Alcohol dependence syndrome and before-discharge intervention method (BDIM)--Report 1. The process to develop the constructed BDIM]

Many alcoholics come to the hospital denying their own drinking problems. So, in the initial treatment stage for alcoholics, it is very important to bring patients' attention to their denial. In those days, there were many kinds of treatment method to help them aware of patients' denial. For example, psycho-educational therapy, Japanese Naikan therapy, attendance to self-help group meetings, and so on. But I don't think that these are effective enough to help them aware of their drinking problems, especially denial. The purpose of my study is to develop the therapeutic intervention method (Before discharge Intervention Method: BDIM). It is for being aware of patient's denial, stimulating his/her motivation for abstinence and attendance to medical follow-up sessions or self-help group meetings. To achieve these purposes, I apply Picard's initial intervention method that is a very useful therapy for alcohol dependence syndrome patients who reject consultation. The subjects of this study are 175 alcohol dependence syndrome inpatients and their family members. The period of BDIM practices is for about 1 week before discharge. BDIM's concrete programs are prepared by medical team under the therapist's guidance. Beforehand the therapist has to ask the patient whether he/she agree to practicing BDIM program or not. Then to obtain his/her family's approval of joining to BDIM, nurses talk by telephone or directly consult with the patient's family members. The therapists requires the patient's family members to write letters to him/her. In advance, the therapist has to take preliminary examination the letters not to be traumatic but spiritual. There are good memories about him/her and merits of the period without his/her drinking problems. Also, they write his/her drinking problems and their hope for abstinence and follow-up therapy after discharge and attendance of self-help group meetings. In BDIM session, the patients shall listen to his/her family members' messages by their letters with tears and receive their letters. Then the patient has an opportunity to talk his/her opinion about the letters and give his/her answer later. All the letters should be copied and kept with their medical file, because the therapists will talk about the letters with the patient and his/her family members in the follow-up session. Talking about letters after discharge helps him/her revive BDIM's memories and motivate abstinence, recovery and participation in self-help group. Even though alcohol dependence syndrome patient has some cognition and (or) memory disorders, I think that BDIM practices using some letters written by the patient and his/her family members are not only so useful for the patient to correct their cognition, but also helpful to be aware of denial and maintain motives to recovery. Owing to the deep emotion and warm heart from his/her family members, the patient can be aware of his/her family's sufferings and maintain abstinence for a long time.     

Alcohol dependence syndrome and BDIM (before-discharge intervention method)--Report 3. The patients' self-reports about BDIM]

The purpose of this study is to identify how the effects of BDIM are evaluated by patients who were practiced BDIM. 153 patients were treated by the structured BDIM (Before-Discharge Intervention Method) program. Among them, 82 patients (53.6%) have attended self-help group meetings or maintained the therapeutic relationship (as outpatients or inpatients) in the 4 months' study period. To identify the maintenance of the effects of BDIM, we made our questionaire that consist of the patients' choice of answer and the patients' self-reporting. 76 of 82 patients answered our questionaire. After 76 patients discharged from hospital, 4 1/3 years have passed on the average. Their positive answers are as follows. (1) I became aware that my drinking had bad effect on my beloved family. (2) I became aware that my family have kept compassion, expectation and appreciation for me. Their message treated me and strengthened my self-esteem. In addition, I accepted the reality of my drinking problems. (3) I recognized all my family members want my abstinence and functional communication. (4) I was extremely impressed by my family members' tears. Their tears made me decide strong abstinence. (5) I was empowered by my family members. Through BDIM, I felt a sense of security, self-esteem and freedom. (6) I thought that BDIM was a good treatment program. And I thought that the application of letters is useful to recover the patients from alcohol dependence syndrome. Their negative answers are as follows. (1) I thought it was impossible for me to be abstinent. (2) I couldn't keep the motivation of abstinence. (3) I thought BDIM was a negative treatment method. Some findings of this study are as follows: First, the letters which was handed from family members to the patient were read again and again, also preserved with much care. Therefore we get know that BDIM is useful for the patient to get and remember some good memories of the family members for a long time. Second, BDIM is helpful for the patients to become aware of their own drinking problems and realize the necessity of recovery.     

