Homeopathic treatment of elderly patients--a prospective observational study with follow-up over a two year period.

BACKGROUND: Very little is known about the range of diagnoses, course of treatment and long-term outcome in elderly patients who choose to receive homeopathic medical treatment. We investigated homeopathic practice in an industrialised country under everyday conditions.The aim of the study was to determine the spectrum of diagnoses and treatments, as well as to describe the course of illness over time among older patients who chose to receive homeopathic treatment. METHODS: In this subgroup analysis of a prospective, multicentre cohort study totally including 3981 patients treated by homeopathic physicians in primary care practices in Germany and Switzerland, data was analysed from all patients > 70 years consulting the physician for the first time. The main outcome measures were: assessment by patient of the severity of complaints (numeric rating scales) and quality of life (SF-36) and by the physician of the severity of diagnoses (numeric rating scales) at baseline, and after 3, 12, and 24 months. RESULTS: A total of 83 patients were included in the subgroup analysis (41% men, mean age 73.2 +/- (SD) 3.1 years; 59% women, 74.3 +/- 3.8 years).98.6 percent of all diagnoses were chronic with an average duration of 11.5 +/- 11.5 years. 82 percent of the patients were taking medication at baseline.The most frequent diagnoses were hypertension (20.5%, 11.1 +/- 7.5 years) and sleep disturbances (15.7%, 22.1 +/- 25.8 years).The severity of complaints decreased significantly between baseline and 24 months in both patients (from 6.3 (95%CI: 5.7-6.8) to 4.6 (4.0-5.1), p < 0.001) and physicians' assessments (from 6.6 (6.0-7.1) to 3.7 (3.2-4.3), p < 0.001); quality of life (SF 36) and the number of medicines taken did not significantly change. CONCLUSION: The severity of disease showed marked and sustained improvements under homeopathic treatment, but this did not lead to an improvement of quality of life. Our findings might indicate that homeopathic medical therapy may play a beneficial role in the long-term care of older adults with chronic diseases and studies on comparative effectiveness are needed to evaluate this hypothesis.

Predictors of transitions in vitality: the italian longitudinal study on aging.

It is widely acknowledged that there is a strong need to identify which modifiable risk factors predict healthy aging to use this information as the scientific basis for systematic interventions. Data from a 4-year longitudinal study on aging among 5632 older Italians were used. The definition of vitality was based on both cognitive and physical status, and the envisaged transitions were: positive or nonpositive stable, positive or negative transition, lost, and deceased. Predictors associated with different vitality trajectories were investigated by multinomial logistic analysis with a six-level outcome. Age and educational level were predictors of being "positive stable," whereas the other factors behaved differently according to comparison group. For example, being overweight is a common predictor except when compared to the deceased group, as is depressive symptomatology except when compared to the "positive transition" group. Interventions are warranted to reduce social inequalities, promote adequate body weight, and prevent and treat depressive symptoms.

Hormesis: Toxicological foundations and role in aging research.

The field of toxicology adopted the threshold dose response in the early decades of the 20th century. The model was rapidly incorporated into governmental regulatory assessment procedures and became a central feature of chemical evaluation and assessment. The toxicological community never validated the capacity of this model to make accurate predictions throughout the remainder of the 20th century. A series of recent investigations have demonstrated that the threshold and linear dose response model failed to make accurate predictions in the low dose zone. Such findings demonstrate a profound failure by the toxicology community on the central pillar of its discipline and one with profound public health, medical and economic implications. Ironically, the hormetic dose response, which was rejected by the toxicology community during the early decades of the 20th century, accurately predicted responses in the low dose zone in the same three large-scale validation assessments. Within the past two decades hormetic dose responses have been frequently reported in the experimental biogerontology literature, associated with endpoints associated enhancing healthy aging and longevity. The low dose stimulatory response of the hormetic dose response model represents the quantification of enhanced biological performance in the experimental facilitation of aging quality via multiple endpoints and mechanisms and in the extension of lifespan in such animal models research.

