RESUMEN

BACKGROUND: Environmental imperatives to eliminate the use of chlorofluorocarbon (CFC) propellants in metered-dose inhalers have led to the development of metered-dose inhalers with the hydrofluoroalkane (HFA-134a) propellants. OBJECTIVES: To evaluate the clinical effect of switching from Ventolin CFC to Ventolin HFA and to compare the efficacy and safety of Ventolin CFC, Ventolin HFA, and placebo in patients with asthma. METHODS: Multicenter, double-blind, randomized safety and efficacy trial comparing regular use of Ventolin CFC versus Ventolin HFA versus placebo for 12 weeks in 313 patients with asthma aged 12 years and older who received Ventolin CFC during a 3-week run-in period. RESULTS: Patients who were switched from Ventolin CFC to Ventolin HFA maintained pulmonary function and other measures of asthma control at levels comparable with run-in baseline. Serial pulmonary function testing demonstrated that both Ventolin treatments had significantly greater mean improvement in FEV1 over baseline than the placebo group at treatment day 1 and weeks 6 and 12 (P < .001). Both Ventolin groups had comparable pulmonary function at every visit. Predose FEV1 values were maintained or improved over time with all treatments. Treatments were well-tolerated. The adverse event profile for both Ventolin treatments was comparable with placebo. No clinically relevant effects on ECG, vital signs, or clinical laboratory tests were noted. Asthma exacerbation rates were 4% to 5% in the Ventolin groups and slightly higher (8%) in the placebo group. CONCLUSIONS: Patients who were switched from Ventolin CFC to Ventolin HFA maintained comparable asthma control with a similar safety profile.

Asunto(s)

RESUMEN

One of the most difficult responsibilities of the forensic toxicologist is the interpretation of postmortem drug levels and their possible significance as to behavior and/or cause of death. During the past 15 years, much work has been performed using human case information and animal studies to illustrate and validate the phenomena of postmortem drug redistribution. These studies provide certain clarification to drug level interpretation. They also cast uncertainty on the interpretation of drugs where analogous studies are incomplete or totally absent. Literature data of more than 30 drugs, as reported by numerous authors, are reviewed to illustrate two phenomena: (a) postmortem redistribution occurs primarily as a function of the diffusion of drugs along a concentration gradient, from sites of high concentration in solid organs into the blood with artificial elevation of the drug levels; and (b) while many drugs seem to subject to postmortem redistribution, there are also others that undergo no change whatsoever. While additional work still needs to be performed, there has been enough achieved to both illustrate and validate that postmortem redistribution does exist. This information is helpful to forensic pathologists in determining sample sets taken during autopsy.

RESUMEN

BACKGROUND: Aerosolized asthma medications with chlorofluorocarbon (CFC) propellants are being phased out because of environmental concerns about the ozone layer. Medications are being reformulated with non-ozone-depleting propellants. OBJECTIVE: To evaluate the clinical comparability of albuterol sulfate formulated in a new hydrofluoroalkane-134a (HFA) propellant (Ventolin HFA Inhalation Aerosol), and conventional CFC-containing albuterol (Ventolin Inhalation Aerosol) in children with asthma. DESIGN: Randomized, double-blind, placebo-controlled 2-week clinical trial with a 1- to 2-week run-in period. During the run-in, patients took Ventolin CFC as needed. Patients (n = 135) aged 4 to 11 years with asthma then were assigned randomly to treatment with Ventolin HFA, Ventolin CFC, or placebo administered 4 times daily via metered-dose inhaler for 2 weeks. All patients were allowed rescue albuterol use in matching propellant as needed for relief of breakthrough symptoms. The main outcome measure was the mean percentage of predicted peak expiratory flow (PEF) after the morning dose of study drug on day 1 and after 2 weeks as assessed by results of 6-hour serial tests. RESULTS: At day 1, the mean (+/- SE) percentage of predicted PEF increased postdose by 14% (+/- 1%) in the Ventolin HFA group and 13% (+/- 1%) in the Ventolin CFC group compared with 6% (+/- 2%) in the placebo group (P

Asunto(s)

Asunto(s)

RESUMEN

Survey data from 113 female physicians, 634 male physicians, and 41 female dentists were compared. Instruments designed to assess work satisfaction, work stress, marital satisfaction, family competence, and psychiatric symptoms and treatment were used, thereby exploring important life domains concurrently. The results suggest that female physicians are much more like both male physicians and female dentists than anticipated. Generally, female physicians describe high levels of work satisfaction, moderate levels of work stress, average-to-high levels of marital satisfaction, and relatively low levels of psychiatric distress. Their lower levels of practice income remain something of an enigma as gender remains the most powerful predictor of income and is not replaced in statistical analyses by specialty, hours worked, or other significant variables. Finally, female physicians who find higher levels of satisfaction in work also report higher levels of marital satisfaction and fewer psychiatric symptoms. For these women, a highly satisfying medical career does not apparently need to be experienced at the cost of marital or personal distress.

