Benzodiazepines and Cognitive Functioning in Older Adults. With Emphasis on Long-Term Use and Withdrawal

Benzodiazepines (BZD) and benzodiazepine related drugs (RD) are the most commonly used psychotropics among the aged. The use of other psychotropics taken concomitantly with BZD/ RD or their cognitive effects with BZD/RD have not been studied frequently. The aim of this academic thesis was to describe and analyse relationships between the use of BZD/RD alone or concomitantly with antipsychotics, antidepressants, opioids, antiepileptics, opioids and anticholinergics in the aged and their health. Especially, the relationships between long-term use of BZD/RD and cognitive decline were studied. Additionally, the effect of melatonin on BZD/RD withdrawal and the cognitive effects of BZD/RD withdrawal were studied. This study used multiple data sets: the first study (I) was based on clinical data containing aged patients (≥65 years; N=164) admitted to Pori City Hospital due to acute disease. The second data set (Studies II and III) was based on population-based data from the Lieto Study, a clinico-epidemiological longitudinal study carried out among the aged (≥65 years) in the municipality of Lieto. Follow-up data was formed by combining the cohort data collected in 1990-1991 (N=1283) and in 1998-1999 (N=1596) from those who participated in both cohorts (N=617). The third data set (Studies IV and V) was based on the Satauni Study’s data. This study was performed in the City of Pori in 2009-2010. In the RCT part of the Satauni Study, ninety-two long-term users of BZD/RD were withdrawn from their drugs using melatonin against placebo. The change of their cognitive abilities was measured during and after BZD/ RD withdrawal. BZD/RD use was related to worse cognitive and functional abilities, and their use may predict worse cognitive outcomes compared with BZD/RD non-users. Hypnotic use of BZD/RD could be withdrawn with psychosocial support in motivated participants, but melatonin did not improve the withdrawal results compared to those with placebo. Cognitive abilities in psychomotor tests did not show, or showed only modest, improvements for up to six months after BZD/RD withdrawal. This suggests that the cognitive effects of BZD/RD may be longlasting or permanent.

Kuivajätehuollon hiilijalanjälki ja kustannukset sekä kuljetusten kilpailutus – Etelä-Karjalan aluekeräyspisteverkoston päivitys

