Moving a youth trauma support group online: participatory adaption, usability and pilot test

Background

Posttraumatic stress poses a significant threat to a young person’s development. Internet-based delivery could ameliorate barriers to care, but has mostly been tested with adults. This project aimed to (i) adapt the group intervention Teaching Recovery Techniques for online delivery through a participatory process, (ii) investigate the usability of the online format and (iii) pilot the new format.

Methods

Adaption recommendations were generated through participatory workshops with service users and providers, and consultation with an advisory panel with professionals and parents. Usability testing was conducted with intervention leaders (n = 5) and youth (n = 5). The public involvement in the project was assessed through a multi-method approach including behavioural observations, questionnaires and field notes. A pilot study (n = 14) is ongoing.

Results

The workshops focused on safety, participation and learning. Recommendations included an emergency response protocol, communication strategies, and guidance on intervention delivery. Whilst the advisory panel largely agreed, points of disagreement included workshop ideas around personalisation, where the panel conveyed the importance of consistency in manualised interventions. Usability testing highlighted the need for explicit guidance, particularly on safety processes.

Conclusions

Online delivery of trauma group support requires adaptions to ensure positive group dynamics, learning and safety. Yet, some adaptions resulting from the usability testing were also relevant to the original format, pointing to the need for more extensive use of usability testing across intervention manuals. The young people, parents and professionals involved in the project provided rich and varied perspectives, illustrating the value of broad stakeholder engagement. The ongoing pilot study explores the feasibility of online delivery, including youth perceptions of the format.

Key messages

• The varied perspectives in the participatory process highlighted the importance of broad stakeholder engagement for interventions to be equally evidence-based and adapted to the target population.

• The current pilot study explores the feasibility of online delivery, including youth perceptions of the format, in order to assess the potential for scale up.

Ethical perspectives of the involvement of vulnerable populations in health research

Background

Public involvement in research has potential to transform public health research processes and outcomes, as well as contribute to sustainable collaborations between academia and the civil society. However, this all relies on public involvement being conducted in an ethical and inclusive way, especially when involving representatives from vulnerable populations.

Methods

In this empirically informed theoretical reflection, ethical perspectives on involvement of vulnerable populations in health research were explored using data collected within a public involvement evaluation project. By analysing observational and longitudinal qualitative data from research projects involving public representatives from vulnerable groups, ethical aspects were identified.

Results

Responsibility and decision-making appeared as important ethical aspects, where laws and regulations conflicted with involvement ideals. Similarly, reimbursement and recognition for public contributors became an ethical issue when facing legislation and bureaucracy, especially when involving children or refugees. Another ethical aspect concerned researchers’ concerns in balancing involvement and protection of vulnerable groups, especially when involving contributors living under unstable circumstances. Finally, effectively communicating around research and involvement in an accessible way, for contributors to be involved but not burdened, was a challenge for researchers.

Conclusions

Public involvement of vulnerable populations led to ethical challenges related to conflicting ideals and practical realities, including balancing involvement and protection of contributors. This highlighted a need for ethical guidance to support ethical decision-making and practice. The findings are used to guide the development of an ethical framework for decision-making in public involvement.

Key messages

• Researchers involving public contributors from vulnerable groups face ethical challenges which causes barriers to involvement.

• There is need for guidance on ethical decision-making for researchers involving representatives from vulnerable groups in research.

OP0298-PARE EXPERIENCES AND IMPACT OF PATIENT AND PUBLIC INVOLVEMENT IN SWEDISH RHEUMATOLOGY RESEARCH: A SURVEY OF RESEARCHERS AND PATIENT RESEARCH PARTNERS

Background

Patient and public involvement (PPI) in research is based on the principle that research should be conducted “with” or “by” members of the public, rather than “to”, “for”, or “about” them.(1) Successful PPI is dependent on active partnerships between researchers and people living with rheumatic diseases throughout the research process. Such partnerships have been shown to improve the quality and relevance of the research. However, as funding bodies increase their demands for PPI, so too may the risk for tokenistic “involvement”.

Since 2008, the Swedish Rheumatism Association (SRA) has trained people living with rheumatic diseases to become patient research partners (PRPs) and encouraged their involvement in research projects. The network has grown substantially in terms of the number of registered PRPs, the number of research projects aiming to include PRPs, as well as the number of active partnerships between researchers and PRPs. However, the quality of partnerships and the impact of PPI on Swedish rheumatology research is unknown.

Objectives

To examine the extent of PPI in Swedish rheumatology research, the nature of partnerships between researchers and PRPs, and the perceived impact of PRPs on the research processes.

Methods

The target population was researchers and PRPs linked to the SRA in 2021, the largest private funder of Swedish rheumatology research. In practice, this included researchers who had applied for research grants from the SRA, researchers that had sought PRPs through the SRA, PRPs trained and registered with the SRA, as well as external PRPs named in grant applications submitted to the SRA.

An online questionnaire was developed to examine the target population’s understanding of the concept of PPI, their current involvement and experience of PPI, the nature of the partnerships between PRPs and researchers, and their future needs.(2,3) The survey was shared via email to the target population and remained open for one month.

PRPs were involved in the development and testing of the survey and will be involved in the interpretation and implementation of results.

Results

A total of 126 researchers that had submitted research grant applications to the SRA were identified. A further 5 researchers who had previously registered interest in collaborating with PRPs were identified from our records. Review of our internal register of trained PRPs identified 36 PRPs, whilst a further 9 external PRPs were identified from grant applications. However, contact details were unavailable for 7 of the external PRPs. As such, the survey was circulated to 131 researchers and 38 PRPs.

Preliminary response rates, one week into the survey period, were 31.3% for the researchers (41 responses) and 39.5% for the PRPs (15 responses).

Conclusion

As funding bodies increase their demands for PPI in grant applications, evaluations of the nature of PPI are required to ensure that funders’ efforts do not mistakenly result in tokenistic efforts to include patients and the public in research. A better understanding of the nature of PPI, the impact of PPI on research, and the needs of the researchers and PRPs will allow appropriate support and training to be developed. This will allow growth not only in the number of partnerships, but also in the quality of partnerships between researchers and PRPs. This, in turn, is likely to improve the quality of rheumatology research.

References

[1]INVOLVE. Briefing notes for researchers - public involvement in NHS, health and social care research. In Eastleigh; 2021.

