Do athletes have a right to access data in their Athlete Biological Passport?

The Athlete Biological Passport (ABP) refers to the collection of data related to an individual athlete. The ABP contains the Haematological Module and the Steroidal Module, which are used for the longitudinal monitoring of variables in blood and urine, respectively. Based on changes in these variables, a statistical model detects outliers which indicate doping use and guide further targeted testing of the athlete. Presently, athletes can access their data of the Haematological Module in the Anti‐Doping Administration and Management System (ADAMS). However, granting athletes access to this data has been a matter of debate within the anti‐doping community. This article investigates whether an athlete has a right to access the contents of their ABP profile. We approached this discussion by comparing the nature of ABP data with that of forensic and medical data and touched on important concerns with ABP data disclosure to athletes such as potentially allowing for the development of alternative doping techniques to circumvent detection; and making athletes vulnerable to pressure by the media to publicly release their data. Furthermore, given that ABP data may contain medically relevant information that can be used to diagnose disease, athletes may over‐interpret its medical significance and wrongly see it as a free health check. We argue that safeguarding the integrity of the ABP system must be seen as the most essential element and thus a departure from immediate data disclosure is necessary. Two different strategies for delayed data disclosure are proposed which diminish the chances of ABP data being misused to refine doping techniques.     

Do asthma patients receive sufficient information to monitor their disease ? a nationwide survey in Finland

Objectives: The aim of this study was to assess to what extent the principles of asthma monitoring are implemented among Finnish asthma patients and if the patients have received sufficient information to adjust their medication according to asthma symptoms.Setting: All Finnish asthma patients receiving asthma medication from Finnish community pharmacies during two days in June 1998.Main outcome measures: The proportions of asthma patients who monitor their asthma status according to the national guidelines and have received specific instructions on how and when to adjust their asthma medication.Results: Eightysix per cent of the respondents (86%) monitored their asthma status on a method recommended by the national guidelines. They made Peak Expiratory Flow (PEF) measurements (39% of the respondents), they monitored their symptoms (34%) or both (13%). A smaller proportion of the respondents (58%) were instructed on adjusting their medication according to symptoms. The lowest rates for monitoring the asthma status was found among the elderly (65 years or more) and among those who reported that they had been on medication for longer than 5 years (17% and 13% of the subgroup populations, respectively). The lowest rates for having received specific instructions on adjusting their asthma medication according to symptoms were found among the elderly (36 %), among those who reported that they had been on asthma medication less than one year (44 %), and among males (54 %).Conclusions: Pharmacists and other health care professionals need to enhance their education activities and their cooperation in training asthma patients to monitor their disease, especially principles of adjusting medication according to symptoms. In this process, especially the training needs of the elderly patients and those who have been using asthma medicines for a long time need to be taken into account.     

Does allowing adolescents to smoke at home affect their consumption and dependence?

Negative parental attitudes towards smoking decrease adolescent smoking initiation but limited research explores the relationship between parental attitudes and degree of adolescent smoking among established smokers. The aim of this study was to examine the relationship between parental allowance of smoking in the home and adolescent smoking behavior and level of dependence. Interviews from 408 youths seeking assistance to quit smoking showed that adolescents who were allowed to smoke at home smoked more cigarettes per day and had higher scores on the Fagerström Test of Nicotine Dependence than those not allowed to smoke at home. Studies that additionally evaluate parental smoking status and the temporal relationship of parental allowance of smoking with changes in adolescent smoking behavior are warranted to clarify public health implications of parental smoking interdictions.     

Pharmacists and their customers: a personal or anonymous service?

Aims — To explore the existence and nature of the pharmacist‐customer relationship. Methods — A qualitative approach was adopted. Semi‐structured interviews were conducted with 20 customers recruited from two pharmacies differing in type and location: Pharmacy A, a multiple chain pharmacy in a more affluent area, and pharmacy B, a small chain pharmacy. Key findings — Customers' views differed according to the pharmacy from which they were recruited. Pharmacy B customers had a personal relationship with the pharmacist and used the pharmacy as a health care resource, while pharmacy A customers did not have a personal relationship with the pharmacist and used the pharmacy simply for medicine supply. Several pharmacy A customers had their own different local pharmacist whom they used for more personal advice and counselling. Both groups described disadvantages of multiple chain pharmacies. Consumerist behaviour was identified among customers whereby they preferred to control the provision of advice, assess it and act upon it. However, lack of information was mentioned by several interviewees, which suggested that different types of customers have different needs from the pharmacy. The pharmacist has therefore to recognise these different needs and to meet them accordingly to provide services, whether anonymous or personal, within their “extended role.” While most customers viewed pharmacists as drug experts and considered managing minor ailments to be part of their job, they were less supportive of a more extended role in the therapeutic monitoring of drug therapy. This presents a serious barrier to pharmacists wishing to extend their role into a more patient‐oriented and clinical domain. Conclusion — This study reinforces the importance of considering customers' views when policies and strategies concerning the development of the “extended role” are considered. Recognising customers' views helps the profession to adapt and respond to changing consumer behaviour. Issues identified through this in‐depth exploration of public perceptions of pharmacists have implications for the extension of pharmacists' roles into areas favoured and appreciated by customers.     