Tutkimuksen tavoitteena oli yhtenäistää Etelä-Karjalan alueen erilaisia tapoja toimia alueke-räyksen suhteen. Aluekeräyksellä tarkoitetaan jätteiden keräystä pisteiltä, joihin kotitaloudet, jotka eivät kuulu kiinteistökohtaiseen keräykseen, voivat tuoda syntypaikkalajitellun kuiva- eli sekajätteensä. Tavoitteena oli myös saada tietoa siitä, minkälaiset ovat eri kuivajätehuoltovaihtoehtojen ilmastonmuutos- ja kustannusvaikutukset. Lisäksi tavoitteena oli selvittää, miten ympäristönäkökohdat voidaan ottaa huomioon kuljetuskilpailutuksissa. Tutkimuksessa kerättiin tietoa internetistä, opinnäytetöistä ja tieteellisistä artikkeleista sekä yritysten edustajilta. Kasvihuonekaasupäästöjen laskennassa hyödynnettiin GaBi 6.0 -elinkaariarviointiohjelmaa. Tutkimuksen perusteella aluekeräyspisteet kannattaa sijoittaa reiteille, joita asukkaat käyttävät vähintään kerran viikossa ja mitkä ovat optimaalisesti myös kuljetusurakoitsijan kannalta. Taajama-alueelle ei nähty suositeltavaksi sijoittaa aluekeräyspisteitä. Suositeltavina astioina aluekeräyspisteille nähtiin syväkeräyssäiliöt, joiden tyhjennys onnistuu samalla keräyskalustolla kuin kiinteistöjen jäteastioiden, kun ajoneuvo on varustettu puominosturilla. Suositeltavaksi nähtiin myös harventaa jäteastioiden talvityhjennystiheyksiä, jos tyhjennystiheys on vakio ympäri vuoden, sillä pääosa aluekeräyspisteiden käyttäjistä on loma-asukkaita. Tyhjennystiheyksien harvennuksella olisi mahdollista saavuttaa kustannussäästöjä. Tutkimuksessa laskettiin kuivajätteen elinkaarenaikaisia kasvihuonekaasupäästöjä kuivajätteen keräyksestä loppusijoitukseen ja energiahyötykäyttöön. Energiahyötykäyttökohteiksi valittiin Riihimäen, Kotkan sekä Leppävirran (suunnitteilla) jätteenpolttolaitokset. Tulosten pohjalta kuivajätteen energiahyötykäyttö oli loppusijoitusta selkeästi parempi vaihtoehto. Kuivajätteen keräys- ja kuljetuspäästöjen vaikutus oli pieni. Kuivajätteen kuljetusmatkan pituus jätteenpolttolaitokselle ei ole siis ratkaisevassa roolissa kokonaiskasvihuonekaasupäästöjä tarkasteltaessa. Etäisyyttä suurempi vaikutus onkin kuivajätteen koostumuksella, polttolaitosten vuosihyötysuhteilla ja korvattavilla polttoaineilla. Jatkossa suositellaan selvittämään vielä vaihtoehtoisia käsittelytapoja kuivajätteen sisältämälle sekamuovijakeelle, jonka poltosta aiheutuu merkittävä osuus (noin 74 %) kuivajätteen polton kasvihuonekaasupäästöistä. Ajankohtaisia kuljetuskilpailutuksia varten tarkasteltiin vielä tarkemmin keräys- ja kuljetuspäästöjä. Tulosten pohjalta havaittiin, että keräys- ja kuljetuspäästöjä on mahdollista vähentää reilusti (46–74 %) siirtymällä dieselistä biopolttoaineiden käyttöön. Tuloksiin vaikuttaa kuitenkin merkittävästi, minkälaisista raaka-aineista biopolttoaineet on valmistettu. Kuivajätteen keräyspäästöjä on mahdollista pienentää myös päivittämällä aluekeräyspisteverkostoa. Tutkimuksessa tarkasteltiin kustannuksia aluekeräyspisteiden astioiden uusinnasta tai korjauksesta kuivajätteen loppusijoitukseen tai energiahyötykäyttöön asti. Merkittävimmät kustannukset aiheutuivat kuivajätteen loppusijoituksesta, energiahyötykäytöstä sekä keräyksestä. Kustannusten näkökulmasta keräyksen rooli oli siis suurempi. Työn lopussa annettiin vielä vinkkejä, joiden avulla jätehuoltoyritykset voivat tehdä jätekuljetushankintoja ympäristönäkökohdat huomioiden. Usein selkein tapa huomioida ympäristönäkökohdat kuljetuskilpailutuksissa on asettaa riittävän tiukkoja pakollisia vaatimuksia, jolloin voi valita hinnaltaan halvimman vaihtoehdon. Kuljetuspalvelun hankinnassa tulee huomioida ainakin energiankulutus, hiilidioksidi-, typenoksidi-, hiilivety- ja hiukkaspäästöt. Lainsäädäntö ei määrää vähimmäistasoja, vaan hankintaa tehdessä kannattaa kartoittaa markkinatilanne, jotta vaatimukset osaa asettaa oikealle tasolle. Markkinoille kannattaa myös tiedottaa tulevaisuuden tarpeista ja suunnitelmista. Suuria hankintakokonaisuuksia suositellaan pilkottavan pienempiin osiin, jotta pienet ja keskisuuret yritykset pystyvät myös osallistumaan tarjouskilpailuihin. Kannustus innovaatioiden huomioimiseen hankinnoissa on lisääntynyt myös jätehuollon alalla. Selvitettyjen kasvihuonekaasupäästöjen perusteella oli merkille pantavaa, miten suuri vaikutus polttolaitoksen valinnalla oli kasvihuonekaasupäästöihin. Oleellista onkin huomioida ympäristönäkökohdat myös energiahyötykäyttökohdetta valittaessa.

