Perceived adherence to prescribed treatment in juvenile idiopathic arthritis over a one‐year period

Objective

To document perceived adherence to treatment (taking medications and performing exercises) in patients with juvenile idiopathic arthritis (JIA) over a 1‐year period and to identify related factors.

Methods

We surveyed parents of patients with JIA at the Montreal Children's Hospital and British Columbia's Children's Hospital in Vancouver. Parents were asked to respond to a series of questionnaires every 3 months over a 12‐month period. Perceived adherence was evaluated on a 100‐mm visual analog scale (VAS) in the Parent Adherence Report Questionnaire (PARQ). Parental coping, distress, child function, disease severity and duration, perceived helpfulness of treatment, problems encountered, and sociodemographic data were also assessed.

Results

The mean age of our sample of 175 children was 10.2 years; mean age at diagnosis was 6.1 years and mean disease duration was 4.1 years. Perceived adherence to medications was consistently high, with average adherence at baseline, 3, 6, 9, and 12 months being 86.1, 91.7, 90.4, 92.0, and 88.8, respectively, on the PARQ VAS. Perceived adherence to exercise was lower but remained steady, with corresponding means of 54.5, 64.1, 61.2, 63.0, and 54.3, respectively. Using generalized estimating equation analysis, factors associated with higher perceived adherence to medications included perceived helpfulness of medications and lower disease severity; those associated with higher perceived adherence to exercise were younger age of the child, child involvement in responsibility for treatment, and higher perceived helpfulness of the treatment.

Conclusion

Belief in helpfulness of treatment is associated with higher parental perceived adherence to treatment.     

个体患者适形调强放疗计划模体内剂量实测验证技术的建立

目的建立个体患者适形调强放疗（IMRT）计划的模体内剂量实测验证技术。方法选择1例鼻咽癌患者，设计IMRT计划。将患者计划转移到模体上设计杂交计划。执行杂交计划时，用针点电离室测量感兴趣点的剂量，并与该点的计算剂量比较。用胶片剂量测量系统测量杂交计划中感兴趣平面的剂量，胶片与计划剂量矩阵登记后，依次进行计划，胶片分析、计划，胶片剖面分析和计划／胶片等剂量线分析。采用复合判断标准评价验证结果。结果针点电离室测量得到杂交计划单次照射的总剂量为121．5cGy，比计算值低约4％。计划，胶片分析得到高剂量、高梯度区域的距离差别均在4mm以内；计划／胶片剖面分析显示，计划与胶片在通过靶区的剖面具有较好的一致性；计划，胶片等剂量线分析显示，计划与胶片对应值的等剂量线重合良好。按照复合判断标准，该计划验证通过。结论初步建立了个体患者IMRT计划的模体内剂量实测验证技术，建立并优化了剂量登记技术、剂量归一方法和评价方法。     

浙江医科大学附二院门诊处方中精神药物使用调查

本文对浙江医科大学附属二院１９９３年７月间３１３７８张合格处方进行统计分析，并用限定日剂量（ＤＤＤ）和药物使用指数（ＤＵＩ）为指标，分析镇静催眠药物使用情况。结果表明苯二氮　类药方２０６７张，占总处方量的６．５９％，巴比妥类药方４９张，占０．１６％，麻醉药方１１１张；占０．３５％。苯二氮　类药方中．女性处方量１２０２张，男性处方量８６５张，男、女组间比较有显著性差异。苯二氮　类药方多分布在神经内科，常用的药有舒乐安定和阿普唑仑。九种常用的苯二氮　类药和麻醉性镇痛药的ＤＵＩ均小于１。提示药物滥用现象少见，该院对这类药物的管理比较严格。麻醉性镇痛药中二氢埃托啡处方占６７．５７％。     

Prevalence of vibration-induced white finger and assessment of vibration exposure among travertine workers in Italy

