Teenage pregnancy and frequent use of alcohol and drugs in the home environment

OBJECTIVE: To assess individual and family factors associated to teenage pregnancy, including frequent use of alcohol and illicit drugs by family members. METHODS: Case-control study conducted with a sample of 408 sexually active female adolescents (aged 13-17 years) in school from the city of Marília (Southeastern Brazil) in 2003-2004. Cases consisted of 100 primigravid teenagers assisted in prenatal care programs in health units. Controls were 308 nulligravid students from state public schools. Standardized instruments identified demographic and educational factors, contraceptive behavior, mental health problems, and family characteristics. Statistical analysis included chi-square tests and logistic regression models. RESULTS: Low paternal education (p=0.01), lack of information on sexuality and fertilization (p=0.001) and the use of illicit drugs by a resident family member (p=0.006) were independent risk factors. Family income per capita and asking the partner to use a condom were confounders. CONCLUSIONS: The frequent use of illicit drugs by a resident family member is a factor strongly associated to teenage pregnancy, regardless of other risk factors. The expectation of going to college constitutes a protective factor, mainly in the presence of low maternal education.     

Patient-perceived side effects to antihypertensive drugs

The Hypertension Detection and Follow-up Program (HDFP) used two methods to collect data on drug side effects. First, questions were asked during annual home visits by nontherapist interviewers, and second, responses were elicited by questionnaire at each clinic visit. Frequency of side effects as reported by the participants was similar in stepped care and referred care participants. Among the stepped care participants attending clinic, 75 percent continued to report at least one of the side effects reported at baseline. New symptoms (not previously reported) were less frequent, reported by 14 percent. Although medications were discontinued in 17 percent of the HDFP participants due to side effects, less than 2 percent of those reporting side effects had their drug discontinued for the symptom they reported. We concluded that questionnaire-elicited reports of drug side effects are a relatively poor index of side effects.     

Depression associated with antihypertensive drugs.

BACKGROUND. Depression is a potential side effect of antihypertensive drug therapy. Consideration of this side effect is a reason often cited by physicians for not choosing certain drugs. METHODS. In this prospective study the relative rates of depression were measured by the Zung Self-Rating Depression Scale (SDS) in patients from four hypertension treatment groups. Treatment groups consisted of 466 patients receiving: (1) no drug therapy, (2) diuretics only, (3) diuretics plus reserpine, and (4) diuretics plus beta-blockers. Demographic data including age, sex, and race were collected. Analysis of variance was used to compare the rate of depression among the treatment groups, as well as among age, sex, and racial groups. RESULTS. Using a Zung SDS index of greater than or equal to 50, 35.4% of the hypertensive population was depressed. Age and sex were not significant factors in the frequency of depression. Blacks scored higher than whites in all drug treatment groups except those treated with high lipophilic beta-blockers, but the rate of depression was not higher. Whites on the lowest dose of reserpine had the lowest rate of depression. The rate of depression among those taking reserpine or beta-blockers was no different than that among those receiving either no treatment or diuretics. CONCLUSIONS. Reserpine or beta-blocker therapy did not cause any more depression than any other antihypertensive treatment.     

A survey on the use of alternative drugs during pregnancy.

OBJECTIVE. To describe the use of alternative drugs during pregnancy. DESIGN. A trial including 3 surveys on drug use during pregnancy in maternity centers in one area of Finland in 1985-86 (study 1), and a retrospective survey in 2 maternity hospitals in Finland in 1988 (study 2). PATIENTS AND METHODS. Study 1: 2912 pregnant women (about 94% of pregnant women in the area during the study period); 97-88% returned questionnaires. Study 2: 180 out of 181 consecutive women giving birth. In study 1, drug use (including drug-like products) in the last two weeks was asked by questionnaires around 12th, 28th, and 36th gestation weeks. In study 2, women were interviewed 2-3 days after birth asking about any drugs used during pregnancy. Due to the method of asking, our studies underestimate the level of using alternative drugs. RESULTS. In study 1, a total of 97 (3.6%) pregnant women reported use of alternative drugs. Most drugs were dietary supplements, and by current knowledge harmless. But a few women had used (potentially) dangerous drugs. The users were from the higher social class and they had also used pharmaceutical specialties more often than non-users. In study 2, 14% had used alternative drugs at some time during pregnancy. CONCLUSION. Because our surveys showed that alternative drugs are used, possibly with increasing frequency, during pregnancy, further studies on safety are needed.     

