Leflunomide improves psoriasis in patients with psoriatic arthritis: An in-depth analysis of data from the TOPAS study

Background: Leflunomide has shown promise in the treatment of psoriasis. Objective: To provide an in-depth analysis of the effect of leflunomide on psoriasis in patients with psoriatic arthritis (PsA). Methods: 190 patients with plaque psoriasis (at least 3% skin involvement) and active PsA were randomized to double-blind treatment with leflunomide (100 mg/day loading dose for 3 days followed by 20 mg/day orally) or placebo for 24 weeks. Results: As previously reported, leflunomide resulted in a significantly higher Psoriatic Arthritis Response Criteria response rate than placebo (58.9 vs. 29.7%; p < 0.0001). Significant differences in favor of leflunomide were also observed in the Psoriasis Area and Severity Index (PASI 50 in 30.4% of patients vs. 18.9% for placebo; p = 0.05), target lesion response (46.4 vs. 25.3%; p = 0.0048), combined skin and joint response (27.2 vs. 8.9%; p < 0.0001), Dermatology Life Quality Index (improvement of 1.9 points vs. 0.2; p = 0.0173) and certain SF-36 subdomains. Dermatological responses were observed at the earliest examination (4 weeks) and increased throughout the 24-week study. Conclusion: Once-daily oral leflunomide is an effective and convenient treatment for PsA and plaque psoriasis. Copyright (c) 2006 S. Karger AG, Basel.

Use of complementary and alternative medicine and quality of life: changes at the end of life

The purpose of this study was to compare the physical, psychological and social dimensions associated with quality-of-life outcomes over the last year of life, between advanced cancer users and nonusers of complementary and alternative medicine. One hundred and eleven patients were identified through Queensland Cancer Registry records, and followed up every four to six weeks until close to death using standardized protocols. Outcome measures were symptom burden, psychological distress, subjective wellbeing, satisfaction with conventional medicine and need for control over treatment decisions. At the initial interview, 36 (32%) participants had used complementary/ alternative medicine the previous week; mainly vitamins, minerals and tonics and herbal remedies. Among all participants, 53 (48%) used at least one form of complementary/ alternative medicine over the study period. Only six (11%) visited alternative practitioners on a regular basis. Overall, complementary/ alternative medicine users reported higher levels of anxiety and pain, less satisfaction with conventional medicine and lower need for control over treatment decisions compared with nonusers. These differences tend to change as death approaches. A more rigorous assessment of complementary/ alternative medicine use, psychological distress, pain and subjective wellbeing among patients with advanced cancer is needed in the clinical setting.

Perspectives on quality of life by people with aphasia and their family: Suggestions for successful living

Understanding the client's perspective is essential for good practitioner care in rehabilitation after stroke, and nothing is more relevant than enquiring directly about our clients' quality of life to inform our management. Relatively little is known about how older people with aphasia consider the quality of their current lives, and this article seeks to explore this issue. Four women's accounts of their life quality are presented, as well as their husbands' or daughter's accounts of their lives. Their stories share some common elements. Who you love or share your life with; where you live; feeling independent and/or in control; and engaging in satisfying activities mattered to these women's life quality. The impact of aphasia varies across the cases, and the need to accept change for successful living is illustrated in all accounts.

