Racialethnic Disparities in Drug Prevalence among Youth

基于美国FAERS 数据库对未成年人群肝衰竭ADE 信号的挖掘与分析Δ李冰 1＊，梁力 1，陈燕 1，郭宇航 1，刘霞 2，郭晋敏 1 #（1.中国人民解放军联勤保障部队第九六〇医院临床药学科，济南　250031；2.海军军医大学药学院临床药学教研室，上海　200433）中图分类号 R 969.3；R 994.1 文献标志码 A 文章编号 1001-0408（2023）17-2144-05DOI 10.6039/j.issn.1001-0408.2023.17.17摘要 目的 基于美国FDA 不良事件报告系统（FAERS ）数据库，对未成年人群中引起肝衰竭的药物进行数据挖掘，以期为相关药物的临床合理应用提供参考。

方法 检索美国FAERS 数据库2013年第1季度—2022年第3季度未成年（小于18岁）人群发生肝衰竭的药物不良事件（ADE ）报告数据并对其进行挖掘与分析，按不同年龄段分为婴儿（≤1岁）、幼儿（＞1～＜6岁）、儿童（6～＜12岁）和少年（12～＜18岁），利用比例失衡法中的报告比值（ROR ）法、比例报告比值法和贝叶斯置信区间递进神经网络法筛选ADE 信号。

结果 共收集到未成年人群的肝衰竭ADE 报告1 051份，涉及60种药物。

少年的肝衰竭发生率最高（410例，占39.01%），其次是幼儿（297例，占28.26%）；有14个药物的说明书未提及肝胆系统损伤和肝衰竭风险，包括左乙拉西坦31例（占2.95%），甲硝唑18例（占1.71%），托吡酯、甲泼尼龙各16例（各占1.52%），地塞米松12例（占1.14%），替沙仑赛11例（占1.05%），硫酸亚铁、二甲双胍和白消安各10例（各占0.95%），丙泊酚9例（占0.86%），onasemnogene abeparvovec 8例（占0.76%），苯海拉明、奥美拉唑各5例（各占0.48%），sebeliesterase α 4例（占0.38%），共计165例，占报告总数的15.70%。

In the contemporary era,the concept of diversity has taken on a new dimension, transcending the traditional understanding of cultural,racial,and ethnic differences.It now encompasses a wide array of elements,including but not limited to,gender identity, socioeconomic backgrounds,and even ideological perspectives.This essay aims to explore the multifaceted nature of diversity and its impact on society,highlighting the importance of embracing and celebrating these differences to foster a more inclusive and harmonious world.The Evolution of DiversityThe traditional notion of diversity was primarily focused on visible differences such as race,ethnicity,and nationality.However,as societies have evolved,so too has our understanding of diversity.It now includes the recognition of invisible differences such as socioeconomic status,educational background,and personal experiences.This broader perspective encourages a more comprehensive approach to understanding and appreciating the unique attributes that each individual brings to the table.Cultural DiversityCultural diversity remains a cornerstone of the diversity paradigm.It is the richness of different traditions,languages,and customs that contribute to the vibrant tapestry of our global community.Embracing cultural diversity not only enriches our personal lives but also fosters mutual respect and understanding among people from different backgrounds. It is through the exchange of cultural practices and ideas that societies can learn and grow together.Linguistic DiversityLanguage is a powerful tool for communication and expression.Linguistic diversity is a testament to the variety of human thought and creativity.It allows for the preservation of unique cultural identities and the sharing of diverse perspectives.Promoting linguistic diversity in educational and professional settings can lead to more effective communication and collaboration.Gender and Sexual DiversityThe recognition of gender and sexual diversity has gained significant momentum in recent years.The understanding and acceptance of various gender identities and sexual orientations have led to greater inclusivity and equality.This diversity enriches our societies by challenging traditional norms and encouraging a more openminded approachto human relationships and identities.SocioEconomic DiversitySocioeconomic diversity is a critical aspect of the broader diversity conversation.It involves acknowledging the different levels of wealth,income,and social status within a community.By addressing socioeconomic disparities,societies can work towards creating more equitable opportunities for all individuals,regardless of their background.Ideological DiversityIdeological diversity refers to the range of beliefs,values,and opinions that individuals hold.It is essential for a healthy democracy,as it encourages debate and the exchange of ideas.Embracing ideological diversity can lead to more innovative solutions and a better understanding of complex issues.The Benefits of DiversityDiversity,in all its forms,offers numerous benefits.It fosters creativity and innovation by encouraging the exchange of different ideas and perspectives.It also promotes empathy and understanding,as individuals learn to appreciate the experiences and viewpoints of others.Moreover,diverse environments are more resilient and adaptable to change,as they draw from a wide range of strengths and capabilities.Challenges and SolutionsDespite the benefits,embracing diversity can also present challenges,such as misunderstandings and conflicts arising from differences.To address these,it is crucial to promote open dialogue,education,and sensitivity training.Creating spaces where individuals can share their experiences and learn from one another can help build bridges and foster a sense of community.ConclusionIn conclusion,the new chapter of diversity is one that is rich with potential for growth and understanding.By recognizing and celebrating the myriad forms of diversity,we can create a more inclusive,dynamic,and resilient society.It is through this collective effort that we can truly harness the power of diversity to build a better world for all.。

