Prescribing and partnership with patients

There have been widespread changes in society and the roles of professionals. This change is also reflected in health care, where there is now acceptance of the need to involve patients in decision making. In prescribing specifically, the concordance agenda was developed alongside these initiatives to encourage improved medication taking and reduce wastage. However the extent to which these partnerships are delivered in practice remains unclear. This paper explores some of the issues to be considered when preparing patients and professionals for partnership and summarizes the limited evidence of barriers to, and benefits of, this approach. Firstly patients must be given the confidence, skills and knowledge to be partners. They need information about medicines, provided in ways known to be acceptable to them. Likewise professionals may need new skills to be partners. They need to understand the patient agenda and may need training and support to change the ways in which they consult with patients. There are also practical issues such as the perceived increase in time taken when consulting in partnership mode, room layout, computer interfaces and record keeping. Health care professionals other than doctors are also expected to behave in partnership mode, whether this is as prescribers in their own right or in supporting the prescribing of others. Whilst much has been claimed for the benefit of partnership approaches, hard evidence is limited. However whilst there is still much more to understand there will be no going back to the paternalistic model of the mid 20th century.     

Weight Care Project: Health professionals' attitudes and ability to assess body weight status - Study protocol

Background  

Health professionals working in primary care and public health have opportunities to address body weight status issues with their patients through face-to-face contact. The objectives of this all-Ireland project are: 1. to assess the attitudes, current practices/behaviours and knowledge of key health professional groups on body weight status; 2. to assess the health professional groups' ability to identify body weight status in both adults and children. The health professional groups are: (a) community related public health nurses; (b) school public health nurses; (c) GPs and practice nurses (primary care); and (d) occupational health nurses (workplace) from both Northern Ireland and the Republic of Ireland.     

Family and home correlates of children's physical activity in a multi-ethnic population: the cross-sectional child heart and health study in england (CHASE)

Background  

The influence of the family and home environment on childhood physical activity (PA) and whether this differs between ethnic groups remains uncertain. This paper investigates associations between family and home factors and childhood PA in a multi-ethnic population and explores whether associations differ between ethnic groups.     

A recombinant model for assessing the role of GSTM1 in styrene-7,8-oxide toxicity and mutagenicity

Styrene-7,8-oxide (SO) is a highly reactive epoxide able to undergo reactions with endogenous nucleophiles, such as DNA. SO is inactivated by glutathione-S-transferase M1 (GSTM1). This detoxification enzyme is absent in approximately one-half of Caucasian (49%) populations. A GSTM1 recombinant human lymphoblastoid cell line (FB7) was generated from a GSTM1 negative parental cell line (WIL2NS). GSTM1 status was determined using RT-PCR and immunochemistry. Cells were challenged with a range of SO doses and subsequent toxicity (population growth in flasks) and genotoxicity (mutations at the HPRT locus) were monitored. FB7 (GSTM1 positive) exhibited greater cell survival after SO exposure relative to the GSTM1 negative parental line. The IC50 following a 1 h exposure to SO was 0.5 mM for WIL2NS, compared to greater than 2.5 mM for FB7. The extrapolated IC50 for FB7 was 5.5 mM. Significantly fewer mutant cells were induced by SO for FB7 than for WIL2NS at equivalent doses of SO. These findings suggest that the sensitivity of cells to styrene-7,8-oxide is influenced by GSTM1 status and that a recombinant GSTM1 positive cell line can efficiently detoxify styrene-7,8-oxide.     

Quantitative structure-activity relationships for gammadelta T cell activation by bisphosphonates

