RESUMO
Overactive bladder and urgency incontinence are common and distressing conditions in older people, for which the first-line pharmacological treatment is a bladder antimuscarinic agent. Of these, oxybutynin is often recommended in guidelines, but is associated with a higher incidence of adverse drug effects, and in particular has been suggested to have deleterious cognitive effects. Despite this, guidelines often suggest oxybutynin as first-line treatment, and insurance based healthcare systems often require oxybutynin to be used as a first-line therapy and fail before reimbursement for the cost of newer anticholinergics is authorised. We reviewed the literature of bladder antimuscarinics in older adults, using the headings overactive bladder, urinary frequency, urgency, urge, oxybutynin, antimuscarinic, older, older people, and frail. In general, oxybutynin had a similar efficacy to other anticholinergic drugs, but a higher incidence of adverse drug events, in particular significant yet unnoticed cognitive impairment. We conclude that oxybutynin should not be used in frail older people.
Assuntos
Idoso Fragilizado , Bexiga Urinária Hiperativa/tratamento farmacológico , Incontinência Urinária/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Compostos Benzidrílicos/efeitos adversos , Compostos Benzidrílicos/uso terapêutico , Antagonistas Colinérgicos/uso terapêutico , Cresóis/efeitos adversos , Cresóis/uso terapêutico , Humanos , Antagonistas Muscarínicos/efeitos adversos , Antagonistas Muscarínicos/uso terapêutico , Fenilpropanolamina/efeitos adversos , Fenilpropanolamina/uso terapêuticoRESUMO
Despite differences in design, many large epidemiological studies using well-powered multivariate analyses consistently provide overwhelming evidence of a link between erectile dysfunction (ED) and lower urinary tract symptoms (LUTS). Preclinical evidence suggests that several common pathophysiological mechanisms are involved in the development of both ED and LUTS. We recommend that patients seeking consultation for one condition should always be screened for the other condition. We propose that co-diagnosis would ensure that patient management accounts for all possible co-morbid and associated conditions. Medical, socio-demographic and lifestyle risk factors can help to inform diagnoses and should be taken into consideration during the initial consultation. Awareness of risk factors may alert physicians to patients at risk of ED or LUTS and so allow them to manage patients accordingly; early diagnosis of ED in patients with LUTS, for example, could help reduce the risk of subsequent cardiovascular disease. Prescribing physicians should be aware of the sexual adverse effects of many treatments currently recommended for LUTS; sexual function should be evaluated prior to commencement of treatment, and monitored throughout treatment to ensure that the choice of drug is appropriate.
Assuntos
Disfunção Erétil/complicações , Sintomas do Trato Urinário Inferior/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Consenso , Disfunção Erétil/epidemiologia , Disfunção Erétil/terapia , Humanos , Sintomas do Trato Urinário Inferior/epidemiologia , Sintomas do Trato Urinário Inferior/terapia , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Prevalência , Hiperplasia Prostática/complicações , Hiperplasia Prostática/epidemiologia , Hiperplasia Prostática/terapia , Encaminhamento e Consulta , Fatores de Risco , Agentes Urológicos/efeitos adversosRESUMO
BACKGROUND: Pharmaceutical subsidy schemes are under increasing pressure to evaluate the cost effectiveness of new highly specialised and orphan drugs for universal subsidy. In the absence of longer-term outcome data, drug sponsors often present modelled data, which can carry a significant level of uncertainty over longer-term projections. Risk-sharing schemes between drug sponsor and government may provide an acceptable method of balancing the uncertainty of longer-term cost effectiveness with the public demand for equitable and timely access to new drugs. METHODS: The Bosentan Patient Registry (BPR) is an example of a unique risk-sharing model utilised in Australia aiming to provide clinical evidence to support the modelled predictions, with the registry survival outcomes linked to future price. Concomitant medication, health and vital status data was collected from clinicians, government health departments and death registries. RESULTS: The BPR has identified a number of issues surrounding registry governance, ethics and patient privacy, and the collection of timely and accurate data, which need to be addressed for the development of a generic registry model for systematic evaluation. CONCLUSION: The success of a generic drug registry model based on the BPR will be enhanced by addressing a number of operational issues identified during the implementation of this project.
Assuntos
Seguro de Serviços Farmacêuticos , Modelos Econométricos , Produção de Droga sem Interesse Comercial/economia , Austrália , Análise Custo-Benefício/métodos , Custos de Medicamentos , Financiamento Governamental , HumanosRESUMO
Two experiments with the Stroop paradigm were conducted to investigate the role of phonological codes in access to the meaning of Chinese characters. Subjects named the ink color of viewed characters or color patches. Key items were color characters, their homophones with the same tone, homophones with different tones, and semantic associates. Apart from finding the usual Stroop interference effect, homophones produced significant interference in the incongruent condition, provided that they had the same tone as the color characters. The interference effect from homophones, however, was significantly smaller than that from color characters. Semantic associates generated an interference effect in the incongruent condition, an effect of the same magnitude as the effect from the same-tone homophones. Finally, in the congruent conditions, all the key items yielded facilitations compared to neutral controls, though the facilitation from color characters was larger than the facilitations from other types of characters. These findings suggest that phonological codes in Chinese are activated obligatorily and provide early sources of constraint in access to meaning.
