A double-blind, placebo-controlled investigation of the residual psychomotor and cognitive effects of zolpidem-MR in healthy elderly volunteers

AIM: To assess residual psychomotor and cognitive effects of a modified-release formulation of zolpidem (zolpidem-MR), developed to provide sustained hypnotic efficacy during the whole night, compared with placebo and flurazepam. METHODS: Twenty-four healthy elderly volunteers received four study treatments (zolpidem-MR 6.25 mg and 12.5 mg, placebo and flurazepam 30 mg) using a randomized, cross-over, double-blind design. Residual psychomotor and cognitive effects were assessed with a psychometric test battery. Quality of sleep and residual effects were evaluated subjectively with the Leeds Sleep Evaluation Questionnaire. RESULTS: Psychometric performance was significantly impaired with flurazepam but not with zolpidem-MR at either dose. Ease of falling asleep and sleep quality were significantly improved with both doses of zolpidem-MR and with flurazepam. Neither active drug modified perception of well-being on awakening. CONCLUSION: In elderly subjects, zolpidem-MR showed no residual functional impairment in psychometric or cognitive tests sensitive to flurazepam.     

Are HIV/AIDS services in Leeds, UK, able to meet the needs of asylum seekers?

BACKGROUND: The Yorkshire and Humberside region of England ranks second only to London for reception of those seeking asylum in the UK. Human immunodeficiency virus (HIV) prevalence amongst asylum seekers is likely to mirror that in the country of origin. In 2001, the city of Leeds received 1100 asylum seekers, including dependents. Many of these were from areas with high seroprevalence of HIV, and HIV-infected asylum seekers require medical and social support. Are the current services for HIV-infected persons in Leeds appropriate and adequate for this new patient group? Provision of sexual health services for this client group needs to be evaluated. OBJECTIVES: To determine whether existing HIV/acquired immunodeficiency syndrome (AIDS) services in Leeds meet the needs of HIV-positive asylum seekers. METHODS: This was a qualitative study using semi-structured interviews. Seven service providers and 14 HIV-positive patients at Leeds Centre for Sexual Health, six of whom were asylum seekers, took part in the study. RESULTS: Asylum seekers and UK residents were equally satisfied with HIV/AIDS services at Leeds Centre for Sexual Health. Other agencies such as the Health Access Team and Terrence Higgins Trust had different strengths that provided valuable support for this client group. Unmet needs of asylum seekers were identified, such as specialist services for torture victims and educational opportunities. In areas of asylum seeker dispersal with increased case loads, this methodology may inform development of client-centred care networks.     

Maternal anxiety and obstetric complications.

The association between maternal anxiety in the third trimester of pregnancy and obstetric complications was studied in 146 patients using the IPAT Anxiety Self-Analysis Form. It was found that the incidence of pre-eclampsia, forceps delivery, prolonged and precipitate labour, primary post-partum haemorrhage, manual removal of the placenta and clinical foetal distress were all significantly higher amongst the high anxiety group.     

Spiral (uteroplacental) arteries of the human placental bed show the presence of amniotic basement membrane antigens

The spiral arteries of the placental bed lose clearly recognizable arterial features early in pregnancy because of their invasion by extravillous trophoblast. Extensive structural alterations take place in the walls of invaded arteries, their walls containing an amorphous acidophilic "fibrinoid" matrix in which endovascular trophoblast is embedded. Such spiral arteries examined by immunofluorescence techniques in placental bed biopsy specimens obtained at cesarean section show a characteristic pattern of reaction with antisera to epithelial basement membrane amniotic antigens. These antisera have been previously demonstrated to react with the basement membrane of human amnion and of ectodermally derived epithelium such as breast ducts and skin. Interstitial trophoblast usually does not contain these antigens, and it is postulated that, following vascular invasion, endovascular trophoblast produces amniotic antigens to establish its presence. This may be of importance in maintaining the structural integrity of spiral arteries and thereby adequate maternal blood flow to the fetal-placental unit.