gammadelta T cells are the first line of defense against many infectious organisms and are also involved in tumor cell surveillance and killing. They are stimulated by a broad range of small, phosphorus-containing antigens (phosphoantigens) as well as by the bisphosphonates commonly used in bone resorption therapy, such as pamidronate and risedronate. Here, we report the activation of gammadelta T cells by a broad range of bisphosphonates and develop a pharmacophore model for gammadelta T cell activation, in addition to using a comparative molecular similarity index analysis (CoMSIA) approach to make quantitative relationships between gammadelta T cell activation by bisphosphonates and their three-dimensional structures. The CoMSIA analyses yielded R(2) values of approximately 0.8-0.9 and q(2) values of approximately 0.5-0.6 for a training set of 45 compounds. Using an external test set, the activities (IC(50) values) of 16 compounds were predicted within a factor of 4.5, on average. The CoMSIA fields consisted of approximately 40% hydrophobic, approximately 40% electrostatic, and approximately 20% steric interactions. Since bisphosphonates are known to be potent, nanomolar inhibitors of the mevalonate/isoprene pathway enzyme farnesyl pyrophosphate synthase (FPPS), we also compared the pharmacophores for gammadelta T cell activation with those for FPPS inhibition, using the Catalyst program. The pharmacophores for gammadelta T cell activation and FPPS inhibition both consisted of two negative ionizable groups, a positive charge feature and an endocyclic carbon feature, all having very similar spatial dispositions. In addition, the CoMSIA fields were quite similar to those found for FPPS inhibition by bisphosphonates. The activities of the bisphosphonates in gammadelta T cell activation were highly correlated with their activities in FPPS inhibition: R = 0.88, p = 0.002, versus a human recombinant FPPS (N = 9 compounds); R = 0.82, p < 0.0001, for an expressed Leishmania major FPPS (N = 45 compounds). The bisphosphonate gammadelta T cell activation pharmacophore differs considerably, however, from that reported previously for gammadelta T cell activation by phosphoantigens (Gossman, W.; Oldfield, E. J. Med. Chem. 2002, 45, 4868-4874), suggesting different primary targets for the two classes of compounds. The ability to quite accurately predict the activity of bisphosphonates as gammadelta T cell activators by using 3D QSAR techniques can be expected to help facilitate the design of additional bisphosphonates for potential use in immunotherapy.     

A randomized control trial of group counseling in a naltrexone treatment program

This study evaluated the additional effectiveness of a 12-week manualized group counseling program over a structured naltrexone treatment program. The randomized controlled trial, the first of its kind in Australia, was conducted at Turning Point Alcohol and Drug Centre, Melbourne, Australia.

Ninety-seven participants received a 50 mg dose of naltrexone daily and were randomized to either the experimental (n = 52) or control (n = 45) conditions. The experimental group received a structured group counseling program, which used a cognitive-behavioral relapse prevention approach.

Using intention-to-treat analyses, there was only one statistically significant difference between the groups, with the control group reporting a significantly higher level of physical functioning at Week 6. All participants improved significantly in their level of heroin use and in psychosocial functioning between Baseline and Weeks 6, 12, and 24. It is not possible to conclude from these results whether or not group counseling provides additional benefit to naltrexone treatment.     

Second Trimester Insulin Resistance,Early Pregnancy Body Mass Index and Gestational Weight Gain

Objectives Because prior work suggests an association between high insulin concentrations in early pregnancy and excess gestational weight gain, we examined such associations in a prospective cohort. Methods Multivariate regression analysis of early pregnancy insulin homeostasis and gestational weight gain among 434 women enrolled in the MGH Obstetrical Maternal Study. Results We found that the association between insulin quartile and gestational weight gain varied depending on maternal body mass index (BMI) in early pregnancy (P for interaction <0.0001). Among women with a BMI of 20, high fasting insulin was associated with greater gestational weight gain (multivariate-adjusted predicted mean 39.6, 95% CI 30.9–40.3 lbs for Quartile 4 (Q4) vs. 31.3, 95% CI 28.6–34.1 lbs for Q1) and higher risk of excessive weight gain. By contrast, among women with a BMI of 35, higher fasting insulin was associated with lower total gain (multivariate-adjusted predicted mean 25.7, 95% CI 22.6–28.7 lbs for Q4 vs. 33.2, 95% CI 10.5–55.9 lbs for Q1) and lower risk of excessive gain. Conclusion In our cohort, early pregnancy BMI modified the association between insulin homeostasis and gestational weight gain. These associations suggest that the physiologic consequences of hyperinsulinemia differ between normal weight and obese women.     

Using risk factor surveillance as a basis for mixed-methodology research: an example from Australia using food intake and anthropometric measures

Objectives  

Risk factor surveillance is an integral part of public health, and can provide a ready-made sample for further research. This study assessed the utility of mixed-methodology research using telephone and postal surveys.     

Contrasting predictors of poor antiretroviral therapy outcomes in two South African HIV programmes: a cohort study

Background  

Many national antiretroviral therapy (ART) programmes encourage providers to identify and address baseline factors associated with poor treatment outcomes, including modifiable adherence-related behaviours, before initiating ART. However, evidence on such predictors is scarce, and providers judgement may often be inaccurate. To help address this evidence gap, this observational cohort study examined baseline factors potentially predictive of poor treatment outcomes in two ART programmes in South Africa, with a particular focus on determinants of adherence.