Postural Fall in Blood Pressure in the Elderly in Relation to Drug Treatment and Other Lifestyle Factors

In a study of 843 independent-living men and women aged between60 and 87 in Perth, Western Australia, stepwise multiple regression,after correction for initial levels of systolic blood pressure,showed that postural fall in systolic blood pressure was positivelyrelated to alcohol intake of more than 20 ml/day, the use ofsleeping tablets and higher levels of anxiety on the Spielbergerstate-trait scale, and negatively related to body mass index.Postural fall in blood pressure was not significantly relatedto treatment for hypertension, age, sex, patterns of usual physicalactivity, tea or coffee drinking, or the diagnosis of diabetesmellitus. This analysis is the first to examine the relationshipbetween lifestyle factors and the magnitude of the fall in systolicblood pressure on standing after adjustment for the associationbetween the change in a variable and its initial level. Ouranalysis suggests the need for further study of the possiblerole of lifestyle factors such as the use of sleeping tabletsand alcohol in postural hypotension in the elderly.     

Tlymphocyte subsets in homosexual men from Copenhagen

Abstract. Screening of sixty-six asymptomatic homosexual men from Copenhagen revealed significantly lower Leu-3a/Leu-2a ratios as compared to controls. Ten (15%) of the homosexuals had a ratio ≤ 1·0. The low Leu-3a/Leu-2a ratios were the result of an increase in the absolute number of Leu-2a cells. Homosexuals with many partners and those who had been sexual partners of patients with the acquired immuno-deficiency syndrome (AIDS) had significantly lower ratios than those without these features. Cytomegalovirus was isolated from urine and/or sputum of 15% and this was associated with a Leu-3a/Leu-2a ratio ≤ 1·0. The observed immunological abnormalities could either represent latent infection with the putative AIDS agent or alternatively be caused by repeated infections and/or exposure to allogenic spermatocytes or lymphocytes.     

Respiratory symptoms,lung function and particulate matter pollution in residential indoor environment in Ile-Ife,Nigeria

Introduction:

Particulate air pollution is associated with increased incidence of respiratory symptoms and decreased pulmonary, function but the relative impact of pollution from different domestic energy sources is not well-known or studied.

Aim:

The study was aimed at assessing the association between particulate concentrations, respiratory symptoms and lung function.

Materials and Methods:

It was a cross-sectional study comprised of randomly selected residents of three communities. These communities were selected according to the predominant type of fuel used for household cooking which were: firewood, kerosene and liquefied petroleum gas (LPG). Assessment of the indoor PM₁₀ levels was done by filtration using the Gent stacked filter unit sampler for collection of atmospheric aerosol in two size fractions (PM_2.5 and PM₁₀). The Medical Research Council (MRC) questionnaire was administered followed by spirometry test.

Results:

The mean PM₁₀ concentration in participants using LPG, kerosene and firewood was 80.8 ± 9.52 μg/m³, 236.9 ± 26.5 μg/m³ and 269 ±93.7 μg/m³, respectively. The mean age and height-adjusted percent predicted forced expiratory volumes in 1 s (FEV1) for men were 127 ± 7, 109 ± 40 and 91 ± 20 and for women were 129 ± 13, 115 ± 14, 100 ± 14 in users of LPG, kerosene and firewood, respectively. A similar trend was found in the forced vital capacity (FVCs). Users of firewood had significantly lower FEV1 and FVC compared with LPG users (P < 0.05). The participants using firewood had the highest prevalence of pulmonary and non-pulmonary symptoms (57.1%), whereas subjects using LPG had the lowest (23.8%).

Conclusion:

There are high levels of particulate matter pollutions with respiratory effects in residential indoor environments in Ile-Ife, Nigeria     

Treatment interventions-looking towards the millennium.

This contribution is focused around treatment interventions employed when dealing with young substance misusers. By necessity, it draws on effective interventions which are applied to adult substance abusers. Where possible, research data on the effectiveness of interventions in young people are outlined and reviewed. The components of a comprehensive service are delineated. Suggestions for a framework for research are discussed, paying particular attention to some methodological difficulties in previous research.     

Orthostatic haemodynamic responses in acute stroke

Little is known about orthostatic blood pressure regulation in acute stroke. We determined postural haemodynamic responses in 40 patients with acute stroke (mild or moderate severity) and 40 non-stroke control in-patients, at two days ('Day 1') and one week ('Week 1') post-admission. Following a 10-minute supine rest and baseline readings, subjects sat up and blood pressure and heart rate were taken for 5 minutes. The procedure was repeated with subjects moving from supine to the standing posture. Haemodynamic changes from supine data were analysed. On standing up, the control group had a transient significant fall in mean arterial blood pressure on Day 1 but not Week 1. No significant changes were seen on either day when sitting up. In contrast to controls, the stroke group showed increases in mean arterial blood pressure on moving from supine to the sitting and standing positions on both days. Persistent postural hypotension defined as > or = 20 mmHg systolic fall occurred in < 10% of either of the study groups on both days. Sitting and standing heart rates in both groups were significantly faster than supine heart rate on both days. The orthostatic blood pressure elevation is consistent with sympathetic nervous system overactivity which has been reported in acute stroke. Upright positioning as part of early rehabilitation and mobilisation following mild-to-moderate stroke would, therefore, not predispose to detrimental postural reductions in blood pressure.     