Alcohol dependence syndrome and before-discharge intervention method (BDIM)--Report 2. Statistical analysis of BDIM]

The present author has developed the structured Before-Discharge Intervention Method (BDIM), a modified version of the intervention methods by Johnson and Picard in an effort to achieve the patient's awareness of his/her problem drinking. The BDIM first involves the patient's family members and helps them recover from co-dependence on the patient's alcoholism and secondly, instructs them to write structured letters to the patient. Each letter should include a few episodes of recent and past drinking problems, and family members' concern and love for the patient, and family members' hope for his/her patient's abstinence. Family members read the letter with emotion and tears in a joint therapist, patient, family members session. We have reported the two-year-post-treatment outcome of group I (the BDIM-treated group) and group II (the BDIM-untreated group) here. Patients living with their spouse or significant other in group I of the series of new patients did significantly better than their counterpart in group II on two treatment outcome variables, that is, family members' attendance at hospital follow-up sessions and/or self-help group meetings, abstinence of the patients who and whose family members attended hospital follow-up sessions and/or self-help group meetings. Patients living with their spouse or significant other in group I of the series of all patients did significantly better than their counterpart in group II on three treatment outcome variables, that is, patients' attendance at hospital follow-up sessions and/or self-help group meetings, family members' attendance at hospital follow-up sessions and/or self-help group meetings, abstinence of the patients who attended hospital follow-up sessions and/or self-help group meetings. But we noted no other statistically significant difference between groups I and II in any of the other two subgroups of discharged patients or in any of the treatment outcome variables. In group I in the series of new patients, 49% of the patients who lived with their spouse and/or significant other attended hospital follow-up sessions and/or self-help group meetings, and 41% of them showed abstinence. In group I in the series of all patients, 49% of inpatients who lived with their spouse and/or significant other attended hospital follow-up sessions and/or self-help group meetings, and 40% of them showed abstinence. We grant that the current study was not conducted in a random patient assignment design and, therefore, needs to be interpreted with some caution. Further research is appropriate.     

Alcohol dependence syndrome and Before-Discharge Intervention Method (BDIM)--No. 5. Patients' evaluation of BDIM by questionnaire survey]

One (A.I) of the authors has developed BDIM (Before-Discharge Intervention Method) for the purpose of making alcoholics aware of their drinking problems. 153 patients were treated by BDIM. After the practiced BDIM, the patients underwent a 52 month observational period. 82 patients (53.6%) continued with either treatment as outpatient or inpatients, or attendance of a self-help group. We administered these 82 patients our questionnaire that asked for their assessment about the therapeutic effects of BDIM. 76 patients (49.7%) completed our questionnaire. Regarding the impression of family members' letters in BDIM, 70 patients (92.1% of 76) answered that the letter have had a positive impression on them. 52 patients (68.4% of 76) answered that they have had very strong or strong impressions. The numbers of patients who have [very strong or strong] impression are significantly more in the abstinence group than in the drinking group. Also, we asked patients about which messages of spouses, daughters and sons in BDIM gave the strongest impression to these patients. The result showed that their daughter gave the strongest impression to many patients. We believe that their children, especially the patients' daughter's messages, have therapeutic effects as impact messages even though alcoholics have cognitive or memory disorder. Patients positively assessed that BDIM strengthened motivation for treatment or attendance of self-help group meetings, for abstinence and for the consequence to their lives. Many patients assessed that BDIM has effect on awareness of their drinking problems. But the ratio of positive answers about motivation of awareness of drinking problem is smaller than the ratio of positive answers about other questions. As a result, we surmised that BDIM will have the effect of empowerment, including the effect of awareness.     

Alcoholism and family interaction

In 16 families, half of which had an alcoholic parent, both parents and an adolescent were videotaped interacting with each other. Mothers, fathers and the adolescent in each family viewed the videotaped interaction and completed ratings of themselves and the other two family members on levels of anxiety, involvement, dominance and friendliness. In families with an alcoholic parent, adolescents and their mothers rated family members as less anxious than did adolescents and mothers in families without a drinking problem. Also mothers in the alcoholic families rated family members as being more involved, and their ratings were higher than mothers in other families. Alcoholic families rated parent-adolescent interactions as more dominant and friendlier. At least in these videotaped interactions where alcohol was not being consumed, mothers in alcoholic families adopted a more positive view of family members than mothers in other families. In addition, possibly due to the efforts of fathers not to drink and memories of interactions when he was drunk, alcoholic families perceived their family interactions as more dominant and friendlier than families without an alcohol-related problem.     