Circulating endothelial progenitor cells: Do they live up to their name?

Preclinical and clinical studies have suggested that specific subsets of cells isolated from the bone marrow or peripheral blood, collectively named endothelial progenitor cells (EPCs), play an essential role in neovascularization and are biomarkers of atherosclerosis, inversely related to the presence and progression of the disease. Conclusive evidence for both the pathophysiological and the biomarker role of these cells is, however, missing, with lack of a unique and universally accepted interpretation for their role, and the absence of general agreement to prompt their use by the practicing clinician. In fact, the engraftment of EPCs after injection into ischemic areas is poor, their secretome is still largely unknown, and there are still many confounding factors—such as co-morbidities and medications—that limit their use as a faithful biomarker of disease. Here we briefly review the literature on EPCs and discuss their significance in cardiovascular disease both as mediators and as biomarkers, including current methods for their identification.     

Granulocyte colony stimulating factors: how different are they? How to make a decision?

Two granulocyte colony stimulating factors (G-CSFs) are available for clinical use in Europe: filgrastim (Neupogen) and lenograstim (Granocyte). The purpose of this literature review is to study how they differ, the clinical implications of these differences (especially in terms of efficacy) and the economic impact of these differences. From a chemical point of view the two molecules are not identical. Their amino acid sequence is different and one is glycosylated, whereas the other is not. The important question to ask is what these structural differences mean for the patient. It appears that glycosylation has important consequences in terms of efficacy. Several recent comparative studies, both in vitro and in vivo, in animals and in humans, reinforce this idea which was often shared intuitively by physicians. In economical terms, in hospitals where the exact dosages are used (150 microg/m2 or 19.2 million units (MU)/m2 for Granocyte, and 5 microg/kg or 0.5 MU/kg for Neupogen), the choice of G-CSF must be made according to the daily cost of treatment which, for an average patient, means comparing the price of 325 microg of Neupogen and of 255 microg of Granocyte. This is in fact equal to comparing the price per MU of each product. In hospitals where one vial per patient per day is used whatever be their weight or body surface area, the price per MU and the price per vial should be considered together, puting into perspective the potential therapeutic benefit for patients, one vial of Granocyte 34 containing more MU than one vial of Neupogen 30.     

Do gene polymorphisms alone or in combination affect the function of human β3-adrenoceptors?

Background and purpose

β₃-Adrenoceptors mediate many important physiological functions, for example, in the urinary bladder. The corresponding gene is polymorphic, and the W64R (Trp64Arg) single nucleotide polymorphism has been associated with disease states such as obesity, type 2 diabetes and bladder dysfunction. While these clinical data suggest that the 64R variant is hypofunctional, previous in vitro studies in which this variant was generated by site-directed mutagenesis and subsequent transfection have not consistently confirmed this.

Experimental approach

We transfected the wild-type human β₃-adrenoceptor and the 64R variant and also the more recently discovered 265M and 306F variants as well as 64R/265M and 64R/306F double mutants into human embryonic kidney cells and selected clones expressing the receptors at a density of about 100 fmol mg protein⁻¹. Receptor activation was measured by cAMP accumulation and ligand affinity by radioligand binding. Desensitisation was assessed as alterations of cAMP responses after prolonged agonist treatment.

Key results

Neither mutated receptor exhibited alterations in efficacy or potency for cAMP accumulation for any of five agonists (isoprenaline, noradrenaline, YM 178, FK 4664, CGP 12 177). In competition binding studies, the mutations did not affect the ability of any agonist to bind to the receptor. Wild-type receptors and the 64R variant exhibited similar isoprenaline-induced functional desensitization during a 24 h treatment.