Assuntos
Cognição/fisiologia , Idioma , Leitura , Semântica , Humanos , FonéticaRESUMO
This experiment examined electrodermal and cardiac activity within a two-stimulus anticipation paradigm. A warning stimulus informed subjects (N = 24) whether an imperative stimulus to follow would contain two or four letters (low or high information conditions) and whether this stimulus would be presented for 60 or 75 msec (short or long duration). The subject's task was to identify as many of the letters in the imperative stimulus as possible. Although the amount of information conveyed by the warning stimulus was identical throughout the experiment (2 bits), skin conductance responses during the warning stimulus-imperative stimulus interval were larger prior to the high information imperative stimulus than prior to the low. Cardiac activity was not affected by the experimental manipulations. The implications of these findings for theories of the orienting response are discussed, particularly with reference to the view that orienting reflects an activation of the information processing system.
Assuntos
Atenção/fisiologia , Resposta Galvânica da Pele , Frequência Cardíaca , Adolescente , Adulto , Cognição/fisiologia , Feminino , Humanos , Masculino , Rememoração Mental/fisiologia , Percepção Visual/fisiologiaRESUMO
This study was designed to investigate the effects of stimulus information and stimulus duration on the skin conductance response (SCR) component of the orienting response (OR). Three levels of stimulus information were combined with two levels of stimulus duration in a 3 X 2 independent groups factorial design (N = 90). On the basis of Sokolov's (1966) theory, it was hypothesized that: (a) high information stimuli would elicit larger initial SCR'S than would stimuli of low information, (B) high-information stimuli would evoke more SCRs throughout a habituation series than would low-information stimuli, and (c) high-information stimuli would require more presentations to reach a habituation criterion than would stimuli of low information. It was also hypothesized that (d) long-duration stimuli would require fewer presentations to reach a habituation criterion and result in a faster rate of habituation than would stimuli of short duration. The stimuli consisted of black and white chequered patterns containing 12, 26 or 60 bits of information. Stimulus duration was either 0.5 or 4.5 sec, and each subject received 20 presentations at randomly ordered intervals of 20, 25, 30 and 35 sec. The results provided support for hypotheses (b), (c) and (d), but not for hypothesis (a). These results support the view that OR habituation can be conceptualized as a process of information extraction.
Assuntos
Condicionamento Clássico/fisiologia , Resposta Galvânica da Pele/fisiologia , Habituação Psicofisiológica/fisiologia , Orientação/fisiologia , Adolescente , Adulto , Feminino , Percepção de Forma , Humanos , Teoria da Informação , Masculino , Estimulação Luminosa , Fatores de Tempo , Percepção VisualRESUMO
Comparative functional neuroimaging studies using the block design paradigm have previously demonstrated that there are no significant differences in the location of areas of cerebral activation when native Chinese speakers independently process single words or sentences in both the Chinese (first) and English (second) languages. While it has also been documented that significant domains of brain response include the inferior to middle left frontal lobe, the latency, amplitude and duration of the associated hemodynamic changes during isolated neural processing of Chinese and English languages still remain unknown. The aim of this study, therefore, was to examine the characteristics of the hemodynamic alterations in the above-mentioned regions with event-related functional MRI (ER-fMRI) when native Chinese speakers performed verb generation tasks in both the Chinese (first) and English (second) languages. Our results demonstrate the presence of a similar neural activity-induced hemodynamic response in the inferior to middle left frontal lobe during both tasks. Further, there were also no statistically significant differences among the variables that described the hemodynamic response curves. These findings strongly imply that the underlying neural mechanism for Chinese (first) and English (second) language processing may be similar in native Chinese speakers.
Assuntos
Nível de Alerta/fisiologia , Lobo Frontal/irrigação sanguínea , Imageamento por Ressonância Magnética , Multilinguismo , Leitura , Comportamento Verbal/fisiologia , Adulto , Dominância Cerebral/fisiologia , Humanos , Masculino , Fluxo Sanguíneo Regional/fisiologiaRESUMO
The effects of orienting responses to different types of stimuli on acquisition of information were studied. Subjects underwent a standard habituation series of 15 trials. On Trial 16, they received one of following three stimuli: (a) no-change stimulus--same stimulus as habituation stimulus, (b) innocuous-change stimulus, (c) significant-change stimulus--the subject's own name. These orienting stimuli were followed 500 msec. later by an imperative stimulus (100 msec.) which contained a number of Chinese characters. The subjects were then unexpectedly asked to recall and recognize these characters. Recall and recognition were consistently superior in conditions with significant and innocuous change relative to no change, which indicated that the orienting response to unexpected stimuli is related to a generalized perceptual enhancement. The data pose problems for the position that the orienting response reflects only the passive 'registration' of the eliciting stimulus information. While digital pulse-amplitude data showed no difference among the conditions for the change trial, these conditions were differentiated by electrodermal and cardiac changes.