How strong is the evidence that illicit drug use by young people is an important cause of psychological or social harm? methodological and policy implications of a systematic review of longitudinal,general population studies

Recreational use of illicit drugs (i.e. use not associated with a diagnosed drug problem) may cause psychological and social harm. A recent systematic review found that evidence for this was equivocal. Extensive evidence was only available in relation to cannabis use. This was relatively consistently associated with lower educational attainment and greater use of other drugs. However whether this association was causal was not clear. Cannabis use was less consistently associated with mental illness and antisocial behaviour. Causal relations between cannabis use and psychosocial harm could plausibly be mediated through either neurophysiological effects of cannabis or through social mechanisms related to use of an illegal substance. These different mechanisms might have different implications for harm-reduction policy. Alternatively associations may arise through non-causal pathways such as reverse causation, bias and confounding. In this latter situation, even effective reduction of cannabis use would be unlikely to be an effective harm-reduction policy in relation to psychosocial outcomes. Research strategies that could clarify these questions are discussed, as are the implications of these considerations for harm-reduction policy.     

Alcohol in Europe – Public Health Perspective: Report summary

Background: Two previous studies have demonstrated the parlous state of undergraduate medical education. A third study was undertaken to evaluate any change.

Methodology: All deans, heads of psychiatry and addiction specialists working in 28 British medical schools were surveyed by questionnaire. Items included time allocated to formal training, clinical resources, training objectives, professional confidence and competence, postgraduate facilities, plans for change, opinion on the importance of addiction in the curriculum, and scientific credibility.

Findings: There was a 100%, 71% and 46% response rate from specialists, heads, and deans respectively. Medical students were receiving, on average, six hours of formal training in substance misuse over their entire course. Although there was disparity in responses between the three groups, there was a clear consensus that the addiction field had scientific credibility. However, this achievement has not been translated into more training, and there is pessimism about any likelihood of change.

Discussion: Barriers to training such as too few addiction specialists, stigma, and tensions in academia resulting from the Research Assessment Exercise, are identified.

Conclusion: Since the General Medical Council and the Alcohol Harm Reduction Strategy have explicitly stated the need for undergraduate training, ways in which medical students, as ‘users’ of the undergraduate training package, may be the drivers of change, are suggested.     

Nortriptyline therapy in elderly patients: Dosage prediction after single dose pharmacokinetic study

Summary Sixteen depressed elderly patients in hospital (mean age 81 years) received a single oral dose of nortriptyline prior to commencing treatment with this drug. Plasma nortriptyline measurements after the single dose were used to calculate the plasma drug clearance and to predict the daily dose required for each patient to achieve a steady-state concentration within the suggested therapeutic range of 50–150 µg·l^–1. Using these dosage regimes, the mean observed steady-state concentration showed a significant correlation with the predicted values (r=0.71, p<0.002). All patients had steady-state concentrations within or very close to this suggested range (mean 106, range 38–157 µg·l^–1). Use of the prediction test can prevent the development of toxic plasma concentrations and enhance the possibility of therapeutic success. Our findings suggest that a safe starting dose of nortriptyline for the elderly is 30 mg per day.     

Pharmacokinetics of dextropropoxyphene and nordextropropoxyphene in young and elderly volunteers after single and multiple dextropropoxyphene dosage.

1. The pharmacokinetics of dextropropoxyphene (D) and nordextropropoxyphene (ND) have been studied in 12 healthy young (21-28 years) and 12 healthy elderly (70-79 years) male and female subjects. Each received 65 mg D and plasma D and ND concentrations were measured by h.p.l.c. with electrochemical detection for up to 7 days and again after 65 mg D, 3 times daily for 1 week. 2. There were no significant differences in median D and ND half-life, AUC, Cmax and tmax between the male and female subjects in either group. Within the groups the mean D half-life (h) was longer in the young after multiple dosing (mean +/- s.d.:13.2 +/- 5.2 and 23.7 +/- 11.3, P less than 0.05, paired t-test) but there were no other significant differences. 3. Between the groups, the median single and multiple dose D and ND half-lives were all significantly longer (P less than 0.02) and the median D AUC for both single and multiple doses was significantly higher (P less than 0.01 and P less than 0.05, respectively, Mann-Whitney U-tests) in the elderly. 4. There was no relation between multiple dose Cmax and other parameters such as single dose D half-life. However, across the groups D and ND half-lives after both single and multiple dosage correlated significantly with estimated creatinine clearance, the correlation being strongest with ND (r = -0.76 and -0.84, respectively).