The Use of Nervous System Drugs and the Risk of Fractures in Old Adults

Hermostoon vaikuttavien lääkkeiden käyttö on yleistä iäkkäässä väestössä. Erityisen yleistä käyttö on pitkäaikaisessa laitoshoidossa asuvilla iäkkäillä. Hermostoon vaikuttavien lääkkeiden haittavaikutuksia on tutkittu paljon, ja useat hermostoon vaikuttavat lääkeaineryhmät on tunnistettu murtumien riskitekijöiksi. Aikaisemmin ei ole kuitenkaan tutkittu usean hermostoon vaikuttavan lääkkeen yhteiskäytön yhteyksiä murtuman riskiin 65 vuotta täyttäneillä. Väitöskirjatutkimuksessa havaittiin, että usean hermostoon vaikuttavan lääkeaineen yhtäaikainen käyttö oli hyvin yleistä Porin kaupunginsairaalan viidellä pitkäaikaisen laitoshoidon osastolla (n = 154) vuosien 2004 ja 2005 vaihteessa. Kolmasosa tutkituista käytti säännöllisesti kolmea tai useampaa hermostoon vaikuttavaa lääkettä samanaikaisesti. Kun huomioitiin myös tarvittaessa otettavat lääkkeet, vastaava luku oli 53 %. Tutkimuksessa havaittiin myös viitteitä lääkkeiden epäasianmukaisesta käytöstä, kun potilaiden käyttämiä lääkkeitä verrattiin heidän kognitiiviseen ja fyysiseen suorituskyynsä sekä asetettuihin diagnooseihin. Liedon kunnassa 1990-luvulla toteutettuun väestöpohjaiseen Liedon Iäkkäät -seurantatutkimukseen osallistui 1177 lietolaista 65 vuotta täyttänyttä. Lääkitystietoja sekä seuranta-aikana tapahtuneita murtumia analysoimalla havaittiin, että kahden tai useamman bentsodiatsepiinin sekä kahden tai useamman psykoosilääkkeen käyttö oli yhteydessä murtuman riskiin 65 vuotta täyttäneillä miehillä. Opioidin ja psykoosilääkkeen yhteiskäyttö sekä opioidin ja bentsodiatsepiinin yhteiskäyttö oli yhteydessä iäkkäiden miesten murtuman riskiin. Naisilla vastaavia tilastollisesti merkitseviä yhteyksiä ei havaittu. Väitöskirjatutkimuksen uusin osa-aineisto perustui Porissa vuosina 2009–2010 toteutetun Satauni-tutkimuksen aineistoon. Tutkimuksessa osoitettiin 89 potilaan aineistossa, että hallittu, yhden kuukauden aikana lääkärin ja hoitajan tuella toteutettu bentsodiatsepiinivieroitus paransi merkitsevästi 55 vuotta täyttäneiden naisten käden puristusvoimaa kuuden kuukauden seuranta-aikana. Vastaavaa yhteyttä ei havaittu miehillä. Bentsodiatsepiinivieroituksella ei ollut yhteyttä osallistujien tasapainotestin tulosten paranemiseen kuuden kuukauden seurantaaikana. Murtumilla on vakavia seurauksia sekä yksilötasolla että yhteiskunnallisesti iäkkäässä väestössä. Murtumien ehkäisy on hyvin tärkeää. Siinä tulee kiinnittää huomiota potilaan käyttämään lääkitykseen ja arvioida erityisesti usean hermostoon vaikuttavan lääkkeen yhteiskäytön tarpeellisuutta.

Receptor localization of steroid hormones and drugs: discoveries through the use of thaw-mount and dry-mount autoradiography

The history of receptor autoradiography, its development and applications, testify to the utility of this histochemical technique for localizing radiolabeled hormones and drugs at cellular and subcellular sites of action in intact tissues. Localization of diffusible compounds has been a challenge that was met through the introduction of the "thaw-mount" and "dry-mount" autoradiographic techniques thirty years ago. With this cellular receptor autoradiography, used alone or combined with other histochemical techniques, sites of specific binding and deposition in vivo and in vitro have been characterized. Numerous discoveries, some reviewed in this article, provided information that led to new concepts and opened new areas of research. As an example, in recent years more than fifty target tissues for vitamin D have been specified, challenging the conventional view about the main biological role of vitamin D. The functions of most of these vitamin D target tissues are unrelated to the regulation of systemic calcium homeostasis, but pertain to the (seasonal) regulation of endo- and exocrine secretion, cell proliferation, reproduction, neural, immune and cardiovascular responses, and adaptation to stress. Receptor autoradiography with cellular resolution has become an indispensable tool in drug research and development, since information can be obtained that is difficult or impossible to gain otherwise

