Somatic complaints and refrain from buying prescribed medications. Results from a cross-sectional study on people 60 years and older living in Kaunas (Lithuania)

Background

The use of medicines by elderly people is a growing area of concern in social pharmacy. A significant proportion of older people do not follow the recommendations from physicians and refrain from buying prescribed medications. The aim of this study is to evaluate associations between self-rated health, somatic complaints and refraining from buying prescribed medications by elderly people.

Findings

Data was collected in a cross-sectional study in 2009. We received 624 completed questionnaires (response rate – 48.9%) from persons aged 60–84 years living in Kaunas (Lithuania). Somatic complaints were measured with the 24 item version of the Giessen Complaint List (GBB-24). Logistic regression (Enter model) was used for evaluation of the associations between refraining from buying medications and somatic complaints. These associations were measured using odds ratio (OR) and calculating the 95% confidence interval (CI).The mean scores in total for the GBB scale and sub-scales (exhaustion, gastrointestinal and cardiovascular) were lowest among respondents who did not refrain from buying prescribed medications (means for GBB-24 scale: 21.04 vs. 24.82; p=0.001). Logistic regression suggests that somatic complaints were associated with a increased risk of refraining from buying prescribed medications (OR=1.35, 95% CI=1.15-1.60).

Conclusions

Somatic complaints were significantly associated with the decision to refrain from buying prescribed medications.     

Preventing relapse in recurrent depression using mindfulness-based cognitive therapy, antidepressant medication or the combination: trial design and protocol of the MOMENT study

Background

Depression is a common psychiatric disorder characterized by a high rate of relapse and recurrence. The most commonly used strategy to prevent relapse/recurrence is maintenance treatment with antidepressant medication (mADM). Recently, it has been shown that Mindfulness-Based Cognitive Therapy (MBCT) is at least as effective as mADM in reducing the relapse/recurrence risk. However, it is not yet known whether combination treatment of MBCT and mADM is more effective than either of these treatments alone. Given the fact that most patients have a preference for either mADM or for MBCT, the aim of the present study is to answer the following questions. First, what is the effectiveness of MBCT in addition to mADM? Second, how large is the risk of relapse/recurrence in patients withdrawing from mADM after participating in MBCT, compared to those who continue to use mADM after MBCT?

Methods/design

Two parallel-group, multi-center randomized controlled trials are conducted. Adult patients with a history of depression (3 or more episodes), currently either in full or partial remission and currently treated with mADM (6?months or longer) are recruited. In the first trial, we compare mADM on its own with mADM plus MBCT. In the second trial, we compare MBCT on its own, including tapering of mADM, with mADM plus MBCT. Follow-up assessments are administered at 3-month intervals for 15?months. Primary outcome is relapse/recurrence. Secondary outcomes are time to, duration and severity of relapse/recurrence, quality of life, personality, several process variables, and incremental cost-effectiveness ratio.

Discussion

Taking into account patient preferences, this study will provide information about a) the clinical and cost-effectiveness of mADM only compared with mADM plus MBCT, in patients with a preference for mADM, and b) the clinical and cost-effectiveness of withdrawing from mADM after MBCT, compared with mADM plus MBCT, in patients with a preference for MBCT.

Trial registration

ClinicalTrials.gov: NCT00928980     

Natural killer cell function is altered during the primary response of aged mice to influenza infection

Influenza is a public health concern, especially for the elderly. While influenza vaccination is efficacious in the young, it offers only limited protection in the elderly. Thus, it becomes imperative to understand age-related changes in the primary response to influenza infection. This study identified potential age-related defects in natural killer (NK) cell function during influenza infection. We showed that NK cells from aged mice were reduced and had impaired function and altered phenotype in lungs during influenza infection. Aged NK cells demonstrated decreased IFN-γ production, but not degranulation, after influenza infection. However, after ex vivo activation with YAC-1 cells, aged NK cells demonstrated both reduced IFN-γ production and degranulation. IFN-γ was also reduced in aged NK cells after activation with anti-NKp46 and soluble cytokines. IFN-β, and IL-12p40 mRNA expression was not significantly different from that observed in adult mice. Analysis of NK cell subsets indicated that aged mice had more immature and less terminally mature NK cells. These data suggest that aging affects the numbers, function and phenotype of NK cells. Thus, these defects in NK cell function could impair the ability of aged mice to induce a strong antiviral immune response during the early stages of the infection.     

Deep veins of the calf: assessment with color Doppler flow imaging

The authors studied the ability of real-time ultrasound aided by color Doppler flow imaging to demonstrate the deep veins of the calf in ten healthy subjects and 49 patients (91 limbs) with suspected deep venous thrombosis. Posterior tibial and peroneal veins demonstrated flow accentuation in 98% (74 of 75) and 96% (72 of 75), respectively, of the limbs without thrombosis and in all 20 normal limbs. Sixteen legs were involved with deep venous thrombosis. Peroneal veins could not be seen in three legs with marked calf swelling due to proximal thrombosis. There were two cases of thrombosis limited to the calf, nine of popliteal thrombosis (seven with contiguous spread of thrombus), and five of thrombosis limited to above the knee (four with sparing of the deep veins of the calf). Visualization of anterior tibial veins, achieved in 65% of all legs, did not correlate with thrombosis. The authors conclude that color Doppler flow imaging can demonstrate patency of posterior tibial and peroneal veins in most patients without deep venous thrombosis and aid in detection of below-the-knee thrombosis.     

21-氯代达哪唑及其C_6-脱氢物的合成

达哪唑(danazol)国产品名炔睾醇(Ⅲa),是治疗子宫内膜异位症的药物,并具有多方面的生理活性,既能抑制垂体前叶腺素的合成与释放,也是3β-羟基甾体脱氢酶(3βHSD)的抑制剂,国外曾作为女用口服避孕药或与睾丸素酯合用作男性抗生育剂,近年来还作为女用事后避孕药。为了寻找新的抗生育调节剂以适应计划生育工作的需要,我们对达哪唑进行结构改造研究,合成了它的21-氯化物(Ⅳa)及其C_6-脱氢物(Ⅳb)。其合成路线如下: