當越來越多的藥物被發展出來進而治療人類的疾病，人們使用藥物時只知道該藥物對疾病的療效，卻忽略了其中可能隱藏的危機，不只是西藥，連中藥也隱藏相當大的危機。雖然國內有藥品管制局進行藥物交互作用的控管，但是藥物交互作用真的被有效控管嗎？成效又如何呢？有鑑於此，這成為大家都想知道的問題。 利用健保資料庫中龐大的門診資料，嘗試推估國人藥物交互作用的情形，由國人十大死因中得知，其中尤以慢性病病患的情形更為嚴重，例如：惡性腫瘤、腦血管疾病、心臟疾病、糖尿病、肝病和高血壓，本次研究以心血管病患為討論主體，試瞭解在長期服用心血管藥物時，醫生在已知病患病情之下卻無法避免藥物交互作用的情形為何，利用資料採礦的方法，找出可能造成交互作用發生的原因、族群，進而去提醒醫療機構避免其發生。 研究發現，心血管疾病病患分為一些併發症族群，如：心臟病、心血管疾病糖尿病、關節炎、消化潰瘍，從這些病患用藥中發現許多交互作用的用藥與其併發症也許多相關。高血壓疾病病患大多以強心劑、利尿劑為主的交互作用，心血管疾病併發糖尿病病患大多以口服降血糖為主的交互作用，心血管疾病併發關節炎病患大多以解熱鎮痛劑為主的交互作用，而心血管疾病併發消化潰瘍病患大多以制酸劑為主的交互作用。 健保局應當面對且對交互作用之高危險族群作一共同用藥規則，將用藥危機降到最低，讓心血管病患在治療的過程中，得以享有良好的醫療品質，亦不造成藥物濫用、浪費之情形。 / As more medicines are being developed to cope with diseases, most of the users think of the therapeutic effect of the medicine without thinking of the risk that might have associated with drug interactions. The risk of drug interactions could have set chemical reactions thereby causing drug side effects. Although the National Bureau of Controlled Drugs has set a procedure for controlling drug interactions, the issue of validity and efficiency remains an open question. The trend of people contracting chronic diseases is on the rise, one of which is cardiovascular. The attempt of this paper is to observe for the effect of drug interactions if any for the long term usage of the cardiovascular medications under the supervision of the doctors. We adopt data mining techniques to single out the probable variable causes in triggering negative effect of drug interactions and presented them to related medical personnel so that a tightening measure is adopted when administered the medications. The data used in this research comes from the National Health Insurance Research Database. Our research findings have reviewed that cardiovascular disease patients suffering from the complications, such as diabetes, arthritis, peptic ulcer and hear disease are highly related to the drug interactions. Heart disease patients are at risk of cardiac stimultants and diuretics. Diabetic’s patients taking the Sulfonylureas suffer from its interactions. And arthritis patients are at risk of having the side effects of taking Aspirin. Bureau of National Health Insurance should set a standard procedure in monitoring the prescription given by the medical personnel in an effort to reduce the risk of drug interactions and set off the stage of quality medical treatment to keep off the abuse of drug usages.

京都大学 / 0048 / 新制・論文博士 / 博士(薬学) / 乙第12774号 / 論薬博第765号 / 新制||薬||236(附属図書館) / 30757 / (主査)教授 金子 周司, 教授 中山 和久, 教授 佐治 英郎 / 学位規則第4条第2項該当 / Doctor of Pharmaceutical Sciences / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(薬学) / 甲第18205号 / 薬博第795号 / 新制||薬||237(附属図書館) / 31063 / 京都大学大学院薬学研究科創薬科学専攻 / (主査)教授 竹本 佳司, 教授 高須 清誠, 教授 川端 猛夫 / 学位規則第4条第1項該当 / Doctor of Pharmaceutical Sciences / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18458号 / 医博第3913号 / 新制||医||1005(附属図書館) / 31336 / 京都大学大学院医学研究科医学専攻 / (主査)教授 妻木 範行, 教授 戸口田 淳也, 教授 松田 秀一 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(薬学) / 甲第19652号 / 薬博第822号 / 新制||薬||239(附属図書館) / 32688 / 京都大学大学院薬学研究科薬学専攻 / (主査)教授 金子 周司, 教授 佐治 英郎, 教授 髙倉 喜信 / 学位規則第4条第1項該当 / Doctor of Pharmaceutical Sciences / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(工学) / 甲第21272号 / 工博第4500号 / 新制||工||1700(附属図書館) / 京都大学大学院工学研究科高分子化学専攻 / (主査)教授 秋吉 一成, 教授 木村 俊作, 教授 永樂 元次 / 学位規則第4条第1項該当 / Doctor of Philosophy (Engineering) / Kyoto University / DFAM

京都大学 / 新制・課程博士 / 博士(農学) / 甲第24650号 / 農博第2533号 / 新制||農||1096(附属図書館) / 学位論文||R5||N5431(農学部図書室) / 京都大学大学院農学研究科応用生物科学専攻 / (主査)教授 太田 毅, 教授 横井 伯英, 教授 舟場 正幸 / 学位規則第4条第1項該当 / Doctor of Agricultural Science / Kyoto University / DFAM

