Receiving Drug Treatment Research Articles

Differences in prescribing and patient demographics of cki agents among United States patients < 65 and 65+ years old.

e14097 Background: Since FDA approval, immune checkpoint inhibitors (CKIs) have become increasingly important in treating NSCLC, particularly among mutation-negative patients who did not benefit from biomarker testing. Because clinical trials typically recruit healthy patients, little information is available to understand the role of CKIs in treating older patients, who also face immunosenescence. This study explores differences in prescribing behavior of CKIs for mutation-negative NSCLC patients < 65 y/o and 65+ y/o in the US and satisfaction with results. Methods: The Ipsos Global Oncology Monitor: an online multi-center medical chart review study of stage IIIb-IV NSCLC patients currently receiving drug treatments seen in consultation from June – November 2018. 170 US physicians provided de-identified data on 1484 patients negative or untested for EGFR, ALK, ROS1 and BRAF. Results: Compared to patients < 65 y/o (n = 539), those 65+ y/o (n = 945) were prescribed a CKI significantly more often, 63% vs 70% (p < 0.01), driven by CKI monotherapy (CKIm) use, 47% vs 55% (p < 0.01). This trend was seen among patients on 1L therapy (n = 1015), with 42% of patients < 65 y/o and 50% of patients 65+ y/o on CKIm (p < 0.05), and on 2L therapy (n = 337), with 62% of patients < 65 y/o and 76% of patients 65+ y/o on CKIm (p < 0.01). In both lines, this was due to more use of nivolumab among 65+ y/o patients (p < 0.01), while among 2L patients < 65 y/o there was also greater use of pembrolizumab (p < 0.05). Physicians’ stated satisfaction with 1L CKI results was similar in both cohorts but, at 2L, greater among patients 65+ y/o (μ = 8.45; σx̅= 1.26) vs patients < 65 y/o (μ = 8.01; σx̅= 1.38) (p < 0.05). Older 2L CKIm patients were more likely to be ECOG 2+ (18% vs 5%; p < 0.01) and to have 2+ concomitant conditions (60% vs 36%p < 0.01). Conclusions: Satisfaction with 2L CKIs is higher in older vs younger patients, despite the former’s association with poorer outcomes. Potentially, lower expectations at treatment initiation caused higher satisfaction for similar treatment success, but this may also be due to immunosenescence, one study suggesting CKIs are more effective in older melanoma patients ( https://dx.doi.org/10.2147%2FOTT.S165368 ). The role of age in CKIs’ efficacy in NSCLC merits further investigation.

Real-world systemic therapy treatment patterns for squamous cell carcinoma of the head and neck in Canada.

In the present study, we examined real-world treatment patterns for squamous cell carcinoma of the head and neck (scchn) in Canada, which are largely unknown. Oncologists across Canada provided data for disease history, characteristics, and treatment patterns during May-July 2016 for 6-8 consecutive patients receiving first-line or second-line drug treatment for scchn (including locally advanced and recurrent or metastatic disease). Information from 16 physicians for 109 patients receiving drug treatment for scchn was provided; 1 patient was excluded from the treatment-pattern analysis. Median age in the cohort was 63 years [interquartile range (iqr): 57-68 years], and 24% were current smokers, with a mean exposure of 26.2 ± 12.7 pack-years. The most common tumour site was the oropharynx (48%). Most patients (84%) received platinum-based regimens as first-line treatment (44% received cisplatin monotherapy). Use of cetuximab-based regimens as first-line treatment was limited (17%). Of 53 patients receiving second-line treatment, 87% received a first-line platinum-based regimen. Median time between first-line treatment with a platinum-based regimen and initiation of second-line treatment was 55 days (iqr: 20-146 days). The most common second-line regimen was cetuximab monotherapy (43%); platinum-based regimens were markedly infrequent (13%). Our analysis provides real-world insight into scchn clinical practice patterns in Canada, which could inform reimbursement decision-making. High use of platinum-based regimens in first-line drug treatment was generally reflective of treatment guidelines; cetuximab use in the second-line was higher than anticipated. Additional real-world studies are needed to understand the effect of novel therapies such as immuno-oncology agents on clinical practice and outcomes, particularly for recurrent or metastatic scchn.

Efficacy of acupressure to prevent adverse reactions to anti-tuberculosis drugs: Randomized controlled trials.