Summary Among 76 stonedrillers and stonecutters/chippers working in the Rapolano travertine quarries (Tuscany, Italy), 27 subjects (35.5%) were affected with vibration-induced white finger (VWF). The median latent period for VWF was ten years (range 0.1–26 years). A VWF prevalence of 8% was found among 60 comparable controls (P < 0.0001). Vibration measurements showed that the frequency-weighted accelerations for two rock-drills and two small chipping hammers ranged from 19.7 to 36.4 m/s². Weighted accelerations between 2.4 and 4.1 m/s². were measured on the handles of a vertical grinder and a hand cutter. Vibration data, daily exposure time and total duration of exposure period were used to calculate two indicators of vibration dose such as the four-hour, energy-equivalent, frequency-weighted acceleration (m/s²) and the vibration exposure level (dB). A significant association between the vibration exposure level and the severity of VWF stages was observed among the travertine operators. The dose-effect relationship proposed by ISO 5349 was not suitable for the data of the present study because it overestimates the risk due to hand-transmitted vibration in the travertine workers. Finally, the results of a cold test indicated that the rewarming time of fingertips to room temperature was more prolonged in the operators with VAT than in those without VWF and in the controls.     

The effectiveness of intermittent isotretinoin treatment in mild or moderate acne

BACKGROUND: Isotretinoin is the only drug that affects almost all factors in acne pathogenesis. Recently, its use for the treatment of chronic mild or moderate acne unresponsive to long-term antibiotic therapy, and with a tendency to cause scarring and leading to negative psychological effects, has became popular. The aim of the study was to investigate the effectiveness of intermittent isotretinoin treatment in mild or moderate acne. METHODS: Sixty patients with mild or moderate acne localized to the face were enrolled in the study. The treatment regimen consisted of isotretinoin, 0.5-0.75 mg/kg per day, applied for 1 week every 4 weeks for a total period of 6 months, according to the degree of acne and number of inflammatory lesions. RESULTS: Forty-one (68.3%) of the 60 patients completed the 6-month therapy. At the end of the treatment complete improvement was observed in 34 patients (82.9%) out of 41. All adverse effects were mild and discontinuation of the treatment was not necessary. CONCLUSION: Intermittent isotretinoin treatment was found to be a safe and effective choice for patients with mild or moderate acne.     

Risk factors for capillary leakage syndrome after bone marrow transplantation

 Age, hematopoietic growth factors, cyclosporin A, mode of bone marrow transplantation (BMT) (autologous, allogeneic-related, unrelated), and underlying disease were assessed as potential risk factors for capillary leakage syndrome (CLS) in 96 patients after BMT. CLS was defined as unexplained weight gain of >3% within 24 h and nonresponsiveness to furosemide. CLS occurred in 9/21 patients after unrelated compared with 2/33 after allogeneic-related BMT (p=0.0017) for hematopoietic disorders (n=54) and in 6/7 patients after allogeneic-related compared with 3/35 after autologous BMT (p=0.0001) for solid tumors (n=42). Hematopoietic growth factors and cyclosporin A were no signficant risk factors on their own. We conclude that unrelated BMTs or high-intensity conditioning regimens used in combination with allogeneic-related BMT are the main risk factors for CLS. Received: 6 January 1997 / Accepted: 10 March 1997     

Pharmacokinetics of Controlled Release and Immediate Release Morphine Sulphate Tablets after a Single Dose and Multiple Doses in Chinese Volunteers

健康志愿者１０名，随机交叉口服硫酸吗啡控释片（ＣＲＭＳ）３０ｍｇ（３０ｍｇ×１）和硫酸吗啡普通片（ＩＲＭＳ）２０ｍｇ（１０ｍｇ×２），分别于服药前后各时点取静脉血，用ＧＣＭＳ测定血浆中吗啡含量。以药代软件程序处理，分别求得ＣＲＭＳ和ＩＲＭＳ的Ｃｍａｘ为１９．３８±３．８０和２１．２７±６．２１ｎｇ／ｍｌ；ｔｍａｘ为２．３６±０．３７ｈ和０．５５±０．１６ｈ；ｔ１／２β为３．５３±０．８７ｈ和３．０３±０．７４ｈ，曲线下面积ＡＵＣ为１４５．１５±１７．６５和９３．０８±１６．６５ｎｇ·ｈ／ｍｌ。癌症病人多次口服硫酸吗啡至稳态，ＣＲＭＳ和ＩＲＭＳ的峰浓度分别为２７．４３±０．３３ｎｇ／ｍｌ，２２．６８±０．１６ｎｇ／ｍｌ；谷浓度分别为１９．４５±１．４４ｎｇ／ｍｌ；１８．１４±０．４９ｎｇ／ｍｌ。     