Young people's awareness of illicit drug use in the family

A sample of Scottish schoolchildren aged 14–15 (N = 1240) were asked a series of questions regarding their knowledge and experience of illicit drugs. They were asked to report on personal lifetime drug use and whether they knew of any family member who had ever used drugs. More than four in ten respondents admitted to having used an illegal drug, with a similar number admitting to awareness of drug use by another family member. There was a strong statistical relationship between respondents’ own use and drug use by all types of family members. However, although respondents who reported using drugs themselves were more likely to nominate other drug users in their family, only a small minority of respondents stated that a family member initiated them into drug use and few stated that they were aware of any problematic use. Although prior drug use by family members may not directly lead to use by young people, these data indicate that illegal drug use tends to cluster within families.     

Cross-pharmacology analysis of G protein-coupled receptors

The degree of applicability of chemogenomic approaches to protein families depends on the accuracy and completeness of pharmacological data and the corresponding level of pharmacological similarity observed among their protein members. The recent public domain availability of pharmacological data for thousands of small molecules on 204 G protein-coupled receptors (GPCRs) provides a firm basis for an in-depth cross-pharmacology analysis of this superfamily. The number of protein targets included in the cross-pharmacology profile of the different GPCRs changes significantly upon varying the ligand similarity and binding affinity criteria. However, with the exception of muscarinic receptors, aminergic GPCRs distinguish themselves from the rest of the members in the family by their remarkably high levels of pharmacological similarity among them. Clusters of non-GPCR targets related by cross-pharmacology with particular GPCRs are identified and the implications for unwanted side-effects, as well as for repurposing opportunities, discussed.     

患者及其家属对临床药师与药学服务认知和需求情况调查研究

目的：了解患者及其家属对临床药师与药学服务的认知和需求情况,为临床药师职业健康发展和药学服务工作深入开展提供参考。方法：以问卷调查形式,采用分类随机抽样法对在上海市30家三级医院就医的患者及家属进行实地问卷调查,并对调查结果进行统计分析。结果：患者及其家属对临床药师与药学服务认知不足,47.98%的患者和家属不知道临床药师;56.56%的患者和家属不知道临床药师与药房药师的区别;91.92%的患者和家属在遇到用药问题时,希望得到药师的专业帮助;90.41%的患者及其家属在住院时希望临床药师前来关心用药情况,提供药学监护;超过90%的患者及其家属欢迎、支持临床药师下临床,开展药学服务,并认为这样有助于疾病的治疗。结论：应通过加强宣传、推进临床药师制建设等措施提高患者及其家属对临床药师与药学服务的认知,并通过提高临床药师的药学服务质量和水平来满足公众不断增长的健康服务需求。     

结核病患者及家属疾病危害认知与自我防护现状的调查分析

目的了解初诊居家治疗的结核病患者及其家属的现有疾病危害认知水平和自我防护现状,为结防工作者制定宣传计划提供依据。方法 2009年1月3日-2010年3月31日采用自编问卷形式对在枣庄市王开传染病医院结防门诊确诊的结核病患者及其家属3100例回访调查。内容涉及结核病患者及其家属基本情况、结核病疾病知识知晓现状和结核病的知、信、行。结果结核病患者及家属疾病认知水平偏低。结论结防工作者须加强对农村居民、流动人口的结核病健康宣传频率和力度,控制传染源,更好地保护易感者。     

Approval Need in Self-Reports of Addicts and Family Members

Ample evidence documents the tendency of research subjects to attribute to themselves socially desirable traits and to deny having socially undesirable qualities. This tendency is particularly marked among subjects who are defensive, lacking in self-esteem, or sensitive to status differences. Drug addicts often have all of these characteristics. This paper examines the extent to which need for social approval is reflected in methadone patients' and family members' self-reports of personal and family functioning. Results demonstrate the importance of taking the approval motive into account when conducting research with this population. Addicts tend to deny negative things about themselves and their families, while family members tend to exaggerate their own and their families' positive qualities. Implications for drug treatment programs and researchers are discussed.     