Envelhecimento: combatê-lo ou compreendê-lo?: O climatério como exemplo / Aging: fight it or understand it?: The climacteric as an example

Enquanto aumenta a expectativa de vida, também cresce a preocupação com a qualidade de vida na velhice. Para muitos, o envelhecimento está associado a aspectos negativos como inatividade, doenças, necessidade de cuidados, além de não encontrarem significado nessa fase da vida. Rudolf Steiner considerava que as mesmas forças vitais empenhadas no crescimento e desenvolvimento orgânicos são as que dão sustentação ao pensamento. Assim, a antroposofia considera que há uma metamorfose das forças que promovem o crescimento em forças do pensamento. Da mesma forma, há uma metamorfose no processo do envelhecimento: as forças vitais se desprendem paulatinamente dos órgãos e ficam disponíveis para o desenvolvimento ou o fortalecimento de algumas habilidades. O exemplo do sentido da audição, metamorfoseado em percepção da verdade é citado. De modo marcante, as ondas de calor no climatério (fogachos) caracterizam forças vitais que se desprendem dos ovários e não encontram destino ou utilidade, causando mal-estar à mulher nessa fase da vida. Mas as mulheres descendentes dos maias, no Yucatán (México), não têm a experiência dos fogachos após a menopausa. Para essa sociedade, envelhecer significa evoluir, ganhar posição superior no status social. Além disso, elas tecem e bordam desde jovens e assim continuam a criar, mesmo após o término do período fértil, usando as forças vitais que se desprendem dos ovários. Ao usar a terapia de reposição hormonal, a mulher terá suas forças vitais artificialmente presas aos órgãos, impedindo que a metamorfose citada aconteça. Então, trata-se de uma necessidade de nossa época encontrar uma nova perspectiva para o envelhecimento, pautada pela compreensão da metamorfose das forças vitais no ser humano.(AU)

While the life expectancy increases, there is also a growing concern about the quality of life in old age. For many, aging is associated with negative aspects such as inactivity, illness, need for care and lack of meaning in this stage of life. Rudolf Steiner considered that the same vital forces engaged in organic growth and development, are those that support the thought. Thus, anthroposophy considers that there is a metamorphosis of growth forces into thinking forces. In the same way, there is a metamorphosis in the process of aging: the vital forces gradually detach from the organs and they become available for the development or the strengthening of some abilities. The example of the sense of hearing, metamorphosed into the perception of truth is cited. Significantly, the hot flushes in the climacteric characterize vital forces that are released from the ovaries and do not find a destiny or a utility, causing discomfort to the woman in this phase of life. But the women descendants of the Maya, in the Yucatán (Mexico), do not experience the hot flashes after the menopause. For this society, aging means to progress, to gain a superior position in social status. In addition, they weave and embroider since youth and thus they continue to create, even after the end of the fertile period, using the vital forces that are released from the ovaries. The hormone replacement therapy artificially attaches the vital forces to the organs, and impedes the event of the mentioned metamorphosis. Therefore, finding a new perspective for aging is a necessity of our time, based on the understanding of vital forces metamorphosis in the human being.(AU)

Alternative medicines for the geriatric veterinary patient.

Over the past several decades, alternative medicines have gained in popularity for use in both humans and animals. While they are not without controversy, client interest and usage dictate that even those practitioners who do not want to practice any of them in their own hospital or clinic should at least be aware of their common use, safety, and efficacy. The author briefly discusses some of the more popular alternative medicines­acupuncture, chiropractic, herbal, homeopathic, and flower essences­with respect to some of the basics that every practitioner should know about them.

[Selective "death programs" or pleiotropic"life programs"? Looking for programmed cell death in the light of evolution]. / Programme de mort ou programme de vie? A la recherche des origines de la mort cellulaire programmée au cours de l'evolution du vivant.

