Pharmacoepidemiology and disability in older adults: can medications slow the age-related decline in physical function?

Age-related disability and loss in physical function are growing public health priorities. Loss in physical function seriously threatens the independence and quality of life of older adults and has a significant social and economic impact on our society. Despite the fact that the negative impact of adverse drug reaction and inappropriate drug use on disability has been widely studied, there is limited evidence regarding the efficacy of pharmacological interventions to prevent decline in physical function among older populations. The effect of statins, angiotensin-converting enzyme inhibitors and testosterone on physical performance in older adults are reviewed. In clinical studies these drugs have recently shown promising effects on the prevention of disability and decline in physical function in older adults. The findings of these studies are not definite and need to be confirmed in large clinical trials.     

Pharmacoepidemiology and disability in older adults: can medications slow the age-related decline in physical function?

Age-related disability and loss in physical function are growing public health priorities. Loss in physical function seriously threatens the independence and quality of life of older adults and has a significant social and economic impact on our society. Despite the fact that the negative impact of adverse drug reaction and inappropriate drug use on disability has been widely studied, there is limited evidence regarding the efficacy of pharmacological interventions to prevent decline in physical function among older populations. The effect of statins, angiotensin-converting enzyme inhibitors and testosterone on physical performance in older adults are reviewed. In clinical studies these drugs have recently shown promising effects on the prevention of disability and decline in physical function in older adults. The findings of these studies are not definite and need to be confirmed in large clinical trials.     

2003 SCI Impact Factor of Acta Pharmacologica Sinica is available

The 2003 Science Citation Index (SCI) Impact Factor of Acta Pharmacologica Sinica has risen to 0.884 according to the Journal of Citation Report published by Institute for Scientific Information, USA. The journal is continued to be the only journal listed in the SCI of Chinese Pharmacology and Pharmacy. The SCI     

“Designer Genes and the Politics of Fear”

Abstract

The recent large commitment of capital and personnel to biotechnology by multi national corporations is evidence that management believes scientists can develop a wide range of products for human and animal health and the production of crops. Yet current food surpluses create an atmosphere wherein actions taken by those who fear the development of biotechnology have succeeded in halting planned experiments and popularized accounts of vast public danger. Thus, the regulatory process for biotechnology is one of the major challenges facing society.

There is need for leadership by industry to present fact, correct misimpressions, debate issues, and to be as dedicated to resolution of the regulatory aspects of biotechnology as to the development of the science itself.     

Discrepancy,Dissonance, and the “Dissonant” Smoker

This paper reexamines, in the light of social psychological research, the theoretical assumptions made by McKennell and Thomas in their study of smoking habits and attitudes in Britain. One assumption made by them is that antismoking messages which are very discrepant from the opinions held by smokers should be avoided since they may produce attitude change in the opposite direction to that intended. It is argued that there is little empirical basis for this assumption, and that the discrepancy of a communication from the initial attitudes of a target audience is not necessarily the most important determinant of its effectiveness. McKennell and Thomas also distinguish “consonant” from “dissonant” smokers—the latter being those who say that they would like to give up smoking if they could do so easily. It is argued that the term “dissonant” is a misnomer when applied to smokers who see themselves as unable to choose not to smoke. Practical and theoretical implications are discussed.     

Misuse and Legend in the “Toad Licking” Phenomenon

Between 1988 and 1992 a new illicit drug experience arrived on the cultural scene in the United States, Canada, South and Central America, and Australia. The media created a frenzy of misinformation in reporting on the latest drug craze which was termed “toad licking.” The uses of bufo toad secretions have occurred throughout history in a variety of cultural milieus. These are explored as a backdrop to contemporary drug use/misuse issues. At the interpersonal and social level, media exposure helped create and maintain the use/misuse phenomenon, turning a fairly obscure activity into a potential epidemic     

Relative Importance of Intestinal and Hepatic Glucuronidation—Impact on the Prediction of Drug Clearance

