上海劳教场所倡导“绿色戒毒”

有效降低戒毒人员复吸率是一个世界性难题,面对居高不下的复吸率,近年来上海劳教场所在不断探索、大胆尝试的基础上,在北京大学医学部韩济生院士和戒毒专家的指导下,引入“绿色戒毒”防复吸理念和科学有效的医疗手段,将科学戒治方法和劳教教育矫治工作有效结合,对戒毒劳教人员进行自主治疗和矫治,进行“绿色戒毒”的实践活动.通过科学、认真的实践和规范运作,已经取得了初步成效,走出一条劳教场所“绿色戒毒”的新路.     

戒毒劳教人员教育矫治的五点思考

戒毒劳教人员的教育矫治是一项系统工作,目前提高劳教戒毒质量的根本出路在于加强对戒毒劳教人员的教育矫治工作,我们应该用科学的理论和科学的方法指导戒毒工作.当前戒毒劳教人员的教育矫治重点应该是:激发戒毒劳动教养人员的积极主动性、树立起科学戒毒观念、落实教育制度、探索新的管理、教育方法、以心理矫治和切实有效的社会帮教尤其是解教后的后续接茬帮教促进戒毒质量的提高.在具体的工作实践中应该注重在下几点:     

临床试验的伦理审查:妇女和孕妇

孕妇以及育龄期妇女参加临床试验,涉及她们本人、妊娠、胎儿和由胎儿长成的人、以及她们生育力的风险和受益,伦理委员会审查时需要有一些特殊的考虑.涉及妇女临床研究的特殊伦理审查问题主要包括：研究期间有怀孕的可能,其本身不能作为排除或限制育龄期妇女参加生物医学研究的理由;详尽讨论研究对孕妇和胎儿的风险,是妇女做出参加临床研究理性决定的先决条件;涉及孕妇临床研究的特殊伦理审查问题主要包括：风险和受益的判断应同时考虑研究对孕妇及胎儿两方面的风险与受益,并结合研究的类别进行考虑;只有当研究是针对孕妇或胎儿特有的健康需要,或针对孕妇总体的健康需要,并且如果合适,有来自动物实验、尤其是关于致畸和致突变风险的可靠证据予以支持,才能在孕妇群体中实施研究.     

从伦理审查批件看临床试验伦理委员会的组成及相关问题的探讨

目的：对照现行法规要求,了解临床试验伦理委员会的人员组成和审查会议情况,发现存在问题并提出相关建议。方法：调查临床试验伦理批件,分析伦理委员会人员名单、会议签到表和审查决定。结果：伦理委员会的人员组成基本符合法规要求,审查会议出席情况有待改进。结论：伦理委员会审查水平日渐提高,人员组成有待优化,独立性有待加强,主管部门加强对伦理委员会的监管很有必要。     

关于加强临床试验招募广告伦理审查的探讨

招募受试者的广告须经伦理委员会审查和批准之后方可使用。其形式和招募的途径多样化。国内的招募广告伦理审查主要存在以下问题：相应的伦理审查法律法规不完善;临床试验相关人员重视度不够;招募广告自身的缺陷等。审查招募广告的要点包括发放媒介及其主要内容。针对招募广告伦理审查存在的问题,建议通过完善法律和各项规章制度、提高审查招募广告的意识和加强监督管理,以提高招募广告伦理审查水平,更好地保障受试者安全和权益。     

劳教戒毒人员心瘾程度和抵抗情绪的对数回归分析

心瘾程度(Craving)和抵抗情绪(Resistance)是影响强制劳教戒毒人员接受劳动教改,戒除毒瘾,回归社会的两个不利因素,本研究的目的在于建立由数个客观变量构成的数学模型,以此对戒毒人员的C和R进行预测,并就模型反映出的情况进行分析.研究结果得到劳教戒毒人员心理渴求程度对数回归模型Z=1.180-.609G(1)-.035G(2)-.096ED+091YEARS-.052AGE+.025TIMES和抵抗情绪对数回归模型Z=-.566-.280G1-.578G2+.301TERM+.041YEARS-.038AGE+.024MONTHS其中影响戒毒人员心瘾的主要变量是与吸毒史有关的变量,如吸毒年数、初吸年龄、戒毒次数;而影响抵抗情绪的变量主要是与刑期有关的变量,如刑期和在所的月数.在模型中有几个重要的变量包括初吸时年龄,对C和R都起负面影响;受教育年数,在各个C模型中,教育年数越长,文化水平越高的劳教人员,越能克服心瘾;刑期,在各个R模型中,刑期对个组的劳教人员的抵抗情绪都有明显的消极作用.三组劳教戒毒人员调查的结果还表明,刚进所的吸毒者无论是对毒品的心理渴求程度还是对强制戒毒的抵抗情绪都是最强烈的,但在经过一段时期的劳动教改后,C和R都会有显著的改善.     

