Psychological and family functioning and quality of life in adolescents with cystic fibrosis.

BACKGROUND: The life expectancy of individuals with CF has increased to 33 years. Thus, issues such as quality of life and psychological well-being, previously thought to be of lesser importance than physical well-being, are now recognised as significant factors. This study examined the interrelationships between quality of life, family functioning, individual psychopathology and optimism of adolescents with CF. METHODS: Adolescents attending the CF clinic completed a number of questionnaires. Quality of Life was measured using the Cystic Fibrosis Questionnaire, family functioning by the Family Environment Scale (3rd edition), general psychopathology with the Symptom Checklist-90-Revised and optimism for the future by the Hunter Opinions and Personal Expectations Scale. Disease severity was assessed using the Shwachman score and spirometry at the time of questionnaire completion. RESULTS: The level of psychopathology (12.5% of those 13 years and over) in the group was lower than that reported for young people in Australia (15-20%). The results indicated that young people with a delayed diagnosis and those who are alienated from their families may be in need of additional psychosocial support. The group was hopeful and positive about their future and these attributes were independent of clinical measures of disease severity. In general, these young people scored relatively highly on the quality of life scale. For example the mean standardised score for physical functioning was 70 points, for respiratory symptoms was 63 points and for emotional state was 78 points. Increased levels of psychopathology and lack of hope for the future were however associated with lower ratings on a number of quality of life measures. Family cohesiveness, expressiveness and organization were associated with better psychological functioning in the young people. CONCLUSIONS: Adolescents with CF appear to be a psychologically well functioning and well-adjusted group. These findings support the importance of a more sophisticated model of well-being for adolescents with CF, which explores the young person's views on their quality of life and wider support frameworks rather than relying solely on measures of physical health to gauge well-being.     

Scale-up of Adhesive Transdermal Drug Delivery Systems

Pharmaceutical Research -     

Minimal volume,hypotense resuscitation

Large volume fluid resuscitation attempting to normalise physiological parameters in hypovolaemic shock has become the accepted management practice during the last 30 years. This doctrine, based on research in the 1950s, teaches that shock increases mortality, aggressive resuscitation improves outcome and normalisation of vital signs protects against multiple organ dysfunction. The wide acceptance of this doctrine is demonstrated by the central role it plays in the American College of Surgeons Advanced Trauma Life Support (ATLS) course and its Australian equivalent the Early Management of Severe Trauma (EMST) course. During the late 1980s, a number of animal research papers demonstrated severe limitations to the earlier work performed in the 1950s and proposed an alternative approach using hypotense or minimal fluid resuscitation. Controlled haemorrhagic shock is hypovolaemic shock in which the source of the bleeding is easily controlled without operation and hence aggressive fluid resuscitation can be pursued with minimum risk. Uncontrolled haemorrhagic shock is hypovolaemic shock due to bleeding which cannot be controlled without surgery. The restoration of blood pressure towards normal levels may lead to dislodgement of thrombus and loss of vascular spasm in damaged vessels, with a subsequent increase in blood loss. It is in this situation that hypotense resuscitation is thought to be of most value. Hypotense resuscitation is defined as the use of fluid resuscitation to maintain blood pressure at lower than normal levels which are sufficient to maintain life, but minimise the risk of exacerbating internal bleeding. Prompted by animal research a number of human studies have been undertaken to clarify the role of fluid resuscitation in uncontrolled haemorrhage. At present, there is wide acceptance of the use of hypotense or minimal volume resuscitation for ruptured abdominal aortic aneurysm and a recent demonstration that morbidity and mortality are decreased by the use of hypotense resuscitation in penetrating truncal trauma. There are however many other clinical situations that may produce uncontrolled haemorrhagic shock about which we have little clinical data to predict appropriate levels of fluid resuscitation. These include ectopic pregnancy, gastro-intestinal haemorrhage and blunt multi-system trauma. This paper will analyse the animal studies that demonstrate the physiological effects of the various fluid resuscitation regimes and discuss all the clinical papers on the subject of hypotense resuscitation. An attempt will then be made to integrate this data into current Australian practice and give broad guidelines on the modern management of uncontrolled haemorrhagic shock, based on minimal volume or hypotense resuscitation.     

Distribution of metabotropic glutamate receptor mGluR5 immunoreactivity in rat brain

The receptor mGluR5 is a metabotropic glutamate receptor with messenger RNA abundantly present throughout cortex, hippocampus, and caudate/putamen that is also coupled to phosphatidyl inositide hydrolysis and calcium mobilization. In this study, the distribution of mGluR5 was examined in rat brain by immunocytochemistry. The antibody utilized is highly specific and does not cross react with the most closely related other metabotropic glutamate receptor, as determined by Western blot analysis of nonneuronal cells transfected with metabotropic receptor coding sequences. The receptor mGluR5 is widely expressed with the highest density in olfactory bulb, caudate/putamen, lateral septum, cortex, and hippocampus, as confirmed with both immunocytochemistry and Western blot analysis. Electron microscopic studies in hippocampus and cortex indicate that the labeling is mostly on membranes of dendritic spines and shafts. Light and electron microscopic evidence indicates that some mGluR5 immunoreactivity is located in presynaptic axon terminals, suggesting that mGluR5 may function as a presynaptic receptor.     

Structure and Behavior in Hydrophilic Matrix Sustained Release Dosage Forms: 4. Studies of Water Mobility and Diffusion Coefficients in the Gel Layer of HPMC Tablets Using NMR Imaging

Purpose. The purpose of this study was to characterise the water mobility in the gel layer of hydrating HPMC tablets. Water mobility in the gel layer of different HPMCs was studied. Methods. NMR imaging, a non-invasive technique, has been used to measure the spatial distribution of self-diffusion coefficient (SDC) and T₂ relaxation times across the gel layer. Results. It has been shown that there is a water mobility gradient across the gel layer of HPMC tablets. Although SDC and T₂ relaxation times in the outer parts of the gel layer approached that of free water, in the inner parts they decreased progressively. Water mobility and SDC in the gel layer of different HPMCs appeared to vary with degree of substitution of the polymer and the lowest values were obtained across the gel layer of K4M tablets. Conclusions. Water mobility varies across the gel layer of hydrating HPMC tablets and it is dependent on the degree of substitution of the polymer.     

Generation of mice with inactivated Rh or Rhag genes.

Mice carrying inactivated Rh and Rhag genes were generated by insertional targeting. KO animals exhibited normal growth, development and fertility and both types were indistinguishable at a gross phenotypic level from their wild type littermates. Preliminary analysis revealed that red cells from Rh-/- mice lack Rh protein and have a moderate decrease of Rhag protein, whereas those from Rhag-/- mice have a total absence of Rhag and Rh proteins. Studies are in progress to delineate the antigenic, biochemical and functional abnormalities of red cells from these animals as well as the impact on hematological parameters and erythropoiesis.     

Changes in elderly suicides in the USA and the developed world 1974–87: Comparison with current homicide

Between 1974 and 1987 there were increases overall in male suicide rates in the USA, with the greatest increases among elderly men. While female suicide levels overall fell in the USA, elderly female suicide rates failed to show the same improvement. Compared with the rest of the western world, suicide rates for elderly people in the USA were among the worst. Suicide was far more prevalent than homicide, but this is not reflected in the media, where homicide is given a high profile but where there is relative silence surrounding suicide among elderly people.