美国药物治疗管理服务的应用现状及对我国的启示

为解决不合理用药问题,美国政府正尝试利用药师的专业技术优势加强对患者药物治疗的管理。在查阅分析国外文献的基础上介绍了美国药物治疗管理服务的形成背景、运作模式、核心要素和实施效果等应用现状,以期为我国临床药学服务的发展提供启示和政策建议。     

Clinical and Non-Clinical Characteristics Associated with Medication Use Among Children with Serious Emotional Disturbance

Our study explores the clinical and non-clinical characteristics associated with medication use among children with serious emotional disturbance who are referred into community-based family-driven system of care settings. Using data collected as part of the Comprehensive Community Mental Health Services for Children and Their Families Program initiative, our study provides results from analyses completed on 7,009 children and adolescents with serious emotional disturbance. Using both bivariate and multivariate statistical analyses, the researchers found that females entering systems of care were less likely to have received medication in the 6-months prior to entry, as were children of African-American and Native-American heritage compared to children from non-Hispanic White heritage. Children referred from mental health, child welfare or who were self-referred were more likely to use medications than those referred from juvenile justice. Children with histories of prior inpatient, outpatient, day treatment, or school-based services were between 2 and 4 times more likely to use medications than children without such histories. Children with family histories of mental illness and those who were Medicaid recipients were also more likely to use medications. Family income was also positively related to medication use and younger children were more likely to use medications than older children. Implications of the findings are discussed.     

The Use of Stimulant Medication and Behavioral Interventions for the Treatment of Attention Deficit Hyperactivity Disorder: A Survey of Parents’ Knowledge, Attitudes, and Experiences

We examined parents’ knowledge, attitudes, and information sources regarding Attention-Deficit/Hyperactivity Disorder (ADHD), including treatment with stimulant medication and behavioral interventions. Responses from parents with a child diagnosed with ADHD and parents without a child diagnosed with ADHD were also compared. Participants consisted of 146 parents of elementary age children from Wisconsin. The surveyed parents were aware of issues surrounding ADHD and the use of stimulant medication, but there were several areas where they possessed inaccurate or incomplete factual information. Parents who had a child diagnosed with ADHD rated the effects of stimulant medication more positively and side effects as less severe than other parents. They also rated behavioral interventions as less effective on all questions. Implications of the study are discussed.     

A quantitative interresponse-time analysis of DRL performance differentiates similar effects of the antidepressant desipramine and the novel anxiolytic gepirone.

We describe an interresponse-time analysis of performance on a differential-reinforcement-of-low-rate 72-s schedule. This analysis compares the obtained interresponse-time distribution of individual rats to a corresponding random interresponse-time distribution. The random interresponse-time distribution is a negative exponential probability function; it predicts the relative distribution of interresponse times if the rat emitted the same number of responses randomly (i.e., with a constant probability) with respect to time. The analysis provides quantitative measures of peak location and dispersion of the interresponse times toward random performance. In Experiment 1, an unexpected outcome of this analysis was that the rats would have obtained more reinforcers had they responded at the same rate but randomly. Based on the interresponse-time analysis in Experiment 1, it was shown that rats trained on the differential-reinforcement-of-low-rate 72-s schedule could increase the number of reinforcers obtained in two ways: first, by a coherent shift of the interresponse-time distribution toward longer durations and, second, by dispersal of the interresponse times toward a random interresponse-time distribution. Experiment 2 applied the analysis described in Experiment 1 to the effects of desipramine and gepirone. Both drugs decreased response rate and increased reinforcement rate, but their effects on the distribution of interresponse times were different. The increase in reinforcement rate observed with desipramine was accompanied by a coherent shift of the reinforcement rate observed with gepirone was accompanied by dispersal of the interresponse-time distribution toward the random negative exponential prediction.     