Health EquityRon Chapman, MD, MPHDirector and State Health Officer California Department of Public Health 钢筋调直切断机钢筋切断机抹光机 What causes health inequities?“The social determinants of health are mostlyresponsible for health inequities -the unfair and avoidable differences in health status seen within and between countries. The structural roots ofhealth inequities lie within education, taxation,labor and housing markets, urban planning,government regulation, health care systems, all of which are powerful determinants of health,and ones over which individuals have little or no direct personal control but can only be alteredthrough social and economic policies and political processes.”WHO Commission on the Social Determinants of Health“Social Determinants of Health”☐Social-Physical-Economic-Services Determinants⏹Income & income inequality⏹Education⏹Race/ethnicity/gender & related discrimination⏹Built Environment⏹Stress⏹Social support⏹Early child experiences⏹Employment⏹Housing⏹Transportation⏹Food Environment⏹Social standingWhat is the role of health care?Public Health Agency of Canada: “there is mounting evidence that the contribution of medicine and health care is quite limited, and that spending more on health care will not result in significant further improvements in population health. On the other hand, there are strong and growing indications that other factors such as living and working conditions are crucially important for a healthy population.”Estimated Deaths Attributable to Social Factors in the US -2000☐Low education: 245,000☐Racial segregation: 176,000☐Low social support: 162,000☐Individual level poverty: 133,000☐Income inequality: 119,000☐Area level poverty: 39,000☐In comparison:⏹Acute MI:192,898⏹Cerebrovascular disease:167,661⏹Lung cancer: 155,521Estimated Deaths Attributable to Social Factors in the US. Galea S et.al.AJPH:June 16,2011;eprint.Oakland, CA❑People who live inWest Oakland canexpect to live onaverage 10 years lessthan those who live inthe Berkeley Hills.❑People who live inBayview/Hunters Pointcan expect to live onaverage 14 years lessthan their counterpartson Russian Hill❑Residents of BayPoint can expect to liveon average 11 yearsless than people inOrinda Life Expectancy in the Bay AreaCompared to a white child born in the Oakland hills, a black child born in West Oakland is:☐Likely to die almost 15 years earlier☐5x more likely to be hospitalized with diabetes☐2x as likely to die of heart disease☐3x more likely to die of stroke☐2x more likely to die of cancer☐7x more likely to be born into poverty☐4x less likely to read at grade level by grade 4☐4 x as likely to live in a neighborhood with highdensity of fast food and liquor outlets☐5.6x more likely to drop out of schoolAlameda County Department of Public HealthInequities in Contra Costa County☐Hospitalization rate for asthma for African American children 5x that of White children☐Latinas have a rate of births to teens more than twice that of the county overall☐Most of the homicide deaths in Contra Costa occurred among African Americans☐People living in San Pablo, Oakley, Richmond, Antioch, Brentwood and Pittsburg, as well as African Americans and men overall, are more likely to die from heart diseaseHealth Equity in California ☐Lowest Infant Mortality⏹African Americans double☐Lowest Teenage Pregnancy⏹Hispanic teens double☐Lowest Tobacco Use⏹Low income population doubleHow could income effect health?Income directly shapes:▪Nutrition & physical activity options▪Housing quality▪Neighborhood conditions▪Social networks & support ▪Stress due to inadequate resources to face daily challenges▪Medical care Parents’ income shapes the next generation’s:▪Education, which shapes their▪Working conditions (physical & psychosocial) &▪IncomeCenter on Social Disparities in Health, UCSFChildren Raised in Poverty☐Have lower levels of educational attainment⏹more likely to score lower on standardized tests, be held backa grade, drop out of high school,⏹less likely to get a college degree⏹attend schools with fewer resources⏹suffer from poor nutrition, chronic stress, and other healthproblems that interfere with their school work⏹change residences and schools frequently as their familiesstruggle to find affordable housing☐Have lower earnings and are more likely to live in poverty as adultsThe Social Gradient in Health* BARHII51015202530354045Black, Non-Hispanic Hispanic White, Non-Hispanic% o f a d u l t s a g e s 25+ w h o a r e p h y s i c a l l y a c t i v e *<100% FPL 100%-199% FPL 200-299% FPL 300-399% FPL ≥400% FPL Across racial and ethnic groups,higher income*, more physically active adultsNHIS 2001-2005 Age-adjusted * Similar by educatio n▪U.S.•California❑ 6.1 million Californians (16.3%) incomes <FPL2.2 million Ca children (nearly ¼) in families <FPLHealth Impact of Resolving Racial Disparities☐1991 to 2000⏹Medical advances averted 176,633 deaths⏹Equalizing the mortality rates of Whites andAfrican Americans would have averted 886,202 deaths☐“The prudence of investing billions in the development of new drugs and technologies while investing only a fraction of that amount in the correction of disparities deserves reconsideration. It is an imbalance that may claim more lives than it saves.”Wolff S. Satcher D., et.al. The Health Impact of Resolving Racial Disparities: An Analysis of US Mortality Data. Am J Public Health. 2004;94:2078–2081How could a neighborhood affect health?▪Safe places to exercise▪Access to healthy food▪Exposure to targeted advertising ofharmful substances▪Social networks & support▪Norms, role models, peer pressure▪Fear, anxiety, stress, despair▪Violence and fear▪Quality of schoolsINSTITUTIONAL POWER Corporations &businesses Government agencies Schools Laws & regulationsNot-for-profitorganizations RISK BEHAVIORS Risk Behaviors Smoking Poor nutrition Low physical activity Violence Alcohol & other Drugs Sexual behavior LIVING CONDITIONS Physical environment Land use Transportation Housing Residential segregation Exposure to toxins Social environment Experience of class, racism, gender, immigrationCulture, incl. mediaViolenceEconomic & WorkEnvironmentEmploymentIncomeRetail businessesOccupational hazardsService environmentHealth careEducationSocial services DISEASE & INJURY Communicable disease Chronic disease Injury (intentional &&unintentional)MORTALITY Infant mortality Life expectancySOCIALINEQUITIESClassRace/ethnicityImmigrationstatusGenderSexualorientation UPSTREAM DOWNSTREAM Community capacity buildingCommunity organizingCivic engagementStrategicpartnershipsAdvocacy Individual healtheducationHealth care Emerging Public HealthPractice Current Public Health PracticePOLICYCasemanagement A PUBLIC HEALTH FRAMEWORK FOR REDUCING HEALTH INEQUITIESBAY AREA REGIONAL HEALTH INEQUITIES INITIATIVEGo Before You ShowPrenatal Campaign☐First trimester prenatal care is key to healthy birth outcomes.☐In Solano County, 1st trimester prenatal care was much higher for women on commercial insurance vs. Medi-Cal.☐Go Before You Show campaign created to increase 1st trimester prenatal care in Medi-Cal.☐Results…Office of Health Equity☐Office of Multicultural Health ☐Office of Multicultural Services ☐Office of Women’s Health☐Health in All Policies☐Healthy Place Team。

