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#64
10.07.2005, 14:41
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А мне вот интересно, как у коллег обстоят дела с финансированием этих самых школ гипертоников, диабетиков и пр. У нас функционирует школа для больных СД в рамках диабет-центра при ОКБ. А вот с ИБС и АГ как то не очень
 Один энтузиаст с гипертониками занимается, но... как бы помягче выразиться... по принципу самоокупаемости этой школы, что ли...
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#65
11.07.2005, 14:19
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А вот, кстати, еще одна интересная новость про АГ из последнего BMJ:
[Ссылки доступны только зарегистрированным пользователям ] Оказывается, осмотр глазного дна не шибко то и нужен гипертоникам. А мы то со своими очередями к окулисту... Или только в моем болоте очереди? Но во всяком случае без глазного дна у нас гипертонию выписывать запрещается
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#66
09.08.2005, 22:05
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Adherence to Medication
Lars Osterberg, M.D., and Terrence Blaschke, M.D. N Engl J Med 2005;353:487-97. Drugs don’t work in patients who don’t take them. — C. Everett Koop, M.D. "Methods that can be used to improve adherence can be grouped into four general categories: patient education; improved dosing schedules; increased hours when the clinic is open (including evening hours), and therefore shorter wait times;and improved communication between physicians and patients." "Conclusion: Poor adherence to medication regimens is common, contributing to substantial worsening of disease, death, and increased health care costs. Practitioners should always look for poor adherence and can enhance adherence by emphasizing the value of a patient’s regimen, making the regimen simple, and customizing the regimen to the patient’s lifestyle. Asking patients nonjudgmentally about medication-taking behavior is a practical strategy for identifying poor adherence. A collaborative approach to care augments adherence. Patients who have difficulty maintaining adequate adherence need more intensive strategies than do patients who have less difficulty with adherence, a more forgiving medication regimen, or both. Innovative methods of managing chronic diseases have had some success in improving adherence when a regimen has been difficult to follow (99,125-127) New technologies such as reminders through cell phones and personal digital assistants and pillboxes with paging systems may be needed to help patients who have the most difficulty meeting the goals of a regimen. [Ссылки доступны только зарегистрированным пользователям ]
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#67
13.08.2005, 23:51
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Цитата:
 Да, ещё один любопытный факт...На одной из конференций приводились данные, что у пациентов, регулярно принимавших АСС + антигипертензивную терапию статистически значимо уменьшался риск сосудистых катастров (инфакт, инсульт), но увеличивалась смертность от онко заболеваний... Я не слышал о рандомизированных мультицентровых двойных слепых и т.д. по этому поводу и, разумеется, никак не намекаю на то, что не нужно лечить АГ. Просто повод для размышления, так сказать, для общей эрудиции....
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#68
14.08.2005, 11:54
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Уважаемый Антон Владимирович,
по поводу "благоприятного" действия алкоголя недавно приводил полнотекстовые материалы http://forums.rusmedserv.com/showthread.php?t=15459 По поводу осложнений и дозы алкоголя работ поменьше, но вот попалась одна в полном тексте: There was a strong relationship between long-term alcohol intake and chronic gastritis, gastrointestinal bleeding, pancreatitis, withdrawal seizures, delirium, polyneuropathy, and severe brain injury. Alcoholics with none of these disorders had an estimated life-time alcohol consumption of 4.9 ± 10.0 kg alcohol/kg body weight, those subjects with one alcohol-related disorder had drunk 6.0 ± 6.9 kg/kg, those suffering from two disorders 6.8 ± 8.9 kg/kg, and the most affected alcoholics (having three or more disorders) 12.9 ± 13.9 kg/kg (Scheffé-test, P < 0.05). то есть тот же дозозависимый эффект. Wetterling T, и соавт. Drinking pattern and alcohol-related medical disorders.Alcohol Alcohol. 