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《英国医生杂志》
Family history and mental illness increase likelihood of relapse among health professionals recovering from addiction
Between 1991 and 2001, 300 health professionals recovering from drug or alcohol addiction enrolled in the Washington Physicians Health Programme for post-treatment monitoring. A quarter of them eventually relapsed (74/292). Analysis of 11 years of patient data from the programme showed that risk of relapse was increased among professionals with coexisting mental illness (hazard ratio 2.25, 95% CI 1.23 to 4.11) or a family history of addiction (2.25, 1.44 to 3.64). Those who used a major opioid such as fentanyl were also more likely to relapse, but only if they also had a coexisting mental illness (5.79, 2.89 to 11.42) (figure). One relapse increased the risk of another (1.69, 1.13 to 2.53).
Credit: JAMA
All health professionals who stayed in the programme for more than five years without relapsing returned to work. So did 61% (31/51) of those who relapsed. The study's authors are careful not to generalise about who should be allowed back to work, but they do suggest that health professionals with a family history of addiction, mental illness, addiction to opioids, or a previous relapse should be monitored more intensively and for longer than the rest.
JAMA 2005;293: 1453-60
Situation still critical for refugees in Darfur
The displaced population in the South Darfur region of Sudan remains seriously malnourished and vulnerable to diarrhoea, measles, and death from violence, according to a survey done in late summer last year. The survey, which included nearly half of the displaced population in South Darfur (190 000 people) found death rates of 2.0-3.2 per 10 000 people a day. That is more than twice the regional average and above the international threshold that defines an emergency. Death rates in children aged under 5 were even higher (1.0-5.9 deaths per 10 000 a day) and mainly due to diarrhoea, although the authors say that measles and malnutrition were also contributors. A substantial minority of families still had no access to clean water or toilets at the time of the survey. Food distribution and measles immunisation were erratic.
Across the region, between 7% and 72% of adult deaths were due to violence. In the worst affected area, Muhajiria, all but one of the people killed were young men, and security here continues to deteriorate. Measles is one of the biggest threats in other parts of South Darfur, say the authors, not least because catch-up immunisations have been vetoed by the local authorities.
JAMA 2005;293: 1490-4
Thyroxine plus liothyronine is no better than thyroxine alone for hypothyroid women
Thyroxine is an effective treatment for hypothyroidism, but it isn't strictly physiological because the human thyroid secretes triiodothyronine too. Trials of thyroid replacement that include liothyronine (triiodothyronine substitution) have had inconsistent but largely disappointing results. Researchers from Spain tried again recently with a small but careful crossover trial in 28 women with symptomatic hypothyroidism who had been taking thyroxine successfully for at least a year.
The trial compared thyroxine alone with a physiological combination of thyroxine and liothyronine. The women were randomised to take one treatment followed by the other in two eight week treatment periods. They all took a higher dose of the combination treatment for the final eight weeks of the trial. In general, patients preferred the physiological combination to thyroxine alone, but a battery of tests evaluating clinical, cognitive, psychological, biochemical, and quality of life outcomes failed to find any important differences between the treatments.
The researchers say their study had 80% power to detect a benefit from combination treatment if there was one, and conclude that there probably isn't. Five of the previous six studies evaluating liothyronine combinations were also negative.
Annals of Internal Medicine 2005;142: 412-24
New injection facility reduces risky behaviour among drug users in Vancouver
A clinic that provides drug users with clean needles, syringes, and a safe place to inject could substantially reduce syringe sharing, according to a recent study. The clinic, North America's first medically supervised safer injection facility, opened in Vancouver in 2003. Analysis of data from a cohort of 431 active injecting drug users in the area found that, once the clinic had opened, those who used it were 70% less likely to report sharing syringes than drug users who didn't (odds ratio 0.30, 95% CI 0.11 to 0.82). The two groups, part of a continuing prospective cohort study, had reported about the same amount of syringe sharing just before the clinic opened.
Although the study is only a snapshot of risk taking behaviour in a non-random sample of local drug users, the authors are fairly confident that the clinic made a real difference. It is impossible to say for certain, but, since randomised trials would be unethical, these kind of observations may be the best we can hope for. At the very least, they will help inform the ongoing debate in Europe and elsewhere about the impact of safer injection services on drug users and the communities they live in.