To determine whether acupressure can prevent or relieve the adverse drug reactions (ADRs) of anti-tuberculosis drugs. People receiving drug treatment for TB often experience ADRs that may cause them to stop taking their medication. Acupressure is a form of traditional Chinese medicine that can be applied to alleviate or prevent disease symptoms. A double-blinded, repeated-measures clinical trial in hospitals in Taiwan was carried out from April 2015 - May 2017. Convenience sampling was used to select 32 people (15 for the experimental group and 17 for the control group) aged >20years who were taking anti-tuberculosis drugs. The people were randomized to receive 4-week of true acupressure and 4-weeks of sham acupressure. Acupressure therapy was given by a researcher in all cases. Both groups received treatment once per day on weekdays, with 15min for each acupressure session. Outcomes (gastrointestinal irritation and adverse skin reactions) were assessed according to the people feedback and the physicians' recordings during the treatment course, and during monthly follow-up visits for 6months thereafter. Both groups typically experienced gastrointestinal irritation and adverse skin reactions within 2months of beginning anti-tuberculosis drug treatment. The 4-weeks intervention involving relevant acupressure points successfully relieved both types of side effects in both immediate and delayed manner. When correctly implemented, acupressure can prevent and relieve the ADRs of anti-tuberculosis drugs, and motivate people to complete their treatment course.

Lipid metabolic reprogramming as an emerging mechanism of resistance to kinase inhibitors in breast cancer.

Breast cancer is one of the leading causes of death in women in the United States. In general, patients with breast cancer undergo surgical resection of the tumor and/or receive drug treatment to kill or suppress the growth of cancer cells. In this regard, small molecule kinase inhibitors serve as an important class of drugs used in clinical and research settings. However, the development of resistance to these compounds, in particular HER2 and CDK4/6 inhibitors, often limits durable clinical responses to therapy. Emerging evidence indicates that PI3K/AKT/mTOR pathway hyperactivation is one of the most prominent mechanisms of resistance to many small molecule inhibitors as it bypasses upstream growth factor receptor inhibition. Importantly, the PI3K/AKT/mTOR pathway also plays a pertinent role in regulating various aspects of cancer metabolism. Recent studies from our lab and others have demonstrated that altered lipid metabolism mediates the development of acquired drug resistance to HER2-targeted therapies in breast cancer, raising an interesting link between reprogrammed kinase signaling and lipid metabolism. It appears that, upon development of resistance to HER2 inhibitors, breast cancer cells rewire lipid metabolism to somehow circumvent the inhibition of kinase signaling. Here, we review various mechanisms of resistance observed for kinase inhibitors and discuss lipid metabolism as a potential therapeutic target to overcome acquired drug resistance.

Guideline recommendations for treatment of patients with inflammatory bowel diseases are not implemented in clinical practice-results of a non-representative survey.

There is a growing evidence for over-, under-, or misuse of health care in patients with inflammatory bowel disease. Most studies looked at treatment variability or used quality measures, which mostly capture supportive interventions rather than treatment of IBD in itself. We aimed to evaluate if current recommendations in clinical practice guidelines regarding the medical treatment of patients with inflammatory bowel diseases are being followed in Germany. A questionnaire was sent to 1901 patients insured with two large German statutory sickness funds and an ICD 10 diagnosis of Crohn's disease (CD) or ulcerative colitis (UC). The questionnaire asked about drug treatment, indications for drug treatment, provision of surveillance endoscopies in ulcerative colitis patients, and smoking status in Crohn's disease patients. Out of 460 evaluable patients, 62.4% of UC patients and 53.9% of CD patients were treated with mesalamine according to guidelines, 91.3% of all patients were treated with glucocorticoids according to guideline recommendations, while only 75.6% received recommended immunosuppressive treatment. Of UC patients, 94.5% had surveillance colonoscopies at the recommended interval and 58.8% of CD patients were non-smokers. No predictor for overall treatment according to guidelines could be found while being of age older than 60 or being treated outside of a dedicated IBD clinic was associated with less immunosuppressive treatment. A large proportion of patients with IBD do not receive drug treatment in accordance with clinical practice guidelines. Quality improvement measures are much needed.

Metabolic Syndrome in Dutch Patients With Bipolar Disorder: A Cross-Sectional Study.