Combined effects of diethylpropion and alcohol on locomotor activity of mice: participation of the dopaminergic and opioid systems

The widespread consumption of anorectics and combined anorectic + alcohol misuse are problems in Brazil. In order to better understand the interactive effects of ethanol (EtOH) and diethylpropion (DEP) we examined the locomotion-activating effects of these drugs given alone or in combination in mice. We also determined whether this response was affected by dopamine (DA) or opioid receptor antagonists. A total of 160 male Swiss mice weighing approximately 30 g were divided into groups of 8 animals per group. The animals were treated daily for 7 consecutive days with combined EtOH + DEP (1.2 g/kg and 5.0 mg/kg, ip), EtOH (1.2 g/kg, ip), DEP (5.0 mg/kg, ip) or the control solution coadministered with the DA antagonist haloperidol (HAL, 0.075 mg/kg, ip), the opioid antagonist naloxone (NAL, 1.0 mg/kg, ip), or vehicle. On days 1, 7 and 10 after the injections, mice were assessed in activity cages at different times (15, 30, 45 and 60 min) for 5 min. The acute combination of EtOH plus DEP induced a significantly higher increase in locomotor activity (day 1: 369.5 ± 34.41) when compared to either drug alone (day 1: EtOH = 232.5 ± 23.79 and DEP = 276.0 ± 12.85) and to control solution (day 1: 153.12 ± 7.64). However, the repeated administration of EtOH (day 7: 314.63 ± 26.79 and day 10: 257.62 ± 29.91) or DEP (day 7: 309.5 ± 31.65 and day 10: 321.12 ± 39.24) alone or in combination (day 7: 459.75 ± 41.28 and day 10: 427.87 ± 33.0) failed to induce a progressive increase in the locomotor response. These data demonstrate greater locomotion-activating effects of the EtOH + DEP combination, probably involving DA and/or opioid receptor stimulation, since the daily pretreatment with HAL (day 1: EtOH + DEP = 395.62 ± 11.92 and EtOH + DEP + HAL = 371.5 ± 6.76; day 7: EtOH + DEP = 502.5 ± 42.27 and EtOH + DEP + HAL = 281.12 ± 16.08; day 10: EtOH + DEP = 445.75 ± 16.64 and EtOH + DEP + HAL = 376.75 ± 16.4) and NAL (day 1: EtOH + DEP = 553.62 ± 38.15 and EtOH + DEP + NAL = 445.12 ± 55.67; day 7: EtOH + DEP = 617.5 ± 38.89 and EtOH + DEP + NAL = 418.25 ± 61.18; day 10: EtOH + DEP = 541.37 ± 32.86 and EtOH + DEP + NAL = 427.12 ± 51.6) reduced the locomotor response induced by combined administration of EtOH + DEP. These findings also suggest that a major determinant of combined anorectic-alcohol misuse may be the increased stimulating effects produced by the combination.

Effect of intracerebroventricularly injected insulin on urinary sodium excretion by cerebroventricular streptozotocin-treated rats

Recent evidence suggests that insulin may influence many brain functions. It is known that intracerebroventricular (icv) injection of nondiabetogenic doses of streptozotocin (STZ) can damage insulin receptor signal transduction. In the present study, we examined the functional damage to the brain insulin receptors on central mechanisms regulating glomerular filtration rate and urinary sodium excretion, over four periods of 30 min, in response to 3 µl insulin or 0.15 NaCl (vehicle) injected icv in STZ-treated freely moving Wistar-Hannover rats (250-300 g). The icv cannula site was visually confirmed by 2% Evans blue infusion. Centrally administered insulin (42.0 ng/µl) increased the urinary output of sodium (from 855.6 ± 85.1 to 2055 ± 310.6 delta%/min; N = 11) and potassium (from 460.4 ± 100 to 669 ± 60.8 delta%/min; N = 11). The urinary sodium excretion response to icv insulin microinjection was markedly attenuated by previous central STZ (100 µg/3 µl) administration (from 628 ± 45.8 to 617 ± 87.6 delta%/min; N = 5) or by icv injection of a dopamine antagonist, haloperidol (4 µg/3 µl) (from 498 ± 39.4 to 517 ± 73.2 delta%/min; N = 5). Additionally, insulin-induced natriuresis occurred by increased post-proximal tubule sodium rejection, despite an unchanged glomerular filtration rate. Excluding the possibility of a direct action of STZ on central insulin receptor-carrying neurons, the current data suggest that the insulin-sensitive response may be processed through dopaminergic D1 receptors containing neuronal pathways.

