RECENT DEVELOPMENTS IN DISULFIRAM TREATMENT

This paper reviews the controlled studies which have led tothe increasing recognition that supervised disulfiram is oneof the few demonstrably effective interventions in alcoholism,both alone and as an adjunct to psychoscial methods. The specificallybehavioural implications of disulfiram treatment are also noted.It examines techniques for maximising disulfiram's therapeuticeffectiveness and reviews recent research into its pharmacokineties,mode of action, toxicology and bioavailability. Finally, theprospects for an effective depot preparation are discussed.     

DISTRIBUTION OF ACETALDEHYDE IN HUMAN BLOOD: EFFECTS OF ETHANOL AND TREATMENT WITH DISULFIRAM

The distribution of free and bound acetaldehyde in human bloodwas studied. Fresh whole blood was precipitated with a perchloricacid (PCA) in saline solution and an aliquot of the crude samplewas taken for determination of ‘total’ acetaldehyde.The remaining sample was centrifuged and the clear supernatanttaken for analysis of ‘soluble’ acetaldehyde. ‘Bound’acetaldehyde was calculated by subtracting soluble from totalamounts. In samples collected from healthy control subjects,the acetaldehyde level in separated plasma was usually belowthe limit of detection of the method (0.2 µM), while muchhigher concentrations (> 2.5 µM) were detected whenanalyses were carried out on whole blood. In whole blood, about70% was recovered as bound (i.e. PCA-insoluble) acetaldehyde.The soluble (i.e. free + PCA-soluble) level was higher thanthat found in separated plasma, suggesting that some acetaldehydewas liberated from the blood cells by PCA treatment. In bloodspiked with ethanol, a spontaneous formation of acetaldehydeoccurred during the analytical procedure. The artefactual formationincreased only the soluble amount, while the bound level remainedunchanged. Likewise, in samples drawn from intoxicated subjects,artefactual formation of acetaldehyde was observed in the solublefraction, while the bound amount was not significantly increased.No significant differences in acetaldehyde levels were foundbetween males and females, nor between healthy control subjectsand alcoholic patients undergoing treatment with the aldehydedehydrogenase inhibitor disulfiram (Antabuse() However, someof the Antabuse patients possessed elevated levels of boundacetaldehyde.     

支气管哮喘患者吸入激素治疗依从性分析

[目的]了解支气管哮喘患者吸入糖皮质激素的依从性及其影响因素。[方法]对23例哮喘患者进行门诊问卷调查。[结果]23例中仅有4例基本遵从医嘱。其余19例均有不同程度的不遵从医嘱现象。平均依从率17.39%。影响因素包括恐惧激素、用药方法不当及用药副作用、经济困难、过早停药或间断用药等。大多数患者均对哮喘相关知识缺乏认识。[结论]应对哮喘患者进行长期系统的教育和管理、丰富患者的哮喘知识及加强对患者对激素应用的认识,是提高哮喘患者对激素吸入依从性的关键。     

MONOAMINE METABOLITES IN LUMBAR CEREBROSPINAL FLUID AND URINE IN ALCOHOLIC PATIENTS BEFORE AND AFTER TREATMENT WITH DISULFIRAM

Fifteen male alcoholic inpatients were treated with 400 mg disulfiramper day for one week. The levels of HVA, MOPEG and 5-HIAA (majormetabolites of dopamine, noradrenaline and serotonin respectively)in the lumbar cerebrospinal fluid and urine were determinedbefore and after the treatment period. No significant differenceswere found between the levels of the metabolites in the CSFon the first and second sampling occasions. There was a highcorrelation between individual MOPEG levels on the two samplingoccasions but not for HVA and 5-HIAA. The levels of HVA, MOPEGand 5-HIAA in the urine increased among the drug-free patients,while those receiving small amounts of oxazepam for insomniashowed no changes in those levels. At the most there is a minor interaction between monamines,disulliram and benzodiazepine metabolism. The absence of appreciableeffects re-emphasises the importance of blocking of aldehydedehydrogenase by disulfiram as the main mechanism by which thedrug acts under conditions of clinical use.     