[2]Wilson P, Mathie E, Keenan J, McNeilly E, Goodman C, Howe A, et al. ReseArch with Patient and Public invOlvement: a RealisT evaluation – the RAPPORT study. NIHR J Libr. 2015.

[3]Warner G, Baghdasaryan Z, Osman F, Lampa E, Sarkadi A. ‘I felt like a human being’—An exploratory, multi-method study of refugee involvement in the development of mental health intervention research. Health Expect Int J Public Particip Health Care Health Policy. 2021 May;24(Suppl 1):30–9.

Disclosure of Interests

None declared

There is no association between combined oral hormonal contraceptives and depression: a Swedish register-based cohort study

OBJECTIVE

To investigate whether users of hormonal contraceptives (HCs) are at increased risk of depression compared with non-users.

DESIGN

Register-based cohort study.

SETTING

Sweden.

SAMPLE

Women aged 15-25 years between 2010 and 2017 with no prior antidepressant treatment, psychiatric diagnose or contraindication for HCs (n = 739 585).

METHODS

Women with a prescription of HC were identified via the Swedish Prescribed Drug Register (SPDR). Relative risks (RRs) for first depression diagnosis in current HC-users compared with non-users were modelled by Poisson regression. Adjustments included age, medical indication for HC-use and parental history of mental disorders, among others.

MAIN OUTCOME MEASURES

Depression, captured by a redeemed prescription of antidepressant treatment, or a first depression diagnosis in the SPDR and the National Patient Register.

RESULTS

Compared with non-users, women on combined oral contraceptives (COCs) and oral progestogen-only products had lower or no increased risk of depression, relative risk (RR) 0.89 (95% CI 0.87-0.91) and 1.03 (95% CI 0.99-1.06) after adjustments, respectively. Age-stratified analyses demonstrated that COC use in adolescents conferred no increase in risk (RR 0.96, 95% CI 0.93-0.98), whereas use of progestogen-only pills (RR 1.13, 95% CI 1.07-1.19), contraceptive patch/vaginal ring (RR 1.43, 95% CI 1.30-1.58), implant (RR 1.38, 95% CI 1.30-1.45) or a levonorgestrel intrauterine device (RR 1.59, 95% CI 1.46-1.73) were associated with increased risks.

CONCLUSIONS

This study did not find any association between use of COCs, which is the dominating HC in first time users, and depression. Non-oral products were associated with increased risks. Residual confounding must be addressed in the interpretation of the results.

TWEETABLE ABSTRACT

There is no association between combined hormonal contraceptives and depression.

'I felt like a human being' – An exploratory, multi-method study of refugee involvement in the development of mental health intervention research

The purpose of this study was to pilot and methodologically appraise innovative patient and public involvement (PPI) evaluation tools and to describe a case study of refugee involvement in the development of mental health intervention research. 'Refugee Advisors' were involved in the development of a randomised controlled trial protocol evaluating a brief group intervention for refugee children experiencing symptoms of post-traumatic stress in Sweden. During an 8-hour research meeting, observation and questionnaire data were collected using the Active Involvement of Users in Research Observation Schedule and Questionnaire, followed by a focus group discussion. The multi-method approach demonstrated good feasibility. There were clear examples of how the advisors influenced research development e.g. recruitment strategy, cultural brokerage among study group participants, outcome measure validation. The advisors described a perceived impact on the research, equality and acceptance, and knowledge gain. A sense of appreciation and empowerment was also interpreted. However, potential issues relating to the relevance of contributions and use of an interpreter were identified.

Implementation and maintenance of a community intervention for refugee youth with symptoms of PTSD

Background

Transferring effective health and wellbeing interventions into community-based settings is challenging, with many only ever implemented in the academic settings in which they were developed. Over the last few years, Teaching Recovery Techniques (TRT), a community-based intervention for refugee youth reporting symptoms of post-traumatic stress, has been scaled up across Sweden using the model of a distribution network pathway. This means the lead organisation works with a distribution organisation using the latter's existing network of implementing organisations. Often the distribution partner is a national organisation with many local member agencies. The model offers possibility for quick spread, but only allows for a low level of control at the local site level. Therefore, it is important to understand the factors and agents that have facilitated the implementation and maintenance of TRT from successful sites, in order to inform ongoing efforts to scale up the intervention.

Methods

Semi-structured interviews were conducted with personnel from 'successful' TRT sites, defined as having conducted at least two TRT groups and maintaining full delivery of the programme. Interview data were analysed using content analysis.

Results

Our results indicated that active networking and collaboration were key to successful maintenance of TRT delivery. Active recruitment strategies, resource availability and management, and careful integration of the interpreter were also raised as important factors.

Conclusions

Although the interviewed professionals represented successful sites, they remained dependent on informal networks and collaboration for programme delivery. The possibility of integrating TRT into a local stepped-care model for post-traumatic stress in refugee children and adolescents will be presented.

Key messages

Transferring effective health and wellbeing interventions into community-based settings is challenging, with many only ever implemented in the academic settings in which they were developed. Active networking and collaboration are key to successful maintenance of community interventions.

Meaningful patient and public involvement to advance healthcare equity, quality and accessibility

Background

A large part of public health is promoting healthcare equity, quality and accessibility. Patient and public involvement (PPI) is a powerful tool to support this goal. It can lead to a richer understanding of public health research topics, improve data quality and analysis, increase trust in and dissemination of research findings, and ultimately achieve health services that are useful, useable and desirable. However, this all relies on PPI being conducted in a meaningful, respectful and inclusive way. Guidance is available on how to conduct, report and evaluate PPI activities. However, evaluative data are often brief, narrative descriptions, which reflects the lack of robust tools specifically developed to assess PPI. The purpose of this study was to develop and pilot tools to objectively assess PPI in the context of research project meetings.

Methods

PPI and group dynamics literature was used to guide the construction of an observation protocol and questionnaire. The research tools were piloted within a randomised trial of a community intervention for refugee children reporting symptoms of posttraumatic stress.

Results

The Active Involvement of Users in Research Observation Schedule is a semi-structured observation protocol, which consists of 12 observable behaviours relating to the interpersonal relations between researchers and PPI advisors; the nature of advisor contributions; and how the advisors guide research development. Each category consists of positive and negative behaviours. There is an accompanying paper-based assessment form that allows attendees to independently and anonymously grade the meeting on a list of items that correspond to those on the observation pro-forma. Preliminary inter-rater reliability for the observation protocol is good (ICC=0.833; 95% CI: 0.569-0.947).