To characterize the prevalence of metabolic syndrome (MetS) among Dutch patients with bipolar disorder (BD), identify factors associated with MetS, and estimate the rate of pharmacologic treatment of MetS in this population. A cross-sectional analysis of medical records of adult patients (≥ 18 years) with BD receiving psychotropic drug treatment was performed in a Dutch psychiatric outpatient setting. MetS was determined according to National Cholesterol Education Program Adult Treatment Panel III-Adapted (NCEP ATP III-A) criteria. Data collection via review of medical records from 2015 was conducted in 2016. The prevalence of MetS in the sample (N = 71) was 42.3%. Multivariate analysis showed sex and body mass index were independently associated with MetS. Males had an almost 8-fold higher risk of MetS than females (OR = 7.7, 95% CI, 1.5-39.6), and with every point of increase on BMI, the risk of MetS increased by 40% (OR = 1.4, 95% CI, 1.2-1.8). Of the patients with hyperglycemia, hypercholesterolemia, and hypertension, 81%, 72.4%, and 65.0%, respectively, did not receive drug treatment for these conditions. The study found a high prevalence rate of MetS and substantial undertreatment of the components of MetS in patients with BD in a Dutch outpatient clinic. Follow-up investigation in larger samples is warranted.

Predicting the effectiveness of drug interventions with \u2018HIV counseling & testing\u2019 (HCT) on the spread of HIV/AIDS: a theoretical study

In this paper, a dynamic compartmental model is constructed for the transmission of HIV/AIDS receiving drug treatment and knowledge from effective awareness programs through media. Using stability theory of differential equations the model is analyzed qualitatively. The equilibrium points in the local and global stability proof are found to be stable under certain conditions. Further, we use Pontryagin’s Minimum Principle in the time-dependent constant control case to derive necessary conditions for the optimal control of the disease. Sensitivity analysis is also performed to check the robustness of the model with respect to small changes in parametric values of the system. In order to predict the long term dynamics of the disease, projections are made. These studies reveal that HIV incidence could be substantially reduced by improving the test-and-treat strategy and implication of media awareness.

The Novel Berbamine Derivative, Cbbm, Downregulates c-Myc to Block Diffuse Large B-Cell Lymphoma Cell Maintenance