Association of MDR1 gene polymorphisms with the risk of hepatocellular carcinoma in the Chinese Han population

The multidrug resistance 1 gene (MDR1) is an important candidate gene for influencing susceptibility to hepatocellular carcinoma (HCC). The objective of the present study was to evaluate the association ofMDR1 polymorphisms with the risk of HCC in the Chinese Han population. A total of 353 HCC patients and 335 healthy subjects were enrolled in the study. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), created restriction site-PCR (CRS-PCR) and DNA sequencing methods were used to identify MDR1 gene polymorphisms. Two allelic variants (c.335T>C and c.3073A>C) were detected. The CC genotype of the c.335T>C polymorphism was associated with an increased risk of developing HCC compared to the TT genotype (OR = 2.161, 95%CI = 1.350-3.459, χ2 = 10.55, P = 0.0011). The risk of HCC was significantly higher for the CC genotype in the c.3073A>C polymorphism compared to the AA genotype in the studied populations (CCvs AA: OR = 2.575, 95%CI = 1.646-4.028, χ2 = 17.64, P < 0.0001). The C allele of the c.335T>C and c.3073A>C variants may contribute to the risk of HCC (Cvs T of c.335T>C: OR = 1.512, 95%CI = 1.208-1.893, χ2 = 13.07, P = 0.0003, and Cvs A of c.3073A>C: OR = 1.646, 95%CI = 1.322-2.049, χ2 = 20.03, P < 0.0001). The c.335T>C and c.3073A>C polymorphisms of the MDR1 gene were associated with the risk of occurrence of HCC in the Chinese Han population. Further investigations are needed to confirm these results in larger different populations.

Single nucleotide polymorphisms predisposing to asthma in children of Mauritian Indian and Chinese Han ethnicity

Our objective was to investigate the distributions of six single nucleotide polymorphisms (SNPs) MS4A2 E237G, MS4A2 C-109T, ADRB2 R16G, IL4RA I75V,IL4 C-590T, and IL13 C1923T in Mauritian Indian and Chinese Han children with asthma. This case-control association study enrolled 382 unrelated Mauritian Indian children, 193 with asthma and 189 healthy controls, and 384 unrelated Chinese Han children, 192 with asthma and 192 healthy controls. The SNP loci were genotyped using polymerase chain reaction (PCR)-restriction fragment length polymorphism for the Chinese Han samples and TaqMan real-time quantitative PCR for the Mauritian Indian samples. In the Mauritian Indian children, there was a significant difference in the distribution of IL13 C1923T between the asthma and control groups (P=0.033). The frequency of IL13 C1923T T/T in the Mauritian Indian asthma group was significantly higher than in the control group [odds ratio (OR)=2.119, 95% confidence interval=1.048-4.285]. The Chinese Han children with asthma had significantly higher frequencies ofMS4A2 C-109T T/T (OR=1.961, P=0.001) and ADRB2 R16G A/A (OR=2.575, P=0.000) than the control group. The IL13 C1923T locus predisposed to asthma in Mauritian Indian children, which represents an ethnic difference from the Chinese Han population. TheMS4A2 C-109T T/T and ADRB2 R16G A/Agenotypes were associated with asthma in the Chinese Han children.

Activation of endogenous angiotensin converting enzyme 2 prevents early injuries induced by hyperglycemia in rat retina

Diabetic retinopathy (DR) is a serious complication of diabetes mellitus that may result in blindness. We evaluated the effects of activation of endogenous angiotensin converting enzyme (ACE) 2 on the early stages of DR. Rats were administered an intravenous injection of streptozotocin to induce hyperglycemia. The ACE2 activator 1-[[2-(dimethylamino) ethyl] amino]-4-(hydroxymethyl)-7-[[(4-methylphenyl) sulfonyl] oxy]-9H-xanthone 9 (XNT) was administered by daily gavage. The death of retinal ganglion cells (RGC) was evaluated in histological sections, and retinal ACE2, caspase-3, and vascular endothelial growth factor (VEGF) expressions were analyzed by immunohistochemistry. XNT treatment increased ACE2 expression in retinas of hyperglycemic (HG) rats (control: 13.81±2.71 area%; HG: 14.29±4.30 area%; HG+XNT: 26.87±1.86 area%; P<0.05). Importantly, ACE2 activation significantly increased the RCG number in comparison with HG animals (control: 553.5±14.29; HG: 530.8±10.3 cells; HG+XNT: 575.3±16.5 cells; P<0.05). This effect was accompanied by a reduction in the expression of caspase-3 in RGC of the HG+XNT group when compared with untreated HG rats (control: 18.74±1.59; HG: 38.39±3.39 area%; HG+XNT: 27.83±2.80 area%; P<0.05). Treatment with XNT did not alter the VEGF expression in HG animals (P>0.05). Altogether, these findings indicate that activation of ACE2 reduced the death of retinal ganglion cells by apoptosis in HG rats.