Conclusions

Although the research tools require further refinement and validation, the methodological approach offers a promising, rigorous way to evaluate PPI.

Key messages

A large part of public health is promoting healthcare equity, quality and accessibility. Patient and public involvement (PPI) is a powerful tool to support this goal. The Active Involvement of Users in Research Observation Schedule and Questionnaire offer a promising, rigorous way to evaluate PPI and promote meaningful involvement to advance public health research.

Effects on jaw function shortly after whiplash trauma

Normal jaw function involves muscles and joints of both jaw and neck. A whiplash trauma may disturb the integrated jaw-neck sensory-motor function and thereby impair chewing ability; however, it is not known if such impairment is present shortly after a neck trauma or develops over time. The aim was to evaluate jaw function after a recent whiplash trauma. Eighty cases (47 women) were examined within 1 month after a whiplash trauma and compared to 80 controls (47 women) without neck trauma. Participants completed the Jaw disability checklist (JDC) and Neck Disability Index (NDI) questionnaires and performed a 5-minute chewing test. Elicited fatigue and pain during chewing were noted, and group differences were evaluated with Fisher's exact test and Mann-Whitney U-test. Compared to controls, cases had higher JDC (P < .0001) and NDI scores (15% vs 2%, P < .0001), and reported more fatigue (53% vs 31%, P = .006) and pain (30% vs 10%, P = .003) during the chewing test. Cases also had a shorter onset time for fatigue and pain (both P = .001) Furthermore, cases reporting symptoms during chewing had higher JDC and NDI scores compared to cases not reporting symptoms (both P = .01). Symptoms mainly occurred in the trigeminal area for both groups, but also in spinal areas more often for cases than for controls. Taken together, the results indicate that jaw-neck sensory-motor function is impaired already within 1 month after a whiplash trauma. The association between neck disability and jaw impairment underlines the close functional relationship between the regions, and stresses the importance of multidisciplinary assessment.

Poor Response to Periodontal Treatment May Predict Future Cardiovascular Disease

Periodontal disease has been associated with cardiovascular disease (CVD), but whether the response to the treatment of periodontal disease affects this association has not been investigated in any large prospective study. Periodontal data obtained at baseline and 1 y after treatment were available in 5,297 individuals with remaining teeth who were treated at a specialized clinic for periodontal disease. Poor response to treatment was defined as having >10% sites with probing pocket depth >4 mm deep and bleeding on probing at ≥20% of the sites 1 y after active treatment. Fatal/nonfatal incidence rate of CVD (composite end point of myocardial infarction, stroke, and heart failure) was obtained from the Swedish cause-of-death and hospital discharge registers. Poisson regression analysis was performed to analyze future risk of CVD. During a median follow-up of 16.8 y (89,719 person-years at risk), those individuals who did not respond well to treatment (13.8% of the sample) had an increased incidence of CVD ( n = 870) when compared with responders (23.6 vs. 15.3%, P < 0.001). When adjusting for calendar time, age, sex, educational level, smoking, and baseline values for bleeding on probing, probing pocket depth >4 mm, and number of teeth, the incidence rate ratio for CVD among poor responders was 1.28 (95% CI, 1.07 to 1.53; P = 0.007) as opposed to good responders. The incidence rate ratio among poor responders increased to 1.39 (95% CI, 1.13 to 1.73; P = 0.002) for those with the most remaining teeth. Individuals who did not respond well to periodontal treatment had an increased risk for future CVD, indicating that successful periodontal treatment might influence progression of subclinical CVD.

Pain and Disability in the Jaw and Neck Region following Whiplash Trauma

The relationship between whiplash trauma and chronic orofacial pain is unclear, especially with regard to the time elapsed from trauma to development of orofacial pain. The aim was to analyze prevalence of jaw pain and disability, as well as the relationship between pain and disability in the jaw and neck regions in the early nonchronic stage after whiplash trauma. In this case-control study, 70 individuals (40 women, 30 men, mean age 35.5 y) who visited an emergency department with neck pain following a car accident were examined within 3 wk of trauma (group 1) and compared with 70 individuals (42 women, 28 men, mean age 33.8 y), who declined to attend a clinical examination but agreed to fill in questionnaires (group 2). The 2 case groups were compared with a matched control group of 70 individuals (42 women, 28 men, mean age 37.6 y) without a history of neck trauma. All participants completed questionnaires regarding jaw pain and dysfunction, rating pain intensity in jaw and neck regions on the Numerical Rating Scale, the Neck Disability Index, and Jaw Disability Checklist. Compared with controls, individuals with a recent whiplash trauma reported more jaw pain and dysfunction. Furthermore, there was a moderate positive correlation between jaw and neck pain ratings for group 1 (r = 0.61, P < 0.0001) and group 2 (r = 0.59, P < 0.0001). In the logistic regression analysis, cases showed higher odds ratios (range, 6.1 to 40.8) for jaw and neck pain and disability compared with controls. Taken together, the results show that individuals with a recent whiplash trauma report more jaw pain and disability compared with controls without a history of neck trauma. Furthermore, the correlation between jaw and neck pain intensity implies that intensity of neck pain in the acute stage after whiplash trauma might be a possible risk factor also for development of chronic orofacial pain.

[Vincenzo Cuomo, pioneer in thalassotherapy]

Thermal Medicine is now well integrated with other therapies such as pharmacotherapy, surgery, physiotherapy, radiotherapy and so on, in the prevention, cure and rehabilitation of many diseases. The methodology of thermal treatments, now recognized as bona fide therapies with their specific indications, adverse side effects, dosages, applications and administration times, are classified into mineral baths, mudcures and grotto treatments. Thalassotherapy is a therapy that is linked to the sea and is one of the most important of the climatotherapeutic methods. It constitutes a complex of therapeutic effects derived from the meteorological and telluric factors characterising a given climate. Thalassotherapy deals with the therapeutic effects conferred by periods of time spent by the sea, including the modes of action of marine agents, and strives to determine their limitations and in what circumstances a sojourn by the sea can provide effective health benefits. Thalassotherapy is affected by three kinds of main factors: climatotherapeutic factors, eliotherapeutic factors and balneotherapeutic factors. Refraining from normal daily activities and a rigorous observance of general hygiene, and diet in particular must also always be observed.

