Risk Factors in the Use of Benzodiazepines

Gené-Badia J, Blay-Pueyo C and Soler-Vila M. Risk factorsin the use of benzodiazepines. Family Practice 1988; 5: 283–288. A case-control study was carried out on 107 benzodiazepine usersand 214 controls not treated with anxiolytic-hypnotic agents,chosen randomly and matched two to one for each case by age,sex and family doctor. The users presented a higher degree ofpsychic disorder than the controls, with depression, interpersonalsensitivity, and the total number of symptoms being the elementsdistinguishing the two groups. We have found two factors thatput the population at large at risk for using benzodiazepines;the family doctor's diagnosis of a mental disorder in the clinicalhistory and the daily use of drugs other than benzodiazepinesexplained the risk independently. The presence of chronic disorders,especially cardiological and musculoskeletal disorders, alsoshowed a significant risk, but were only explained by theirclose association with one of the first two factors. It is postulatedthat general practitioners, who are the principal prescribersof drugs, are causing over-medication in the population.     

Do Electrode and Lead Design Differences for Permanent Cardiac Pacing Translate into Clinically Demonstrable Differences? (Comparison of Sintered Platinum and Activated Vitreous and Porous Carbon Electrodes)

A randomized prospective study was undertaken to compare the electrical performances of three permanent, endocardial, tined pacing leads with different electrode designs--sintered platinum, vitreous carbon, and porous carbon. Ninety-nine patients received one of the leads (S80 31; 423S 32; S100 36). Acute R wave amplitude and ST elevation of the native endocardial electrogram, voltage threshold, impedance, and current flow at four pulse durations (0.25-1.0 msec) were measured. Voltage thresholds were measured noninvasively at each of four pulse durations at 2 days and 1, 3, and 6 months after implantation. No significant differences were found in sensing properties, or current flow at threshold at 0.5 msec pulse duration. The 423S lead had a significantly higher impedance at threshold and both a higher impedance and lower current flow at 5 V. No significant differences in threshold voltages were found between the three leads at any pulse duration, at any of the assessed times after implantation. Six-month thresholds for the S80, 423S, and S100 leads were 1.18 +/- 0.35, 1.17 +/- 0.29, and 1.06 +/- 0.38 V respectively at 0.5 msec pulse duration. Differences between 'high performance' pacing leads need to be of a greater order of magnitude before they can be exploited to give any real clinical advantage to patients.     

Polychlorinated Biphenyl Congeners in Adipose Tissue Lipid and Serum of Past and Present Transformer Repair Workers and a Comparison Group

Polychlorinated Biphenyl Congeners in Adipose Tissue Lipid andSerum of Past and Present Transformer Repair Workers and a ComparisonGroup. FAIT, A., GROSSMAN, E., SELF, S., JEFFRIES, J., PELLIZZARI,E. D., AND EMMETT, E. A. (1989). Fundam. Appl. Toxicol 12, 42-55. The concentrations of individual PCB's were determined inboth serum and adipose tissue lipid from 35 transformer repairworkers currently exposed to PCBs, mainly Aroclor 1260, 17 previoustransformer repair workers, and 56 comparison workers neveroccupationally exposed to PCBs. The analysis used fused-silicacapillary gas chromatography with electron capture detector(FSCGC/ECD) and FSCGC with negative ion chemical ionizationmass spectrometry to verify PCB congener levels. Eighty-ninePCB peaks were identified and confirmed. More congeners weredetected in adipose tissue. In serum approximately 50% of peakswere below the level of detection. Statistical techniques toaccount for left and interval censoring allowed comparison ofconcentration distributions even where data were incomplete.We found that unquantifiable levels were unlikely to contributesubstantially to the true values for total [PCBs] over and beyondthe contribution of the measured values. However, the totalserum [PCBs] determined by FSCGC/ECD greatly exceeded that fromstandard packed cell gas chromatography (PCGC/ECD). The underestimationwas less marked for adipose samples. In serum the total [PCBs]was highest in currently exposed workers and lowest in unexposedworkers, with past-exposed workers clearly intermediate. Inadipose tissue [PCBs] in the currently exposed group was muchhigher than in the other two groups, in whom the distributionof results was broadly similar. In all worker groups hexachlorinatedand heptachlorinated species predominated followed by octachlorinatedand pentachlorinated. The relative distribution of individualPCB congeners in the three groups was similar although the amountsvaried. The seven major peaks in serum and adipose tissue were2,3,5,6,3',4',5'/2,3,4,5,2',4',5' hepta-CB; 2,3,4,2',3',5' hexa-CB;2,4,6,3',4',5'/ 2,4,5,2',4',5'/2,3,4,5,2',5' hexa-CB; 2,3,4,5,2',3',4'hepta-CB; 2,3,4,5,2',3',5',6'/2,3,4,5,6,2',3',5', octa-CB; 2,4,5,3',4',/3,4,5,2',3'penta-CB; and 2,3,4,2',3',4'/2,3,5,6,2',4',5'/2,3,4,5,2',4',6'multi-CB. The distribution of PCB peaks in our populations differsfrom that in capacitor workers (exposed to less highly chlorinatedPCBs) and from Yu-Cheng patients suggesting differing toxicpotentials from PCBs in these three circumstances.     