The experience of insomnia among older women

Study Objectives: To measure sleeping difficulty and sleep quality among older women, explore experience and attitudes towards sleep, and test for negative association between difficulty sleeping and health-related quality of life. Design: Four-year longitudinal study. Setting: Women were participants in the Australian Longitudinal Study on Women's Health. Participants: Women were sampled according to use of sleeping medication and classified into 4 groups: sleeping badly and using sleeping medications; not sleeping badly, but using sleeping medications; sleeping badly, not using sleeping medications; not sleeping badly, not using sleeping medications. Interventions: None. Measurements and Results: Sleeping difficulty and sleeping-medication use were measured at Survey 1, Survey 2 (3 years later), and Survey 3 (4 years later). Survey 3 included: Nottingham Health Profile Sleep Subscale, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Geriatric Depression Scale, Duke Social Support Index, Medical Outcomes Study Short-Form 36-item Health Survey, and a 21-item life events scale. Survey 3 was returned by 1011 women (84%). Sleeping problems were negatively associated with SF-36 subscale scores. Most associations remained significant after comorbid conditions, Geriatric Depression Scale, life events scores, and medication use were added to models. Most women with sleeping problems (72%) sought help from a doctor, and 54% used prescribed sleeping medications in the past month. Conclusions: Sleeping difficulty is a serious symptom for older women and is associated with poorer quality of life. Some of this effect can be explained by comorbidities, depression scores, life events, and use of sleeping medications.

Strength-ductility behaviour of Al-Si-Cu-Mg casting alloys in T6 temper

A comparative study of the mechanical properties of 20 experimental alloys has been carried out. The effect of different contents of Si, Cu, Mg, Fe and Mn, as well as solidification rate, has been assessed using a strength-ductility chart and a quality index-strength chart developed for the alloys. The charts show that the strength generally increases and the ductility decreases with an increasing content of Cu and Mg. Increased Fe (at Fe/Mn ratio 0.5) dramatically lowers the ductility and strength of low Si alloys. Increased Si content generally increases the strength and the ductility. The increase in ductility with increased Si is particularly significant when the Fe content is high. The charts are used to show that the cracking of second phase particles imposes a limit to the maximum achievable strength by limiting the ductility of strong alloys. The (Cu + Mg) content (at.%), which determines the precipitation strengthening and the volume fraction of Cu-rich and Mg-rich intermetallics, can be used to select the alloys for given strength and ductility, provided the Fe content stays below the Si-dependent critical level for the formation of pre-eutectic alpha-phase particles or beta-phase plates.

Seasonal variations of phenolic compounds in Australia-grown tea (Camellia sinensis)

Seasonal variations of phenolic compounds in fresh tea shoots grown in Australia were studied using an HPLC method. Three principal tea flavanols [epigallocatechin gallate (EGCG), epicatechin gallate (ECG), and epigallocatechin (EGC)] and four grouped phenolics [total catechins (Cs), total catechin gallates (CGs), total flavanols (Fla), and total polyphenols (PPs)] in fresh tea shoots were analyzed and compared during the commercial harvest seasons from April 2000 to May 2001. The levels of EGCG, ECG, and CGs in the fresh tea shoots were higher in the warm months of April 2000 (120.52, 34.50, and 163.75 mg/g, respectively) and May 2000 (128.63, 44.26, and 183.83 mg/g, respectively) and lower during the cool months of July 2000 (91.39, 35.16, and 132.30 mg/g, respectively), August 2000 (91.31, 31.56, and 128.64 mg/g, respectively), and September 2000 (96.12, 33.51, and 136.90 mg/g, respectively). Thereafter, the levels increased throughout the warmer months from October to December 2000 and remained high until May 2001. In the warmer months, the levels of EGCG, ECG, and CGs were in most cases significantly higher (P < 0.05) than those in the samples harvested in the cooler months. In contrast, the levels of EGC and Cs were high and consistent in the cooler months and low in the warmer months. The seasonal variations of the individual and grouped catechins were significant (P < 0.05) between the cooler and warmer months. This study revealed that EGCG and ECG could be used as quality descriptors for monitoring the seasonal variations of phenolics in Australia-grown tea leaves, and the ratio (EGCG + ECG)/EGC has been suggested as a quality index for measuring the differences in flavanol levels in fresh tea shoots across the growing seasons. Mechanisms that induce seasonal variations in tea shoots may include one or all three of the following environmental conditions: day length, sunlight, and/or temperature, which vary markedly across seasons. Therefore, further studies under controlled conditions such as in a greenhouse may be required to direct correlate flavonoid profiles of green tea leaves with their yields and also to with conditions such as rainfall and humidity.