低剂量甲基汞在小鼠体内分布及其对细胞周期进程的影响

连续９０天饮用含甲基汞浓度为１／１０００ＬＤ５０、１／１００ＬＤ５０、１／５０ＬＤ５０和１／１０ＬＤ５０的自来水的雄性昆明小鼠，各脏器中总汞含量均高于对照组（Ｐ＜０．０５～０．００５），并且随着染毒剂量增加，脏器中总汞含量也随之增高。同时采用ＦＡＣＳｃａｎ流式细胞仪和“ＣｅｌｌＦＩＴ”软件分析脾细胞周期进程，发现除１／１０００ＬＤ５０剂量组外，其余各剂量组从Ｇｏ／Ｇ１时相进入Ｓ时相的脾细胞百分数均明显高于对照组（Ｐ＜０．０５），与染毒剂量呈明显正相关。表明连续经口摄入低剂量甲基汞小鼠脾细胞周期进程加快，细胞ＤＮＡ复制增强。     

外伤性视神经病变的临床治疗分析

目的　探讨大剂量甲基强的松龙冲击疗法治疗外伤性视神经病变的疗效。方法　 2 0例 (2 0只眼 )外伤性视神经病变患者为治疗组 ,应用大剂量甲基强的松龙冲击治疗 ,另 2 0例 (2 0只眼 )外伤性视神经病变患者为对照组 ,使用常规剂量的地塞米松治疗。两组均同时使用高渗剂、血管扩张剂、神经营养剂及 B族维生素治疗 ,对两组病例药物治疗的结果进行总结分析。结果　治疗组经治疗后视力开始恢复的时间早于对照组 ,治疗组的总有效率为 80 % ,对照组的总有效率为 6 0 % ,治疗组的疗效优于对照组 ,且治疗越早疗效越好。两组比较具有显著的统计学差异 (P <0 .0 5 )。结论　大剂量甲基强的松龙冲击疗法治疗外伤性视神经病变疗效显著 ,治疗方便 ,是较理想的治疗方法     

Assessment of hand-arm vibration exposure among traffic police motorcyclists

 The aims of this study were (1) to evaluate subjective symptoms in the hand-arm system of all traffic police motorcyclists of a city located in the central part of Japan and (2) to assess their hand-arm vibration exposure associated with traffic police motorcycle riding. The study population consisted of 119 motorcycling traffic policemen and 49 male controls. By means of a questionnaire, information on the occupational history and the presence of subjective symptoms in the hand-arm system of all subjects was obtained. Vibration was measured on the handlebars of the representative motorcycles and on the hands of the riders. The 4- and 8-h energy-equivalent frequency-weighted acceleration as well as the lifetime vibration dose were calculated for all police motorcyclists. The prevalence of finger blanching in the traffic police motorcyclists was 4.2%, but none of the controls had this symptom. The rates of finger numbness (19.3%), finger stiffness (16.0%), shoulder pain (13.4%), and shoulder stiffness (45.4%) were significantly higher among police motorcyclists as compared with controls. The root-mean-square (rms) frequency-weighted acceleration on the handlebars of police motorcycles was in the range of 2.2–4.9 m/s² rms. The computed 4- and 8-h energy-equivalent frequency-weighted acceleration values were 2.8– 4.5 and 2.0 –3.2 m/s² rms, respectively. A pattern of increasing percentage prevalence with increasing cumulative vibration dose was noticed. The subjects with a lifetime vibration dose of more than 20.1 m² h ³ s^-4 (ln scale) showed significantly higher prevalence rates for symptoms in the fingers and shoulders as compared with the control group. As occupational vibration exposure of traffic police motorcyclists might be considered a risk factor for the development of symptoms in the hand-arm system of the riders, its evaluation and control is needed for prevention methodology evolution. Received: 15 April 1996/Accepted: 8 November 1996