The effects of age,body mass index,smoking and general health on the risk of venous thromboembolism in users of combined oral contraceptives

Objectives To investigate the factors associated with idiopathic venous thromboembolism in combined oral contraceptive users and to estimate the crude and age-specific incidence rates of idiopathic venous thromboembolism among this population.

Methods The UK MediPlus Database and the General Practice Research Database were searched to identify women with evidence of venous thromboembolism while exposed to combined oral contraceptives. Cohort and nested case-control studies were carried out using the same methodology on both databases. We conducted a meta-analysis using the individual data for the cases and controls from the two case-control studies to identify factors associated with idiopathic venous thromboembolism in women using combined oral contraceptives.

Results The incidence rate of idiopathic venous thromboembolism among oral contraceptive users was 39.4 per 100 000 exposed woman-years. The age-specific incidence rates were found to rise sharply after the age of 39 years. Factors identified as being significantly associated with idiopathic venous thromboembolism in women using combined oral contraceptives were: body mass index of 25 kg/m² and over, the association rising dramatically in women with a body mass index of 35 kg/m² or more; smoking; general ill health; and asthma.

Conclusion We believe that, before prescribing combined oral contraceptives, the venous as well as the arterial factors need to be considered and, in addition, age, obesity and smoking are all relevant when assessing an individual patient's risk.     

Efficacy and safety of the combination fluticasone propionate plus salmeterol in asthmatic preschoolers: An observational study

Background: Inhaled Corticosteroids (ICS) are the cornerstone of asthma management in pediatric patients. However, in some cases, asthma is not adequately controlled on ICS alone. Long-acting beta₂-agonists (LABA) are one of the available additional therapies but their use has rarely been studied among children younger than 5 years. Objective: The aim of this observational study was to evaluate the efficacy and safety of the combination of fluticasone propionate and salmeterol (FP/SA) in asthmatic children younger than 5 years of age. Methods: A retrospective study of 796 children under the age of 5 years (2.87 ± 1.22 years, 64.2% males), who were treated with FP/SA was conducted. Hospitalization rates, frequency of wheezing, exercise induced asthma, nocturnal wheeze and drug-related side-effects were recorded through children's medical records. Results: The children had previously received short-acting β₂-agonists (73%), ICS (17%), montelukast (1%), and ICS with montelukast (2%). Mean duration of therapy with FP/SA was 12.45 ± 9.14 months. After adjusting for age, gender, and duration of treatment, a 89% reduction was recorded in annual hospitalization rates (from 27.13% before treatment to 3.01% after FP/SA therapy, p < 0.001), a 71% reduction in incidence of exercise-induced asthma (36.8% vs. after 10.6%, p < 0.001), a 81% reduction in nocturnal asthma (33.7% vs. after: 6.4%, p < 0.001), as well as in frequency of wheezing (p < 0.01),. No previous treatment carry-on effect was observed. No major drug-related side-effects occurred in the study group. Conclusions: Combination therapy (FP/SA) is well-tolerated and highly effective in asthmatic children under the age of 5 years.     

Ca2+ channels in the apical membrane of the toad urinary bladder

Previously (Van Driessche et al. 1987) we showed that small inward (mucosa towards serosa) oriented shortcircuit currents (I _sc) were recorded through the toad urinary bladder when the mucosal side was exposed to Ca²⁺ free solutions containing K⁺, Na⁺ (+amiloride), Cs⁺ or Rb⁺ as main cation. This current component is inhibitable by micromolar concentrations of mucosal La³⁺ and divalent cations (Ca²⁺, Cd²⁺) and is considerably elevated by oxytocin (0.1 U/ml). The present study demonstrates that the addition of 50 nmol/l Ag⁺ to the mucosal medium during oxytocin treatment caused an additional large increase of the La³⁺-sensitiveI _sc component. The power density spectrum of the fluctuation in current contained a Lorentzian component which was enhanced by oxytocin treatment. The Lorentzian component disappeared as a consequence of the administration of mucosal Ag⁺. In experiments with Ca²⁺, Ba²⁺ or Mg²⁺ as principal mucosal cation, the La³⁺-sensitiveI _sc component was negligible under control conditions and during oxytocin treatment. Mucosal Ag⁺ (40 nmol/l) elicited a large inward oriented current which was blockable by the calcium channel blockers, La³⁺ and Cd²⁺. Also the organic calcium entry blockers, nicardipine and verapamil (10 mol/l) depressed the inward current considerably. Noise analysis of the currents carried by divalent cations showed a La³⁺-sensitive noise component. Oxytocin-Ag⁺ activated currents could not be recorded in the absence of the divalent cations or small inorganic cations, e.g. with solutions which contained N-methyld-glucamine (NMDG) as main mucosal cation.     

The cooperative apartment

The article discusses a two-year rehabilitation program for mentally ill women who live in a cooperative apartment without a live-in supervisor and who are offered the helping services of volunteers and mental health professionals. Present results indicate the program is a success, due mainly to well-coordinated rehabilitation plans and constant availability of volunteers and mental health professionals.The assistance in this project of Dr. Herbert J. Hoffman, John Levis, Dr. William F. McLaughlin, and Dr. Gladys R. Whipple is gratefully acknowledged.     

Assessing quality in community pharmacy

Objective This review aimed to identify English‐language instruments used to assess quality in community pharmacy and to evaluate their reported validity, reliability, feasibility and acceptability. Method A systematic review was conducted to identify literature relating to the use of instruments to assess quality in community pharmacy. The electronic databases searched included Embase, International Pharmaceutical Abstracts, Medline, e‐PIC and Pharmline, covering the period of time between January 1990 and March 2007. Reference lists of identified studies and websites of pharmacy bodies were also searched. Key findings Ten instruments were identified from Canada, Malta, the UK and the US. These were used for quality‐assurance and/or quality‐improvement purposes and focused on: clinical governance systems; organisational culture/maturity; safety (climate and systems); effectiveness of pharmacy services; and stakeholders' feedback on services. The assessments were at different stages of development, and the majority had not been tested for construct validity, reliability and feasibility. Conclusions Assessments with high validity and reliability give a good indication of the quality of care provided and can indicate areas for improvement. Further research is needed to establish a composite view of quality in community pharmacy; and many of the instruments identified required validation.     

Reasons for non-compliance with screening for infection with Helicobacter pylori, in a multi-ethnic community in Leicester, UK

In this study, we aimed to identify reasons for non-compliance with a screening programme for Helicobacter pylori (H pylori), in a multi-ethnic community and to assess the effectiveness of Asian language materials towards increasing compliance. A serological screening test for infection with H pylori was offered to 200 Asians and 200 non-Asians (mainly Europeans), aged 21–55 y, registered at a single general practice. Reasons for non-attendance for screening were identified by reply slip or interview. A second group of 200 Asians who were offered screening were sent information in Gujarati as well as English. When information was mailed in English only, 30% Asians and 22% non-Asians attended (P = 0.09, ns). Stated reasons for non-attendance in the Asian group were not generally language related; reasons were similar in the Asian and non-Asian groups and were most frequently related to other commitments. The use of materials in Gujarati did not improve compliance.Language problems should not be assumed to dominate reasons for non-compliance with screening in ethnic minority groups. In common with those of UK origin, subjects from ethnic minority groups may more generally have insufficient interest in preventive medicine for them to prioritise health screening above other commitments.