Trichiasis among close relatives, central Ethiopia

Active trachoma is known to cluster in close contacts, such as mother and child and between siblings, but we do not know the pattern for trichiasis. This cross-sectional study was conducted to determine if there is as much trichiasis as active trachoma within families having close contact. This information will be helpful in designing intervention strategies. Trichiasis patients that presented for surgery were interviewed for the presence or absence of trichiasis in the current nuclear family, their parent/s, brother/s, sister/s, aunt/s or uncle/s. Of the 739 trichiasis patients interviewed, 78% were women. Fourteen percent of trichiasis cases had at least one nuclear family member with the same condition, and 20.0% had other relative/s (parent/s, brother/ s, sister/s, aunt/s or uncle/s) with trichiasis. Trichiasis increases in parallel with the increase in family size of the index case (c2 for trend = 70.6; P < 0.001). Sixty-nine percent of affected nuclear family members of the index cases were female members. In the relative with trichiasis, 92.8% of cases were parents, sisters and brothers of the index cases. Out of these, the majority (70%) were mothers and sisters. The chance of a female trichiasis patient having another relative with trichiasis is 70%. The chance of the mother/sister/s of a male trichiasis patient being trichiasis patients themselves is 80%, while that of the father/brother/s is 20% (c2=21.88; P < 0.001). If a female has trichiasis there is a 70% chance of her mother/sister/s, and 30% chance of the father/ brother/s (c2 = 27.52; P <0.001) also being trichiasis patients.     

Professionals' evaluation of the '5-step method' for helping family members of substance misusers in the context of the Italian Health Services

Background: A feasibility study of an intervention aimed at helping and supporting family members, affected by a relative's alcohol or drug problems, was undertaken in an Italian health services context.

Aims: To assess professionals' (Italian general practitioners and community addiction staff) views about the usefulness and applicability of a 5-step intervention for helping family members affected by someone else's substance-misuse problems.

Method: Analysis of professionals' written reports following each of 52 interventions, plus analysis of focus-group discussions with these professionals.

Findings: Forty-one professionals within southern Italy (18 Italian GPs and 23 community addiction staff) were trained and 23 of them (10 and 13 respectively) went on to recruit at least one affected family member and undertake an intervention with them. These 23 staff worked with 52 affected family members (mean, 2.3 treatments/professional). Analysis of the staff-completed intervention reports following each intervention, and of focus-group discussions with the professionals, showed that professionals rated the interventions as being effective and helpful, especially the giving of space to individual family members to discuss their problems in relation to their relative's alcohol or drug dependence. Many positive changes were noticed in families being helped, as well as some difficulties being reported by the professionals related to them using this method. A number of differences between staff from different settings were found, with community addiction service staff being more likely to consider that this intervention would be easy to incorporate into routine practice, and with Italian GPs finding the focus on the family members (as opposed to the substance misusing relative) to be more problematic.

Conclusions: The large majority (79%) of professionals from both services stated that they were planning on utilizing the 5-step intervention again. It may be feasible to implement this intervention more widely within Italy.     

Activation of ATP-dependent potassium channels is a trigger but not a mediator of ischaemic preconditioning in pigs

1. Activation of ATP-dependent potassium channels (K(ATP)) is involved in ischaemic preconditioning (IP). In isolated buffer-perfused rabbit hearts, activation of mitochondrial K(ATP)--through a generation of free radicals--acted as a trigger rather than a mediator of IP; the isolated buffer-perfused heart preparation, however, favours free radical generation. In contrast, in vivo studies in rats and dogs suggested that activation of K(ATP) acts as a mediator of IP's protection. A detailed analysis on the role of K(ATP) in IP's protection in vivo by varying the time and dose of K(ATP) blocker administration is, however, lacking. 2. In 54 enflurane-anaesthetized pigs, the left anterior descending coronary artery was perfused by an extracorporeal circuit. Infarct size (IS, %, TTC) following 90 min sustained low-flow ischaemia and 120 min reperfusion was 26.6+/-3.5 (s.e.m.) (n=8). IP with one cycle of 10 min ischaemia and 15 min reperfusion reduced IS to 6.5+/-2.1 (n=7, P<0.05). Blockade of K(ATP) with glibenclamide (0.5 mg kg(-1) i.v., 50 microg min(-1) continuous infusion) starting 10 min before or immediately following the preconditioning ischaemia abolished IS reduction by IP (20.7+/-2.7, n=7 and 21.9+/-6.6, n=6, respectively) while having no effect on IS per se (22.2+/-5.2, n=7), supporting a trigger role of K(ATP) in IP. In contrast, starting glibenclamide following the preconditioning ischaemia 10 min prior to the sustained ischaemia did not prevent IS reduction by IP (3.7+/-2.3, n=6), even when its bolus dose was increased to 1.5 mg kg(-1) (26.6+/-3.8 with IP vs 37.5+/-2.9 without IP; n=7 and 6 respectively, P<0.05), thereby refuting a mediator role of K(ATP) in IP. 3. In conclusion, activation of K(ATP) in the immediate reperfusion following the preconditioning ischaemia is pivotal for triggering IP.     