Uso da acidez titulável no controle de qualidade do leite humano ordenhado

O perfil físico-químico do leite humano ordenhado cru (LHOc) com acidez titulável acima de 7ºD após 15 dias de congelamento, teores de creme, gordura total e valor energético, foram avaliados. Na etapa controle, os valores absolutos de creme, gordura total e valor energético (n=3887) foram determinados pelo método do crematócrito e a acidez titulável (n=4204) do LHOc por um método titulimétrico adaptado de leite de vaca. Na etapa teste, determinou-se o teor de creme, gordura total e valor energético de amostras (n=66) com acidez acima de 7ºD armazenadas entre -10º e -18ºC por 15 dias. A acidez titulável variou de 0,5 a 21ºD (3,52 ± 2,45ºD) e os teores de creme, gordura total e valor energético foram, respectivamente, 4,90 ± 0,25 %, 4,49 ± 0,26 % e 617,47 ± 17,37 Kcal/Litro. Houve redução significante nos teores de creme (6,45 ± 2,28% para 5,79 ± 2,57%), gordura total (4,0 ± 1,81% para 3,49 ± 1,76%) e valor energético (716,27 ± 176,59 Kcal/Litro para 666,82 ± 171,90 Kcal/Litro), com p<0,05. O uso do teste da acidez titulável constitui uma ferramenta importante no controle de qualidade do LHOc.

Catalogus librorum & instrumentorum chirurgicorum b. m. viri Josephi Pippingsköld, m. d. profess. chirurg. [et] art. obstetr. ad Imp. Acad. Aboëns. nec non imp. coll. med. assessoris, sub hasta d. Oct. XXX & sqq. a. MDCCCXVI

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Consumer’s purchase intention of ethical fashion. Examining beliefs about fashion industry and attitudes towards ethical fashion

Globalization and the developments of supply chain have made inexpensive labor and the low production costs of developing countries available to businesses worldwide. Unfortunately, these developments have also led to the exploitation of human and natural resources. The increasing supply of cheap and fashionable clothing has created a contradiction between consumers’ concerns for sustainability and their purchase behavior in the fashion industry. Since the uncovering of several sweatshop scandals in the 1980’s and 1990’s ethical fashion brands have started to emerge. Ethical fashion has sparked the interest of consumers and studies have shown promising positive attitudes towards it. However, these attitudes have failed to translate into action and purchase behavior of ethical fashion has not reached the expectations. In order to translate the positive attitudes into buying companies must understand consumer’s motivations and reasons behind the purchase decision. The objective of this study is to understand the antecedents behind young consumer’s purchase intention of ethical fashion. The study is based on the theory of planned behavior which has been widely used to study consumer behavior and purchase decisions. The theory has also been used in ethical decision-making and fashion context before. According to the theory, in order to understand purchase intentions consumer’s attitudes toward buying ethical fashion were studied. The theory also states that attitudes are formed from beliefs, thus, consumer’s beliefs about the fashion industry were studied. To contribute to existing research, the effect of sweatshop issues and environmental issues were compared. The data was collected from university students (n=617) with an online survey. The results were analyzed by statistical methods and they revealed that young Finnish consumers hold positive attitudes towards buying ethical fashion as well as positive purchase intentions of ethical fashion. A strong relationship was found between positive attitudes and positive purchase intentions. Also, the more negative consumers’ beliefs of the fashion industry were the more positive their attitudes toward buying ethical fashion were. In contradiction to previous research this study revealed that environmental issues had greater effect on attitudes than sweatshop issues. Interesting differences between consumers were found depending on their field of education. Students from humanities and social sciences held the most negative beliefs as well as most positive attitudes and purchase intentions of ethical fashion.