▪Diffuse large B-cell lymphoma (DLBCL), is one of the most common lymphoma subtypes worldwide, and represents 30% of non-Hodgkin lymphoma (NHL). The current DLBCL chemotherapy R-CHOP regimen is limited by lack of specificity and toxicity to normal hematopoietic cells. Identification of a targeted therapeutic approach is an unmet need for the disease. Through translocations, amplifications or overexpression, c-Myc is dysregulated in many human cancers, including DLBCL. Aberrant overexpression of c-Myc promotes tumorigenesis by activating target genes critical for cell proliferation/survival. In our preliminary study, c-Myc protein levels in 119 cases of newly diagnosed DLBCL were evaluated by immunohistochemistry. We found that c-Myc levels were evident (>30% positive cells) in 40.52% (47/116) and high (>80% positive cells) in 6.90% (8/116) of patients. We also observed that relative to c-Myc negative cases, c-Myc positive cases (>30% positive cells) were associated with adverse prognostic indicators including high international prognostic index (IPI) score (≥60 years old group) (p=0.033), high Ki-67 index (p=0.002), high central nervous system involvement (p=0.003) and low complete response rate (p=0.028), confirming that c-Myc plays a critical role in DLBCL pathogenesis.Currently, c-Myc is considered to be an “undrugable” oncoprotein. Chemotherapeutic agents do not affect c-Myc activity. Our previous work in T-cell lymphoma (Cancer Cell, 32:115-128) demonstrated that berbamine, a natural bis-benzylisoquinoline alkaloid, effectively reduced N-Methyl-N-Nitrosourea (MNU)-induced lymphoma burden by disrupting the Ca 2+ /calmodulin-dependent protein kinase II (CaMKII)γ/c-Myc axis. We also showed that CaMKIIγ stabilizes c-Myc by phosphorylating it at the serine 62 residue (Ser62). We created the berbamine derivative 4-chlorobenzoyl berbamine (CBBM) (Fig.1), and evaluated its efficacy in vitro using DLBCL cell lines (n=5) which expressed high levels of c-Myc. The IC50 of CBBM was an order of magnitude lower than that of berbamine across a panel of DLBCL cell lines: the IC50 (μmol/L) of CBBM vs. berbamine in these cells were OCI-Ly3 (1.39±0.04 vs 12.20±0.71), OCI-Ly10 (2.56±0.04 vs 23.66±0.53), U2932 (3.89±0.07 vs 17.78±0.29), SU-DHL 16 (1.82±0.05 vs 17.56±0.71) and Pfeiffer (3.73±0.06 vs 26.16±0.56). CBBM also induced apoptosis in a dose-dependent manner in these cell lines while sparing normal hematopoietic cells from healthy donors (n=2). As an example, CBBM treatment dose-dependently induced apoptosis on OCI-Ly3 cells (vehicle control was 4.43±0.06%, 4 μmol/L CBBM was 24.43±0.72% and 6 μmol/L CBBM was 75.43±0.25%, vehicle control vs CBBM at 4 μmol/L, p<0.001). Conversely, more than 85% of normal hematopoietic cells from mobilized healthy donor peripheral blood were still viable after exposure of CBBM at 10 μmol/L, which is a lethal dose for DLBCL lines. Moreover, CBBM treatment significantly reduced cycling of DLBCL cells (SG2M fractions: vehicle control 68.11±0.40%, CBBM 4 μmol/L 38.36±0.34%, p<0.001). Mechanistically, exposure of DLBCL lines (n=5) to CBBM decreased c-Myc protein levels in a dose-dependent manner. We also validated the reduction of PD-L1 expression, a reported c-Myc target through immunoblots. The proteasome inhibitor MG132 prevented CBBM-induced c-Myc protein degradation, indicating that reduced c-Myc after CBBM treatment is related to downregulation of protein stability. Importantly, we also explored the effect of CBBM on the CaMKIIγ/c-Myc axis. CBBM treatment reduced phospho-c-Myc (Ser62) levels in all the lines. We observed CBBM-mediated inhibitory effects (IC50 of five lines) was correlated with the basal level of CaMKIIγ (R2 = -0.8269, p=0.0323) (Fig.2). Beyond targeting c-Myc, CBBM also exhibited immune modulator potency including downregulation of autocrine interleukin 10 (IL10) level assayed by ELISA, leading to reduction of the downstream JAK2/STAT3 levels. Currently, we are in the process of testing CBBM in vivo effects using an OCI-Ly3 xenograft model. Although the overall survival result is pending, following 4 weeks of CBBM treatment (1 g/kg, i.g.), tumors from animals receiving drug treatment show decreased c-Myc expression levels relative to that of vehicle treated animals. Collectively, our results support further evaluation of CBBM as a promising compound to treat c-Myc associated DLBCL. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Characteristics and management of 1093 patients with clinical diagnosis of familial hypercholesterolemia in Greece: Data from the Hellenic Familial Hypercholesterolemia Registry (HELLAS-FH)

Background and aimsAlthough familial hypercholesterolemia (FH) is one of the most common genetic disorders, it remains largely underdiagnosed and undertreated. The Hellenic Atherosclerosis Society has established the Hellenic Familial Hypercholesterolemia (HELLAS-FH) Registry, part of the Familial Hypercholesterolemia Studies Collaboration (FHSC), to evaluate the characteristics and management of patients with FH in Greece. MethodsPatients with diagnosed FH were recruited by a network of sites throughout Greece. The prevalence of cardiovascular disease (CVD) risk factors, as well as management of FH, was recorded. ResultsThis interim analysis included 1093 patients (556 male; 950 adults). The median age of FH diagnosis was 42.2 years (interquartile range 27.2–53.0). A family history of CVD was present in 47.8%, while 21.1% of patients had a personal history of CVD. At diagnosis, low-density lipoprotein cholesterol (LDL-C) was 241 ± 76 mg/dL in adults and 229 ± 57 mg/dL in children. Overall, 63.1% of the patients were receiving hypolipidemic drug treatment, mainly statins, at inclusion in the registry. Mean LDL-C of patients receiving drug treatment was 154 ± 76 mg/dL in adults and 136 ± 47 mg/dL in children. The majority of treated patients (87.9%) did not achieve LDL-C targets. ConclusionsFH in Greece is characterized by a significant delay in diagnosis and a high prevalence of both family and personal history of established CVD. The vast majority of FH patients do not achieve LDL-C targets. Improved awareness and management of FH are definitely needed.