Effectiveness of sulphur spa therapy with politzer in the treatment of rhinogenic deafness

Several studies have focused on the usefulness of sulphur, radioactive and bromo-iodine mineral waters in the treatment of chronic inflammatory lower and upper respiratory processes. The purpose of this study was to evaluate the tolerability, effectiveness and impact on quality of life of sulphur spa therapy with Politzer in subjects with chronic inflammatory processes responsible for the onset or persistence of rhinogenic deafness. The study was performed on 27 subjects (mean age 62 +/- 2.2 years, range: 28-88) with chronic catarrhalis otitis, chronic rhino-sinusitis and pharyngeal inflammation. These patients underwent 12 sessions of humid-hot inhalation, with vapour jet 20 cm from the face, at 38 degrees C for 10 min, followed by Politzer with sulphur sodium chloride bicarbonate alkaline mineral water from "Rosapepe" Spa, in Contursi (Salerno, Italy). Middle ear function and possible social recovery (based on Giaccai and Gardenghi guidelines) of the patients were assessed, at the beginning and end of the spa therapy. Results, at the end of this treatment, showed a significant (p < 0.05) increase in audiometric curves corresponding to the normal ventilation of the tympanic box (incidence of 24% before therapy and 33% thereafter) and a decrease in pathological curves. Moreover, a significant (p < 0.05) reduction in the percentage of auditory loss was recorded (N = 41; 19.7% +/- 2.5 --> 13.9% +/- 1.9) and improved hearing, at the frequencies required for daily activities: 500-1000 and 2000 Hz (31.1 dB +/- 1.7 --> 26.8 dB +/- 1.5). No adverse effects to the spa therapy were observed during the study. In conclusion, the results of this study are in agreement with data in the literature, demonstrating that associated spa therapy with Politzer and inhalation have a positive impact on the therapeutic strategy of chronic inflammatory processes, responsible for the onset or persistence of rhinogenic deafness, in order to enhance and combine with the already consolidated pharmacological approaches.

Alternative therapy of earth elements increases the chondroprotective effects of chondroitin sulfate in mice

The administration of mineral sulphur water is an alternative experimental approach for the treatment of rheumatic diseases, such as osteoarthritis (OA), that cause the degeneration of bone and cartilage and sufferance to the patients. Chondroitin sulfate (CS) is a symptomatic slow acting nutropeucital agent currently used in molecular therapy of OA. Therefore, we have studied the role and efficacy of the selective soil paste from the mineral sulphur enriched spring (mud)-therapy alone or in combination with CS in the treatment of OA. The study was performed on 40 C57 Black 6N mice, an experimental model which spontaneously develop an osteoarthritic process. The animals were divided in 4 groups and were treated with the single agents or with the combination. After 30 days of treatment all the mice were sacrificed and right knees and blood were collected. It was found that CS determined a reduction of radiological and histological features of chondrodegeneration and that mud-therapy increased the effects of CS in the animal group treated with the combination. However, the effects of thermal therapy alone were not statistically significant. Since OA is characterized by an increase of the production of nitric oxide (NO) by chondrocytes in extracellular matrix with its consequent elevation in serum and synovial fluid, we have evaluated the effects of the treatments on serum NO levels. CS alone induced a statistically significant reduction of NO serum levels (90+/-13 micromM vs 219+/-60 microM of control group, P<0.05) while mud-therapy alone induced a not statistically significant reduction of serum NO (170+/-62 microM, P>0.05). However, the latter strongly potentiated the decrease of serum NO induced by CS (31+/-1.5 microM) with a high statistical significance if compared to both the control group (P<0.01) and the CS-treated group (P<0.05). In conclusion, this study demonstrates that mud-therapy with sulphur mineral water could represent an important phase of the therapeutic strategy of OA. This experimental strategy could integrate and potentiate the standard pharmacological tools. Moreover, we have set a valid experimental in vivo model for the study of the thermal effects on the development of OA.

[Psoriasis and mud bath therapy: clinical-experimental study]

OBJECTIVE

The psoriasis is chronic disease characterized from an acceleration of the kinetic of the cells of epidermis. To front of the empirical evidence of the benefits of the thermal therapy in the psoriasis, the experimentals-clinics studies is insufficient. The aim of research it has been that of quantify the benefits of the mud-bath therapy with mineral water in the psoriasis.

PATIENT AND METHODS

The study has been channel on a champion of 30 subjects of which 19 of male sex and 11 of female sex with middle equal age to 56 years +/- 5.3 affected from psoriasis. The subjects of the examined champion have been divided to random in 2 groups: A and B. The group A has been treated with drugs used for psoriasis for 12 days; the B group has been treated, always for 12 consecutive days, with mud-bath therapy (FBT) with mineral water obtained from the mineral sources (chlorinate-sulphureous-bicarbonate) of the Spa of Stabia in Castellammare (NA). To the beginning and at the end of the advised treatments has been valued the prurient symptomatology and the PASI (Psoriasis and Severity Index).

RESULTS

The data highlight an significant (P < 0.05) reduction is of the prurient symptomatology and of the PASI in both the groups considered.

CONCLUSIONS

The results of this first step of investigations seems to highlight that the FBT treatment, to the same way of the drugs anti-psoriasis, results useful in the ameliorate the quality of life of these patients.

[Inhalation therapy with sulphur water in ORL: clinical-experimental study]

OBJECTIVE

Several clinics and experimental researches have highlighted the utility of the inhalant mineral therapy in numerous diseases to load of the tall and low respiratory streets. Aim of the our clinical-experimental study has been that of appraise "to brief term" the curative effects and the adverse reactions of a thermal inhalant treatment with sulphur water in the care of diseases ORL apparatus (laryngitis, pharyngitis, rhinitis, rhinosynusitis), appraise the course of some End points to distance.

