RESUMEN
OBJECTIVES: The purpose of this study was to identify the optimal dose of osmotic release oral system methylphenidate (OROS-MPH) using a dosage forced-titration scheme to achieve symptomatic remission in children with attention- deficit/hyperactivity disorder (ADHD). We also evaluated the efficacy and safety of, and patient and parent satisfaction with, the change in therapy from immediate-release methylphenidate (IR-MPH) to OROS-MPH over 10 weeks. METHOD: We recruited 521 children and adolescents aged 6-18 years with an American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) diagnosis of ADHD, who had received IR-MPH treatments (<70 mg/day) for at least 1 month. The treatment, switched from IR-MPH to OROS-MPH according to a conversion scheme, started with a 6-week forced-titration phase of OROS-MPH to achieve symptomatic remission (defined as a score of 0 or 1 for each of the first 18 ADHD items in the Chinese version of the Swanson, Nolan, and Pelham, Version IV [SNAP-IV]), followed by a 4-week maintenance phase. The global ADHD severity and drug side effects of the participants were evaluated. Parents completed the ratings scales for the ADHD-related symptoms. Patient and parent satisfaction for the OROS-MPH treatment was also assessed. RESULTS: Among the 439 participants with ADHD who completed the trial, 290 participants (66.1%) achieved symptomatic remission. The mean dose of OROS-MPH among participants in remission was 36.7 mg (1.08 mg/kg) per day. Increased efficacy, superior satisfaction, and safety equivalent to that of IR-MPH were demonstrated in intra-individual comparisons from the baseline to the end of study. Determinants for remission included less severe ADHD symptoms (SNAP-IV score < 40), no family history of ADHD, and an appropriate dosage of medication according to the patient's weight. CONCLUSIONS: The findings suggest remission as a treatment goal for ADHD therapy by providing an optimal dosage of medication for children and adolescents with ADHD through using an effective and tolerable forced-titration scheme.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Estimulantes del Sistema Nervioso Central/uso terapéutico , Metilfenidato/uso terapéutico , Administración Oral , Adolescente , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Estimulantes del Sistema Nervioso Central/administración & dosificación , Estimulantes del Sistema Nervioso Central/efectos adversos , Niño , Preparaciones de Acción Retardada , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Masculino , Metilfenidato/administración & dosificación , Metilfenidato/efectos adversos , Presión Osmótica , Padres/psicología , Satisfacción del Paciente , Estudios Prospectivos , Inducción de Remisión , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
AIM: To determine the differences in the remission rate, recovery rate, functional improvement, and treatment adherence related to treatment with short-acting immediate-release methylphenidate (IR-MPH) and long-acting osmotic-release oral system-methylphenidate (OROS-MPH) in a naturalistic setting among Taiwanese children with attention-deficit-hyperactivity disorder (ADHD). METHODS: A total of 757 children with ADHD, aged 6-18 years, was evaluated using the following in order determine functional improvement and treatment adherence: the Chinese version of the Swanson, Nolan, and Pelham, version IV scale (SNAP-IV-C), Clinical Global Impression-ADHD-Severity (CGI-S) to measure remission and recovery rates, the Chinese version of the Social Adjustment Inventory for Children and Adolescents (CSAICA), and caregiver's satisfaction rate, treatment adherence, and frequency of adverse effects. RESULTS: According to the SNAP-IV-C scores, the remission rate was 30.72%, and the recovery rate was 16.38%. Compared to short-acting IR-MPH, OROS-MPH was associated with greater functional improvement and treatment adherence among children with ADHD. CONCLUSION: OROS-MPH treatment at the adequate dosage can achieve higher remission and recovery rates, produce greater functional improvement, and result in better treatment adherence than IR-MPH treatment.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Metilfenidato/uso terapéutico , Administración Oral , Adolescente , Niño , Preparaciones de Acción Retardada/uso terapéutico , Femenino , Humanos , Masculino , Cumplimiento de la Medicación/estadística & datos numéricos , Metilfenidato/administración & dosificación , Metilfenidato/efectos adversos , Metilfenidato/farmacocinética , Ósmosis , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Inducción de Remisión , TaiwánRESUMEN