155例中学生正畸治疗依从性分析

目的研究中学生牙齿畸形患者的心理意识与正畸治疗依从性的关系。方法随机选取来我院口腔科门诊进行正畸治疗的155名13～19岁的中学生牙齿畸形患者,采用问卷调查,结合临床追踪调查的方法进行研究。结果中学生牙齿畸形患者治疗依从性与患者的自我意识水平、艾森克人格内外向等因子存在明显的相关关系。结论自我意识水平较高、偏外向和中间型人格的中学生牙齿畸形患者治疗依从性较好。     

糖尿病病人药物治疗依从性影响因素调查

[目的]了解泸州地区糖尿病病人药物治疗依从性现状及影响因素,为糖尿病的社区综合防治提供依据。[方法]采用问卷方式对医院门诊诊断的260例糖尿病病人进行描述性调查。[结果]糖尿病病人药物依从性为19.62%,糖尿病健康教育能提高药物治疗的依从性,地区、性别、年龄差异影响了糖尿病病人药物治疗的依从性,药物副作用、经济状况也是影响药物治疗依从性的不可忽视是因素。[结论]该地区糖尿病病人药物治疗依从性很低,多种因素影响了糖尿病药物治疗的依从性,这应当在糖尿病的社区综合防治工作中引起重视。     

护理干预在老年病人服药治疗依从性中的作用

目的探讨护理干预在老年病人药物治疗依从性中的临床作用,提高老年病人对药物治疗的依从性。方法通过实施QC小组[1]活动进行护理干预,比较活动前后老年病人对药物治疗依从性、对护士工作的满意度。结果病人药物治疗依从性由75%提高至97%(p<0.001),满意度由84%上升至97%(p<0.05),对发药方式满意度由50%上升至97%(p<0.001)。结论积极的护理干预可提高老年病人服药依从性,对治疗起促进作用,可提高病人对护理工作的满意度。     

眼科手术围手术期患者治疗依从性及抑郁焦虑影响因素分析

[目的]探讨眼科患者围手术期影响治疗依从性与抑郁焦虑的因素,为临床眼科的治疗护理方法选择提供参考意见。[方法]选取2011年1月~2011年3月某院收治的80例眼科手术患者,作为研究对象。对每个患者的性别、年龄、文化程度、经济状况、并发症情况等进行分组统计,所有患者均采用眼科手术常规护理方法结合健康教育、心理护理进行围手术期的护理,统计所有患者手术前后的抑郁、焦虑评分,统计所有患者治疗过程中的依从性,分析影响患者围手术期抑郁、焦虑情绪及治疗过程中依从性的患者因素及护理因素。[结果]经研究显示,患者术前的焦虑、抑郁程度和治疗过程中的完全依从性密切相关,焦虑、抑郁程度越高,治疗过程中的完全依从性越低;影响抑郁、焦虑情绪的患者自身因素中,抑郁、焦虑程度比较,男性明显高于女性,高中以上文化程度患者明显低于高中以下文化程度患者,医疗费用占年收入20%以下者明显低于医疗费用占年收入50%以上者;影响抑郁、焦虑情绪的治疗护理因素中,对疾病的认知水平即健康教育效果、治疗方案对患者焦虑、抑郁评分影响最大。[结论]患者因素、治疗护理因素对患者的抑郁、焦虑情绪及治疗依从性有较大的影响,在眼科手术的实践中,应针对这些因素,合理选择手术方案及护理方法,降低患者的负面情绪,增强其遵医性,可以是治疗效果得到有效提升。     