Mediators of the effects of past corporal punishment experiences on the intent to use corporal punishment

Les analyses statistiques ont été réalisées avec le logiciels SPSS 11.0(Statistical Package for Social Sciences) et AMOS 6 (Analysis of Moment Structures. La base de données de l'étude a été crée et receuillie par Caroline Despatie en collaboration avec Dr. Dianne Casoni.

Use of anti-infective drugs during pregnancy : prevalence, predictors of use and the risk of preterm birth and small-for-gestational-age newborns

Résumé: Les anti-infectieux sont parmi les médicaments les plus utilisés pendant la grossesse. Les indications pour l’utilisation de ces médicaments, telles que les infections bactériennes, figurent parmi les facteurs de risque les plus importants pour la prématurité et les enfants nés petits pour l'âge gestationnel («Small-for-gestational-age », SGA). Ces complications de la grossesse peuvent avoir des incidences sur la santé du nouveau né et sur son développement futur. Compte tenu des impacts sur la santé de la mère et de l’enfant, la prise en charge et le traitement efficace de ces infections sont impératifs. Cependant, l'utilisation des anti-infectieux, pour éviter des issues de grossesse défavorables, fait l’objet d’une controverse dans la littérature. Cette controverse est en partie liée à la qualité méthodologique discutable des études disponibles sur le sujet. Les quatre études présentées dans cette thèse ont donc pour objectif d’investiguer l’utilisation des anti-infectieux durant la grossesse ainsi que d’évaluer le risque de prématurité et de SGA après utilisation de ces médicaments en période gestationnelle. Une révision systématique de la littérature sur l’utilisation du métronidazole durant la grossesse est également présentée. Nous avons utilisé, comme source de données le Registre des Grossesses du Québec, une cohorte longitudinale conçue à partir du jumelage de trois bases de données administratives de la province du Québec (RAMQ, Med-Echo et ISQ). Le registre fournit des informations sur les prescriptions, les services pharmaceutiques et médicaux, ainsi que des donnés sur les soins d’hospitalisation de courte durée et démographiques. Les deux premières études présentées dans cette thèse ont eu pour objectif d’évaluer la prévalence, les tendances, les indications et les prédicteurs de l’utilisation des anti-infectieux dans une cohorte, extraite du registre, de 97 680 femmes enceintes. A l’aide d’un devis cas-témoins, les 2 dernières études ont mesuré l’association entre l’utilisation d’anti-infectieux durant les 2 derniers trimestres de grossesse et le risque de prématurité et de SGA, respectivement. Un cas de prématurité a été défini comme un accouchement survenu avant 37 semaines de gestation. Un cas de SGA a été défini comme l’accouchement d’un enfant dont le poids à la naissance se situe sous le 10ème percentile du poids normalisé à la naissance (compte tenu de l’âge gestationnel et du sexe du bébé). Les données ont été recueillies pour les agents systémiques oraux, ainsi que pour les classes et les agents individuels. Nos résultats ont montré que la prévalence de l’utilisation des anti-infectieux durant la grossesse était comparable à celle d’autres études déjà publiées (25%). Nous avons observé une augmentation de l’utilisation des agents plus anciens et ayant des profils d’innocuité connus. Les prédicteurs de l’usage en début de grossesse identifiés sont : avoir eu plus de deux différentes prescriptions (OR ajusté = 3,83, IC 95% : 3,3-4,3), avoir eu un diagnostic d’infection urinaire (OR= 1,50, IC 95% : 1,3-1,8) et un diagnostic d’infection respiratoire (OR= 1,40, IC 95% : 1,2-1,6). L’utilisation des macrolides a été associée à une diminution du risque de prématurité (OR =0,65, IC 95% : 0,50-0,85). En revanche, les femmes ayant été exposées au métronidazole ont vu leur risque augmenté de 80% (OR=1,81, IC 95% : 1,30-2,54). L’utilisation d’azithromycine a été associée à une diminution importante du risque chez les femmes ayant un diagnostic de rupture prématurée des membranes (OR=0,31, IC 95% : 0,10-0,93). Cependant, l'utilisation de sulfaméthoxazole-triméthoprime (SXT) a été significativement associée à une augmentation du risque de SGA (OR= 1,61, IC 95% : 1,16-2,23), tandis que celle des anti-infectieux urinaires a été associée à une diminution du risque (OR= 0,80, 95%CI : 0.65-0.97). Les conclusions de nos travaux suggèrent que l’utilisation des macrolides et des pénicillines diminuent le risque de prématurité et de SGA. Nous devons considérer l'utilisation de différents choix thérapeutiques tels que l’azithromycine, lors de la prise en charge des infections pouvant induire la prématurité et le SGA.