OBJECTIVE: To evaluate the distribution of symptoms related to Yin deficiency syndrome (YDS), and to analyze the relationship between the severity of YDS and the function of the autonomic nervous system (ANS) in cancer patients. SETTING: Outpatient clinic in a teaching hospital in central Taiwan. SUBJECTS: Eighty (80) patients had been diagnosed with cancer by pathologic and clinical findings. METHOD: The severity of YDS in each subject was evaluated by a questionnaire consisting of 12 items concerning symptoms and signs related to YDS, scored from 1 to 4 points. OUTCOME MEASURES: The total score for all 12 items represented the severity of YDS. ANS function in each subject was evaluated by measuring heart rate variability (HRV), including time-frequency analysis. We coded the collected questionnaire material and performed statistical analysis (description analysis, ANOVA, and Pearson's correlation coefficients) using SPSS v.12.0 software. RESULTS: The highest total YDS score was 36 points and the lowest was 10 points. The 3 most common YDS signs were dry mouth (58.8%), sleeplessness with annoyance (56.3%), and flush over face in the afternoon (22.5%). The total YDS scores had a significantly positive correlation with heart rate (HR), but had significantly negative correlation with the standard deviation of the 5-minute mean R-R intervals (SDANN), total HRV power, power in the very low frequency band, and in the low frequency band. CONCLUSIONS: The above results suggest that the severity of YDS in cancer patients was associated with increased HR and decreased ANS activity. There is a possibility that the disturbance of ANS function may contribute to the occurrence of YDS in cancer patients.
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Sistema Nervioso Autónomo/fisiopatología , Frecuencia Cardíaca/fisiología , Neoplasias/fisiopatología , Deficiencia Yin/fisiopatología , Adulto , Anciano , Análisis de Varianza , Femenino , Rubor/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Índice de Severidad de la Enfermedad , Trastornos del Inicio y del Mantenimiento del Sueño/fisiopatología , Encuestas y Cuestionarios , Síndrome , Xerostomía/fisiopatología , Deficiencia Yin/complicacionesRESUMEN
AIMS: To determine factors for switching to osmotic release oral system methylphenidate (OROS-MPH) among poor adherents to immediate-release methylphenidate (IR-MPH); and to compare the efficacy of OROS-MPH on the three attention-deficit/hyperactivity disorder (ADHD) subtypes in a multi-site prospective observational study in Taiwan. METHODS: The sample included 240 children with ADHD, aged 6-16 years, who were poor adherents to IR-MPH, 137 of whom were switched to OROS-MPH. The child psychiatrists diagnosed the Diagnostic Statistical Manual of Mental Disorders (4th edition) ADHD subtypes and assessed the medical history, adherence, side-effects, global ADHD severity, and family/school effectiveness. Parents reported their child's behavioral symptoms. RESULTS: The determinants for an OROS-MPH switch were higher dosage, shorter treatment and thrice-daily administration of IR-MPH, and more severe inattention symptoms. Hyperactivity and oppositional symptoms were greater in the ADHD combined and hyperactive-impulsive subtypes than the inattentive subtype. Switching to OROS-MPH significantly improved behavioral symptoms and family/school measures, and this was most evident in the ADHD-combined group, followed by the ADHD-inattentive group. Inattention influenced not only academic performance, but also overall classroom behaviors and the parent-child relationship, with the latter two also influenced by oppositional symptoms. CONCLUSIONS: This study suggests better efficacy for the OROS-MPH among poor adherents to IR-MPH; however, its effectiveness varied across the three ADHD subtypes (ClinicalTrials.gov number NCT00460720).