Identifiable semen donors--attitudes of donors and recipient couples.

Fifty-three couples embarking on donor insemination (DI) replied to an anonymous questionnaire asking what they wanted to know about the donor should they become pregnant. Fifty-one percent were definitely and 32% probably going to tell a child of its donor origins. Items most frequently listed for themselves and on behalf of a child were--interests/sports (57%), physical attributes (41%), occupation (37%) and family background (26%). Forty-two percent of the women and 28% of the men thought the child should have access to the identity of the donor eventually. Thirty-eight donors were surveyed by a questionnaire; 68% were agreeable to their identity being available to a donor insemination child when the child reached maturity. When the category of identifiable donor was created, 20 of 36 (56%) new donors and donors still donating chose this option.     

Mental health and family relations among people who inject drugs and their family members in Vietnam

BackgroundThis article explores the association of people who inject drugs and their family members in terms of mental health and family relations. The objective was to understand the family context and its impact on people who inject drugs in a family-oriented culture in Vietnam.MethodsCross-sectional assessment data were gathered from 83 people who inject drugs and 83 of their family members recruited from four communes in Phú Th? province, Vietnam. Depressive symptoms and family relations were measured for both people who inject drugs and family members. Internalized shame and drug-using behavior were reported by people who inject drugs, and caregiver burden was reported by family members.ResultsWe found that higher level of drug using behavior of people who inject drugs was significantly associated with higher depressive symptoms and lower family relations reported by themselves as well as their family members. Family relations reported by people who inject drugs and their family members were positively correlated.ConclusionThe findings highlight the need for interventions that address psychological distress and the related challenges faced by family members of people who inject drugs. The article has policy implication which concludes with an argument for developing strategies that enhance the role of families in supporting behavioral change among people who inject drugs.     

The problems of dual-diagnosis patients and the value of integrated therapy: a look at the effectiveness of group therapy methods for dually diagnosed patients]

In order to compare the prevalence and problems of dual- diagnosis patients in Japan with those in other countries, previous studies are reviewed in this article. Following this, our investigation into the prevalence and situations of severe psychiatric patients with co-occurring substance abuse/dependence at Narimasu-kousei hospital is described. In addition, this discussion necessitates a review of integrated therapy, which is especially recommended for dually diagnosed patients. Finally, the group therapies conducted in our hospital employing integrated therapy for dually diagnosed patients are illustrated, examining the effectiveness of the methods. OBJECTIVE: Dually diagnosed inpatients in the chronic psychiatric ward at Narimasu-kousei Hospital. METHODS: (1) A small, short-term group therapy for two alcoholics with co-morbid other psychiatric disorders were conducted to give them individualized psycho-educational intervention and opportunities for mutual support. (2) Five dually diagnosed inpatients were introduced to an AA 12 step group running in the hospital through motivational interviewing to improve their knowledge of alcohol dependency. RESULTS: Patients have gained a degree of perception and recognition regarding their alcohol dependency and have decided to stop drinking. They have also shown some degree of recognition and realization concerning the anger felt by their family members towards them. Some patients have convinced family members through the improvements in their attitude to help in having them discharged from the hospital. CONCLUSION: Group therapy is an effective treatment method for dually diagnosed patients when considerations of their needs and limitations are taken into account.     