Differences by sex in associations between injection drug risks and drug crime conviction among people who inject drugs in Almaty, Kazakhstan

BackgroundThe criminalization of drug use leads to high rates of drug crime convictions for engaging in injection drug use behaviors, introducing barriers to HIV prevention and drug treatment for PWID. Females (FWID) face unique vulnerabilities to HIV compared to males (MWID) in Kazakhstan. This study examined sex differences in associations between HIV/HCV infection, HIV knowledge, injection drug risk behaviors, and conviction for a drug crime in a sample of people who inject drugs (PWID) in Almaty, Kazakhstan. MethodsAnalyses were performed on baseline data from 510 PWID and stratified by males (MWID) (329) and females (FWID) (181) from Kazakhstan in a couples-focused HIV prevention intervention. Logistic regression analyses using mixed effects (AOR) examined associations between HIV/HCV infection, HIV knowledge, injection drug risk behaviors, drug use severity, drug treatment history and conviction for a drug crime. ResultsAbout three quarters of PWID reported drug crime conviction (73.92%, n = 377). HCV infection was associated with increased odds of drug crime conviction for FWID (AOR = 4.35, CI95 = 1.83–10.31, p < .01) and MWID (AOR = 3.62, CI95 = 1.09–12.07, p < .01). HIV transmission knowledge was associated with increased odds of conviction for MWID (AOR = 1.19, CI95 = 1.00–1.41, p < .05). Injection drug risk knowledge was associated with lower odds of conviction (AOR = .75, CI95 = .59–.94, p < .05) for FWID. Receptive syringe sharing (AOR = 3.48, CI95 = 1.65–7.31, p < .01), splitting drug solutions (AOR = 4.12, CI95 = 1.86–7.31, p < .05), and injecting with more than two partners (AOR = 1.89, CI95 = 1.06–3.34, p < .05) was associated with increased odds of conviction for FWID. Receptive syringe or equipment sharing with intimate partners was associated with conviction for both MWID (AOR = 1.90, CI95 = 1.03–3.92, p < .05) and FWID (AOR = 1.95, CI95 = 1.02–3.70, p < .05). For FWID, injection drug use in public spaces was associated with conviction (AORME = 3.25, CI95 = 1.31–7.39, p < .01). Drug use severity was associated with increased odds of conviction for FWID (AOR = 1.29, CI95 = 1.09–1.53, p < .001) and MWID (AOR = 1.24, CI95 = 1.09–1.41, p < .001). Ever receiving drug treatment was associated with conviction for MWID (AOR = 2.31, CI95 = 1.32–4.12, p < .01). ConclusionHigh-risk behaviors, HCV infection and more severe substance use disorders are associated with drug crime conviction for PWID, particularly FWID. Structural interventions are necessary to increase the engagement of PWID with drug crime convictions in HIV prevention and substance abuse treatment.

Clinical high risk factors and prognosis of 25 pulmonary mucormycosis cases

Objective: To analyze high risk factors, therapeutic regimen and prognosis of patients with pulmonary mucormycosis. Methods: A retrospective analysis was performed on the clinical data of 25 patients who were diagnosed as pulmonary mucormycosis in the First Affiliated Hospital, School of Medicine, Zhejiang University, between January 2009 and December 2017. Results: Univariate analysis revealed that no risk factor had significant effect on prognosis of these 25 cases, while multivariate logistic regression analysis confirmed that the exposure to antifungal drugs was correlated to worse prognosis(P=0.046). All 4 patients who had received surgical lesionectomy were cured, and 8 patients who had not received any therapy targeted to mucormycosis were all dead. Seven of 13 patients received antifungal drug to mucormycosis were effective, with an effective rate of 54.0%. The mortality rate of the operative group was lower than that of the non-operative group (P=0.026), and the prognosis of the patients received drug treatment was better than patients without treatment(P=0.022). There was no significant difference in the prognosis between groups of single drug or combination of amphotericin B and posaconazole. Conclusions: Pulmonary mucormycosis is more likely to occur in patients with tumor of the hematopoietic and lymphoid tissues, immunosuppression after solid organ transplantation, long-term glucocorticoid usage and diabetes. Surgical lesionectomy can improve the survival rate, and the treatment with amphotericin B and /or posaconazole can also improve the prognosis of the patients.

