Health-risk warning labels on smokeless tobacco products: are they effective?

This study investigated whether adolescents attend to the health-risk warnings placed on smokeless tobacco products and the impact the warnings have on intentions to use such products. The subjects (86 male and 106 female high school students) viewed illustrations of five consumer products, including a can of oral snuff and a pouch of chewing tobacco displaying one of the three required health warnings or no warning, and then indicated via questionnaire the likelihood that they would use each of the products. Fewer than half of the subjects (43.4%) exposed to the warnings recalled seeing them, and approximately a third of those who saw the warnings (32.2%) recalled the content of the message. Males were significantly better than females (p less than .02) at recalling the content. A series of 2 x 4 (Sex x Warning Label) ANOVAs revealed that the warning labels had no significant effect on subjects' ratings of whether they would use smokeless tobacco in the future. These results question the effectiveness of the warning labels for discouraging adolescent smokeless tobacco use.     

PVC输液制品的安全性研究进展

PVC输液制品在临床静脉输液中应用极为广泛,但在实际应用过程中存在安全问题。一方面,PVC输液制品对某些药物存在吸附作用,降低疗效;另一方面,PVC输液制品中的增塑剂邻苯二甲酸二-(2-乙基己基)酯(DEHP)有可能与某些药物发生化学反应或是从PVC输液制品迁移到药物溶液中,对患者的身体健康造成威胁。本文综述了近十年来能被PVC输液制品吸附的药物,与PVC输液制品发生化学反应的药物,能使PVC输液制品中的DEHP溶出的药物,以便于指导临床安全用药。     

Pharmacokinetic studies on parenteral infusion of tobramycin in newborn and premature infants

The fundamental trials on intravenous administration of tobramycin (TOB) were studied in a total number of 29 neonates and premature babies who was divided into 3 groups by their ages; 0--3, 4--7 and 8 or more days after birth. Moreover, the results obtained in them were compared with those in a small number of infants and the school children reported previously to investigate the possibility of administration of the drug to neonates and premature babies. Analysis of the pharmacokinetics of TOB in neonates and premature babies demonstrated that its half-life (T 1/2) became shorter with age; it was 5.37, 4.28 and 3.03 hours at the age of of 0-- 3, 4--8 or more days, respectively when 1.5 mg of the drug per kg body weight is instilled into the vein for 30 minutes. A similar trend was observed at a dose of 3.0 mg per kg body weight. Although the number of subject was small, T 1/2 averaged 2.07 hours at the dose of 1.5 mg/kg in 2 infants and 1.40 hours at 3.0 mg/kg in 3 infants. These results indicate that administration of TOB based on the same conception as that in infants and school children should be avoided in neonates and premature babies. Especially in 0--3, 4--7 day-old neonates and premature babies the behavior of the drug in the body suggests that once or twice administration a day may be safer and better to avoid its accumulation. The peak serum concentrations in neonates and premature babies were slightly higher with decrease in number of days after birth, but it was not specially high as compared with those in infants and school children. It is, therefore considered that 1.5 mg/kg is an adequate single dose to moderate cases. On the basis of the above-mentioned results of the pharmacokinetic study we are confirming the clinical safety and utility of TOB in cases in which its administration is essential.     

The impact of primary packaging on the quality of parenteral products

The unique approach in manufacturing of pharmaceutical dosage forms of active substances known to be unstable in aqueous solution is the introduction of lyophilization process. Nevertheless, these products must be reconstituted using the diluent from a separate container before application. The possible solution for this problem is the application of dual chamber vials comprising the freeze-dried product in a lower compartment of the vial and the solution for reconstitution in the upper chamber. The main issue in development of such product is the choice of contact packaging (rubber closures, glass vials and the container closure system as a whole). The most important parameter used for evaluation of the influence of contact material on product quality was the pH value. The results have shown that the type of vials (moulded or tubular glass) has no impact on pH shift of the solution for reconstitution (tested solution-TS), while significant differences in pH value of the TS were observed depending on the rubber closures formulation used (with some formulations, the pH shift during the test was 6.5-9.14). Benzyl alcohol assay during the tests remained unchanged. Integrity tests of the container closure system (CCS) have demonstrated the adequacy of the selected packaging system. The quality of the CCS of choice was confirmed in the course of stability studies, only parameters directly influenced by CCS being presented in this work: loss on drying and pH value. On the basis of these results, no changes in loss on drying were connected to CCS, and the pH value of the reconstituted solution remains unchanged in samples tested both ex-tempore and after in-use period of 48 h.     

Preliminary experience with parenteral mecillinam.

Case reports are reviewed of 26 patients, mainly with severe Gram-negative infections, treatment with parenteral mecillinam. Twenty-three patients received other antibiotics in addition to mecillinam. In 19 patients, potentially synergistic antimicrobial therapy was given. Overall, a beneficial clinical effect was recorded in 17 (68%) of the 25 patients assessed. A better response was observed in those patients who had not received other antibiotics before treatment with mecillinam was instituted. It is concluded that parenteral mecillinam may have an important role in the treatment of severe Gram-negative infections.     