Educating an iPod generation: undergraduate attitudes, experiences and understanding of vodcast and podcast use

ognyline) There is an increasing pressure on university staff to provide ever more information and resources to students. This study investigated student opinions on (audio) podcasts and (video) vodcasts and how well they met requirements and aided learning processes. Two experiments within the Aston University looked at student opinion on, and usage of, podcasts and vodcasts for a selection of their psychology lectures.

MLCMS actual use, perceived use, and experiences of use

Mobile learning involves use of mobile devices to participate in learning activities. Most elearning activities are available to participants through learning systems such as learning content management systems (LCMS). Due to certain challenges, LCMS are not equally accessible on all mobile devices. This study investigates actual use, perceived usefulness and user experiences of LCMS use on mobile phones at Makerere University in Uganda. The study identifies challenges pertaining to use and discusses how to improve LCMS use on mobile phones. Such solutions are a cornerstone in enabling and improving mobile learning. Data was collected by means of focus group discussions, an online survey designed based on the Technology Acceptance Model (TAM), and LCMS log files of user activities. Data was collected from two courses where Moodle was used as a learning platform. The results indicate positive attitudes towards use of LCMS on phones but also huge challenges whichare content related and technical in nature.

Preparation of polymeric micelles for use as carriers of tuberculostatic drugs

Purpose: This paper focuses on the characterization of polymeric micelle-forming tuberculostatic prodrugs and the antimycobacterial activity of these prodrugs.Method: By the condensation of hydroxymethylpyrazinamide, isoniazid and rifampin with free carboxyl groups on the copolymer poly(ethyleneglycol)-poly(aspartic acid), micelle-forming carrier-drug conjugates were obtained. These micelles were characterized by dynamic light scattering, to measure the micelle diameter; by acid-base titration, to determine the percentage of carboxylic groups occupied by the tuberculostatic; by Sudan III solubility tests, to estimate the critical micelle concentration (CMC); and visual control and spectrophotometric measurement, to determine the stability of micelles. These micelles were tested in vitro against several Mycobacterium strains.Results: As expected, the size and distribution of the micelle-forming tuberculostatic prodrugs found to be small (78.2nm, 84.2nm and 98.9 nm) while the level of the drug conjugated was high (65.02-85.7%). Furthermore, the micelles were stable in vitro, exhibiting a low level of CMC and stronger antimycobacterial activity than the original drugs.Conclusion: the results demonstrate that polymeric micelles can be used as efficient carriers for drugs, which alone, exhibit undesired pharmacokinetics, poor solubility, and low stability. The synthesized micelle-forming tuberculostatic prodrugs opens a perspective of alternative prodrugs that prolong action and decrease the toxicity of the tuberculostatic drugs of choice.

Risk factors that may signify a propensity to the use of drugs in students at a public university

Introduction: We sought to evaluate the risk factors that may increase the propensity to use licit and illicit drugs among students at a public university. Methods: The project involved students (n = 268) enrolled in the first and fourth years of courses in the areas of the social and biological sciences at a public university. Data collection was conducted by means of self-administered, semistructured questionnaires, based on such standardized assessment instruments as Audit, Assist, Cage and Duse. Collected data were analyzed quantitatively by calculating the percentages and evaluating the data in terms of categories of risk, classifying them by age, gender, religion, schooling, use (before or after entering university) and contexts of use. By means of this survey the researchers were able to correlate the use of drugs to the risk factors that might increase the students’ propensity to use these substances. Results: The results revealed a high proportion of current drug-using students, but showed no significant differences between the first and fourth year students as regards contexts of use. However, 67% of students regarded the university environment as encouraging the use of drugs. Students pointed to such major risk factors as friends’ and fellow-students’ influence, university parties, excessive curiosity and desire to experiment. Conclusion: Due to the high rate of drug use among university students, by the determination of the risk factors related to the university environment and also knowing that the process of addiction is one of growing chemical dependence, the importance of the development and implementation of public health policies at all levels, especially in terms of approaches and specific interventions addressing this population, should be noted.