北京大学医院抗高血压药物应用分析

目的调查分析北京大学医院抗高血压药物的使用情况,为临床合理用药和科学管理提供依据。方法用限定日剂量、用药频度和日治疗费用等客观指标分析药物利用的动态。结果2009午北京大学医院使用的各类抗高血压药物中用药金额最大的是钙拮抗剂,构成比超过50％;左旋氨氯地平和厄贝沙坦的消耗金额名列前茅;高血压药日治疗费用最高5．31元;最常使用的抗高血压药为左旋氨氯地平;多数抗高血压药的消耗金额与用药人次数基本同步,使用合理。结论北京大学医院抗高血压药物的使用基本合理,做到了科学、有效、安全、经济用药。     

某院门诊处方中抗高血压药物的利用分析

目的:回顾性调查与分析某院门诊抗高血压药处方,为临床合理用药提供参考依据。方法:采用世界卫生组织推荐的剂量,随机抽取和分析某院2010年每月3天门诊处方抗高血压药的使用情况。结果:20 926张门诊处方中抗高血压药处方3872张,以钙拮抗剂使用频率最高,单一、二联、三联处方分别1061、2198、613张。结论:某院抗高血压药治疗应用总体较为合理,临床医师应遵循药物治疗指南,做好抗高血药的选择。     

A prospective evaluation of persistence on antihypertensive treatment with different antihypertensive drugs in clinical practice

Persistence on treatment affects the efficacy of antihypertensive treatment. We prospectively investigated the persistence on therapy and the extent of blood pressure (BP) control in 347 hypertensive patients (age 59.4 +/- 6 years) randomly allocated to a first-line treatment with: angiotensin-converting enzyme (ACE) inhibitors, calcium-channel blockers (CCBs), beta-blockers, angiotensin-II receptor blockers (ARBs), or diuretics and followed-up for 24-months. Persistence on treatment was higher in patients treated with ARBs (68.5%) and ACE inhibitors (64.5%) vs CCBs (51.6%; p < 0.05), beta-blockers (44.8%, p < 0.05), and diuretics (34.4%, p < 0.01). No ARB, ACE inhibitor, beta-blocker, or diuretic was associated with a higher persistence in therapy compared with the other molecules used in each therapeutic class. The rate of persistence was significantly higher in patients treated with lercanidipine vs others CCBs (59.3% vs 46.6%, p < 0.05). Systolic and diastolic BP was decreased more successfully in patients treated with ARBs (-11.2/-5.8 mmHg), ACE inhibitors (-10.5/-5.1 mmHg), and CCBs (-8.5/-4.6 mmHg) compared with beta-blockers (-4.0/-2.3 mmHg p < 0.05) and diuretics (-2.3/-2.1 mmHg, p < 0.05). No ARB, ACE inhibitor, beta-blocker, or diuretic was associated with a higher BP control compared with the other molecules used in each therapeutic class. A trend toward a better BP control was observed in response to lercanidipine vs other CCBs (p = 0.059). The present results confirm the importance of persistence on treatment for the management of hypertension in clinical practice.     

Estrogen use and blood pressure in later life

Use of oral estrogens did not alter the blood pressure (BP) or BP lability of women aged 52--87. The effect was similar in normotensives and women who were hypertensive before starting estrogen. Compared with nonusers of estrogen, users had lower systolic pressures, but did not differ in diastolic blood pressure, lability, frequency of doctor visits or BP determination, obesity, smoking or use of alcohol or psychotropic medication. The data neither confirm a previously reported association between estrogen use and hypertension nor do they suggest pre-selection of users for hypertension or labile BP.     