男性吸毒劳教者与普通劳教者生存质量对比研究

目的：探讨男性吸毒劳教人员与普通劳教人员的生存状况差异及其影响因素。方法：运用世界卫生组织生存质量量表简表,对340名男性吸毒劳教人员和普通劳教人员进行问卷调查。结果：普通劳教人员在生存质量量表的生理、心理和社会三领域得分显著低于常模,而吸毒劳教人员的各领域得分均显著低于普通劳教人员;文化程度和婚姻状况对普通劳教人员无明显影响,而在吸毒劳教人员则差异显著;两者的生存质量均随年龄增长而降低。结论：劳教模式和吸毒、戒毒行为作为同时存在的两个重要影响因素,共同影响了吸毒劳教者的生活质量。     

关于研究伦理问题的说明

根据《学术出版规范期刊学术不端行为界定(CY/T174-2019)》论文涉及的研究未按规定获得伦理审批,或者超出伦理审批许可范围,或者违背研究伦理规范,应界定为违背研究伦理。违背研究伦理的表现形式包括:1.论文所涉及的研究未按规定获得相应的伦理审批,或不能提供相应的审批证明。2.论文所涉及的研究超出伦理审批许可的范围。     

关于研究伦理问题的说明

根据《学术出版规范期刊学术不端行为界定(CY/T174-2019)》论文涉及的研究未按规定获得伦理审批,或者超出伦理审批许可范围,或者违背研究伦理规范,应界定为违背研究伦理。违背研究伦理的表现形式包括:1.论文所涉及的研究未按规定获得相应的伦理审批,或不能提供相应的审批证明。2.论文所涉及的研究超出伦理审批许可的范围。     

对劳教管理中的吸毒人员的调查

目的:通过对戒毒劳教人员的实地调查,客观评价吸毒的危害和对经劳教而强制戒毒提出相关建议。方法:深入湖南省衡阳市某劳教机构,对劳教戒毒人员进行调查。结果:重点调查了26位戒毒劳教人员,并对其中的5人进行了深入交谈和分析。结论:吸毒成瘾与年龄、社会地位及经济状况密切相关;吸毒影响机体多器官的功能;劳教戒毒过程中应加强技能培训和科学管理。     

临床试验的伦理审查:精神障碍

精神障碍可能影响患者理解知情告知信息的能力,并可能影响他们做出参加临床研究理性决定的能力.对于涉及因精神障碍而不能给予充分知情同意受试者的临床研究,伦理委员会应该确保：在给予充分知情同意能力没有受损的人身上能同样好地进行研究,这类人就不能成为受试者;研究的目的是为获得有关精神障碍者特有的健康需要的知识;已获得与每位受试者能力程度相应的同意,可能的受试对象拒绝参加研究应始终受到尊重,除非在特殊情况下,没有合理的医疗替代方法,并且当地法律允许不考虑拒绝;如果可能的受试对象没有能力同意,应获得其法定代理人的许可.     

Pharmacokinetics and metabolism of salbutamol in premature labour.

1 The pharmacokinetics of salbutamol and its sulphate conjugate were examined during intravenous and steady-state oral administration in nine patients receiving the drug for the prevention or treatment of premature labour. 2 Uterine contractions were inhibited by plasma salbutamol concentrations in the range 8-33 ng ml-1 in six of the seven patients who were receiving intravenous drug. 3 By comparison with our previous study in a control group of healthy males and nonpregnant females, the total clearance of salbutamol in premature labour (501; s.d. 185 ml min-1) was similar to that in the control group (480; s.d. 123 ml min-1). Renal salbutamol clearance (208; s.d. 51 ml min-1), however, was significantly less than that in the control group (283; s.d. 51 ml min-1). 4 The systemic availability (n = 3), urinary recovery of unchanged oral salbutamol and area under the plasma curve during the oral dosage interval (n = 5) were all only slightly lower (10-20%) than control values, suggesting slightly lower oral absorption. 5 Formation and elimination of the sulphate conjugate were similar to those observed in control subjects suggesting that first-pass sulphation in the gut wall is unchanged in pregnancy. Overall there were only minor differences in salbutamol pharmacokinetics between control subjects and patients in premature labour.     

临床试验中特殊受试人群选择的国际伦理要求

弱势人群是指那些相对地(或绝对地)没有能力维护自身利益的人，即他们没有足够的权力、智力、教育、财力、力量、或其他必需的属性束保护他们的自身利益。邀请弱势个体作为受试需要特殊的理由，如果选择他们，必须切实履行保护他们权利和健康的措施。本重点论述了涉及儿童、因智力或行为障碍不能给予充分知情同意、妇女、孕妇等弱势群体生物医学研究的国际伦理要求。最后谈到研究是负担和利益并存的，任何群体或个人，包括弱势人群，都不应过多承担研究的负担，但也绝不能被排除在能使其受益的研究之外。     

Evaluation of an alternative program for MMTP drop-outs: impact on treatment re-entry