"Nothing in biology makes sense except in the light of evolution", wrote Theodosius Dobzhansky, one of the founders of the Modern Synthesis that led to the unification of evolutionary theory and genetics in the midst of the 20th century. Programmed cell death is a genetically regulated process of cell suicide that is central to the development, homeostasis and integrity of multicellular organisms. Conversely, the dysregulation of mechanisms controlling cell suicide plays a role in the pathogenesis of a wide range of diseases. While great progress has been achieved in the unveiling of the molecular mechanisms of programmed cell death, a new, and somehow puzzling level of complexity has recently begun to emerge, suggesting i) that several different self destruction pathways may exist and operate in parallel in our cells, and ii) that molecular effectors of cell suicide might also perform other functions unrelated to cell death induction and crucial to cell survival, such as cell differentiation, metabolism, and the regulation of the cell cycle. These new findings, with important physiopathological and therapeutic implications, seem at odds with the paradigm of programmed cell death derived from the studies of Caenorhabditis elegans, which led to the concept of the existence of selective, bona fide death genes that emerged and became selected for their sole capacity to execute or repress cell death. In this review, I will argue that this new level of complexity might only make sense and be understood when considered in a broader evolutionary context than that of our phylogenetic divergence from C. elegans. A new view of the regulated cell death pathways emerges when one attempts to ask the question of when and how they may have become selected during a timeline of 4 billion years, at the level of ancestral single-celled organisms, including the bacteria. I will argue that there may be no such thing as a bona fide genetic cell death program. Rather, in the framework of a model that I have termed the "original sin" hypothesis, I have proposed the existence of an initial pleiotropy of the molecular tools involved in the control and execution of self-destruction--an ancestral involvement in both pro-life and pro-death activities. I will discuss how this hypothesis may be reconciled with the C. elegans paradigm of programmed cell death. Finally I will discuss how an ancestral level of pleiotropic functions of the molecular tools involved in the control of cell death, aging and genetic diversification might have favored their initial selection, their constant availability for de novo selection, and their progressive propagation in most--if not all--species during the course of evolution.

The potency of pancuronium at the adductor pollicis and diaphragm in infants and children.

To measure the potency of pancuronium at the diaphragm and adductor pollicis in infants and children, train-of-four stimulation was applied to the ulnar and phrenic nerves under N2O-halothane anesthesia. The force of contraction of the adductor pollicis was measured and compared with the diaphragmatic electromyogram (EMG). Cumulative dose response curves were determined for pancuronium in 18 patients divided equally into three age groups: 0-1 yr, 1-3 yr, and 3-10 yr. The potency of pancuronium at both muscles decreased with increasing age (P less than 0.05), while the adductor pollicis:diaphragm potency ratio remained constant. The mean doses (+/- SEM) required to depress adductor pollicis first twitch responses by 90% (ED90) were 42 +/- 3.3 micrograms/kg in the 0-1-yr group, 47 +/- 4.2 micrograms/kg in the 1-3-yr group, and 62 +/- 4.1 micrograms/kg in the 3-10-yr group. Corresponding figures for the diaphragm were 70 +/- 4.3 micrograms/kg, 81 +/- 5.1 micrograms/kg, and 101 +/- 4.4 micrograms/kg, respectively. The ED90 ratios (diaphragm ED90/adductor pollicis ED90) in the three age groups were 1.69 +/- .07, 1.75 +/- .14, and 1.64 +/- .09, respectively. These results are consistent with similar rates of maturation of the diaphragm and the adductor pollicis muscles in infancy and childhood. Thus, train-of-four monitoring of the adductor pollicis is likely to overestimate the degree of neuromuscular blockade of the diaphragm in pediatric patients.

Alternative therapies and empowerment of older women.

There has been a striking increase in Americans' awareness and use of alternative therapies over the last decade. Women, in particular, have been drawn to explore these unconventional health practices, which include herbal medicine, acupuncture, homeopathy, manual therapies, energy healing, and mind-body therapies. From a feminist perspective, the rise in alternative therapies' use in the United States represents a shift in cultural concepts of health from an out-moded patriarchical model which disempowers older women, to a more feminine, holistic model which can reempower older women. Throughout history, older women have developed, applied, and taught the principles and practices of what are now considered alternative healing modalities, in their roles as mothers, expert herbalists, midwives, wise women, and shaman. By becoming familiar with these therapies, older women can increase their control over their health, enhance prevention and self-care, and enjoy a health-care pathway that leads to wholeness in body, mind, and spirit.