Assuntos
Nível de Alerta , Discriminação Psicológica , Orientação , Percepção Visual , Adolescente , Adulto , Atenção , Feminino , Habituação Psicofisiológica , Humanos , MasculinoAssuntos
Corticosteroides/sangue , Corticosteroides/urina , Ritmo Circadiano , Pregnanos/sangue , Pregnanos/urina , Esteróis/sangue , Esteróis/urina , Adulto , Contagem de Células Sanguíneas , Temperatura Corporal , Isótopos de Carbono , Eosinófilos , Glucocorticoides/sangue , Glucocorticoides/urina , Humanos , Masculino , Potássio/urinaAssuntos
Nível de Alerta , Atenção , Percepção de Forma , Orientação , Reconhecimento Visual de Modelos , Adolescente , Adulto , Feminino , Humanos , Masculino , Tempo de ReaçãoAssuntos
Nível de Alerta , Atenção , Eletroencefalografia , Orientação , Potenciais Evocados Visuais , Feminino , Humanos , MasculinoRESUMO
Kaposi's sarcoma-associated herpesvirus (KSHV or HHV-8) has been associated with several neoplasias, including childhood endemic Kaposi's sarcoma (KS). It is possible that strain genotypes could contribute to the differences in regional presentation (mainly sub-Saharan Africa), childhood infection, lack of male sex bias, distinct disseminated forms and rapid fatality observed for childhood endemic KS. Early studies, at the advent of the HIV/AIDS epidemic, identified only the K1-A5 genotype in childhood KS biopsies as well as blood of a few HIV positive and negative febrile infants in Zambia, a highly endemic region. This current enlarged study analyses blood infections of 200 hospitalized infants (6-34 months age) with symptoms of fever as well as upper respiratory tract infection, diarrhoea, rash or rhinitis. KSHV and HIV viraemia and were prevalent in this group, 22% and 39%, respectively. Multiple markers at both variable ends of the genome (K1, K12, and K14.1/K15) were examined, showing diverse previously adult-linked genotypes (K1 A2, A5, B, C3, D, with K12 B1 and B2 plus K14.1/K15 P or M) detected in both HIV positive and negative infants, demonstrating little restriction on KSHV genotypes for infant/childhood transmission in a childhood endemic KS endemic region. This supports the interpretation that the acquisition of childhood KSHV infections and subsequent development of KS are due to additional co-factors.
Assuntos
Doenças Endêmicas/prevenção & controle , Infecções por HIV , Herpesvirus Humano 8/genética , Sarcoma de Kaposi/epidemiologia , Sequência de Aminoácidos , Pré-Escolar , Diarreia/patologia , Exantema/patologia , Febre de Causa Desconhecida/patologia , Febre de Causa Desconhecida/virologia , Genes Virais , Humanos , Lactente , Dados de Sequência Molecular , Rinite/patologia , Alinhamento de Sequência , Proteínas Virais/genética , Viremia , Zâmbia/epidemiologiaRESUMO
Three experiments were conducted to examine cross-language priming in bilinguals. The first was a cross-language primed lexical decision task experiment with Chinese-English bilinguals. Subjects made lexical decisions about primary associate targets in the two languages at the same rate, but priming occurred only when the prime was in their first language (L1), Chinese, and the target was in their second language (L2), English. Experiment 2 produced the same pattern of asymmetrical priming with two alphabetic languages, French and Dutch. In Experiment 3, the crucial stimuli were translation equivalents. In contrast to the results of Experiments 1 and 2, priming occurred across languages in both the L1-L2 and L2-L1 conditions. However, this priming was also asymmetrical, with more priming occurring in the L1-L2 condition. A tentative separate-interconnected model of bilingual memory is described. It suggests that the representations of words expressed in different languages are stored in separate memory systems, which may be interconnected via one-to-one links between some translation-equivalent representations as well as meaning-integration processes.