Purpose  To assess the extent of intestinal and hepatic glucuronidation in vitro and resulting implications on glucuronidation clearance prediction. Methods  Alamethicin activated human intestinal (HIM) and hepatic (HLM) microsomes were used to obtain intrinsic glucuronidation clearance (CL_int,UGT) for nine drugs using substrate depletion. The in vitro extent of glucuronidation (fm_UGT) was determined using P450 and UGT cofactors. Utility of hepatic CL_int for the prediction of in vivo clearance was assessed. Results  fm_UGT (8–100%) was comparable between HLM and HIM with the exception of troglitazone, where a nine-fold difference was observed (8% and 74%, respectively). Scaled intestinal CL_int,UGT (per g tissue) was six- and nine-fold higher than hepatic for raloxifene and troglitazone, respectively, and comparable to hepatic for naloxone. The remaining drugs had a higher hepatic than intestinal CL_int,UGT (average five-fold). For all drugs with P450 clearance, hepatic CL_int,CYP was higher than intestinal (average 15-fold). Hepatic CL_int,UGT predicted on average 22% of observed in vivo CL_int; with the exception of raloxifene and troglitazone, where the prediction was only 3%. Conclusion  Intestinal glucuronidation should be incorporated into clearance prediction, especially for compounds metabolised by intestine specific UGTs. Alamethicin activated microsomes are useful for the assessment of intestinal glucuronidation and fm_UGT in vitro.     

Does social integration confound the relation between alcohol consumption and mortality in the Multiple Risk Factor Intervention Trial (MRFIT)?

OBJECTIVE: It has been proposed that social integration would act as a confounder in the relationship between alcohol consumption and all-cause mortality. This study tested the assumption that the J-shaped relationship between drinking and all-cause mortality may partly reflect a protective effect of social integration, to the extent that moderate drinkers are more socially integrated than either abstainers or heavy drinkers, and to the extent that social integration offers direct protection from mortality. METHOD: This hypothesis was tested using data from 10,832 of the 12,866 men in the Multiple Risk Factor Intervention Trial (MRFIT). Indicators of social integration were derived from an exploratory factor analysis of 25 relevant items in the MRFIT data and from a scale of six items selected by the investigators. RESULTS: We failed to confirm a direct protective effect of social integration. Nondrinkers had the highest rates of all-cause mortality. Compared with heavy drinking, relative risks of all-cause mortality for abstinence, light and moderate drinking were unaffected by inclusion of social integration variables in the proportional hazards models. CONCLUSIONS: The MRFIT data fail to confirm a confounding effect of social integration.     

Examining the association between the “My Pharmacist” model and the service quality of community pharmacies

BackgroundIn Japan, patients can freely choose medical facilities. Many visit different medical facilities for different diseases, and for convenience, often utilize the pharmacies neighboring these facilities. Accordingly, a “My Pharmacy” model was recommended, in which patients select a single pharmacy using their own judgement to receive proper medication services. A “My Pharmacist” model, in which the pharmacist is constantly involved in the treatment of a patient, was also proposed. However, patients’ evaluations of pharmacist/pharmacy services under these models have not been investigated.ObjectiveTo examine how a patient's constant involvement with the same pharmacist and pharmacy is associated with their evaluation of the quality of pharmacy services.MethodsA cross-sectional survey using a self-administered questionnaire was conducted among patients who used pharmacies periodically. Patients evaluated the pharmacist/pharmacy services and were classified into 4 groups (“My Pharmacy/My Pharmacist,” “My Pharmacy/Multiple Pharmacists,” “Multiple Pharmacies/My Pharmacist,” and “Multiple Pharmacies/Multiple Pharmacists”) according to the form of their usage of pharmacies and pharmacists. An intergroup comparison was then performed and correlations within each group analyzed.ResultsData from 3,492 individuals using 147 pharmacies were analyzed. “My Pharmacy” users had significantly higher scores than did “Multiple Pharmacies” users on patient experience of proper medication services (e.g., identifying duplicate medication) (p < 0.001). “My Pharmacy/My Pharmacist” users scored higher than the other three groups on four evaluation factors, including “pharmacy/pharmacist's interpersonal services” (“sharing and utilizing patient information,” “enhanced health support function,” and “consideration towards patients”), “patient satisfaction with the pharmacy,” “placing more emphasis on quality of interaction with pharmacist than on waiting time,” and “attitude when visiting healthcare facilities” (all p < 0.001).ConclusionThe findings indicate that highly tailored, in-person services provided by “My Pharmacists” are associated with not only with the degree of patients’ overall satisfaction, but also their evaluation of “the quality of pharmacist services.”     

Transfer of the “Assay” and “Dissolution” Methods: Comparative Testing and Acceptance Criteria (Review)

Pharmaceutical Chemistry Journal - Transfer of the “Assay” and “Dissolution” analytical methods in most cases is used in comparative testing of samples. A number of...