Distribution and development of catecholaminergic neurons in the brain of the brown trout. A tyrosine hydroxylase immunohistochemical study.

We report the distribution of tyrosine hydroxylase immunoreactive (TH-ir) neurons in the brain of adult and developing trout. In the adult brain TH-ir neurons were observed in the telencephalon (in the olfactory bulbs and the ventral telencephalic region), the diencephalon (in both the parvicellular and magnocellular portions of the preoptic nucleus, the suprachiasmatic nucleus, the ventromedial thalamic nucleus, the posterior tuberal nucleus, the organon vasculosum hypothalami, the lateral recess nucleus and the dorsal periventricular region of the medial lobe recess), the pretectal region (nucleus pretectalis periventricularis), the isthmal region (locus coeruleus) and the medulla oblongata (in the area postrema, nucleus solitarius, the reticular area of the vagal region, and the reticular nucleus of the octaval region). The earliest TH-ir nuclei were observed in 10- to 11-min embryos in the posterior tuberal nucleus, locus coeruleus, nucleus solitarius and vagal reticular neurons. In the olfactory bulb, nucleus ventromedialis thalami and octaval reticular area, TH-ir cells a latter appeared at a later stage in development. In fry, juveniles and adults cerebrospinal fluid-contacting TH-ir cells were observed in circumventricular organs. The evolution of these TH-ir neuronal populations during development is described, and we discuss their significance for both comparative and developmental analysis.

Differences in temperature changes between pediatric and adult patients after cardiopulmonary bypass.

Nasopharyngeal (NPT) and rectal (RT) temperatures were continuously monitored in 51 adult or pediatric patients undergoing cardiac surgical procedures until 1 hour after the termination of cardiopulmonary bypass (CPB). The measurement also included the lowest NPT achieved and the dwelling time at that temperature on CPB, the rewarming time, the time on CPB, and the time that the chest remained opened after CPB. After the termination of CPB, the decrease of NPT (afterdrop) was significantly greater in the adult group than in the pediatric group. The mean decrease in adult patients was 1.34 +/- 0.65 degrees C versus 0.63 +/- 0.8 degrees C in pediatric patients. The combination of the NPT at the end of bypass (EndNPT), body weight times the EndNPT, and the dwelling of the lowest temperature times the EndNPT could predict 45% of the afterdrop. It is concluded that afterdrop occurs to a lesser degree in pediatric patients than in adults. This may be due to more efficient supplying of external heat to pediatric patients in whom there is a larger body surface area to weight ratio.

Dose-response characteristics of pancuronium in neonates, infants and children.

This paper presents pharmacodynamic data for pancuronium in neonates, infants, children and adolescents during N2O-O2-fentanyl anaesthesia. Neuromuscular block (NMB) was evaluated by the adductor pollicis electromyogram. Dose-response curves of pancuronium were parallel in all age-groups. ED95 was greatest in children and least in infants (93 vs. 66 micrograms/kg, P less than 0.05). The rate of spontaneous recovery following 95% NMB was comparable in all age-groups, as was the maintenance requirement of pancuronium when related to ED-values. The hourly requirement to maintain NMB greater than 85% was 60-68% of the individual ED95 dose. When administered on this basis, pancuronium is an equally long-acting neuromuscular blocking agent in patients of all ages.

La place de l'homeopathie en geriatrie quotidienne / The place of the homeopathy in the geriatric quotidian

L'objectif principal de la geriatrie n'est pas seulement de prolonger la vie mais aussi d'en ameliorer la qualite afin que la periode de dependence ou de decheance physique et mentale qui caracterise trop souvent la fin de la vie... (AU)