Older people turn age into a resource

Life-long skills and newly discovered talents are being put to work in innovative programs throughout Europe. Bob Boote CVO was the first Director General, Nature Conservancy Council and has a long and distinguished career working extensively for the environment. He is a Vice President of the National Council on Ageing and Chairman of Age Resource, which he was a prime instigator in founding.     

Roundtable discussion: problems in the management of hypertension

Following a symposium on hypertension sponsored by the National Heart, Lung, and Blood Institute in Chicago, IL on October 3, 2001, a panel was convened to discuss various aspects of hypertension treatment. Moderating the panel was Dr. Marvin Moser, Clinical Professor of Medicine at The Yale University School of Medicine. Panel members included Dr. George Bakris, Professor of Preventive Medicine and Director, Hypertension/Clinical Research Center at the Rush‐Presbyterian‐St. Luke's Medical Center in Chicago, Illinois and Dr. Henry Black, Professor of Medicine, Associate Vice President for Research, and Chairman of the Department of Preventive Medicine at Rush‐Presbyterian.     

Roundtable Discussion: Problems in the Management of Hypertension

Following a symposium on hypertension sponsored by the National Heart, Lung, and Blood Institute in Chicago, IL on October 3, 2001, a panel was convened to discuss various aspects of hypertension treatment. Moderating the panel was Dr. Marvin Moser, Clinical Professor of Medicine at The Yale University School of Medicine. Panel members included Dr. George Bakris, Professor of Preventive Medicine and Director, Hypertension/Clinical Research Center at the Rush-Presbyterian-St. Luke's Medical Center in Chicago, Illinois and Dr. Henry Black, Professor of Medicine, Associate Vice President for Research, and Chairman of the Department of Preventive Medicine at Rush-Presbyterian.     

Pence,Putin, Mbeki and Their HIV/AIDS-Related Crimes Against Humanity: Call for Social Justice and Behavioral Science Advocacy

Indiana, a large rural state in the Midwestern United States, suffered the worst North American HIV outbreak among injection drug users in years. The Indiana state government under former Governor and current US Vice President Mike Pence fueled the HIV outbreak by prohibiting needle/syringe exchange and failed to take substantive action once the outbreak was identified. This failure in public health policy parallels the HIV epidemics driven by oppressive drug laws in current day Russia and is reminiscent of the anti-science AIDS denialism of 1999–2007 South Africa. The argument that Russian President Putin and former South African President Mbeki should be held accountable for their AIDS policies as crimes against humanity can be extended to Vice President Pence. Social and behavioral scientists have a responsibility to inform the public of HIV prevention realities and to advocate for evidence-based public health policies to prevent future outbreaks of HIV infection.     

Underreporting of alcohol-related mortality from cirrhosis is declining in Sweden and Denmark

Death rates for alcoholic cirrhosis ran parallel to alcohol consumption in Sweden and Denmark from 1961 to 1986, according to official statistics. Reported death rates for alcoholic cirrhosis and for non-alcoholic cirrhosis increased linearly from 1965 to 1976 in Sweden and from 1967 to 1973 in Denmark. This suggests that constant proportions of deaths from real alcoholic cirrhosis are misclassified in official statistics as due to non-alcoholic cirrhosis during these time periods. Assuming that the mortality from real non-alcoholic cirrhosis is constant (c), a statistical model for estimating both c and the misclassification rates for real alcoholic cirrhosis (p) is proposed. In the Sweden population and in Danish males c was about 5 deaths per 100,000 adults annually. The model was not applicable to Danish females because their mortality from non-alcoholic cirrhosis decreased. The misclassification rate p was about 55% in both Swedish and Danish males and 70% in Swedish females during the above time periods. Moreover, during the past decade p has decreased to 30% in Swedish and Danish males.     

On a personal note

Sally Greengross is Director of Age Concern England, Secretary General for Eurolink Age, and Vice President for Europe of the International Federation on Ageing. She was voted UK Woman of Europe 1990 and awarded the OBE in the 1993 New Year’s Honours List.     