INTRODUCTION: Retention in a Methadone Maintenance Treatment Program (MMTP) is predictive of abstaining from heroin and has other benefits. Many individuals leave treatment before they experience these positive outcomes. OBJECTIVE: This research project targeted MMTP drop-outs with an intervention designed to assist them in returning to drug treatment. METHODS: Subjects who had left MMTP within the prior 12 months were randomly assigned to intervention or comparison groups. The 3-month long intervention consisted of street outreach, cognitive behavioral groups, and individual counseling. Data were analyzed for 175 subjects who were out of treatment at baseline and who returned for a 6-month follow-up interview (Intervention group, N=111; Comparison group, N=64). RESULTS: A total of 87% of subjects assigned to the intervention condition participated in at least one component. Intervention subjects who attended two or more cognitive behavioral group sessions were more likely than those who attended 0-1 sessions or those in the comparison group to have returned to treatment during the 6 month follow up time period (72 vs. 53 vs. 50%, respectively, P<0.05, chi square test). CONCLUSION: MMTP drop-outs need not be lost to the drug treatment system if special efforts are made to engage them in interventions developed to encourage treatment re-entry.     

Recommendations for routine cervical screening

Because of concern about the rising incidence of cervical cancer in young women, the Department of Health and the Cancer Society invited a working group to make recommendations on cervical screening. There is now compelling evidence that cytological screening is an effective preventive measure. All women who have had sexual intercourse should be offered screening. They should be screened as soon as possible after commencing sexual activity, or when first receiving contraceptive advice, antenatal care, or treatment of a sexually transmitted disease. If the first smear is negative, it should thereafter be repeated at least every three years. A special effort must be made to reach women who have never been screened, including those who are middle-aged, or elderly. The cervical smear test should be part of the assessment of women with gynaecological symptoms regardless of whether there has been a negative smear within the previous three years. The three-yearly schedule also does not apply to women who have had an abnormal smear.     

Recombinant human erythropoietin for treatment of anemia in persons with AIDS not receiving zidovudine

Because few data exist on the effect of recombinant human erythropoietin (EPO) for anemia not induced by zidovudine (ZDV) in persons with AIDS, we analyzed a subset of 523 subjects not taking ZDV ('non-ZDV') who participated in an open-label EPO treatment program involving 1943 subjects. Non-ZDV subjects had a mean hematocrit of 27.3% on entry and their mean weekly EPO dose was 354-464 U/kg that was given for a mean of 17 weeks. EPO was well tolerated with an adverse event discontinuation rate of 2.3%. The mean hematocrit increased to 30.8% at week 6 and remained between 32 and 34% for the next 18 weeks. Subjects requiring one or more transfusion per 6-week period decreased from 43% before study entry to 14% for weeks 13-18 and 18% for weeks 19-24. These changes were comparable to those observed in the entire group of 1943 patients. We concluded that EPO was safe and as effective for anemia in persons with AIDS not taking ZDV as for those receiving it.     

Inter-Individual Differences in Metabolism of Drugs: The Role of Genetic Factors

Abstract: Variability is a frequent finding in pharmacology, and may have a unimodal or polylmodal distribution. Both types of variation are analysable by genetic techniques. Experiments reveal that the variability between persons in their capacity to metabolize drugs is largely genetically determined. Persons who have a greater ability to metabolize a drug may be protected from adverse reactions, but may also not receive therapeutic benefits as compared with those less well endowed, when fixed dosage regimes are utilized.     

Higher prevalence of systemic hypertension among moderate alcohol drinkers: an exploration of the role of underreporting

OBJECTIVE: Heavy alcohol drinking is associated with increased prevalence of systemic hypertension (HTN), but the relationship between moderate drinking and HTN remains unclear. We explored the possible role of underreporting among moderate drinkers. METHOD: In a cross-sectional analysis of 105,378 persons, we defined a subset among persons reporting three or fewer drinks per day that was likely to include a disproportionate number of underreporters. This subset included persons who, on another occasion, indicated intake of three or more drinks per day or who ever had a diagnosis of an alcohol-related condition; these persons are called "positive." Persons who never reported three or more drinks per day and who had no alcohol-related diagnosis were called "negative." Logistic regression models estimated the odds ratios (ORs) for prevalent HTN (140/90 mm Hg or greater) in the positive and negative subgroups, compared with lifelong abstainers as referent. All persons and four race-gender groups were studied, and they were controlled for age, education, smoking, and body mass index. We also studied the relationship of blood liver transaminase enzyme levels in the positive and negative subgroups at specific alcohol intake strata. RESULTS: For persons reporting one to two drinks per day, the OR (95% confidence interval) of HTN was 1.32 (1.21-1.43) for positive persons and 1.16 (1.09-1.25) for negative persons. For those reporting less than one drink per day, the ORs were 0.97 (0.89-1.06) for positives and 0.92 (0.87-0.98) for negatives. For those reporting one to two drinks per day, positive/negative comparisons showed approximately a 75% increased prevalence of high liver transaminase enzymes. For those reporting less than one drink per day, the positive/negative difference was approximately 30%. CONCLUSION: In these data, increased prevalence of HTN among persons reporting one to two drinks per day appears to be partially due to underreporting of alcohol intake.