综合方法治疗儿童弱视的疗效观察及年龄依从性对治疗效果的影响

目的通过比较不同因素下患儿疗效及依从性的结果,探究综合方法治疗儿童弱视的疗效,观察年龄依从性对治疗效果的影响。方法选取110例弱视儿童患者,均行眼部常规检查以排除器质性病变,复方托品酰胺滴眼液散瞳验光后,并给予他们综合法治疗,观察不同年龄和不同家长因素下患儿的治疗效果,探究患儿的治疗效果与患儿治疗依从性的关系。结果 3⁶岁年龄段的儿童依从性好,其次是76岁年龄段的儿童依从性好,其次是7⁹岁年龄段的儿童依从性好,109岁年龄段的儿童依从性好,10¹2岁年龄段的儿童依从性很差,差异有显著性意义。家长监督的天数越多,患儿的治疗依从性越好,患儿的依从性越好,其疗效也越好,可见依从性与疗效是正相关的关系,差异有显著性意义。结论综合方法治疗儿童弱视效果良好,其疗效与患儿接受治疗的依从性有很大关系,临床上要尽早治疗儿童弱视,尽可能提高患儿接受治疗的依从性。     

DIMENSIONS OF PARENTAL INVOLVEMENT IN PRESCHOOL PROGRAMMES

Summary This report describes an approach towards the clarification of the role of parent involvement in the decision-making process and assessment of preschool programmes. A model-placing involvement on a continuum is developed using as its endpoints high and low levels of parent involvement. The implications of this distinction in the decision-making process are examined from the viewpoint of practical consequences for all those concerned with maximizing the effects of various pre-school programmes. Finally, an example of a case of programme evaluation which actively sought high levels of parent involvement in the development of a behaviour rating scale is presented and an extension of the model to other aspects of a child's life is suggested.     

结核病个案社会支持及自我效能对遵从服药治疗之影响

目的：了解社会支持及自我效能对结核病个案遵从服药治疗的影响。方法：采用横断性研究问卷调查方法,共抽取80位结核病个案进行调查。并将回收后之资料,通过统计软件包SPSS11．0进行资料分析。结果：从支持对象来源中以来自“家人”支持最多,“亲朋好友”次之,“医疗人员”最低。从功能性社会支持程度,以“情感性”社会支持最高,“实质性”社会支持最低。自我效能部分,个案以在“无论有任何困难,您都会依预约时间回医院复查”把握度最高,“当药物有副作用引起轻微不适时,你仍会按照服药”之把握度最低。结核病个案之遵从服药治疗,本文结果发现遵从服药治疗者80％,社会支持与遵从服药治疗影响差异无统计学意义,自我效能差异有统计学意义。社会支持对与自我效能之相关性探讨,研究结果显示：两者间成正相关,此外家人之支持程度与自我效能也成正相关。结论：医护人员由专业技能提升结核患者的社会支持：加强结核病的认识教育倡导,及与个案治疗有关之其他慢性病认识及其自我照护技巧：由关怀、支持、鼓励以提升个案自我效能。     

健康教育对门诊老年高血压患者治疗依从性的影响

[目的]探讨门诊老年高血压患者治疗依从性及健康教育对其的影响。[方法]通过自行设计的问卷调查对97例门诊老年高血压患者的治疗依从性进行统计分析,并随机将其分为干预组和对照组,干预组给予3个月的有针对性的全程健康教育。干预3个月后对两组患者治疗依从性、收缩压和舒张压下降水平进行了对比分析。[结果]97例老年高血压患者治疗依从性差的发生率为47.4%(46/97);文化程度、经济状况及对高血压知识了解程度与治疗依从性呈显著正相关,均P﹤0.05。经护理干预3个月后,干预组治疗依从性明显优于对照组,P﹤0.05;收缩压和舒张压下降幅度亦较对照组更明显,均P﹤0.01。[结论]老年高血压患者治疗依从性差,健康教育能明显改善其治疗依从性及血压控制。     

茂名地区妇幼卫生指标监测分析

目的在“两纲”实施中期,探讨茂名地区妇幼卫生指标完成情况和影响因素。方法对照茂名市“两规划”目标,对茂名地区2001~2004年妇幼卫生指标监测分析。结果妇幼卫生指标16项,已达标有7项,占43.75%,其中出生缺陷发生率有升高趋势,孕产妇死亡率有反弹现象,婚前医学检查率大幅下降。结论加大“母婴保健法”执法力度和宣传,加强社区妇幼卫生宣教,让社会关爱母婴,设立贫困危重母婴救助基金,加大妇幼卫生投入,提高妇幼保健人员综合素质,是促进“二纲”妇幼卫生指标预期完成的关键。