THE UTILITY OF CURRICULUM-BASED MEASUREMENT FOR EVALUATING THE EFFECTS OF METHYLPHENIDATE ON ACADEMIC PERFORMANCE

Two case studies were conducted to investigate the utility of curriculum-based measurement of math and reading for evaluating the effects of methylphenidate on the academic performance of 2 students diagnosed with attention deficit hyperactivity disorder. Following baseline measurement, double-blind placebo-controlled procedures were employed to evaluate each student's response to three levels (5 mg, 10 mg, and 15 mg) of the medication. Results of the first study suggest that the curriculum-based measures were sensitive indicators of the student's response to medication. This finding was replicated in the second study. In the second study, when the student's follow-up dose of medication was based on trial-phase data, follow-up performance was improved compared to baseline performance. These case studies suggest that further research is warranted on the utility of curriculum-based measurements for monitoring and evaluating stimulant medication interventions with children with this disorder.     

Neuropsychological dysfunction in asthmatic children

Neuropsychological dysfunction associated with pediatric asthma is reviewed. Significant methodological confounds associated with clinical research, including problems with the objective measure of asthma, are prevalent in many studies. Most evidence does not support the belief that asthma alone results in homogeneous neuropsychological compromise. Studies of adverse reactions to asthma medications indicate medication-specific effects including slight improvements in some aspects of neuropsychological functioning, such as attention, and deficiencies in other aspects of neuropsychological functioning, such as memory. The acute neuropsychological effects of various medication regimens appears to be reversible with cessation of the asthma medication under suspicion, although no data yet exist regarding the long-term effects of therapeutic dosages of asthma medications upon a developing nervous system. The hypothetical effects of asthma on school performance have been related to non-neuropsychological variables such as a child's socioeconomic status, though there is also evidence suggesting that poorly controlled asthma is related to learning problems. Implications for pediatric neuropsychologists are discussed.     

A SOCIAL ECOLOGY OF HYPERACTIVE BOYS: MEDICATION EFFECTS IN STRUCTURED CLASSROOM ENVIRONMENTS

Hyperactive boys on methlyphenidate (Ritalin), hyperactive boys on placebo, and comparison boys were observed in quasi-naturalistic classroom settings. Ambient stimulation (quiet versus noisy conditions) and source of regulation (self-paced versus other-paced activities) were varied in a 2 × 2 design. Compared to their peers, hyperactive boys on placebo showed lower rates of task attention and higher rates of gross motor movement, regular and negative verbalization, noise-making, physical contact, social initiation, disruption, and acts that were perceived as energetic, inappropriate, or unexpected. Self-paced activities resulted in increased rates of verbalization, social initiation, and high-energy episodes. High ambient noise levels reduced task attention and increased the rates of many other behaviors including verbalization, physical contact, gross motor movement, and high-energy acts. Medication-by-situation interactions emerged for both classroom dimensions, with hyperactive boys on placebo being readily distinguishable from their peers under some classroom conditions and indistinguishable under other conditions. Moderate relationships were found between teacher ratings and many individual behavior categories. Discussion focused on (a) the merits and limitations of a social ecological research perspective, and (b) the implications of these findings for the design of intervention strategies.     

中国古代堕胎考略

中国见于史书记载的堕胎行为从汉代就开始了,并且形成三种堕胎技术。唐宋以后,由于人口增长的压力,堕胎在一些地区出现了普遍化倾向,导致堕胎的公开化和职业化。但由于传统重生育、反堕胎观念的存在,堕胎技术一直受到歧视,得不到完善,人们为此付出了长期的血的代价。     

Statin Use,Ageing, and Cognition: A Review

Cholesterol performs a number of important roles in normal brain functioning, including the formation of myelin sheaths and communication between cells, and it has been theorised that statin use could disrupt these roles leading to deficits in cognition. Relevant research was identified via the La Trobe University library Summon^TM search tool, using search terms including “statin cognition,” “statins cognition,” “statin brain,” “cholesterol cognition,” “cholesterol brain,” and “statin adverse effects” in addition to examination of the reference lists of the retrieved research articles. Research was examined from the published literature across several different research modalities: systematic reviews and meta‐analyses, randomised control trials, cohort studies, and case reports. On the basis of the surveyed literature, it is not possible to indicate any consistent caution or limitation with regard to the use of statins and their effects upon cognitive functioning due to the contradictory and inconsistent results arising from this literature. In summary, it is not possible to conclusively determine whether there are either cognitive benefits or detriments associated with the use of the statins. The determination of the effect of these agents on neuropsychological functioning requires more methodologically controlled long‐term longitudinal follow‐up studies of these treatments due to the complex and multisystem effects of these agents.