PATIENT AND METHODS

The study has been channel on a champion of 83 subjects of which 45 of male sex and 38 of female sex with age serious equal average to 53 years +/- 2.6. The subjects of the examined champion that affections from diseases inflammatory chronic of ORL relevance (laryngitis, pharyngitis, rhinitis) were subjected to a cycle of sulphur mineral inhalant therapy disbursed with businesslike individual of inhalations to bud of vapor to the T of 38 degrees C to 20 cm from the face with duration of 10 min, follows from aerosol for likewise minutes. To the beginning and at the end of the sulphur mineral inhalant cycle has been valued the subjective symptomatology susceptible of amelioration, some End Points to distance and the adverse reactions.

RESULTS

The data seem to highlight the end cycle curative sulphur mineral inhalant an significant (P < 0.05) amelioration of best part of the symptoms examined like cough, nasal itch, expectoration [etc]. The analysis of the End Points to advised Distance show an significant (P < 0.05) progressional diminution of such indicators to succession of the annual continuity of the inhalant sulphur mineral treatment.

CONCLUSIONS

The results of such research seem to demonstrate that the inhalant sulphur mineral therapy can induced notable benefit in different inflammatory chronic diseases of ORL relevance in peculiar in the first ten of life with a positive relapse on some End Points to distance and an excellent local and systemic tolerable.

Bioequivalence assessment of two different tablet formulations of diltiazem after single and repeated doses in healthy subjects

The study was performed on 14 healthy volunteers in order to compare the pharmacokinetics and hence assess the bioequivalence of two different tablet formulations of diltiazem administered orally. The study was carried out after single doses (60 mg) and repeated doses (60 mg three times a day for six days and 60 mg on the seventh day) according to a randomised, cross-over, open design. The pharmacokinetic parameters AUC0-infinity (ng h/ml), Tmax(h) and Cmax (ng/ml) were calculated for the two formulations after a single dose, while AUCt1-t2 (= AUC for a repetitive dose interval or dosing cycle, ng h/ml) and PTF (peak trough fluctuation) were calculated after repeated doses. The bioequivalence assessment was the shortest 90% confidence interval for the ratio (difference) of expected medians in the respective bioequivalence range (0.80-1.20). The results of this study show that, after either a single dose or repeated doses of test or reference formulations of diltiazem, the pharmacokinetics of the two formulations are similar. The ratios of AUC on day 1 (for single-dose treatment) and on day 7 (for repeated-dose treatment), and the corresponding 90% confidence intervals demonstrate bioequivalence between the two formulations of diltiazem within the accepted range of 0.80-1.20 (80-120%).

Pharmacokinetics of cefodizime in patients with various degrees of renal failure

The pharmacokinetics of cefodizime, a new expanded-spectrum cephalosporin for parenteral use, was studied in 45 subjects with various degrees of renal failure. Patients were divided into five groups according to the following creatinine clearances: group I >80 ml/min; group II <80-30 ml/min; group III <30-15 ml/min; group IV <15-5 ml/min and group V <5 ml/min. Cefodizime was administered as a 1 g i.v. bolus. Plasma and urinary concentrations of cefodizime were determined by high-performance liquid chromatography, using for detection UV absorbance. The following pharmacokinetic parameters were calculated: maximum plasma concentration (C5 min), area under the plasma concentration-time curve (AUC), terminal half-life (T1/2), terminal rate constant (lambda-z), total clearance (Clt), volume of distribution (Vd), mean residence time (MRT), urine data-derived terminal half-life (T1/2 r), renal clearance (Clr). The results of this study showed that renal failure induced changes in cefodizime pharmacokinetics. Our data demonstrated a close correlation between degree of renal impairment and pharmacokinetic changes. The maximum plasma concentration (C5 min) was higher in patients with renal failure; T1/2 was increased; AUC also increased from 470.40 +/- 17.80 mg.h/l in the control group to 1,562.30 +/- 170.8 mg.h/l in group V. Moreover, no side effect was observed after treatment with 1 g i.v. of cefodizime. Although renal failure induces significant changes of cefodizime pharmacokinetics, the drug was well tolerated and only in patients with severe renal insufficiency we advise to monitor the interval dose of cefodizime or adjust doses to renal function.

Bioavailability of timolol and aceclidine after ocular instillation in the rabbit

The bioavailability of timolol and aceclidine after the ocular instillation of each drug (timolol 0.5% or aceclidine 2%) or both combined (timolol 0.5% + aceclidine 2%) has been evaluated in rabbits. 15 male albino rabbits were treated by the instillation of timolol and aceclidine alone or combined in the conjunctival sac of the right eye. Timolol concentrations in humor aqueous were assayed at 10 min, 30 min, 1 hr, 2 hr, 4 hr and 6 hr after instillation by high-performance liquid chromatography (HPLC). Aceclidine was assayed by a pharmacodynamic method: pupillary diameter at the following time intervals 0 (basal value), 1 min, 5 min, 30 min, 1 hr, 2 hr, 4 hr, 6 hr after treatment. Our results demonstrated that no differences in timolol and aceclidine bioavailability were found between simple-drug preparations and their combination.

Synthesis of 1-methyl-4-(N-aroyl)-piperidinamides with anti-inflammatory and analgesic activities

Two series of 1-methyl-4-(N-aroyl)-piperidinamides were synthesized and evaluated for their anti-inflammatory and analgesic properties, as well as for their gastrointestinal irritation liability. A non-aromatic derivative, 1-methyl-4-(N-cyclohexanoyl)-piperidinamide, was synthesized and evaluated in order to obtain a more exhaustive knowledge of the structure-activity relationship.

[Problems associated with the use and monitoring of cyclosporin. Experience at a Clinical Pharmacology Service]

BACKGROUND

A study on cyclosporine A (CyA) monitoring in the January 1992-December 1995 period is reported. The aim of this work was to give epidemiological data on the use of CyA, to verify the progressive increase of CyA determinations and to evaluate the use in other diseases as well as to compare the different technics of CyA assay in blood samples, to stress the timing of blood samples and to underline the CyA monitoring importance.

METHODS

The CyA dosage was evaluated by fluorescence polarization immunoassay (FPIA) and high-performance liquid chromatography (HPLC).

RESULTS

The study showed that 70% of CyA determinations come from patients undergone to renal, bone marrow and liver transplantations; the remaining 30% was associated to other diseases (psoriasis, uveitis, diabetes, rheumatoid arthritis).

CONCLUSIONS

The results obtained showed a progressive and constant increase of CyA determinations. Moreover, the use of drug was increased in autoimmune diseases. It is stressed that CyA monitoring in blood samples is essential to optimize the therapeutic efficacy of drug and minimizing its toxicity.