Between- and within-person variation in affect and personality over days and years: How basic and applied approaches can inform one another

Distinguishing within-person from between-person variability in personality and well-being constructs is important for understanding their stability and change over varying periods, from moments to decades. Regardless of whether the variation is over days or years (or seconds to decades), it is important for researchers and practitioners alike to comprehend what it means for a person to vary from himself or herself, and what it means for one person to vary from another. The current study gives two examples of within- and between-person. The first example involves two major personality traits, extraversion and neuroticism, over a 12-year longitudinal period. The second example involves negative affect in a one-week daily diary study. Researchers should be aware of the within vs. between distinction because it is at the heart of important theoretical problems in ageing and development. Practitioners should appreciate it because it can distinguish between long-term clinical trends and short-term fluctuations. He received his Bachelor’s Degree from Loyola University Chicago and his Ph.D. from Boston University. He also completed an NIMH postdoctoral fellowship at the Survey Research Center of the Institute for Social Research at the University of Michigan. He is also Assistant Professor of Epidemiology and Biostatistics, Boston University School of Public Health. He received his Bachelor’s Degree from Emory University and his Ph.D. from Penn State University. He received his Bachelor’s Degree from California State University, Northridge and his Ph.D. from the University of Victoria. He also completed an NIMH postdoctoral fellowship at the Survey Research Center of the Institute for Social Research at the University of Michigan. In January, 2004, he will join the faculty of Human Development and Family Studies at Penn State University.     

Between- and within-person variation in affect and personality over days and years: How basic and applied approaches can inform one another

Distinguishing within-person from between-person variability in personality and well-being constructs is important for understanding their stability and change over varying periods, from moments to decades. Regardless of whether the variation is over days or years (or seconds to decades), it is important for researchers and practitioners alike to comprehend what it means for a person to vary from himself or herself, and what it means for one person to vary from another. The current study gives two examples of within- and between-person. The first example involves two major personality traits, extraversion and neuroticism, over a 12-year longitudinal period. The second example involves negative affect in a one-week daily diary study. Researchers should be aware of the within vs. between distinction because it is at the heart of important theoretical problems in ageing and development. Practitioners should appreciate it because it can distinguish between long-term clinical trends and short-term fluctuations. He received his Bachelor’s Degree from Loyola University Chicago and his Ph.D. from Boston University. He also completed an NIMH postdoctoral fellowship at the Survey Research Center of the Institute for Social Research at the University of Michigan. He is also Assistant Professor of Epidemiology and Biostatistics, Boston University School of Public Health. He received his Bachelor’s Degree from Emory University and his Ph.D. from Penn State University. He received his Bachelor’s Degree from California State University, Northridge and his Ph.D. from the University of Victoria. He also completed an NIMH postdoctoral fellowship at the Survey Research Center of the Institute for Social Research at the University of Michigan. In January, 2004, he will join the faculty of Human Development and Family Studies at Penn State University.     

The cost utility of bupropion in smoking cessation health programs: simulation model results for Sweden

STUDY OBJECTIVES: To calculate incremental cost-utility ratios (cost per quality-adjusted life-year [QALY] gained) for bupropion (Zyban; GlaxoSmithKline; Gothenburg, Sweden), as compared to nicotine replacement therapy (NRT) in smoking cessation programs for a follow-up period of 20 years. DESIGN: The Global Health Outcomes simulation model was used for a male cohort and for a female cohort as a point of departure but was further extended in order to include the following: (1) the indirect effects of smoking cessation on production and consumption in the economy, and (2) morbidity-specific QALYs gained. SETTING: Sweden in 2001.Patients or participants: Model cohort consisting of 612,851 male and 780,970 female smokers, distributed by age, > or = 35 years old, as in the Swedish population of 2001. INTERVENTIONS: Bupropion, as compared to NRT (nicotine patches and nicotine gums), in smoking cessation programs for a follow-up period of 20 years. MEASUREMENTS AND RESULTS: When the indirect effects on production and consumption were taken into account, bupropion was cost saving in comparison to both NRTs. When only the direct costs were included, bupropion was still cost saving in comparison to nicotine gum. The incremental costs per QALY gained were relatively low for bupropion in comparison to nicotine patches, 6,600 Swedish kronas (SEK) (approximately 725 euro) per QALY gained for men and 4,900 SEK (approximately 535 euro) for women, all calculations in 2001 Swedish prices. The comprehensive sensitivity analysis showed robust results; results were, however, more sensitive to quit rates and intervention costs than to other variables. CONCLUSIONS: Bupropion is a cost-effective therapy in smoking cessation programs. Furthermore, recent studies report even higher effectiveness in terms of quit rates than was assumed here, indicating that our estimated cost-utility ratio should be even more favorable to bupropion.     