GENETIC POLYMORPHISM OF LIVER ALCOHOL DEHYDROGENASE IN SPANTSH SUBJECTS: SIGNIFICANCE OF ALCOHOL CONSUMPTION AND LIVER DISEASE

Class I alcohol dehydrogenase (ADH) phenotypes have been studiedby starch gel electrophoresis and activity analysis in livertissue obtained at necropsy from 61 non-alcoholic subjects withnormal liver (controls), and in biopsies from 60 chronic alcoholicswith liver disease and from 24 subjects with non-alcoholic liverdisease. Twenty-three per cent of controls exhibited the ADH₂^2–1phenotype, which represents the highest frequency for atypicalADH found in a Caucasian population. Both alcoholic and non-alcoholicpatients with liver disease showed a lower frequency of theatypical phenotype (6.6% and 8.8%, respectively). No differencesin the ADH₂ locus were detected among groups of patients withdifferent severity of alcoholic and non-alcoholic liver disease.Theallele frequencies of the ADH₃ locus for the controls (ADH₃¹= 0.63, ADH₃² = 0.37) are common to those of other Caucasianpopulations. Similar ADH₃ allele frequencies were observed inpatients with alcoholic and non-alcoholic liver disease. Discrepanciesbetween the various phenotyping and genotyping studies now knownfor several populations suggest that local differences may existin the distribution of the ADH polymorphism in even geographicallyclose regions, and that the effect of ADH polymorphism on vulnerabilitytowards alcohol may not be identical in different populations.     

1-Aminobenzotriazole-Induced Destruction of Hepatic and Renal Cytochromes P450 in Male Sprague-Dawley Rats

1-Aminobenzotriazole (ABT) is a suicide substrate of both hepaticand pulmonary cytochromes P450. The present studies were designedto compare the effects of ABT on hepatic and renal metabolism.Hepatic and renal microsomes and cytosol were prepared frommale Sprague-Dawley rats following ABT pretreatment (0–100mg/kg ip) for various times. Administration of 100 mg ABT/kgproduced profound reductions in P450 content in both liver andkidney within 2 hr; loss of P450 in both tissues persisted forat least 48 hours. ABT-induced destruction of P450 was dose-dependent.Maximal destruction of about 80% of total hepatic P450 occurredat dosages of ABT equal to or greater than 10 mg/kg. Maximaldestruction of about 80% of total renal P450 occurred at dosagesof ABT equal to or greater than 50 mg/kg. In vitro, ABT rapidlyand efficiently destroyed P450 in both hepatic and renal microsomesprepared from naive male Sprague-Dawley rats. Incubation ofhepatic or renal microsomes in vitro with ABT produced detectabledestruction of P450 within 5 min. Maximal destruction of P450occurred within 10 min in both hepatic and renal microsomesduring in vitro incubation with ABT. ABT-induced destructionof P450 in vitro was concentration-dependent. For hepatic microsomes,maximal destruction of about 70% of P450 required concentrationsof ABT equal to or greater than 10 mM. For renal microsomes,maximal destruction of about 80% of P450 required concentrationsof ABT equal to or greater than 10 mM. In both liver and kidney,only P450 content and P450-dependent activities were significantlydecreased. Cytochrome b₅, NADPH cytochrome c reductase, glutathioneS-transferase, glucuronyl transferase, and reduced glutathionecontents were unaltered. These data suggest that ABT selectivelyand effectively destroys both hepatic and renal P450. ABT maybe a useful tool to probe the potential role of P450 in thebioactivation of certain compounds.     