Asunto(s)

RESUMEN

In a climate that many practitioners find increasingly oppressive, data suggesting the most and least satisfying aspects of medical practice are important. In a joint effort, the Dallas County Medical Society, Timberlawn Psychiatric Hospital, and Timberlawn Psychiatric Research Foundation explored levels of work satisfaction for their relationships with marital satisfaction and psychiatric symptoms as reported by physicians and dentists and their spouses. Most physicians and dentists rate various aspects of direct patient care and service to humanity as highly satisfying aspects of professional life. Physicians highly satisfied with their work are more likely to report high satisfaction in their marriages and fewer psychiatric symptoms. Most spouses of physicians report high levels of marital satisfaction, and high agreement exists between the marital satisfaction ratings of physicians and their spouses. Physicians and dentists are quite similar on the wide range of professional and personal variables surveyed.

Asunto(s)

RESUMEN

The work stress of physicians is considered high, and many are contemplating leaving the profession. Documenting the specific aspects of practice found to be most stressful is important, and useful insights may be obtained by contrasting physicians who report high and low levels of work stress. Contrasting the work stress of physicians and dentists can be useful for both professions. Accordingly, we surveyed 3156 members of the Dallas County Medical Society and 1273 members of the Dallas County Dental Society plus a large group of their spouses. Although the level of work satisfaction is the most powerful predictor of work stress, other significant predictors are younger age, long working hours, and solo practice. Physicians who report high levels of work stress also report lower levels of marital satisfaction and a higher prevalence of psychiatric symptoms. Dentists are much like physicians in their reports of overall work stress, and the similarities and differences regarding specific stressors suggest the two professions are more alike than different in reporting the stresses of professional practice.

Asunto(s)

RESUMEN

Marital satisfaction data from a large sample of physicians and their spouses and dentists and their spouses suggest that about 85% of professionals and spouses are satisfied with their marriages. High levels of marital satisfaction are associated with high work satisfaction, low work stress, and fewer psychiatric symptoms. These findings do not support the widely held belief that physicians' marriages are more apt to be dysfunctional than those of other persons. The authors discuss this difference from two perspectives: (1) sampling differences and (2) differences between marital assessments from inside and outside the marriage.

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

Treatment planning that is highly individualized and systematically improved must be based on careful assessments of the effectiveness of current technics. This report describes the long-term (three to eight years) outcome of psychiatric hospitalization for 120 severely disturbed adolescent patients as it is measured on three dimensions: peer and social functioning, relationship with parents, and educational and occupational functioning. The measurement scales and the follow-up procedures are practical and easily used.

Asunto(s)

RESUMEN

Although the development of psychiatric residents has been studied extensively, continuing changes in psychiatrists after graduation from training have not. The authors present results of a survey research study of 263 psychiatrists recently graduated from a wide variety of training programs. The psychiatrists reported alarming symptoms of stress during this period, yet they used effective coping mechanisms and perceived themselves as increasing in growth, mastery, and confidence. Their overall contenment with their personal and professional lives effective coping mechanisms were those involving the establishment of support systems with loved ones.

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

Procedural problems inhibiting follow-up research on psychiatric patients are discussed, and solutions offered, in the areas of ethical concerns, study design, selection of variables, collection of data, and researcher-clinician relationship. Early communication with patients about methods and goals, and maintenance of rapport and feedback between research and treatment staffs may overcome many difficulties of long-term research, and even aid treatment.

Asunto(s)

RESUMEN

Clinical, pathologic, and epidemiologic observations of malignant tumors of children in sub-Sahara Africa suggest alternative theories of causation, and give insight into environmental influences that may play a large role in the etiology and form of malignant lymphatic tumors and cerebral neoplasms of infants.

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)