Increasing hospital-wide delivery of smoking cessation care for nicotine-dependent in-patients: a multi-strategic intervention trial

Aims, design and intervention   Smoking care provision to in-patients is important in assisting smoking cessation and for management of nicotine withdrawal. Limited studies have reported the effectiveness of interventions designed to increase the hospital-wide provision of such care. A quasi-experimental matched-pair trial, involving two intervention and two control hospitals in NSW, Australia, investigated whether a multi-strategic intervention increased hospital-wide smoking care provision.
Participants and measurements   Patient surveys ( n  = 274–347 per experimental condition), medical notes audits ( n  = 181–228) and health professional surveys ( n  = 229–302) were used to collect outcome data at baseline and follow-up.
Findings   Significantly greater increases in intervention hospitals compared to control hospitals were found for patient-reported offer of nicotine replacement therapy (NRT) (intervention 34% versus control 12%), provision of NRT (16% versus 4%) and provision of written resources (11% versus 2%), and for the recording in medical notes of smoking management discussion (13% versus 3%), offer of NRT (24% versus 3%) and provision of NRT (21% versus 5%). Intervention group health professionals reported significantly greater increases in the mean estimate of patients who: had their smoking management discussed (30% versus 17%); were offered or provided with NRT (30% versus 18%); were asked their intention to smoke post-discharge (22% versus 10%); and were provided with discharge NRT (21% versus 4%).
Conclusions   Implementation of a multi-strategic intervention is effective in increasing hospital smoking care delivery, particularly the provision of NRT. Research is required to identify methods to increase further the delivery of this and other forms of smoking care.     

A cohort study to examine whether time and risk preference is related to smoking cessation success

Aim   To identify whether time and risk preference predicts relapse among smokers trying to quit.
Design   A cohort study of smokers who had recently started to quit. Time and risk preference parameters were estimated using a discrete choice experiment (DCE).
Participants   A total of 689 smokers who began quitting smoking within the previous month.
Measurements   Time discount rate, coefficient of risk-aversion measured at study entry and duration of smoking cessation measured for 6 months.
Findings   In the unadjusted model, Cox's proportional hazard regression showed that those with a high time discount rate were more likely to relapse [hazard ratio: 1.18, 95% confidence interval (CI): 1.11–1.25]. A high coefficient of risk-aversion reduced the hazard of relapse (0.96, 0.96–0.97). When adjusted for other predictors of relapse (age, gender, self-efficacy of quitting, health status, mood variation, past quitting experience, the use of nicotine replacement therapy, nicotine dependence), the hazard ratios of time discount rate and the coefficient of risk-aversion is 1.17 (95% CI: 1.10–1.24) and 0.98 (95% CI: 0.97–0.99), respectively.
Conclusions   Those who emphasize future rewards (time–patient preference) and those who give more importance to rewards that are certain (higher risk-aversion) were significantly more likely to continue to abstain from smoking.     

Ceremony for the inaugural issuance of the Journal of Geriatric Cardiology

The Journal of Geriatric Cardiology ( JGC )started publication in September 2004. To announce the publication of its first issue, a ceremony was held at China Grand Hotel in Beijing on October 18th, 2004during the 15th Great Wall International Congress of Cardiology. Many guests were present at the ceremony.……     

James Luke 1799–1881

James Luke was born at Exeter on December 12, 1799, the third son of a merchant and banker. At the age of 17, and upon the death of his father, he became attached to John Andrews of the London Hospital. He attended the lectures and three years later was appointed Demonstrator of Anatomy. In 1827 he was elected Assistant Surgeon and ultimately achieved the position of Consulting Surgeon in 1861. At the Royal College of Surgeons, Luke was a member of the Council for 20 years, and was President in 1853 and again in 1862. He was a Hunterian Orator in 1852. Luke was a tall man and was said to harbor an irascible temper. He was scrupulously careful about the cleanliness of his instruments, a peculiarity which was rather unique during his day. A rapid surgeon, he once amputated at the hip and removed the limb in 27 seconds. He was particularly interested in the treatment of cleft palate, fractures, and the repair of groin hernias. In thisClassic article, Luke describes his approach to the management of colonic obstruction. He is believed to have been the first surgeon to perform a pararectus incision, bringing the bowel out in the neghborhood of the rectus muscle. He mentions in the article that this appears to be the preferred approach when the site of the obstruction is not clearly delineated. This is in contrast to the operation advocated by Amussat (Dis Colon Rectum 1983; 26: 483–487). Luke retired to Buckinghamshire, where he lived as a country gentleman and employed himself in woodcarving until his death on August 15, 1881. Luke J. A case of obstruction of the colon, relieved by an operation performed at the groin.     