Between 1991 and 2001, 300 health professionals recovering from drug or alcohol addiction enrolled in the Washington Physicians Health Programme for post-treatment monitoring. A quarter of them eventually relapsed (74/292). Analysis of 11 years of patient data from the programme showed that risk of relapse was increased among professionals with coexisting mental illness (hazard ratio 2.25, 95% CI 1.23 to 4.11) or a family history of addiction (2.25, 1.44 to 3.64). Those who used a major opioid such as fentanyl were also more likely to relapse, but only if they also had a coexisting mental illness (5.79, 2.89 to 11.42) (figure). One relapse increased the risk of another (1.69, 1.13 to 2.53).
Credit: JAMA
All health professionals who stayed in the programme for more than five years without relapsing returned to work. So did 61% (31/51) of those who relapsed. The study's authors are careful not to generalise about who should be allowed back to work, but they do suggest that health professionals with a family history of addiction, mental illness, addiction to opioids, or a previous relapse should be monitored more intensively and for longer than the rest.
JAMA 2005;293: 1453-60
Situation still critical for refugees in Darfur
The displaced population in the South Darfur region of Sudan remains seriously malnourished and vulnerable to diarrhoea, measles, and death from violence, according to a survey done in late summer last year. The survey, which included nearly half of the displaced population in South Darfur (190 000 people) found death rates of 2.0-3.2 per 10 000 people a day. That is more than twice the regional average and above the international threshold that defines an emergency. Death rates in children aged under 5 were even higher (1.0-5.9 deaths per 10 000 a day) and mainly due to diarrhoea, although the authors say that measles and malnutrition were also contributors. A substantial minority of families still had no access to clean water or toilets at the time of the survey. Food distribution and measles immunisation were erratic.
Across the region, between 7% and 72% of adult deaths were due to violence. In the worst affected area, Muhajiria, all but one of the people killed were young men, and security here continues to deteriorate. Measles is one of the biggest threats in other parts of South Darfur, say the authors, not least because catch-up immunisations have been vetoed by the local authorities.
JAMA 2005;293: 1490-4
Thyroxine plus liothyronine is no better than thyroxine alone for hypothyroid women
Thyroxine is an effective treatment for hypothyroidism, but it isn't strictly physiological because the human thyroid secretes triiodothyronine too. Trials of thyroid replacement that include liothyronine (triiodothyronine substitution) have had inconsistent but largely disappointing results. Researchers from Spain tried again recently with a small but careful crossover trial in 28 women with symptomatic hypothyroidism who had been taking thyroxine successfully for at least a year.
The trial compared thyroxine alone with a physiological combination of thyroxine and liothyronine. The women were randomised to take one treatment followed by the other in two eight week treatment periods. They all took a higher dose of the combination treatment for the final eight weeks of the trial. In general, patients preferred the physiological combination to thyroxine alone, but a battery of tests evaluating clinical, cognitive, psychological, biochemical, and quality of life outcomes failed to find any important differences between the treatments.
The researchers say their study had 80% power to detect a benefit from combination treatment if there was one, and conclude that there probably isn't. Five of the previous six studies evaluating liothyronine combinations were also negative.
Annals of Internal Medicine 2005;142: 412-24
New injection facility reduces risky behaviour among drug users in Vancouver
A clinic that provides drug users with clean needles, syringes, and a safe place to inject could substantially reduce syringe sharing, according to a recent study. The clinic, North America's first medically supervised safer injection facility, opened in Vancouver in 2003. Analysis of data from a cohort of 431 active injecting drug users in the area found that, once the clinic had opened, those who used it were 70% less likely to report sharing syringes than drug users who didn't (odds ratio 0.30, 95% CI 0.11 to 0.82). The two groups, part of a continuing prospective cohort study, had reported about the same amount of syringe sharing just before the clinic opened.
Although the study is only a snapshot of risk taking behaviour in a non-random sample of local drug users, the authors are fairly confident that the clinic made a real difference. It is impossible to say for certain, but, since randomised trials would be unethical, these kind of observations may be the best we can hope for. At the very least, they will help inform the ongoing debate in Europe and elsewhere about the impact of safer injection services on drug users and the communities they live in.