Religiosity as a Protective Factor Against the Use of Drugs

Although many studies have suggested that risk and protective factors are related to the use of drugs, their role has not been given due importance. More attention to protective factors could make them a fundamental tool in prevention programs. Since low socioeconomic level and adolescence are known as risk factors, the aim of this study was to identify which factors would prevent Brazilian adolescents from low-income families from using drugs. A qualitative method and an intentional sample selected by criteria were adopted for this investigation. During 2003, sixty-two youngsters, ages 16 to 24 years old, 30 drug users, and 32 nonusers were administered a semistructured interview. The subjects perceived family and religiosity as important protective factors in their lives. With regard to religiosity, 81% of nonusers believed in and practiced a religion, whereas only 13% of users considered themselves as being religious. The belief in and practice of a religion were also more evident among family members of nonusers (74%) than those of users (33%). These results indicated that religion may be a relevant protective factor for the sample studied, helping the family unit in keeping youth away from drugs. The study's limitations were noted.     

Religiosity as a protective factor against the use of drugs

Although many studies have suggested that risk and protective factors are related to the use of drugs, their role has not been given due importance. More attention to protective factors could make them a fundamental tool in prevention programs. Since low socioeconomic level and adolescence are known as risk factors, the aim of this study was to identify which factors would prevent Brazilian adolescents from low-income families from using drugs. A qualitative method and an intentional sample selected by criteria were adopted for this investigation. During 2003, sixty-two youngsters, ages 16 to 24 years old, 30 drug users, and 32 nonusers were administered a semistructured interview. The subjects perceived family and religiosity as important protective factors in their lives. With regard to religiosity, 81% of nonusers believed in and practiced a religion, whereas only 13% of users considered themselves as being religious. The belief in and practice of a religion were also more evident among family members of nonusers (74%) than those of users (33%). These results indicated that religion may be a relevant protective factor for the sample studied, helping the family unit in keeping youth away from drugs. The study's limitations were noted.     

Mental health and emotional relationships of family members whose relatives have drug problems

The presence of a drug abuser in a family can seriously affect the family's mental health and relationships. This study focuses on the stress of families of drug abusers, relationships, and their relevant factors, as well as examines ways to support them. The subjects of this study were family members of drug abusers treated at drug abuser family support groups, medical institutions, or municipal mental health and welfare centers. To these institutions, 1,298 questionnaires were sent, and 543 responses with sufficient data were used for analysis. The survey consisted of the 12-item General Health Questionnaire (GHQ-12), and questionnaire items regarding disruptions to family life, relationship with drug users, and the use of family support services. The survey results showed that the mean GHQ score was 4.5, and those whose score are cut-off 3 and more, indicating poor mental health accounted for 54.7%. More than half of the subjects responded that drug problems have affected family members in terms of the health condition, daily living, and financial problems. Regarding emotional relationships with the addicts, most of the families answered that they have had negative feelings toward them, such as "being dragged into drug problems" and "being over-protective". A significant correlation was observed between the GHQ score and family members' relationship with the addict, and these variables were closely correlated with participation in the family group, the status of drug abstinence, living environment, and participation in a self-support group by the addict. As the results, most of the family members of drug users have problems with mental health and the recovery of relationships even though they have accessed support centers, and it was verified that the family support group works effectively to help solve their problems.     

Death by drug overdose: impact on families

Death by overdose is loaded with social/moral stigmas, in addition to strong feelings of anger, helplessness, guilt and shame in the families. The objective of this study was to analyze the impact of these feelings on families facing death by overdose. Qualitative methodology was used to study six families with a history of death by overdose of one of their members. The interview was open, and guided by the question "What did you feel with the death of your family member by overdose and what was the impact of this death on your family as a whole?" The families were grouped into two categories: families who knew about the drug use of their family member, and families who were not aware of it. The reports show that secrecy regarding drug use followed by death by overdose arouses feelings of anger, guilt, helplessness, and deprives the family members of information that could allow them to take action. As regards families that were aware of the drug use, there seems to be a "veiled preparation" for a possible death by overdose, bringing about ambivalent situations of grief and relief. The report stresses how disturbing it is to lose a family member by overdose, and points to the need for psychological support for those families.