Conclusions and implications

None of the polymorphisms tested here significantly altered the interaction of isoprenaline, noradrenaline, YM 178, FK 4664 or CGP 12 177 with the human β₃-adrenoceptor when expressed at near physiological levels in a human cell line.     

To smoke or not to smoke: Does delay discounting affect the proximal choice to smoke?

Background: Delay discounting rate shows robust predictive validity for tobacco use behaviors and is a new therapeutic target in the treatment of tobacco use. Identifying factors that influence relations between delay discounting and the choice to smoke cigarettes is key to the development of effective interventions that target delay discounting to reduce cigarette consumption. Objective: To examine relations between delay discounting, motivational factors, self-efficacy, nicotine dependence level, and the proximal choice to smoke in the context of other commonly rewarding activity choices. Methods: In this cross-sectional design, daily smokers (n?=?480) from Amazon Mechanical Turk completed a questionnaire that assessed delay discounting rate; motivation, intention, and self-efficacy to quit smoking; nicotine dependence level, and the preference for immediately engaging in multiple commonly rewarding activities. We hypothesized that 1) greater motivation to quit would be associated with lower priority given to smoking; 2) the relation between delay discounting and the priority given to smoking would be mediated by motivation, self-efficacy, and nicotine dependence level. Results: Greater motivation to quit was significantly associated with a lower priority given to smoking. The relation between delay discounting and the priority given to smoking was marginally mediated by nicotine dependence level (p > .057). Conclusions: Motivation to quit influences decision-making by impacting the prioritization of choices. Nicotine dependence is likely to mediate the relation between delay discounting and the choice to smoke. Interventions that target delay discounting to reduce cigarette consumption or prevent relapse need to account for motivation to quit and nicotine dependence level.     

Do we need a statin-nicotinic acid-aspirin mini-polypill to treat combined hyperlipidaemia?

This review considers the treatment for combined hyperlipidaemia (CH) with a combination formulation of three drugs: a statin, nicotinic acid (NA) and aspirin – a mini-polypill. CH is a highly atherogenic dyslipidaemia manifested either as familial combined hyperlipidaemia or dyslipidaemia related to the metabolic syndrome or Type 2 diabetes mellitus. These types of dyslipidaemia are highly prevalent in the general population. Statin plus extended-release NA is a promising treatment option for the normalisation of these atherogenic lipid alterations, regression of atherosclerosis, as well as for primary or secondary prevention of cardiovascular disease (CVD) events. The addition of aspirin might prove a useful adjunct that might reduce the cutaneous side effects of NA while also acting as an antiplatelet agent in high-CVD-risk patients. However, the effective dose of aspirin may need to be at least 160 mg/day. This triple combination might improve patient compliance when compared with the three drugs administered separately.     

Azole antimycotics--a highway to new drugs or a dead end?

Azole antimycotics are a well-known and important class of agents that are used in hospital practice, everyday health care, veterinary medicine and for crop protection. The era of azole fungicides began with the breakthrough of chlormidazole roughly 50 years ago. Since then, more than 20 drugs of this group, including triazoles, have been brought to the market. The specific chemical structure and mechanism of the action of azoles along with the eukaryotic character of fungal pathogens raise several serious issues. Resistance to drugs and disturbance to metabolic pathways are among the most important. On the other hand, these same features are responsible for unique and novel applications of these drugs. As a result, old and ineffective antifungal drugs can be successfully used in the treatment of parasitic diseases, bacterial infections or cancers. Are azoles getting their second wind?     

Do we need a statin-nicotinic acid-aspirin mini-polypill to treat combined hyperlipidaemia?

This review considers the treatment for combined hyperlipidaemia (CH) with a combination formulation of three drugs: a statin, nicotinic acid (NA) and aspirin--a mini-polypill. CH is a highly atherogenic dyslipidaemia manifested either as familial combined hyperlipidaemia or dyslipidaemia related to the metabolic syndrome or Type 2 diabetes mellitus. These types of dyslipidaemia are highly prevalent in the general population. Statin plus extended-release NA is a promising treatment option for the normalisation of these atherogenic lipid alterations, regression of atherosclerosis, as well as for primary or secondary prevention of cardiovascular disease (CVD) events. The addition of aspirin might prove a useful adjunct that might reduce the cutaneous side effects of NA while also acting as an antiplatelet agent in high-CVD-risk patients. However, the effective dose of aspirin may need to be at least 160 mg/day. This triple combination might improve patient compliance when compared with the three drugs administered separately.     

Do medical students copy the drug treatment choices of their teachers or do they think for themselves?