科学研究費補助金 研究種目:基盤研究(C)(2) 課題番号:10672124 研究代表者:大澤 功 研究期間:1998-2001年度

研究目的：本研究使用共通信念模式，以瞭解第二型糖尿病患者持有的疾病表徵對自我照護行為的預測關係。過去的研究顯示，糖尿病患者的「控制」表徵能夠有效預測患者的自我照護行為和糖化血色素值；也就是，患者相信疾病能被控制的程度愈高，在自我照護行為的表現愈好，糖化血色素值愈低。但是，「結果」表徵與「情緒」表徵無法顯著一致的預測患者的自我照護行為。透過回顧與健康行為相關的理論發展與文獻，考量慢性疾病的自我調節歷程中，除了疾病表徵以外，還需要納入與自我意識有關的人格特質。為此，本研究目的有四:(1)先檢驗在台灣糖尿病患者的疾病表徵建構，是否與國外使用疾病共通信念模式的研究結果一致，有相同的因素結構。(2)檢定台灣第二型糖尿病患者，其持有的疾病表徵對自我照護行為與血糖控制的預測，是否與Harvey和Lawson(2009)的研究結果一致。(3)評估糖尿病患者的人格特質對自我照護行為與糖化血色素值的影響。(4)探索第二型糖尿病患者反芻反思特質，在疾病表徵影響自我照護行為上的調節效果。 研究方法：本研究以立意取樣的方式，邀請新竹某教學醫院門診的第二型糖尿病患者為受試。排除漏答與亂填者，共有142位符合資格的受試者；每位受試者皆需完成受試者同意書、背景資料、糖尿病自我照護量表、疾病表徵問卷與中文版反芻反思量表。根據研究目的，以階層回歸和羅吉斯回歸分析等統計方法進行假設考驗。 研究結果：(1)臺灣第二型糖尿病患者的疾病表徵結構與國外患者相似，共包含：「認同」、「病因」、「時間感急慢性」、「時間感循環性」、「結果」、「情緒」和「控制」表徵。(2)研究結果與Harvey和Lawson(2009)的研究結果一致，「控制」表徵可以顯著預測整體自我照護行為和糖化血色素值。(3)第二型糖尿病患者的反芻反思特質，無法單獨預測自我照護行為與糖化血色素值。(4) 第二型糖尿病患者的反芻反思特質會與病表徵產生交互作用，共同調節各種自我照護行為的表現。 結論：本研究資料與其他使用共通信念模式的研究資料一致，亦即控制表徵能預測自我照護行為和糖化血色素值。此外，本研究發現，不同自我照護行為會受到疾病表徵與反芻或反思特質的交互作用而影響。由於，增加自我照護行為的執行度，是目前糖尿病治療與衛教的首要目標。建議未來從事糖尿病照護的實務工作者，能提供疾病表徵與反芻反思特質的專業心理評估；以協助建立個別評估與個別介入的個別化治療方案，進而提高患者在自我照護行為的執行度、增加臨床治療的效果。 / Background and Aims. It is increasingly being used to understand and predict individuals' coping with and subsequent self-care of chronic illness is Leventhal and colleagues' the common sense model. This model postulates that it is the individual's illness representation is the proximal determinant of coping behavior. The role of personality in determining self-care behavior has been relatively ignored, possibly because of the lack of convergence in concepts and measures. Due to the lack of research in the area of interest, the present study attempt to resolve this issue. We investigated, (a) using subjects of Type-II diabetes in Taiwan, are the results of present study similar as others studies directed by common sense model to identify the factors of illness representation, (b) discussing the influences of illness representation to self-care behavior and glycemic control (HbA1c); like as Harvey and Lawson(2009)’s study, (c) assessing whether traits of normal personality are associated with variations in self-care behavior and glycemic control in patients with type 2 diabetes, (d) examining whether personality moderate the relationships between illness representations and self-care behavior. Methods. Patients were eligible if they had Type 2 diabetes, were aged 20 years or more at diagnosis. Before we collect data, a physician will invite patient to enter the study. Patient want to join this study, they be giving an informed consent and be asked to complete four questionnaires. A total 142 patients completed the demographic survey ( age, educational level, diabetes duration et al.), Diabetes Self-Care Scale, the Revised Illness Perception Questionnaire(IPQ-R), the Chinese version of Rumination- Reflection Questionnaire. Analysis were concluded using multiple regression analysis, logistic regression and so on. Results. The results revealed that: (1) as our hypothesis, the structures of the IPQ-R in type 2 diabetes in Taiwan were similar as other foreign studies directed by common sense model. (2) Control representation can induce main effect on self care behavior. Higher control representation was significantly positive associated with self care behavior, and it was significantly negative associated with HbA1c. (3) Self reflection and self rumination were inconsistently associated with self care behavior and HbA1c. (4) Personality moderated the relationships between illness representations and self-care behavior. Conclusions. This study supports the Common Sense Model (CSM) of illness representation when considering type 2 diabetes in Taiwan. Based on our results, we found personality traits may offer new insights in to variations in self-care in patients with type 2 diabetes undergoing standard management. Personality refers as self-reflection and self-rumination which moderated the relationships between illness representations and self-care behavior. Therefore, CSM could become the theoretical framework for psychological interventions in type 2 diabetes. Furthermore, according to the study result, we suggested the practitioners paying attention to the different interaction when representation and personality are together in diabetes’ each self-care behavior.

University of Macau / Institute of Chinese Medical Sciences