Effect of atenolol and ramipril on regression of left ventricular hypertrophy: comparative echocardiographic assessment

Left ventricular hypertrophy (LVH) dramatically worsens hypertensive illness. Because the genesis of LVH appears to be multifactorial, antihypertensive treatment should aim to reduce not only pressor values but also the hypertrophic ventricular mass. This result can be obtained only when drugs able to act on both pathogenetic factors are used. To evaluate the effectiveness of antihypertensive therapy on regression of LVH, 21 patients with stage 2 essential hypertension were treated for a year with either atenolol (120 mg/d orally), a cardioselective beta-blocker without intrinsic sympathomimetic activity, or ramipril (5 mg/d orally), an angiotensin-converting enzyme inhibitor with high tissue activity. Both treatments produced significant control of hypertension and regression of LVH. No statistically significant difference between treatments was noted, except for heart rate, which was substantially unchanged by ramipril but significantly decreased by atenolol. Both drugs were well tolerated. Atenolol and ramipril have a major role in the long-term treatment of hypertension and in the regression of hypertension-associated LVH.

Synthesis and pharmacological activities of ethyl 5-cyano-1,6-dihydro-6-oxo-2-(2,3,4-pyridyl)-3-pyridinecarboxylates and derivatives

The synthesis of ethyl esters of 5-cyano-1,6-dihydro-6-oxo-3-pyridinecarboxylic acids carrying as 2-substituent the 2-,3- or 4-pyridyl group is described. By alkaline hydrolysis followed by acidification, these esters gave the corresponding carboxylic acids, which were decarboxylated to 1,2-dihydro-2-oxo-6-(2,3,4-pyridyl)-3-pyridinecarbonitriles. As milrinone analogues, the above compounds were tested on contractile activity and frequency rate of spontaneously beating atria from reserpine-treated guinea-pigs. Ethyl 5-cyano-1,6-dihydro-6-oxo-2-(2-pyridyl)-3-pyridinecarboxylate showed an appreciable positive inotropic activity, although inferior to that of milrinone; moreover, some other compounds bearing the above 2-substitution pattern showed interesting antiinflammatory, analgesic and hypotensive activity.

Effects of dietary vitamin D deficiency on the cardiovascular system

Experiments were performed on normotensive rats exposed to vitamin D deficient and control diets from the 22nd to the 180th day of age. In 60-120- and 180-day-old rats. The following parameters were evaluated: a) The vasomotor responses elicited by receptor agonists in the absence and in the presence of the respective antagonists [L-norepinephrine (NE) before and 5 min after prazosin; L-isoprenaline (I) before and 5 min after DL-propranolol; L-dopamine (DA) before and 5 min after L-sulpiride or SCH 23390 or chlorpromazine; acetylcholine (Ach) before and 5 min after atropine; histamine (H) before and after chlorpheniramine; 5-hydroxytryptamine (5-HT) before and 5 min after methysergide or ketanserin]; by carotid-sinus baroreceptor stimulation (CO) before and 5 min after hexamethonium, and by electrical stimulation of the vagus peripheral head (V) before and after atropine; b) Reflex tachycardia elicited by bilateral carotid occlusion (CO) (for 40 sec) and by sodium nitroprusside; c) Catecholamine (norepinephrine, epinephrine) and arginine-vasopressin plasma levels; d) Cholesterol, triglyceride and electrolyte (Na+, K+, Cl-, Ca2+) serum levels. Our results showed that vitamin D deficient diets induced a decrease in pressor responses to NE and CO, and an increase in hypotensive responses to I, DA, Ach, H, 5-HT and V. Changes of arterial blood pressure, heart rate, catecholamine and arginine-vasopressin plasma levels were not observed. Cholesterol, triglyceride and electrolyte (Na+, K+, Cl-) serum levels were not modified, while Ca2+ serum levels decreased. In conclusion, our data suggest that vitamin D depletion can induce changes of pressor and depressor vasomotor responses and suppose a direct role for vitamin D in regulating vasomotor reactivity.

Cobalt blocks L-glutamate-induced apnea and arterial hypotension in the nucleus tractus solitarii of anaesthetized rats

The local application of cobalt reversibly blocks calcium-channel conductance and therefore synaptic transmission. In this study pretreatment with a solution of cobalt (100 mM) in the nucleus tractus solitarii (NTS) of anaesthetized rats significantly blocked the apnea (P < 0.01) and arterial hypotension induced by L-glutamate (25 mM) and N-methyl-D-aspartate (0.4 mM) microinjected in the NTS. We conclude that cobalt causes these effects by acting at the postsynaptic level.

Wizards and scientists: the pharmacologic experience in the Middle Ages

During the Dark ages, Greco-Roman science survived in the eastern Roman Empire and the most important advances in pharmacology and pharmacy were made in Byzantium. As the Arab empires spread in the 7th and 8th centuries, they incorporated earlier learning, and the most important contribution of Arabic medical writers was probably the introduction of formularies to aid in the preparation of medicines. In turn, the later spread of Arabic knowledge to the West introduced little-known plants and fostered an interest in collecting and cultivating them, and also introduced the palatable dose forms preferred by the Arabic doctors. In the West, however, the Christian Church taught a doctrine of unquestioning faith, and despite the centers of learning, e.g. at Salerno, most ordinary people depended on the healing power of faith, religious relics and traditional folk medicine. Hydrology was also well developed in the Middle Ages. The formularia that survive describe many indigenous plants, but with few illustrations. Their gathering and preparation is generally guided by magic ceremonies and ritual, and plants often took their properties from their habitat, e.g. the wayside plantain was thought good for tired or wounded feet. Concepts of therapeutic plants were also influenced by alchemy and were linked to related metals and planets.