Glass for parenteral products: a surface view using the scanning electron microscope.

The scanning electron microscope was utilized to explore the internal surface of glass ampuls and vials used in parenteral products. The surface topography of USP Type I borosilicate glass containers was viewed after exposure to "sulfur," ammonium bifluoride, and sulfuric acid treatments. The scanning electron micrographs showed startling differences in the appearance of the surface regions. "Sulfur treatment" of ampuls was associated with a pitting of the surface and the presence of sodium sulfate crystals. The sulfur treatment of vials altered the glass surface in a characteristically different manner. The dissimilarity between the surface appearances was attributed to the method of sulfur treatment. Ampuls exposed to sulfuric acid solutions at room temperature did not show the pitting associated with the sulfur treatment. Scanning electron micrographs of ammonium bifluoride-treated ampuls showed a relief effect, suggesting that the glass was affected by the bifluoride solution but that sufficient stripping of the surface layer did not occur to remove the pits associated with the sulfur treatment. Flakes emanating from the glass were identified with the aid of the electron microprobe. Scanning electron micrographs showed that these vitreous flakes resulted from a delamination of a thin layer of the glass surface. It is concluded that the scanning electron microscope, in conjunction with other analytical techniques, is a valuable tool in assessing the quality of glass used for parenteral products. The techniques studied should be of particular importance to the pharmaceutical industry where efforts are being made to reduce the levels of particulate matter in parenteral dosage forms.     

Association of hyperglycemia and markers of hepatic dysfunction with dextrose infusion rates in Korean patients receiving total parenteral nutrition.

The association of hyperglycemia and markers of hepatic dysfunction with dextrose infusion rates in Korean patients receiving total parenteral nutrition (TPN) was studied. A retrospective study of 122 patients with normal glucose levels and liver function tests (LFTs) was conducted. Pharmacy and medical records of all patients who received TPN from three university-affiliated teaching hospitals in Korea between January 1998 and December 1999 were reviewed. Each patient was categorized as receiving dextrose at (1) < or = 5 or > 5 mg/kg/min and (2) < or = 4, 4.1-5, 5.1-6, or > 6 mg/kg/min. Fifty-five patients received dextrose at a rate of > 5 mg/kg/min for 15.1 +/- 12.8 days and 67 patients at a rate of < or = 5 mg/kg/min for 10.1 +/- 6.8 days. Two patients in each group did not have follow-up glucose levels. Of the 53 patients in the > 5 mg/kg/min group, 16 exhibited hyperglycemia, compared with 21 of the 65 receiving lower rates of dextrose infusion. Elevated aspartate transaminase was the most common abnormal LFT value in both groups (25% and 29% in the < or = 5- and > 5-mg/kg/min groups, respectively). In the group receiving dextrose at > 5 mg/kg/min, 22.2% had two hepatic enzyme levels elevated concurrently, while 18.5% had two hepatic enzyme levels elevated in the group receiving dextrose at < or = 5 mg/kg/min. Regression analysis revealed that duration of TPN and dextrose infusion rate were positively correlated with blood glucose levels and that duration of TPN was positively correlated with abnormal LFT values. A retrospective study of Korean patients revealed no significant difference in the risk of hyperglycemia or hepatic dysfunction between those receiving < or = 5 and > 5 mg/kg/min dextrose infusion in their TPN.     

Observations on the use of ready-to-use and point-of-care activated parenteral products in automated dispensing cabinets in U.S. hospitals.

PURPOSE: The use of ready-to-use (RTU) and point-of-care (POC) activated parenteral products and their storage in automated dispensing cabinets (ADCs) in U.S. hospitals were evaluated. METHODS: A survey on the use of RTU and POC activated parenteral products, including storage and dispensing of the products, was developed and sent electronically to hospital pharmacy administrators. Survey respondents were identified using the American Society of Health-System Pharmacists' member database. RESULTS: Of the 4070 surveys sent, 965 (23.7%) were completed and returned. Most pharmacy administrators (94.7%) reported that their institution used some form of RTU and POC activated parenteral product, with 74% using ADCs to dispense these products. Efficiency was the most common reason cited for storage of RTU and POC activated products in ADCs. Facilities varied on reasons for not implementing this technology, with 47 facilities citing implementation costs, limited number of RTU and POC activated products on the hospital's formulary, lack of available pediatric formulations, and safety concerns as the main reasons. More than half of respondents noted space limitations as the greatest challenge to adding RTU and POC activated products to ADCs. CONCLUSION: Nearly three fourths of survey respondents reported using RTU and POC products in conjunction with ADCs; however, the approach to including these products in ADCs varied based on the characteristics, policies, and preferences of the individual facility. Advantages of RTU and POC products identified by respondents included enhanced safety benefits, increased dispensing efficiency, cost avoidance due to reduced waste, and improved compliance with federal and state regulations.     