Purpose

Although the importance of rational prescribing is generally accepted, the teaching of pharmacotherapy to undergraduate medical students is still unsatisfactory. Because clinical teachers are an important role model for medical students, it is of interest to know whether this extends to therapeutic decision-making. The aim of this study was to find out which factors contribute to the drug choices made by medical students and their teachers (general practitioners and clinical specialists).

Methods

Final-year medical students (n?=?32), and general practitioners (n?=?29), lung specialists (n?=?26), orthopaedic surgeons (n?=?24), and internists (n?=?24) serving as medical teachers from all eight medical schools in the Netherlands participated in the study. They were asked to prescribe treatment (drug or otherwise) for uncomplicated (A) and complicated (B) written patient cases and to indicate which factors influenced their choice of treatment, using a list of factors reported in the literature to influence drug prescribing.

Results

Final-year medical students primarily based their drug choice on the factors ‘effectiveness of the drugs’ and ‘examples from medical teachers’. In contrast, clinical teachers primarily based their drug choice on the factors ‘clinical experience’, ‘effectiveness of the drugs’, ‘side effects of the drugs’, ‘standard treatment guidelines’, and ‘scientific literature’.

Conclusions

Medical teachers would appear to base their drug choice mainly on clinical experience and drug-related factors, whereas final-year medical students base their drug choice mainly on examples provided by their medical teachers. It is essential that medical teachers clearly explain to their students how they arrive at a specific choice of medication since medical students tend to copy the therapeutic drug choices from their teachers, mainly because of a lack of experience. Presenting students with clinical therapeutic problems early during undergraduate training will not only give them a chance to gain experience in solving medical problems but will also give meaning to what they are studying as opposed to merely reproducing what they learn or copying what they are told.     

Do personality traits related to affect regulation predict other tobacco product use among young adult non-daily smokers?

IntroductionUnderstanding factors that influence non-cigarette tobacco use is important given these products' prevalence and health risks. The goal of this study was to test the hypothesis that personality traits related to affect regulation would be associated with greater frequency of other tobacco product (OTP) use in a sample of young adult non-daily smokers.MethodsParticipants (n = 518, 51% male) aged 18–24 were non-daily cigarette smokers recruited from the community for a longitudinal study of tobacco use. Personality characteristics (impulsivity, anhedonia, and negative affectivity) were measured at baseline, and participants reported recent tobacco use at baseline and 3, 6, and 9 months later. Assessments were conducted online or via mobile phone.ResultsAcross the 4 assessments, 33–52% of participants reported recent OTP use, with frequency of use decreasing over time. Longitudinal negative binomial regression models indicated that greater sensation seeking and lack of premeditation were associated with more frequent OTP use (ps < 0.05). These effects were consistent over time.ConclusionsFindings suggest that young adult non-daily cigarette smokers with greater propensity for immediately rewarding behaviors may use OTPs more frequently. Young, non-daily cigarette smokers with high levels of sensation seeking and/or lack of premeditation may be at increased risk for harms related to OTP use and may benefit from prevention and cessation strategies that specifically address affect.     

Review: Do engineered nanoparticles pose a significant threat to the aquatic environment?

Nanotechnology is a rapidly growing industry of global economic importance, exploiting the novel characteristics of materials manufactured at the nanoscale. The properties of engineered nanoparticles (ENPs) that make them useful in a wide range of industrial applications, however, have led to concerns regarding their potential impact on human and environmental health. The aquatic environment is particularly at risk of exposure to ENPs, as it acts as a sink for most environmental contaminants. This paper critically evaluates what is currently known about sources and discharge of ENPs to the aquatic environment and how the physicochemical characteristics of ENPs affect their fate and behaviour and thus availability for uptake into aquatic organisms, and assesses reported toxicological effects. Having reviewed the ecotoxicological information, the conclusion is that whilst there are data indicating some nanoparticles have the potential to induce harm in exposed aquatic organisms, there is insufficient evidence for harm, for known/modelled environmental concentrations for almost all ENPs considered. This conclusion, however, must be balanced by the fact that there are significant gaps in our understanding on the fate and behaviour of ENPs in the aquatic environment. Greater confidence in the assessments on ENP impacts in aquatic systems to enable effective comparisons across studies urgently requires more standardised approaches for ENP hazard identification, and critically, more thorough characterisations on the exposed particles. There is also an urgent need for the advancement of tools and techniques that can accurately quantify and visualise uptake of nanoparticles into biological tissues.