific drugs for therapeutic use will be discussed.