香港青年药物滥用与社会政策分析【内容提要】药物滥用是当今人类面临的重大问题，受到国际社会的高度关注。

早在上一世纪五十年代末，香港便将药物滥用视为“一项最严重的社会和经济问题〞，并在1959年和1974年发表毒品问题白皮书决心铲除药物滥用问题。

[1] 尽管成绩不小，但药物滥用问题、尤其是青年药物滥用问题却一直没有得到彻底的根治。

近年来，中国内地青年药物滥用问题呈增长趋势。

本文将在回忆香港青年药物滥用现象及其政策的根底上，讨论其原因及应有的社会政策取向，以期对我们制止青年药物滥用及其政策制定起到借鉴作用。

【摘要题】青少年社会调查【关键词】香港青年/药物滥用/社会政策分析【正文】一、香港青年药物滥用现状广义上说，药物指的是所有可以改变人类身体功能的物质。

[2] 但是，从社会问题的角度出发，药物又特指那些直接影响人类大脑和神经系统、并造成习惯性依赖的物质。

或者更确切地说，药物指的是那些可以影响人的心理功能、情绪、感觉和意识，具有被错误使用可能，并对使用者和社会造成危害的化学物质。

而所谓的药物滥用，那么是指使用不被社会认可的，或过量、不适宜地使用社会认可的药物，并导致生理、心理和社会伤害的情形。

[3]以国际公认的标准来看，具有被滥用可能性的药物范围比我们以往关于毒品概念的界定更为广泛。

它既包括非法的大麻、海洛英和可卡因等毒品，也包括通常被社会认可的香烟、酒精饮料和局部处方药品。

尽管它们的社会认可程度不一，但对人的伤害程度却有一致性，许多研究甚至认为香烟和酒精饮料的危害程度远远超过某些毒品。

[4] 在香港，被认为具有滥用可能性的药物包括麻醉镇痛剂、迷幻剂、抑制剂、兴奋剂、镇静剂和包括烟酒等六大类。

其中使用频率最高的非法药物分别为海洛英、氯胺酮(俗称K仔)、亚甲二氧基甲基安非他明(俗称摇头丸)和大麻，它们在滥用药物者中的比例分别为74％、17％、9％和8％。

[5] 对于21岁以下的青年，经常被滥用的药品主要为氯胺酮、亚甲二氧基甲基安非他明、大麻、甲基安非他明(俗称冰)和海洛英，其2003年的人数分别为1099、599、499、136和114。