Analysis of the diagnosis and treatment of Castleman disease originating in the head and neck

Objective:To improve diagnosis and treatment of Castleman' s disease (CD) originating in the head and neck.Method:Of 15 cases of Castleman' s disease originating in the head and neck, 8 cases occurred in the right side of the neck, 6 cases in the left side, and 1 case in both sides. Eleven cases were focal type CD (UCD), and 4 cases were multi-center type CD (MCD). All patients underwent imaging examination and neck nephrectomy. Four patients with MCD received drug treatment after surgery.Result:During follow-up from 12 to 69 months, one patient suffered a slight facial paralysis due to a close relationship between mass and the parotid gland. One patient had obvious postoperative scar growth and occasional itching; another patient suffered mild pain in shoulder;4 cases of multi-center patients survived with tumor; 2 cases lost follow-up at 57 months, 65 months after follow-up, respectively. There were no recurrence in these two cases during the follow-up period; the remaining 6 cases had no exceptions.Conclusion:The clinical manifestations of CD patients are different. Pathological examination is an important basis for diagnosis. After a definite diagnosis, related examinations need to be completed. The LCD patients generally had a good prognosis, and the MCD patients often had a poor prognosis. For patients with parapharyngeal masses complicated by thyroid tumors, surgery can be performed at the same time..

Hypertension in Mexican adults: prevalence, diagnosis and type of treatment. Ensanut MC 2016.

To describe the prevalence, awareness and proportion of adults with an adequate control of hypertension. Blood pressure was measured at 8 352 adults who participated in the Ensanut MC 2016. The adults who reported having diagnosis of hypertension or had systolic blood pressure values (TAS) ≥140mmHg or diastolic blood pressure (TAD) ≥90mmHg were classified as hypertensive. Hypertension was considered controlled when blood pressure was TAS <140mmHg and TAD <90mmHg. The prevalence of hypertension was 25.5%. Of these, 40.0% were unaware of having high blood pressure. Of the hypertensive adults who had previous diagnosis of hypertension and receiving drug treatment (79.3%), 45.6% had blood pressure under control. A high percentage of adults are unaware of having hypertension and nearly half have inadequate control. The relevance of current programmes for diagnosing hypertension should be assessed, as well as the effectiveness of their control strategies.

Social reinforcement as alternative to sucrose reinforcement is increased by nicotine and methylphenidate in male Fischer-344 rats.

Stimulant drugs such as nicotine (NIC) and methylphenidate (MPH) are hypothesized to increase the reinforcing value of sensory stimuli, thus increasing the effectiveness of such reinforcers as alternatives to sucrose reinforcers. Inbred Fischer-344 rats (n = 30) were assigned to three groups: saline (SAL; n = 10), nicotine (NIC; n = 10), or methylphenidate (MPH; n = 10). Testing was done in three phases: sucrose only, (SUC), sucrose and drug (SUC/DRUG), and sucrose, drug, and social reinforcement (SUC/DRUG/SOC). During the SUC phase, rats were trained on a progressive ratio 5 (PR5) reinforcement schedule for sucrose (20% solution). In the SUC/DRUG phase, animals were treated with SAL, NIC (0.4mg/kg, n = 10 SC), or MPH (2.0mg/kg, n = 10 IP) 30min prior to testing. In the SUC/DRUG/SOC phase, animals continued receiving drug treatment, and social reinforcement was introduced concurrently with the sucrose reinforcer. The progressive ratio for each reinforcer ran independently of the others. Reinforcing value was measured as break point (BP), the highest number of responses resulting in a reinforcer. SAL-treated animals showed no significant change in sucrose BP. MPH-treated animals showed decreased sucrose BP in the SUC/DRUG phase, with a further reduction in the SUC/DRUG/SOC phase. NIC-treated animals decreased sucrose BP only when a social alternative was offered. Both NIC and MPH reduce the sucrose BP in the presence of a social alternative. The decrease in sucrose responding, coupled with increased social responding, suggests that the social alternative acted as an effective alternative reinforcer to sucrose. From a translational perspective, these results suggest that stimulant drugs such as NIC and MPH may increase the effectiveness of treatments that use alternative social reinforcers to decrease eating.