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Estimulantes del Sistema Nervioso Central/administración & dosificación , Estimulantes del Sistema Nervioso Central/uso terapéutico , Metilfenidato/administración & dosificación , Metilfenidato/uso terapéutico , Cooperación del Paciente/psicología , Adolescente , Trastorno por Déficit de Atención con Hiperactividad/psicología , Estimulantes del Sistema Nervioso Central/efectos adversos , Niño , Conducta Infantil , Preparaciones de Acción Retardada , Relaciones Familiares , Femenino , Humanos , Masculino , Metilfenidato/efectos adversos , Padres/psicología , Escalas de Valoración Psiquiátrica , Desempeño Psicomotor/efectos de los fármacos , Instituciones Académicas , Resultado del TratamientoRESUMEN
OBJECTIVES: To identify the determinants of adherence to immediate-release (IR) methylphenidate in children and adolescents with attention-deficit/hyperactivity disorder (ADHD); to examine the impact of adherence on ADHD-related symptoms; and to compare the efficacy, adherence, and side effects of IR methylphenidate and osmotic release oral system (OROS) methylphenidate. METHOD: This national survey, involving 12 hospitals, consisted of 2 phases of assessment. Treatment adherence in 240 (39.5%) of the 607 children aged 5 to 16 years with a clinical diagnosis of DSM-IV ADHD enrolled in the study was poor (defined as missing >or= 1 dose of ADHD medication a day and on 2 days or more during school days). Children with poor adherence at phase 1 were able to switch to OROS methylphenidate, while adherents remained on the IR variant. We reassessed 124 poor adherents who switched to OROS methylphenidate. The global ADHD severity, parent-child interaction, classroom behavior, academic performance, and side effects of the child subjects were evaluated by investigators. Parents completed the rating scales about the ADHD-related symptoms. The study began in April 2005 and was completed in February 2006. RESULTS: Determinants for poor adherence included older age, later onset of ADHD, family history of ADHD, higher paternal education level, and multi-dose administration. Mental retardation and treatment at medical centers were inversely related to poor adherence. Overall, poor adherence was associated with more severe ADHD-related symptoms by comparison to good adherence. Similar side effect profile, superior adherence, and improved efficacy were demonstrated in intra-individual comparison of the OROS and IR methylphenidate forms. CONCLUSION: Given that poor adherence to medication may be an important reason for suboptimal outcome in ADHD treatment, physicians should ensure adherence with therapy before adjusting dosage or switching medication. TRIAL REGISTRATION: clinicaltrials.gov Identifier NCT00460720.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Estimulantes del Sistema Nervioso Central/uso terapéutico , Metilfenidato/uso terapéutico , Cooperación del Paciente/estadística & datos numéricos , Adolescente , Edad de Inicio , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Áreas de Influencia de Salud , Niño , Preescolar , Demografía , Femenino , Estado de Salud , Humanos , Masculino , Encuestas y Cuestionarios , Taiwán/epidemiología , Resultado del TratamientoRESUMEN
Astroglial cell lines have many applications for advancing neural developmental and functional studies. However, few astroglial cell lines have been reported from fish. In this study, we report the characterization of the immortal cell line TB2 isolated from adult tilapia brain tissue. The cell line was established at 25 degrees C in L15 medium supplemented with 15% fetal bovine serum. Most of the cells displayed a fibrous morphology and were immunoreactive for A2B5 antigen, glial fibrillary acidic protein (GFAP), keratin, vimentin, and the gap junction protein connexin 43 (Cx43). They weakly expressed glutamine synthetase (GS), S100 protein, and the neural stem cell markers Sox2 and brain lipid binding protein (BLBP). In contrast to astroglia in vivo, most TB2 cells also expressed galactocerebroside (GalC), substance P (SP), and tyrosine hydroxylase (TH). By immunoblot and RT-PCR, the cells also expressed myelin basic protein (MBP), proteolipid protein (PLP), and Cx35. On a poly-L-lysine-coated substrate in vitro, TB2 cells showed increases in neuronal dopamine decarboxylase (DDC) and microtubule-associated protein 2 (MAP2), indicating that they can initiate differentiation into neurons. Taken together, the results suggest that TB2 cells are astroglial progenitor cells (neural stem cells) and may develop into oligodendrocytes and neurons in a suitable environment. The present study advances our knowledge of fish astroglia. However, the factors that affect neural development in fish remain unknown, as do the characteristics of the intermediate differentiation stages between stem cells and mature nerve cells. The TB2 cell line will promote these investigations.