1999 May-Jun;34(3):330-6. [Ссылки доступны только зарегистрированным пользователям ] Не скажу за назначение аспирина у гипертоников и связи с опухолевой смертности, но проспективные данные и даже отдельные долгосрочные рандомизированные такой связи не отмечают, напр.: Anticancer Res. 2004 Sep-Oct;24(5B):3177-84. Aspirin use and mortality from cancer in a prospective cohort study. Ratnasinghe LD, Graubard BI, Kahle L, Tangrea JA, Taylor PR, Hawk E. Division of Molecular Epidemiology, NCTR, Food and Drug Administration, Jefferson, Arkansas 72079, USA. There is evidence that use of aspirin offers several potential health benefits including cancer prevention and cardiovascular disease prevention. The purpose of this study was to assess the association between aspirin use and death from cancer and cardiovascular diseases with a special emphasis on cancer mortality. MATERIALS AND METHODS: The baseline data for this prospective cohort study were collected in 1971--1975 for the first National Health and Nutrition Examination Study (NHANES I) and 1976--1980 as part of the second NHANES (NHANES II) with mortality follow-up using the National Death Index (NDI) through December 31, 1992. The main analyses were the relative risks of total mortality and cause-specific mortality for persons who used aspirin compared to persons who did not use aspirin adjusted for confounding using Cox proportional hazards. RESULTS: The proportion of aspirin users was lower among cancer cases than non-cases (58% versus 66%) and use of aspirin decreased with age. Consequently, age was a negative confounder attenuating the protective association between aspirin use and cancer and cardiovascular mortality. After adjusting for age, BMI, sex, race, poverty index, education and smoking, we observed a significant association of reduced all cause mortality among all aspirin users (relative risk [RR] = 0.88; 95% confidence interval [CI] 0.85 - 0.99) and lung cancer mortality among male aspirin users (RR = 0.69; CI 0.49-0.96). However, for women we observed adverse associations between aspirin use and bladder (RR=12.31; CI 2.98-50.80) and brain cancer mortality (RR=3.13; CI 1.09-9.00), although case numbers were small. ------------------------------ JAMA. 2005 Jul 6;294(1):47-55. Low-dose aspirin in the primary prevention of cancer: the Women's Health Study: a randomized controlled trial. Cook NR, Lee IM, Gaziano JM, Gordon D, Ridker PM, Manson JE, Hennekens CH, Buring JE. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA. CONTEXT: Basic research and observational evidence as well as results from trials of colon polyp recurrence suggest a role for aspirin in the chemoprevention of cancer. OBJECTIVE: To examine the effect of aspirin on the risk of cancer among healthy women. DESIGN, SETTING, AND PARTICIPANTS: In the Women's Health Study, a randomized 2 x 2 factorial trial of aspirin and vitamin E conducted between September 1992 and March 2004, 39 876 US women aged at least 45 years and initially without previous history of cancer, cardiovascular disease, or other major chronic illness were randomly assigned to receive either aspirin or aspirin placebo and followed up for an average of 10.1 years. INTERVENTION: A dose of 100 mg of aspirin (n=19 934) or aspirin placebo (n=19 942) administered every other day. MAIN OUTCOME MEASURES: Confirmed newly diagnosed invasive cancer at any site, except for nonmelanoma skin cancer. Incidence of breast, colorectal, and lung cancer were secondary end points. RESULTS: No effect of aspirin was observed on total cancer (n = 2865; relative risk [RR], 1.01; 95% confidence interval [CI], 0.94-1.08; P = .87), breast cancer (n = 1230; RR, 0.98; 95% CI, 0.87-1.09; P = .68), colorectal cancer (n = 269; RR, 0.97; 95% CI, 0.77-1.24; P = .83), or cancer of any other site, with the exception of lung cancer for which there was a trend toward reduction in risk (n = 205; RR, 0.78; 95% CI, 0.59-1.03; P = .08). There was also no reduction in cancer mortality either overall (n = 583; RR, 0.95; 95% CI, 0.81-1.11; P = .51) or by site, except for lung cancer mortality (n = 140; RR, 0.70; 95% CI, 0.50-0.99; P = .04). В целом, достаточно много материалов об эпидемиологии аспирина (НПВС) и риска опухолей: Baron JA. Epidemiology of non-steroidal anti-inflammatory drugs and cancer.Prog Exp Tumor Res. 2003;37:1-24. Rao CV, Reddy BS. NSAIDs and chemoprevention. Curr Cancer Drug Targets. 2004 Feb;4(1):29-42.
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