Racial/ethnic differences in mental health and drug treatment among juvenile arrestees

The purpose of this study was to test for racial/ethnic differences in drug and mental health treatment-related perceptions and experiences among a sample of 377 juvenile arrestees. Bivariate analyses revealed that white juvenile arrestees reported receiving more past drug treatment and mental health messages than black, Latino, and ‘other’ juvenile arrestees. They were also more likely to perceive a need for mental health treatment than Latinos and other racial/ethnic minority arrestees. No racial/ethnic differences were found for past mental health treatment or perceive need for drug treatment. Multivariate analyses revealed that Latinos were less likely than white youth to perceive a need for mental health treatment; and other racial/ethnic minority youth were less likely than white youth to have ever received drug treatment even after controlling for demographic variables and risk factors. Practice implications are discussed.

Некоторые вопросы применения института условно-досрочного освобождения от отбывания наказания к осужденным, прошедшим лечение от наркомании в период отбывания наказания, и предложения по его совершенствованию

Некоторые вопросы применения института условно-досрочного освобождения от отбывания наказания к осужденным, прошедшим лечение от наркомании в период отбывания наказания, и предложения по его совершенствованию

Endemic status of schistosomiasis in People's Republic of China in 2016

This report presents the endemic status of schistosomiasis in the People's Republic of China at national level in 2016, and analyzes the data collected from the national schistosomiasis prevention and control system and 454 national schistosomiasis surveillance sites. Among the 12 provinces (municipality and autonomous region) of endemic of schistosomiasis japonica in P. R. China, 5 provinces (municipality and autonomous region), i.e., Shanghai, Zhejiang, Fujian, Guangdong and Guangxi, had achieved elimination, and 7 provinces of Sichuan, Yunnan, Jiangsu, Hubei, Anhui, Jiangxi and Hunan had achieved transmission control by the end of 2016. There are 451 endemic counties (cities, districts) covering 257 million people, specifically including 29 692 endemic villages of 69.39 million people at risk. Among the 451 endemic counties (cities, districts), 35.25 % (159/451), 42.35% (191/451) and 22.39% (101/451) reached the criteria of elimination, transmission interruption and transmission control, respectively in 2016. By the end of 2016, it was estimated of 54 454 infections of schistosome, decreased by 29.46% compared with 77 194 in 2015. No acute schistosomiasis case was reported in 2016. There were 30 573 advanced schistosomiasis cases documented in 2016. A total of 8 500 710 individuals received schistosomiasis examinations and 600 individuals were parasitologically diagnosed, decreased by 83.36% compared with 3 606 in 2015. The Oncomelania hupensis snail survey was performed in 22 140 endemic villages and O. hupensis snails were found in 7 106 villages, accounting for 32.109% of the total villages, with 20 newly detected villages with snails. The snail survey covered area of 813 963.91 hm2 and snails were found in an area of 235 096.04 hm2, including a newly detected area of 1 346.48 hm2. No schistosome-infected snails were found in 2016. A total of 881 050 bovines were raised in the schistosomiasis endemic area. Of them, 510 468 bovines received examinations, resulting in 8 schistosome-infected bovines. There were 147 642 schistosomiasis cases receiving drug treatment in 2016, with 2 303 555 individuals undergoing expanded chemotherapy; there were 9 bovines with schistosomiasis receiving drug treatment, with 439 857 bovines undergoing expanded chemotherapy; a total of 139 483.84 hm2 area with snail control by using molluscicides, with actual molluscicide-treated area of 73 941.75 hm2; and 3 101.52 hm2 snail habitants were treated by environmental modification. Based on the data from the 454 national schistosomiasis surveillance sites, the mean Schistosoma japonicum infection rate was 0.02% and 0.0078% in humans and bovines, respectively. No schistosome-infected snails were found in all the surveillance sites. The results demonstrate a decline in the endemicity of schistosomiasis in P. R. China compared with the level of 2015. However, the distribution area of snails in China is still large and the infection source of schistosomiasis still exists to some extent in some endemic areas; in some regions, the task to reach the standard of transmission interruption is still arduous. There are still objective factors of epidemic and transmission and risk factors of endemic reversal and rebound for schistosomiasis. So, further control and effective surveillance as well as accurate prevention and control should be implemented to promote the elimination process on schistosomiasis in P. R. China.