Community and cluster centre residential services for adults with intellectual disability: long-term results from an Australian-matched sample

Changes in residential accommodation models for adults with intellectual disability (ID) over the last 20 years in Australia, the United Kingdom and the United States have involved relocation from institutions primarily into dispersed homes in the community. But an evolving alternative service style is the cluster centre. This paper reports on the relocation of a matched group of 30 pairs of adults with moderate and severe IDs and challenging behaviour who were relocated from an institution into either dispersed housing in the community or cluster centres but under the same residential service philosophy. Adaptive and maladaptive behaviour, choice-making and objective life quality were assessed prior to leaving the institution and then after 12 and 24 months of living in the new residential model. Adaptive behaviour, choice-making and life quality increased for both groups and there was no change in level of maladaptive behaviour compared with levels exhibited in the institution. However, there were some significant differences between the community and cluster centre group as the community group increased some adaptive skills, choice-making and objective life quality to a greater extent than the cluster centre group. Both cluster centre and dispersed community living offer lifestyle and skill development advantages compared with opportunities available in large residential institutions. Dispersed community houses, however, offer increased opportunities for choice-making, acquisition of adaptive behaviours and improved life quality for long-term institutionalized adults with IDs.

Phenolic compounds in tea from Australian supermarkets

Phenolic compounds constitute 50-70% of tea water extract and are the main quality parameters for teas. Theaflavins (TF), thearubigins (TR) and theabrownins (TB) are the major polyphenols that determine the quality of black tea. These compounds were measured in 56 leaf teas and teabags sampled from Australian supermarkets in Queensland. The various quantities of TF, ranging from 0.29% to 1.25%, indicate a quality difference that exists among the teas studied. Low TF content in black tea may be due to over-fermenting and/or long periods of storage. The solubility of TR and TB from teabags ranged from 82% to 92%, indicating that the permeability of teabags was variable. Variable quantities of TF in Australian teas show instability and a tendency of TF to oxidize during storage. Total polyphenols in green teas ranged from 14% to 34%, indicating a large variation, which was not reflected in price. The solubility of total polyphenols from teabags has been proposed as a useful quality index of the filtering paper used for the teabags. This chemical analysis of phenolic compounds in commercial teas may be a potential tool for the quality control of Australian manufactured and imported teas in Australian markets. (C) 2005 Elsevier Ltd. All rights reserved.

WHOQOL-BREF as a measure of quality of life in older patients with depression

Objective: To assess the reliability and validity of a brief measure of quality of life recently developed by the World Health Organization, the WHOQOL-BREF, and to examine its association with a variety of clinical and sociodemographic factors in older depressed patients. Design: Cross-sectional study. Methods: Older depressed patients (N=41) underwent diagnostic assessment using the Composite International Diagnostic Interview (CIDI) and were independently assessed on a variety of measures including the WHOQOL-BREF (a 26-item self-report questionnaire generating four domain scores), Hamilton Depression Rating Scale (HAM-D); Geriatric Depression Scale (GDS); Mini-mental State Examination (MMSE); Modified Barthel Index (MBI); Instrumental activities of daily living (IADL), and measures of physical health status and social relationships. Estimates of inter-rater and test-retest reliability, and concurrent validity were made. Results: 39 subjects completed the study. The majority of subjects (94.9%) received a diagnosis of DSM-IV Major Depressive Disorder. Levels of comorbidity were high. Three of the four domains of the WHOQOL-BREF (Physical, Psychological and Environment domains) demonstrated satisfactory reliability and validity. However, the Social Relationships domain exhibited poor validity. Quality of life scores were strongly correlated with severity of depression, number of self-reported physical symptoms and self-assessed general health status. There was no relationship between diagnostic comorbidity and quality of life scores. Conclusions: The WHOQOL-BREF was successfully administered to older depressed patients although the concurrent validity of one of its four domains was poor. Quality of life scores were strongly correlated with severity of depression, raising the issue of measurement redundancy.