Blood pressure circadian rhythm and endothelial function in heavy smokers: acute effects of transdermal nicotine

Nicotine replacement therapy appears to be safe when used by healthy patients to aid in smoking cessation; however, the immediate acute effects of nicotine replacement therapy on the circadian rhythm of blood pressure (BP) and endothelial function in heavy smokers are not well understood. Twenty-six heavy smokers were requested to stop smoking for 48 hours. BP and heart rate were recorded over 48 hours by ambulatory BP monitoring, with beat-to-beat changes being monitored for the first 10 hours by a noninvasive finger device. The reactivity of the brachial artery was evaluated using flow-mediated dilation immediately after smoking cessation, before the application of a 21-mg nicotine patch or placebo patch, and 24 hours after patch placement. Transdermal nicotine caused a mild but significant elevation in BP in the early morning in 21 of 26 volunteers. The decrease in nocturnal BP was attenuated in patients with the nicotine patch compared with the placebo patch; this was associated with impaired endothelium-dependent vasodilation.     

Efficacy of a nicotine mouth spray in smoking cessation: a randomised, double-blind trial

A nicotine mouth spray has advantages over other acute forms of nicotine replacement therapy, such as a faster uptake of nicotine and faster relief of craving. This multicentre, randomised (2:1), double-blind, placebo-controlled efficacy and safety study evaluated self-reported, carbon monoxide-verified continuous abstinence from smoking from week 2 until weeks 6, 24, and 52 in 479 smokers (≥1 cigarette per day) who were treated with either active (n=318) or placebo (n=161) spray for 12 weeks and low-intensity counselling at three smoking cessation clinics in Denmark and Germany. Active treatment yielded significantly higher continuous abstinence rates than placebo from week 2 until week 6 (26.1% versus 16.1%; relative success rate (RR) 1.62, 95% CI 1.09-2.41), week 24 (15.7% versus 6.8%; RR 2.30, 95% CI 1.23-4.30), and week 52 (13.8% versus 5.6%; RR 2.48, 95% CI 1.24-4.94). Most adverse events were mild to moderate, and 9.1% of subjects on active spray withdrew due to adverse events, compared to 7.5% on placebo. The overall rate of treatment-related adverse events was 87.4% with active spray versus 71.4% with placebo spray. Nicotine mouth spray delivered significantly higher 6-, 24- and 52-week continuous abstinence rates than placebo.     

A randomized, controlled trial to assess the efficacy and safety of a transdermal delivery system of nicotine/mecamylamine in cigarette smokers

AIMS: To determine the efficacy and safety of nicotine transdermal therapy co-administered with the nicotine antagonist, mecamylamine, compared to a nicotine transdermal patch alone (21 mg nicotine + 6 mg mecamylamine, 21 mg nicotine + 3 mg mecamylamine, and 21 mg nicotine + 0 mg mecamylamine). DESIGN: Multi-center (n = 4), double-blind, randomized, parallel group, repeat-dose study. SETTING: Clinical laboratory. PARTICIPANTS: A total of 540 subjects were enrolled into the study-135 from each of four sites; 180 patients in each of three treatment arms. INTERVENTION: Treatment was administered for the first 6 weeks of the 8-week study. Patients were instructed to continue smoking for the first 2 weeks of treatment. MEASUREMENTS: The primary efficacy parameter was 4-week continuous abstinence after the quit date, confirmed with an expired carbon monoxide of < 10 parts per million. FINDINGS: Analysis of the 4-week continuous abstinence for the intent-to-treat population showed overall rates of 29% (nicotine + 6 mg mecamylamine), 29% (nicotine + 3 mg mecamylamine) and 23% (nicotine only) using the slip definition which allows smoking in the first 2 weeks after the quit date. Statistical analyses revealed no significant treatment differences. Analyses using the strict definition (no smoking after the quit date) yielded similar non-significant group differences (29%, 27%, 26%). CONCLUSION: If adding mecamylamine to nicotine replacement therapy (NRT) improves the chances of success at stopping smoking, the results of this study suggest that the effect is very small.     