Supraventricular tachycardia in newborns and its association with gastroesophageal reflux disease

Abstract Introduction Supraventricular tachycardia (SVT) is the most common arrhythmia in the neonatal period, but its association with other triggering processes is not well established. The aim of the study was to analyse the possible relationship between neonatal SVT and gastroesophageal reflux disease (GERD), a condition which was recently linked to atrial arrhythmias. Material and methods A retrospective longitudinal descriptive study was conducted over a period of 5 years on newborns who were diagnosed with SVT in a level III neonatal unit, assessing morphological aspects, associated symptoms, and treatments received. Its association with GERD and the impact of this on SVT was studied. Results Eighteen patients (1.2 per 1000 newborns) were diagnosed with SVT. Fifty percent of them were combined with clinically significant GERD (P = .01), and all of them received drug treatment. The average time of control of SVT without GERD since diagnosis was 6 days (95% CI: 2.16–9.84, with a median of 3) and 7.6 days when both pathologies were present (95% CI: 4.14–10.9, with a median of 7) (P = .024). Conclusions Patients with SVT in the neonatal period frequently have GERD, and this combination leads to more difficulty in controlling the tachycardia. The reflux could act as a trigger or perpetuator of arrhythmia, therefore it is important to find and treat GERD in infants with SVT.

PP-14 Substandard prescription of drugs in a population of overweight and obese children. an observational retrospective cohort study

Background Obesity is a major area of public health concerns, since it is associated with a wide range of se-rious health complications, including diabetes type 2, musculoskeletal disorders, sleep apnea, depression, asthma, hypertension, and cancer. Consequently, obese children are more likely to receive drug treatment than their normal weight peers. Further, obesity is known to be associated with changes in pharmacokinetics of drugs (1–5). Dosing overweight (OW) and obese (OB) children by the use of traditional paediatric dosage strategies (e.g. mg per kilogram or fixed dose by age) may therefore result in a potential risk of sub-or supra-therapeutic doses. We aimed to investigate currently applied dosage strategies in OW/OB children, in a clinical treatment facility. In par-ticular, whether dosage guidelines were used and metrics of body size applied with special attention to drugs with a narrow therapeutic interval and/or loading dose of clin-ical importance. Methods A retrospective cohort study conducted at the Children’s Obesity Clinic in Denmark, in the period 2008–2015. OW/OB children≤18 years, having at least one drug prescribed, were included. 200 patient records were reviewed. The study was approved by the Data Protection Agency (BBH-2014–045, I-suite 03045) Drug treatments/prescriptions were registered with ref-erence to the Anatomical Therapeutic Chemical (ATC) Classification System. Dosage strategies were registered as dosage by total body weight (TBW), fixed dose by age (years), use of adjusted weight measures (e.g. IBW, ABW) or dose estimation by other strategies. Results A total number of 455 prescriptions were iden-tified, primarily distributed in ATC groups N, A, R and J. Guidelines for dosage of OW/OB children were not avail-able in the clinic, for any of the recorded drugs. Only one prescription of gentamicin was adjusted by weight (ABW) using metrics of body size. Otherwise, gentamicin was dosed after three different dosage regimens. In 35/455 prescriptions, dose was adjusted by an undocumented dosage strategy. Dose was primarily limited to the max-imum recommended adult dose, when dose (mg/kg) exceeded adult dose, i.e. acetaminophen. Conclusion This study highlights the shortage of dos-age guidelines in OW/OB children. We found as suspect-ed a large inter-individual variability in dosage regimens even in drugs with narrow therapeutic intervals or drugs which has loading doses important for clinical effects. The clinicians are left with ‘best practice’, as evidence based dosage regimens are missing for several drugs prescribed during childhood.

THE ROLE PLAYED BY SHIATSU AND STRETCHING IN THE FUNCTIONAL REHABILITATION OF STABLE ANGINA PATIENTS

Angina pectoris is a more or less intense coronary symptom, more or less severe, according on the associating pathology. Stable effort angina is less severe than the stable resting angina, both being less severe than the unstable angina. Taking into consideration the fact that alongside the basic treatment of this coronary disease and the emergency nitroglycerin treatment, a series of physical manifestations caused by repeated angina crises can be approached through Shiatsu and stretching, we have structured and applied a specific program on six patients with stable angina, and compared their results with the results of other six patients with the same pathology, but who only received drug treatment. The results have proven that the application of specific Shiatsu and stretching programs on stable angina patients over the course of eight weeks (three sessions per week during the first four weeks, and two sessions per week during the following four) contributes more than the drug treatment to the decrease of the intensity, frequency and duration of angina crises.