Use of alcohol and other drugs among Brazilian college students: effects of gender and age

Objective: To assess the frequency of drug use among Brazilian college students and its relationship to gender and age. Methods: A nationwide sample of 12,721 college students completed a questionnaire concerning the use of drugs and other behaviors. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST-WHO) criteria were used to assess were used to assess hazardous drug use. A multivariate logistic regression model tested the associations of ASSIST-WHO scores with gender and age. The same analyses were carried out to measure drug use in the last 30 days. Results: After controlling for other sociodemographic, academic and administrative variables, men were found to be more likely to use and engage in the hazardous use of anabolic androgenic steroids than women across all age ranges. Conversely, women older than 34 years of age were more likely to use and engage in the hazardous use of amphetamines. Conclusions: These findings are consistent with results that have been reported for the general Brazilian population. Therefore, these findings should be taken into consideration when developing strategies at the prevention of drug use and the early identification of drug abuse among college students.

Drug Use and Attitudes Toward Drugs among Young Bulgarian Males

This project aimed to evaluate young people's attitudes towards drugs and to draft preventive strategies for use among young people at school and during military service. Three target groups were surveyed: young heroin users in Sofia, drug users undergoing treatment in the Military Medical Academy, and male students between the ages of 16 and 18. The research showed that more than half the respondents had used heroin for the first time before they were 16 and 11% tried it first at the age of 13, the lowest age registered since drug use in Bulgaria has been studied. One in five male students aged 16 to 18 has used hashish or marijuana at least once and amphetamines and non-prescription medications are the second-choice drugs for Bulgarian school pupils. The best predictors of drug use among young people are drug use among friends, early alcohol and tobacco use, perceived availability of drugs, an underrating of the health hazards of drug use and a lack of proper information about these, willingness to take drugs, where and with whom the young people have grown up, and a sensation-seeking attitude.

Use of audiovisual messages from land user to land user for sharing knowledge about SLM: experiences from a pilot project in Kenya and Tajikistan

The global World Overview of Conservation Approaches and Technologies (WOCAT) initiative has developed standardised tools and methods to compile and evaluate knowledge available about SLM. This knowledge is now combined and enriched with audiovisual information in order to give a voice to land users, reach a broad range of stakeholders, and assist in scaling up SLM to reverse trends of degradation, desertification, and drought. Five video products, adapted to the needs of different target groups, are created and embedded in already existing platforms for knowledge sharing of SLM such as the WOCAT database and Google Earth application. A pilot project was carried out in Kenya and Tajikistan to verify ideas and tools while at the same time assessing the usefulness of the suggested products on the ground. Video has the potential to bridge the gap between different actor groups and enable communication and sharing on different levels and scales: locally, regionally, and globally. Furthermore, it is an innovative tool to link local and scientific knowledge, raise awareness, and support advocacy for SLM. Keywords: Sustainable Land Management (SLM), knowledge sharing, audiovisual messages, video, World Overview of Conservation Approaches and Technologies (WOCAT)

Use of multi-media for spreading the experiences

The global World Overview of Conservation Approaches and Technologies (WOCAT) initiative has developed standardised tools and methods to compile and evaluate knowledge available about SLM. This knowledge is now combined and enriched with audiovisual information in order to give a voice to land users, reach a broad range of stakeholders, and assist in scaling up SLM to reverse trends of degradation, desertification, and drought. Five video products, adapted to the needs of different target groups, are created and embedded in already existing platforms for knowledge sharing of SLM such as the WOCAT database and Google Earth application. A pilot project was carried out in Kenya and Tajikistan to verify ideas and tools while at the same time assessing the usefulness of the suggested products on the ground. Video has the potential to bridge the gap between different actor groups and enable communication and sharing on different levels and scales: locally, regionally, and globally. Furthermore, it is an innovative tool to link local and scientific knowledge, raise awareness, and support advocacy for SLM.