Increased cerebrovascular mortality in patients with hypopituitarism

OBJECTIVE  An increased prevalence of atherosclerosis has been shown among patients with hypopituitarism. The aim of the present study was to assess whether patients with hypopituitarism experience increased cardiovascular, in particular cerebrovascular, mortality.
DESIGN AND PATIENTS  Retrospective cohort study of mortality, 1952–1992, in 344 patients, of whom 130 were female, receiving conventional hormone replacement for hypopituitarism following neurosurgery for pituitary tumours. The general population in the catchment area of southern Sweden from which the patients were recruited constituted the reference population. Expected mortality was obtained from cause, sex, calendar year, and 5-year age-specific death rates for the area.
RESULTS  Increased mortality from cerebrovascular disease (standardized mortality ratio (SMR) 3.39; 95% CI 2.27–4.99) was the main contributor to the increased overall cardiovascular mortality (SMR 1.75; 95% CI 1.40–2.19). The increase in mortality from cardiac diseases was much smaller (SMR 1.41; 95% CI 1.04–1.88). The risk for cerebrovascular death was higher in women (SMR 4.91) than in men (SMR 2.64). The relative risk for cerebrovascular death was independent of the time interval since diagnosis of pituitary insufficiency, but was greater in subjects diagnosed at an earlier age (<55 years). No increased mortality in malignant tumours was observed (SMR 0.95; 95% CI 0.60–1.48).
CONCLUSION  The increased cerebrovascular mortality may be due to GH deficiency, or to long-term lack or inadequacy of substitution for other pituitary hormones. The observations that an early onset of pituitary insufficiency and female sex are predictors for a high risk for cerebrovascular mortality merit particular attention when treating this group of patients.     

Treatments for smokers

Research in treatments for smokers benefits from the feasibility of relatively large samples and well developed evaluative methodology. The field is currently dominated by nicotine replacement methods, for which some degree of efficacy has been clearly demonstrated, A number of psychological methods are widely used as well, although there is little consistent evidence that one specific method is better than any other. Two approaches 10 treating smokers can be distinguished, i.e. intensive clinic-based treatments and brief community-orientated interventions, e.g. in primary health care. The latter are applicable on a large scale, and aim to affect overall smoking prevalence. Among intensive treatments, the current state of the an would include nicotine replacement and group support of several weeks’ duration. In primary health care, simple routine interventions are the preferred option.     

Plasma Nicotine Concentrations from Repeated Doses of Nasal Nicotine Solution

A nasal nicotine solution (NNS) has been proposed as a potential cessation aid for cigarette smokers [1], the principle being similar to that underlying use of nicotine chewing gum, i.e. nicotine replacement following cessation to ease withdrawal symptoms. We conducted a study to determine the plasma nicotine concentrations resulting from eight, hourly administrations of 2 mg NNS. The peak plasma nicotine concentrations rose to an average of 16.3 ng/ml, which is higher than is normally obtained from 2 mg nicotine chewing gum. There was considerable variability in levels obtained from the NNS, with one subject obtaining levels similar to those found in heavy cigarette smokers. The initial doses produced noticeable light headedness in four of the five subjects. Nasal nicotine solution could provide more effective nicotine replacement than nicotine gum.     

Nicotine gum-induced atrial fibrillation

A 39-year-old man with no prior history of atrial fibrillation was hospitalized with atrial fibrillation and a rapid ventricular rate. For the 7 months before presentation, he had been chewing nicotine polacrilex gum on his own. The week he first developed palpitations, he was chewing more than 1 piece of nicotine Polacrilex gum per hour during work. His diagnostic work-up during hospitalization found no cause for atrial fibrillation. He was cardioverted to sinus rhythm. At 6-month follow-up, he had not renewed chewing nicotine polacrilex gum, was in sinus rhythm, and had no history of palpitations. The temporal relation between more frequent gum usage and the excessive consumption of nicotine polacrilex chewing gum with a probable high serum nicotine level at the time the patient developed his first episode of atrial fibrillation suggests a causal relationship.