Aging and in vitro vascular responses to endothelin-1 in several rat strains

The endothelins are a recently discovered family of potent contractile peptides produced by endothelial cells. These peptides have been suggested to play an important role in the pathogenesis of hypertension, myocardial infarction, cardiogenic shock, and so on. The aim of our study was to compare the responses to endothelin-1 (ET-1) with those to L-noradrenaline (NA) in aortic rings from rats of different strains and ages. Thoracic aorta rings from spontaneously hypertensive (SHR), Wistar Kyoto (WKY), Brown Norway (BN) and spontaneously hyperlipemic (Yoshida, YOS) rats 2-4 (young), 6-8 (adult) and 20-25 (old) months old were used. There were no changes in the pD2 values for ET-1 and NA between WKY and SHR rats at the ages studied. The ET-1 and NA Emax in adult SHR rats was significantly lower than in the age-matched WKY animals. Old age reduced the ET-1 and NA Emax in both SHR and WKY rats abolishing the difference observed at 6-8 months in the same groups. The reactivity to ET-1 and NA of BN and YOS rats was modified only in young rats. In YOS strain aging did not modify the ET-1 and NA responses as the pD2 and Emax values remained unchanged. Our findings demonstrate that ET-1 is a more potent vasoconstrictor than NA and that this potency remains unchanged throughout the ages and the pathologies studied. In contrast, the pD2 of NA decreases with old age in SHR and WKY rats. We conclude that rat strain but not hypertension or hyperlipemia can modify the response to ET-1 or NA in old age. We suppose that this functional change may involve alterations in the responsiveness of vascular smooth muscle.

2H-1-benzopyran derivatives with platelet antiaggregating and other activities

The synthesis of some N,N-disubstituted 4-amino-5,6,7,8-tetrahydro-3,6- diphenyl-2H-1-benzopyran-2-ones by reaction of phenylchloroketene with a series of N,N-disubstituted 2-aminomethylene-4-phenylcyclohexanones, followed by dehydrochlorination in situ of the primary adducts with DBN, is described. Some compounds showed a platelet antiaggregating activity in vitro superior or comparable to that of acetylsalicylic acid and an appreciable antiarrhythmic activity, as well as weak anti-inflammatory and local anesthetic activities in rats and mice.

Clinical pharmacokinetics of theophylline during co-treatment with ticarcillin plus clavulanic acid in patients suffering from acute exacerbation of chronic bronchitis

The effect of ticarcillin/clavulanic acid, taken for 7 days as vials containing 1000 mg of ticarcillin and 200 mg of clavulanic acid twice daily intramuscularly, on the steady-state pharmacokinetics of theophylline was studied in 12 patients suffering from acute exacerbation of chronic obstructive pulmonary disease. Initially, patients were treated for four days with theophylline as sustained-release formulation in the amount of 600 mg daily; on the last day, blood samples were taken for theophylline determination. Theophylline concentrations were measured serially for 12 hours by the method of polarized immunofluorescence (Abbott TDx system). Subsequently, while theophylline was continued at the same dosage, each patient received in addition ticarcillin/clavulanic acid vials every 12 hours. After seven days of this combined medication, the serial assays of plasma were repeated at the same time intervals as before. No influence of ticarcillin/clavulanic acid was detectable on the steady-state theophylline pharmacokinetics. It is concluded that both drugs can be administered concomitantly without any dosage adjustment of theophylline.

N-acyl-4,7,7-trimethyl-N-phenyl-3-(1-piperidinyl or dimethylamino)bicyclo[2.2.1]hept-2-ene-2-carbothioamides with platelet antiaggregating and other activities

A series of N-acyl-4,7,7-trimethyl-N-phenyl-3-(1-piperidinyl or dimethylamino)bicyclo[2.2.1]hept-2-ene-2-carbothioamides was prepared in excellent yields by reaction of 4,7,7-trimethyl-N-phenyl-3-(1-piperidinyl or dimethylamino)bicyclo[2.2.1]hept-2-ene-2-carbothioamides with a number of aromatic or heterocyclic acyl chlorides in dry pyridine solution and in the presence of sodium hydride. Some of the above compounds showed a platelet antiaggregating activity in vitro superior or comparable to that of acetylsalicylic acid; moreover, some compounds exhibited moderate analgesic, antiinflammatory and hypotensive activities in mice or rats.

Effects of some cephalosporins and teicoplanin on platelet aggregation

Antibiotics may interfere with platelet (PLT) function, and beta-lactam antibiotics may interact with PLT aggregation, by inhibiting the binding of agonists of this aggregation (such as ADP and collagen) to specific receptor sites. In this study we have evaluated the relative in-vitro antiplatelet effects of some old and new cephalosporins (cefonicid, ceftazidime, ceftriaxone, cefotaxime, cefuroxime and flomoxef) and of teicoplanin, a new glycopeptide antibiotic. All the cephalosporins tested, and also teicoplanin, were found to have the potential to adversely affect human platelet aggregation only at high concentrations which are not achieved in vivo.

Synthesis and pharmacological activity of imidazo[2,1-b]benzothiazole acids

We have prepared twelve imidazo[2,1-b]benzothiazole carboxylic and acetic acids by reaction of substituted 2-aminobenzothiazoles with ethyl bromopyruvate and 4-chloroacetoacetate, respectively. The acids, obtained from esters by hydrolysis, were tested for their antiinflammatory, analgesic and ulcerogenic activities.

3,5-Diphenyl-1H-pyrazole derivatives. X. N-substituted 1-(2-aminopropyl)- and 1-(3-amino-2-hydroxypropyl)-3,5-diphenyl-1H-pyrazoles with antiinflammatory and other activities

The syntheses of 1-(2-hydroxypropyl)-3,5-diphenyl-1H-pyrazole 1 by reaction of 1-hydrazino-2-propanol with dibenzoylmethane and of N-substituted 1-(2-aminopropyl)-3,5-diphenyl-1H-pyrazoles 3 by reaction of primary and secondary amines with the tosylate of 1, as well as of N-substituted 1-(3-amino-2-hydroxypropyl)-3,5-diphenyl-1H-pyrazoles 6 starting from 3,5-diphenyl-1H-pyrazole, are described. Some compounds 3 and 6 showed remarkable antiinflammatory activity in rats, as well as weak analgesic, antipyretic, antiarrhythmic, hypotensive activities in mice and rats and moderate platelet antiaggregating effects in vitro.