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Astrocitos/metabolismo , Encéfalo/metabolismo , Neuronas/metabolismo , Células Madre/metabolismo , Tilapia/metabolismo , Animales , Astrocitos/citología , Encéfalo/citología , Diferenciación Celular , Línea Celular , Conexina 43/metabolismo , Gangliósidos/metabolismo , Proteína Ácida Fibrilar de la Glía/metabolismo , Glutamato-Amoníaco Ligasa/metabolismo , Neuronas/citología , Oligodendroglía/metabolismo , Células Madre/citología , Tirosina 3-Monooxigenasa/metabolismoRESUMEN
BACKGROUND: Clinical studies of children with learning disorders (LD) in Chinese-speaking society are still very limited. The aim of this study was to obtain the clinical picture of children with LD in Taiwan. METHODS: Medical records of diagnoses-validated subjects in a local children's hospital from 1998 through 2005 were reviewed in detail. Relevant data were collected and analyzed. The diagnoses were made based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria for learning disorders. RESULTS: Among the 27 subjects (23 boys and 4 girls) identified, the average age upon diagnosis was 9.6 +/- 2.0 years with school grade of 3.5 +/- 1.9. The percentages of subjects with reading disorders (RD), mathematics disorders (MD) and disorders of written expression (DWE) were 66.7%, 11.1% and 77.8%, respectively. Over half (55.6%) of the subjects had two subtypes concurrently, and the majority of which had both RD and DWE. The overall, psychiatric, and medical comorbid rates were 88.9%, 81.5% and 22.2%, respectively. Attention-deficit/hyperactivity disorder (ADHD) was the most common (66.7%) co-existing condition. Subtypes were slightly different in terms of demographic data, IQ profile and comorbid conditions. CONCLUSIONS: Our LD sample was predominantly male with average levels of intelligence and highly comorbid with ADHD. Each subtype of LD seemed to have its own unique feature in terms of cognitive function, comorbid condition, sexual differences, and other aspects. Further research is eagerly warranted. When evaluating learning problems, clinicians should keep in mind that ADHD often exists. Treating concomitant ADHD and other co-existing problems should bring more favorable outcomes. Due to the heterogeneity of LD, evaluation of each suggested case should be carefully monitored and individually tailored.
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Discapacidades para el Aprendizaje/psicología , Trastorno por Déficit de Atención con Hiperactividad/psicología , Niño , Comorbilidad , Dislexia/psicología , Femenino , Humanos , Inteligencia , Masculino , Matemática , Caracteres SexualesRESUMEN
The aim of this project was to improve the handling of cases of domestic violence by a local hospital. Through the project, medical personnels may gain an improved understanding of this problem and increase their ability and knowledge in relation to domestic violence. The hope was to provide professional medical services while protecting the personal privacy of the patients who needed to be helped. Our previous observations had led us to note that there was inadequate recognition of domestic violence, inadequate keeping of medical records, no standardized working protocol and an environment that was not sufficiently secure and safe for victims of domestic violence. During the project, several improvements were made, including the setting up of a one-stop service counter, a standard working protocol, a design for a safer environment and advanced training for medical personnel dealing with cases of domestic violence, and the creation of a special form of medical document for domestic violence. The results showed improved understanding of the problem among nursing staff, from an initial 58% to 97%. The satisfaction rate among patients was also elevated, from 55% to 85%. Thus with this project, we hope to help victims of domestic violence to banish their unpleasant memories early on, to obtain proper medical care both physically and psychologically, and finally to benefit from an improved quality of service provided by a local hospital, the professional image of whose nursing stuff has also been enhanced.
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Violencia Doméstica , Actitud del Personal de Salud , Hospitales/normas , Pacientes/psicología , Privacidad , TaiwánRESUMEN
The purpose of this article is to describe a nursing experience with a patient with esophagus cancer combined with tumor ulcer. The author assessed the patient's health condition by observation, interview, medical history and the Gorden functional health assessment guide. The client had three nursing problems: impaired tissue integrity, diarrhea and body image disturbance. The author used the nursing process and empathy to assist the patient to face disease and treatment. Nursing intervention was also performed to enhance the patient's comfort and provide psychological support.