Assuntos
Idioma , China , Comparação Transcultural , Humanos , Memória , Semântica , Comportamento VerbalRESUMO
Age-specific quarterly asthmatic hospital discharge rates in Hong Kong during 1983 to 1989 were examined in relation to mean levels of six pollutants: sulfur dioxide (SO2), ozone (O3), total suspended particles (TSP), respiratory suspended particles (RSP), nitrogen dioxide (NO2), and nitrogen oxides (NOX). Discharges from the hospital of children under 14 years of age represented 56% of 33,952 discharges recorded in all age groups. Trends of adult hospitalization rates over time remained stable during the study period. In children, however, there was an increase in these rates, particularly marked in the age group of 1 to 4 years. Univariate analysis revealed a strong correlation between quarterly mean TSP and hospital discharge rate for the 1 to 4-year-old children (r = .62, P less than .001). In the 5 to 14-year-old age group, there was an inverse relationship between hospital discharge rate and sulfur dioxide level (r = -.38, P less than .05). Stepwise multiple regression analysis, controlling for confounding variables (seasonal and annual trends of asthma hospitalizations) confirmed these relationships. A highly significant linear regression equation was derived between hospitalization rate for ages 1 to 4 years and total suspended particles (P less than .001). The highly significant correlation between pollution and asthmatic hospitalization rate for the 1 to 4-year-old group suggests that young children are vulnerable to the adverse environmental effects of pollution. Auditing these relationships offers a logical basis for approaching control.
Assuntos
Poluição do Ar/análise , Asma/epidemiologia , Hospitalização , Adolescente , Adulto , Criança , Pré-Escolar , Hong Kong/epidemiologia , Humanos , Lactente , Dióxido de Nitrogênio/análise , Óxidos de Nitrogênio/análise , Ozônio/análise , Análise de Regressão , Estações do Ano , Dióxido de Enxofre/análiseRESUMO
A total of 153 schizophrenic subjects were included for outcome assessment in different aspects of their life functions. The same group of subjects was followed-up 1 year later to assess the consistency of their outcome pattern. A factor analysis on the outcome measures was conducted, and 5 independent factors were noted. Outcome on symptomatic control was most favourable but less consistent over time. Psychosocial deficits, on the other hand, were more enduring and noted in a significant proportion of the subjects.
Assuntos
Atividades Cotidianas/psicologia , Comparação Transcultural , Esquizofrenia/reabilitação , Psicologia do Esquizofrênico , Adolescente , Adulto , Terapia Combinada , Estudos Transversais , Feminino , Seguimentos , Hong Kong , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Qualidade de Vida , Reabilitação Vocacional , Ajustamento SocialRESUMO
The experience and perception of effective sources of help of 101 schizophrenic patients were studied. A combination of professional help, social support, and self-coping efforts was listed as helpful. The more experiences patients had with the various sources of help, the better were their outcomes. Premorbid adjustment, exposure to the magnitude and nature of helpful sources, as well as the patients' own ability and motivation to make use of available helpful sources were thought to be important mediating variables for a better outcome. Apart from psychotropic medications, over half of the patients were not using any one of the sources of help mentioned. It remains an important research question whether or not schizophrenic patients may benefit from direct coaching in self-help skills in conjunction with making optimal use of professional and environmental supports.
Assuntos
Adaptação Psicológica , Esquizofrenia/reabilitação , Adulto , Feminino , Humanos , Masculino , Análise de Regressão , Resultado do TratamentoRESUMO
Vibration signatures of the Low Power Atmospheric Compensation Experiment satellite were obtained with a ground-based CO(2) laser radar. The laser radar operated in a cw mode and used autodyne receivers to extract relative target velocity information between a germanium retroreflector located at the base of the satellite and a retroreflector array located at the tip of an extended forward boom. Time-frequency analysis algorithms were applied to the vibration data to investigate the correlation between excitations and modal structure. The resultant analysis suggests that vibration modes of an on-orbit spacecraft can be suppressed with simple open-loop techniques.
RESUMO
Written Chinese as logographic script differs notably from alphabets such as English in visual form, orthography, phonology, and semantics. Thus, research on the Chinese language is important to advance our understanding of the universality and particularity of the organization of language systems in the brain. In this study, we examine the neural systems associated with logographic reading using functional magnetic resonance imaging. Two experimental tasks were devised, one based on semantic decision and the other on homophone decision. Compared to the fixation baseline, peak activations resulting from semantic as well as homophony decisions were localized in the left middle frontal gyrus (BA 9). Left inferior frontal cortex also mediated Chinese processing. In addition, more right hemisphere cortical regions (i.e., BAs 47/45, 7, 40/39, and the right visual system) were involved in reading Chinese relative to reading English. This is attributed to the square shape of the logograph which requires an elaborated analysis of the spatial information and locations of various strokes comprising the logographic character. We suggest that the left middle frontal area (BA 9) coordinates and integrates the intensive visuospatial analysis demanded by logographs' square configuration and the semantic (or phonological) analysis required by the present experimental tasks. Our study has implicated brain regions common to both logographic and alphabetic languages as well as brain regions specialized in processing logographs.