Psychometric properties of the Brazilian version of the drug use screening inventory

BACKGROUND: Adolescent involvement with alcohol and other drugs is rising in Brazil, and there is an increasing need for psychometrically sound assessment tools to detect early drug involvement. METHODS: The psychometric properties of the Brazilian version of the Drug Use Screening Inventory (DUSI) were examined in a sample composed of 71 non-drug-dependent adolescents and 142 adolescents who met DSM-III-R criteria for drug dependence. RESULTS: With a cutoff score of 13% or lower for the absolute density index of the substance use area, DUSI correctly classified 80% of the drug-dependent adolescents and 90% of the non-drug-dependent adolescents, thus correctly classifying 83.6% of the sample. Factor analysis applied to each of the 10 DUSI areas indicated their unidimensionality, with substantial percentages of variance on the first factor. The Brazilian version of DUSI presented strong internal consistency reliability for the whole sample (drug-dependents and non-drug-dependent adolescents) with an average across all 10 scales for Cronbach's alpha reliability coefficient of 0.96 (standard deviation = 0.02) and for the split-half reliability coefficient of 0.88 (standard deviation = 0.08). CONCLUSIONS: These results suggest that the Brazilian version of DUSI preserves its original psychometric properties and is a sensitive and useful screening instrument for drug use.     

Hepatitis C and the heart: to beat or not to beat

BACKGROUND: Many enteroviruses as well as hepatitis C have been increasingly found in association with cardiomyopathies, even though, the evidence has been inconclusive. METHODS: From 1998 to 2001, at the liver clinic of our community-based hospital, in the cohort of hepatitis C patients, infection evidence by PCR confirmation and echocardiographic measures of left ventricular (LV) function were obtained. RESULTS: One hundred-eight patients were identified. Fifty percent of them have echocardiographic abnormalities. Patient's mean age was 55 +/- 10 years; 45% women, 55% men; 32% had LVH, 13.8% had high right ventricular systolic pressures, and 4% displayed contractility abnormalities. No cases of dilated or hypertrophic cardiomiopathies were found. CONCLUSIONS: Echocardiographic abnormalities are not uncommon findings associated with hepatitis C infection, however all these findings can easily be explained by existing co-morbidities. High right ventricular systolic pressure, suggestive of pulmonary hypertension, which may be secondary to portal hypertension, is an independent finding for hepatitis C.     

安全用药之我见--评药物患者和医师

中国医学论坛报于2005年3月24日至4月21日连续五期发表了题为“安全用药,临床实践的永恒主题——由COX-2特异性抑制剂引发的争论”的纪要和文章。尽管这些报道的起因源自新一代抗炎药罗非昔布和塞来昔布在防治结、直肠腺瘤样息肉的长疗程中引发的心脑血管事件,而它给人们的忠告则说明,在临床上使用任何药物都必须以安全为前题而不应给患者带来伤害。因此,安全用药应成为临床治疗的出发点和归宿。但是,如何做到安全用药?如何在安全用药的前题下最大限度地发挥药物的疗效及将药物的不良反应降到最低?或者简单地说,如何做到取药物之利防药物…     

New perspectives on the use of niacin in the treatment of lipid disorders

Therapy with niacin (nicotinic acid) is unique in that it improves all lipoprotein abnormalities. It significantly reduces low-density lipoprotein cholesterol, triglyceride, and lipoprotein(a) levels, while increasing high-density lipoprotein cholesterol levels. This makes niacin ideal for treating a wide variety of lipid disorders, including the metabolic syndrome, diabetes mellitus, isolated low high-density lipoprotein cholesterol, and hypertriglyceridemia. Niacin-induced changes in serum lipid levels produce significant improvements in both coronary artery disease and clinical outcomes. Niacin is currently available in 3 formulations (immediate release, extended release, and long acting), which differ significantly with respect to their safety and efficacy profiles. Immediate-release niacin is generally taken 3 times a day and is associated with adverse flushing, gastrointestinal symptoms, and elevations in blood glucose levels. Long-acting niacin can be taken once daily and is associated with significantly reduced flushing, but its metabolism increases the risk of hepatotoxic effects. Extended-release niacin, also given once daily, has an absorption rate intermediate between the other formulations and is associated with fewer flushing and gastrointestinal symptoms without increasing hepatotoxic risk.     

Value of bacteriological screening of urine samples from HIV infected patients.

A retrospective analysis of the results of bacteriological examination of all urine samples from adult HIV infected patients admitted to the City Hospital, Edinburgh during the year 1 April 1988 to 31 March 1989 was made to assess the usefulness of this investigation in HIV positive patients without clinical evidence of urinary tract infection.     

Toxidrome recognition to improve efficiency of emergency urine drug screens

We correlated clinical symptom complexes of drugs (toxidromes) to results of 204 consecutive toxicological screens ordered in our emergency department. The toxidromes were divided into eight categories: sedative hypnotic, narcotic, stimulant, coma-apnea-seizure, hallucinogenic, anticholinergic, unknown, and "no drugs." Emergency medicine nurses, clinical pharmacists, and medical residents were asked to choose one or more of the above toxidromes independently when ordering the toxicology screen. The nurses achieved the highest symptom complex recognition of the drug (55 of 61, 88%) followed by medical residents (76 of 90, 84%) and clinical pharmacists (27 of 34, 79.4%), but the differences were not statistically significant. We conclude that the major determinant in selecting correct toxidromes is clinical experience of the practitioners. Given the percentages of toxidrome recognition, it should be possible to increase efficiency of laboratory use by ordering tests only for the drugs clinically suspected in a particular toxic patient.     

Detection of drug use in a methadone maintenance clinic: sweat patches versus urine testing

Aims. To evaluate the novel use of sweat patches in outpatients attending a methadone maintenance clinic. Design. Assessment of inter-patch reliability and validity of patch results compared to urine tests at the start and end of the patch period. Semi-structured questionnaire on patients' opinion of the patches. Randomized cross-over trial comparing illicit drug use during the week that the patch was worn with a control period. Setting. Methadone maintenance outpatient clinic in a deprived urban area. Participants. Forty-eight patients with a diagnosis of opiate addiction prescribed methadone for a median of 5 years. Measurements. Analysis of urine and patch tests by standard methods for methadone, opiates, morphine (heroin metabolite) and benzoylecgonine (cocaine metabolite). Findings. There was good inter-patch reliability between arm and side patches for methadone (all positive), opiates ( k = 0.8) and morphine ( k = 1.0) but only moderate agreement for benzoylecgonine ( k = 0.49). There was good agreement between the sweat patches and urine tests for methadone (all positive), opiates ( k = 1.00) and morphine ( k = 0.8), but again only moderate agreement for benzoylecgonine ( k = 0.50). The patches were well tolerated and the main side effect was minor irritation. The majority of men preferred a urine test while more women preferred a sweat patch. There was no evidence of reduced use of illicit drugs during the period that the patch was worn . Conclusion. Sweat patches are reliable and give valid results for patients on maintenance methadone. There are few side effects and it is practical to use them in busy outpatient clinics. They are preferred by some patients but there was no evidence that they altered behaviour.