Evidence for Stem Cells in the Peripheral Blood of Mice

Leukocytes from the peripheral blood of normal F₁ hybrid mice have beensuccessfully used to promote survival of lethally irradiated parent andclosely related homologous animals. Identification of donor-type red cellsand leukocytes has been established on samples of blood taken from severallong-term survivors. Histologic data and serologic typing of cells from lymphnodes, bone marrow, and spleens of chimeras killed early after irradiation andtreatment established that injected peripheral leukocytes had transplantedand were proliferating into lymphocytes, granulocytes, and erythrocytes. Fe⁵⁹was taken up by red cells and spleens of leukocyte-injected mice but not bytissues of radiation control animals. The newly formed, Fe⁵⁹-labeled erythrocytes were hemolyzed by immune serum specific for donor-type antigens.

Submitted on November 10, 1961 Accepted on March 6, 1962     

THE APPLICATION OF THE PETIOLE INJECTION METHOD FOR THE DIAGNOSIS OF MINERAL DEFICIENCY TO A EUCALYPT

The transition in forest management from timber dominance to all the uses and values of the forest requires forest planning processes to be advanced. The context of forest management planning in Victoria is described. The Otway Forest Management Planning Project is described and reflections are made about generic criteria of relevance, guidance, coherence, durability, reality, credibility, acceptance and efficiency. The processes of advanced, modern forest planning are seen as epitomising those required for attaining ecologically sustainable development in other sectors.     

The relationship between structural empowerment and psychological empowerment for nurses: a systematic review

wagner j.i.j., cummings g., smith d.l., olson j., anderson l. & warren s. (2010) Journal of Nursing Management 18 , 448–462
The relationship between structural empowerment and psychological empowerment for nurses: a systematic review Aim To describe the findings of a systematic review examining the relationship between structural empowerment and psychological empowerment for registered nurses (RNs). Background Workplace empowerment research reveals a link between empowerment and positive work behaviours and attitudes. Research demonstrating the essential relationship between structural empowerment and psychological empowerment will provide direction for future interventions aimed at the development of a strong and effective health care sector. Methods Published research articles examining structural empowerment and psychological empowerment for nurses were selected from computerized databases and selected websites. Data extraction and methodological quality assessment were completed for the included research articles. Results Ten papers representing six studies reveal significant associations between structural empowerment and psychological empowerment for RNs. Implications for nursing management Creation of an environment that provides structural empowerment is an important organizational strategy that contributes to RNs’ psychological empowerment and ultimately leads to positive work behaviours and attitudes. Critical structural components of an empowered workplace can contribute to a healthy, productive and innovative RN workforce with increased job satisfaction and retention.     

Bone Fragility: Assessment of Risk and Strategies for Prevention

Objective: To review the literature related to risk factors for bone fragility and strategies for prevention.
Data Sources: Computerized searches.
Study Selection: All human research articles from indexed journals in the English language related to the topics in this review and published afler 1982 (except for earlier classic pieces) were evaluated.
Data Extraction: The author extracted data independently using tables that included the following headings: author, year, design, sample size, age range of subjects, results, and comments. Power analyses were done on all reports that included enough Information.
Data Synthesis: The following are determinants of bone fragility: peak bone mass, genetic influences, hormonal status, dietary factors, exercise patterns, and personal exposures.
Conclusions: Women should be informed of the risk factors and helped to determine whether they are at risk for osteoporosis. All women, starting with young girls, should be taught what methods can be used to decrease their risk. Additional research is needed on methods of improving bone health and decreasing risk.     

An Exploratory Study of Antenatal Preparation for Cesarean Birth

An exploratory study was designed to develop and test an antenatal education program of cesarean birth information. Eighty-one pregnant women and their husbands received the educational program. Eighteen couples experienced cesarean childbirth. Mailed questionnaires containing items dealing with reactions to the educational program and responses to cesarean birth were returned by 15 of these couples. Findings indicated that the educational program met most of the information needs of the study participants. Both mothers and fathers exhibited adaptive and ineffective responses to the cesarean, although the responses were more positive than previous studies have reported.