孕期新型抗癫痫药物的合理应用和研究进展

癫痫是神经系统的一种常见慢性疾病,约25%癫痫患者为育龄期妇女,而该类患者为控制痫性发作,即使在孕期也必须坚持口服抗癫痫药物(AED)治疗。AED可不同程度地通过胎盘屏障进入胎儿体内,对其健康产生潜在危害。新型AED由于具有相对较低的致畸风险,而倍受临床医师和癫痫患者的青睐。但妊娠所致的新型AED药代动力学改变,却对该药在癫痫患者孕期中的应用带来巨大挑战。因此,孕期应对癫痫患者进行系统的健康教育和用药指导、规律的血药浓度监测、严格的产前检查及恰当的叶酸制剂补充,以达到新型AED在癫痫患者孕期的个体化治疗。     

Diet during pregnancy, neonatal outcomes and later health

Renewed interest in nutrition during pregnancy has been generated by the hypothesis that adult disease has origins in early life. Animal experiments clearly show that altering maternal diet before and during pregnancy can induce permanent changes in the offspring's birth size, adult health and lifespan. Among women living in Western societies, cigarette smoking is the most important factor known to reduce fetal growth, followed by low pre-pregnancy weight and low gestational weight gain. Obesity is also associated with pregnancy complications and adverse neonatal outcomes, so inadequate or excessive energy intake is not optimal for the developing fetus. Against a history of inconsistent results, several recent studies suggest that in Western settings the balance of macronutrients in a woman's diet can influence newborn size. Effects appear to be modest, but this relationship may not encapsulate the full significance for health of the child, as there is emerging evidence of associations with long-term metabolic functioning that are independent of birth size. Consequences of inadequate maternal nutrition, for the offspring, may depend on timing during gestation, reflecting critical windows for fetal development. Where women are not malnourished, changing a woman's nutritional plane during pregnancy may be detrimental to the unborn baby, and systematic reviews of the literature on dietary supplementation during pregnancy indicate few benefits and possible risks. In view of this, improved diet before pregnancy deserves greater attention.     

重度子痫前期降压药物的研究进展

]妊娠期高血压疾病是妇女妊娠期常见的并发症,重度子痫前期为妊娠期高血压疾病的严重阶段,当孕妇血压≥21.3/14.7kPa(160/110mmHg)时,可能导致心肌梗死、脑出血、肾脏功能不全或衰竭、胎盘早剥或胎死宫内的发生,其严重地威胁着母婴健康.因此,降压治疗在重度子痫前期的治疗中起着关键作用.该文就近来治疗重度子痫前期降压药物的研究进展作以综述.     

International variation in prescribing antihypertensive drugs: Its extent and possible explanations

Background  

Inexpensive antihypertensive drugs are at least as effective and safe as more expensive drugs. Overuse of newer, more expensive antihypertensive drugs is a poor use of resources. The potential savings are substantial, but vary across countries, in large part due to differences in prescribing patterns. We wanted to describe prescribing patterns of antihypertensive drugs in ten countries and explore possible reasons for inter-country variation.     

218例社区高血压患者服用降压药物依从性及其影响因素分析

目的 探讨影响高血压患者使用降压药物依从性的因素。方法 通过调查问卷分析218例社区高血压患者用药依从性以及主要影响因素,包括药物副作用、服药种类、文化程度、经济状况以及服药周期等。数据统计分析采用SPSS 20.0软件。结果 患者病程、药物种类、服药周期以及药物副作用、经济状况、文化程度、对于高血压病知识的了解程度和心理反应可显著影响患者使用降压药物的依从性,其中依从性低的患者中高中以下学历者占86.67%,不了解高血压病防治知识者占77.33%。结论 高血压患者用药依从性直接关系到疾病的转归,临床治疗时应实施有效措施,提高治疗依从性,维持血压正常水平。