Self-instructional program on pediatric parenteral nutrition.

A self-instructional package on pediatric parenteral nutrition was designed and its effectiveness in educating health-care practitioners was studied. Participants included eight medical students, 10 pediatricians, 10 pharmacists and 10 pharmacy students at a teaching hospital. Each participant reviewed the program and completed 25-point pre- and posttests. Participants consistently scored higher on the posttest than on the pretest. Further, participants felt that they better understood parenteral nutrition therapy and that they better understood how to write or check orders as a result of their participation in the program. It is suggested that a self-instructional package is an effective method of educating practitioners and students in total parenteral nutrition.     

First effects of warning labels on alcoholic beverage containers.

Health warning labels are now required on alcoholic beverage containers in the United States. This study addresses who has seen these labels and respondents' reported changes in relevant knowledge, attitudes and behavior. Random samples of adults in the general population of the United States were interviewed by telephone 6 months prior to and 6 months after the enactment in November 1989 of the warning label law (N = 2006 and 2000, respectively). Six months after introduction of warning labels, over one fifth of the respondents reported having seen the labels. Greater proportions of key target groups, such as heavy drinkers and young men at risk for drunk driving, reported seeing the warnings. No statistically significant changes in knowledge of the health risks included on the labels were detected, but we found that knowledge levels for two non-included potential warnings had declined somewhat. After controlling for demographics and alcohol consumption, respondents who probably saw the warning labels were significantly more likely to report several behaviors indicative of heightened awareness of, and caution regarding, the hazard of drinking and driving and of drinking during pregnancy, hazards that are both included on the warning labels.     

Interactions of parenteral solutions with sulphur-treated glass bottles.

Concern about limited surface durability has been the main reasons for recommendations by advisory committees and government health authorities, not to reu-use sulphur-treated soda-lime glass (type II) bottles for intravenous solutions. In order to contribute specific data, the interactions of slightly acid and neutral parenteral solutions with ammonium sulphate-treated type II glass bottles have been investigated. It was established that the amounts of silica, sodium and calcium released into the solution are not greater than the potential background contamination from the raw materials. The number of particles in the solution was well below the limits set by the British Pharmacopoieia and not much higher than the lowest background count practically achievable. On an average, bottle surfaces released less material after the first time of use. Bottle-to-bottle variations revealed by scanning electron microscopy point at problems in achieving smooth, evenly surface-treated bottle surfaces during bottle manufacture.     

Interaction of chlorpromazine with biological membranes. A photochemical study using spin labels.

Fatty acid spin labels have been included into erythrocyte ghosts and synaptic plasma membranes in order to study the interaction of phenothiazine derivatives (particularly chlorpromazine— CPZ) with these membranes. The following results have been obtained. (1) Weak modifications of the spin label spectroscopic response are observed only on the label of the polar part of the membrane and with CPZ concentrations higher than 5 × 10^?4 M. (2) Under ultraviolet irradiation (λ = 310 nm) phenothiazine derivatives reduce fatty acids spin labels. Measurement of the reduction kinetic constants of two different types of spin labels give information about the location of the drugs inside the membranes. The photochemical interaction is influenced by the membrane proteins. These results suggest that, in the pharmacologically active concentration range, chlorpromazine seems to localize at the interface between the phospholipids and the proteins of the membranes.     

Long-term parenteral exposure to mercury in patients with hypogammaglobulinaemia.

Patients with hypogammaglobulinaemia commonly receive regular long-term replacement therapy with a concentrate of pooled normal human immunoglobulin G (IgG) containing an organic mercury compound (thiomersal) as a preservative. In 26 such patients the total estimated mercury dosage received ranged from 4 to 734 mg (mean 157 mg) over treatment periods of six months to 17 years (mean 6.5 years). Nineteen patients (73%) had raised urine mercury concentrations, but no correlation was found between urine mercury and the age of the patient, the IgG dose, or the duration of treatment. Urine mercury concentrations are often used to control exposure and evaluate risks in exposed subjects. Hence most patients with hypogammaglobulinaemia are theoretically at risk from mercury exposure, although no clinical evidence of toxicity is yet apparent.     

Development of a questionnaire to examine the role of counsellors working with school students and their families with alcohol or other drug-related problems

The Role Perception Questionnaire (RPQ) was developed to measure the perceptions of school-based counsellors who work with students or their families with alcohol, tobacco or other drug-related problems. The Alcohol and Alcohol Problems Perception Questionnaire (AAPPQ) was used as a guide in developing the RPQ. This paper addresses the conceptual development, factor structure and internal reliability of this new questionnaire. Content and face validity were examined using expertise from the field. Statistical analysis of the 47 items resulted in the identification of four factors (sub-scales) described as Role Adequacy, Role Support, Role Perception and Role Definition. Recommendations are made for further development of the questionnaire and its use as a tool for assessing training needs for those who work with young people in schools.