N-substituted O-(3-amino-2-hydroxypropyl)oximes of 1,3,3-trimethyl-5-endo-(1-piperidinyl or 4-morpholinyl)-2-oxabicyclo [2.2.2]-octan-6-ones with platelet antiaggregating and local anesthetic activities

The synthesis of a series of N-substituted O-(3-amino-2-hydroxypropyl)oximes of 1,3,3-trimethyl-5-endo-(1-piperidinyl or 4-morpholinyl)-2-oxabicyclo [2.2.2]octan-6-ones is described. Some of these ethers showed strong local anesthetic activity in mice and platelet antiaggregating activity in vitro comparable to that of acetylsalicylic acid, as well as moderate hypotensive, antiarrhythmic and analgesic activities in rats and mice.

4-substituted 1-methyl-1H-indazoles with analgesic, antiinflammatory and antipyretic activities

The synthesis of [(1-methyl-1H-indazol-4-yl)oxy]acetic acid 4, 1-methyl-1H-indazole-4-acetic acid 9, 2-(1-methyl-1H-indazol-4-yl)propanoic acid 15 and [[(1,5,6,7-tetrahydro-1-methyl-4H-indazol-4-ylidene)amino]oxy]acet ic acid 16, as well as of amides and esters derived from 4 and 9, starting from 1,5,6,7-tetrahydro-1-methyl-4H-indazol-4-one is described. Some of the above compounds showed weak antiinflammatory, analgesic, antipyretic and hypotensive activities in rats and mice, as well as moderate platelet antiaggregating effects in vitro.

Participation of arginine vasopressin-mediated and adrenergic system-mediated mechanisms in the hypertension induced by intracerebroventricular administration of NMDA in freely moving rats

Effects of intracerebroventricular (third ventricle) injection of N-methyl-D-aspartate (NMDA) on arterial blood pressure, on heart rate, on arginine vasopressin (AVP) and levels of catecholamines in plasma and on the behaviour of normotensive freely-moving rats have been evaluated. N-Methyl-D-aspartate significantly (P less than 0.01) increased arterial blood pressure and levels of catecholamines and AVP in plasma. With 0.1-1.0 micrograms/rat all animals presented psychomotor agitation, stereotyped movements, hyperexcitability, exophthalmus, dyspnoea, jumping, rearing and teething. The selective antagonist for NMDA receptors, 2-APV injected in the third ventricle, significantly (P less than 0.01) antagonized the hypertension, the increase in levels of catecholamines and AVP in plasma and behavioural effects. An antagonist of alpha 1 adrenergic receptors, prazosin (i.v.), an agonist of alpha 2 adrenergic receptors, clonidine (i.c.v.) and a relatively selective antagonist of V1 subtype of receptor of AVP, CGP 25838 (i.c.v. and i.v.), 15 min before NMDA, significantly (P less than 0.01) decreased the effects induced by the injections of NMDA. On the contrary, an antagonist of opiate receptors, naloxone (i.v.), 15 min before NMDA, significantly (P less than 0.01) increased the NMDA-induced modifications. Pretreatment with the antagonists at these doses, did not significantly modify the basal values of arterial blood pressure and behaviour. Only 2-APV sometimes induced ataxia, lasting about 5 min. This study points out an increase in the central sympathetic efferent activity and in release of AVP involved in the NMDA-induced cardiovascular and behavioural effects.

Research on heterocyclic compounds. XXVIII. Imidazo[1,2-c]pyrimidines

A group of 24 imidazo[1,2-c]pyrimidines was taken into consideration in order to study their relationships between chemical structure and antiinflammatory activity. Some of these compounds were synthesized by us in the past, the others have been synthesized and characterized to complete the series. Antiinflammatory, analgesic, antipyretic and gastric ulcerogenic activities of such compounds were compared with those of indomethacin and discussed in terms of the effects exerted by the presence on the heterocyclic system of various substituents and an acidic or nonacidic moiety.

omega-Dialkylaminoalkyl esters of 3-dialkylamino-4,7,7-trimethyl-N-phenylbicyclo[2.2.1] hept-2-ene-2-iminothiolic acids with local anesthetic activity

A series of omega-dialkylaminoalkyl esters of 3-dialkylamino-4,7,7-trimethyl-N-phenylbicyclo[2.2.1]hept-2-ene-2- iminothiolic acids 3 was prepared by reaction of 4,7,7-trimethyl-3-(dimethylamino or 1-piperidinyl)-N-phenylbicyclo[2.2.1] hept-2-ene-2-thiocarboxamides with a number of omega-chloroalkyldialkylamines in the presence of sodium hydride in DMF or benzene solution. Some esters 3 showed an appreciable local anesthetic activity in mice.

Central and peripheral cardiovascular effects of beta-endorphin in normotensive and spontaneously hypertensive rats and in rats rendered hypertensive by deoxycorticosterone acetate administration

The cardiovascular effects of beta-endorphin [beta-LPH-(61-91)] were investigated after systemic (i.v.) and central (third ventricle and right lateral ventricle) administration in urethane-anesthetized rats. beta-Endorphin (10 and 100 micrograms/kg i.v. or 40 micrograms into the third ventricle or into the lateral ventricle) in normotensive animals induced a decrease in blood pressure and bradycardia. The same dose of beta-endorphin by systemic and central administration induced much more pronounced cardiovascular effects in spontaneously hypertensive rats and in rats rendered hypertensive by DOCA administration than in normotensive rats. Naloxone i.v. pretreatment reduced the cardiovascular effects induced by beta-endorphin.

Research on heterocyclic compounds. XVIII. Imidazo[2,1-b]-1,3,4-thiadiazole derivatives

The synthesis of a series of 6-carbethoxy-, 6-carbethoxy-methyl-, and 5-carbethoxy-6-methylimidazo[2,1-b]-1,3,4-thiadiazoles was accomplished by reacting some 2-amino-1,3,4-thiadiazoles with ethyl bromopyruvate, 4-chloroacetoacetate, and 2-chloroacetoacetate, respectively; such carbethoxy derivatives afforded the corresponding carboxylic acids by hydrolysis. The antiinflammatory, analgesic, antipyretic and ulcerogenic activities were studied on three of the new acidic compounds.

Antagonistic effects of guanabenz, carteolol, and muzolimine on hypertensive responses in the anesthetized dog

In dogs, treatment with guanabenz, carteolol, and muzolimine for 7 days, reduced the blood pressure responses to bilateral occlusion of the carotid arteries, electric stimulation of central vagus nerve, acetylcholine after atropinization, nicotine, l-noradrenaline, angiotensin II, l-adrenaline, KC1 and asphyxia.