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Biomedical subjects

Susan Bennett

Publications and source records attributed to Susan Bennett.

7 recordsLinked to original sources
PubMed2004

Pramipexole vs levodopa as initial treatment for Parkinson disease: a 4-year randomized controlled trial.

BACKGROUND: The best way to initiate dopaminergic therapy for early Parkinson disease remains unclear. OBJECTIVE: To compare initial treatment with pramipexole vs levodopa in early Parkinson disease, followed by levodopa supplementation, with respect to the development of dopaminergic motor complications, other adverse events, and functional and quality-of-life outcomes. DESIGN: Multicenter, parallel-group, double-blind, randomized controlled trial. SETTING: Academic movement disorders clinics at 22 sites in the United States and Canada. PATIENTS: Patients with early Parkinson disease (N = 301) who required dopaminergic therapy to treat emerging disability, enrolled between October 1996 and August 1997 and observed until August 2001. INTERVENTION: Subjects were randomly assigned to receive 0.5 mg of pramipexole 3 times per day with levodopa placebo (n = 151) or 25/100 mg of carbidopa/levodopa 3 times per day with pramipexole placebo (n = 150). Dosage was escalated during the first 10 weeks for patients with ongoing disability. Thereafter, investigators were permitted to add open-label levodopa or other antiparkinsonian medications to treat ongoing or emerging disability. MAIN OUTCOME MEASURES: Time to the first occurrence of dopaminergic complications: wearing off, dyskinesias, on-off fluctuations, and freezing; changes in the Unified Parkinson's Disease Rating Scale and quality-of-life scales; and adverse events. RESULTS: Initial pramipexole treatment resulted in a significant reduction in the risk of developing dyskinesias (24.5% vs 54%; hazard ratio, 0.37; 95% confidence interval [CI], 0.25-0.56; P<.001) and wearing off (47% vs 62.7%; hazard ratio, 0.68; 95% CI, 0.49-0.63; P =.02). Initial levodopa treatment resulted in a significant reduction in the risk of freezing (25.3% vs 37.1%; hazard ratio, 1.7; 95% CI, 1.11-2.59; P =.01). By 48 months, the occurrence of disabling dyskinesias was uncommon and did not significantly differ between the 2 groups. The mean improvement in the total Unified Parkinson's Disease Rating Scale score from baseline to 48 months was greater in the levodopa group than in the pramipexole group (2 +/- 15.4 points vs -3.2 +/- 17.3 points, P =.003). Somnolence (36% vs 21%, P =.005) and edema (42% vs 15%, P<.001) were more common in pramipexole-treated subjects than in levodopa-treated subjects. Mean changes in quality-of-life scores did not differ between the groups. CONCLUSIONS: Initial treatment with pramipexole resulted in lower incidences of dyskinesias and wearing off compared with initial treatment with levodopa. Initial treatment with levodopa resulted in lower incidences of freezing, somnolence, and edema and provided for better symptomatic control, as measured by the Unified Parkinson's Disease Rating Scale, compared with initial treatment with pramipexole. Both options resulted in similar quality of life. Levodopa and pramipexole both appear to be reasonable options as initial dopaminergic therapy for Parkinson disease, but they are associated with different efficacy and adverse-effect profiles.

Aged↗
PubMed2004

Child protection: a neglected area of pediatric residency training.

BACKGROUND: Child maltreatment is prevalent in Canadian society, and medical professionals are frequently required to provide care in these cases. Physician knowledge and training in child protection have been questioned. This study examined the experience, perceived adequacy of training, and perceived competency of Canadian pediatric residents in child protection. METHODS: Structured questionnaires were sent to child protection program directors (CPPDs), pediatric program directors (PPDs) and pediatric residents at the 16 Canadian pediatric academic centers. Data were analyzed using descriptive statistics, chi(2)-analyses, a Mann-Whitney test, and linear regression. RESULTS: Responses were obtained from 15 of 16 CPPDs, all 16 PPDs, and 190 of 348 (54.6%) residents. All programs provided didactic teaching sessions. Only 3 programs had mandatory clinical rotations, 9 programs offered clinical electives, and 7 programs did not offer any specific clinical experience in child protection. Half of the residents had seen 5 or fewer cases of maltreatment. Residents and program directors most commonly rated the training as "somewhat adequate, needs improvement" with a significant minority rating it as "poor, inadequate." Residents' self-rating of competency was positively associated with number of years of training and number of cases of maltreatment seen. Almost all residents (92%) felt that they needed further training in child protection, including 85% of graduating residents. Some of the residents (16.4%) did not anticipate dealing with child protection cases as practicing pediatricians. CONCLUSIONS: Canadian pediatric residents receive little exposure and limited training in child abuse and neglect. As a result, even senior pediatric residents feel poorly trained. These results highlight the need to establish effective training programs for residents in child protection.

Attitude of Health Personnel↗
PubMed2004

Consistency in efficacy and safety of ezetimibe coadministered with statins for treatment of hypercholesterolemia in women and men.

BACKGROUND: Women are often not treated as aggressively as men to control levels of low-density lipoprotein cholesterol (LDL-C), despite evidence that women and men realize comparable cardiovascular benefit from lipid-lowering therapy. Statins are the most effective drugs currently available for treating hypercholesterolemia. Despite the impressive cholesterol-lowering capacity of statins, however, many patients on statin therapy fail to reach established target levels of LDL-C. The cholesterol absorption inhibitor, ezetimibe, blocks the intestinal absorption of dietary and biliary cholesterol, a mechanism of action complementary to that of statins, which inhibit hepatic cholesterol synthesis. Ezetimibe coadministered with statins produces significant incremental reductions in LDL-C compared with statin monotherapy. METHODS: Four randomized, double-blind, placebo-controlled, balanced-parallel group trials compared the efficacy and safety of statin monotherapy (lovastatin or pravastatin 10, 20, or 40 mg; simvastatin or atorvastatin 10, 20, 40, or 80 mg) vs. ezetimibe 10 mg plus statin (as above). A gender subset analysis (women, n = 1065; men, n = 796) on data pooled across these four trials was carried out to determine whether ezetimibe plus statin for the treatment of hypercholesterolemia is equally efficacious in women and men. RESULTS: Compared with statin monotherapy, ezetimibe plus statin demonstrated greater efficacy in reducing blood levels of LDL-C, apolipoprotein B, and triglycerides and raising high-density lipoprotein cholesterol. The beneficial effects of ezetimibe were comparable in women and men. The safety profile of subjects receiving ezetimibe plus statin was similar to that of patients receiving statin monotherapy and similar between the two sexes. CONCLUSIONS: Ezetimibe plus statin was more effective than statin alone in improving the lipid profile of patients with hypercholesterolemia and was equally efficacious in women and men. Ezetimibe plus statin was well tolerated and had a favorable safety profile in both patient subgroups. Ezetimibe coadministered with statins, a dual inhibition treatment strategy that targets both cholesterol absorption and synthesis, is an effective therapeutic option for women with hypercholesterolemia.

Adult↗
PubMed2003

Armoured brain.

Explore the source record for details and available documents.

Calcinosis↗
PubMed2003

Constitutive and inducible levels of CYP1A1 and CYP1A2 in rat cerebral cortex and cerebellum.

We examined the constitutive and inducible levels of microsomal cytochromes P450 1A1 and 1A2 (CYP1A) in rat cerebral cortex and cerebellum at the level of proteins by western blot analysis, and by catalytic activities via ethoxyresorufin O-deethylase (EROD) and methoxyresorufin O-demethylase (MROD). In the cerebral cortex, cytochrome P450 1A1 (CYP1A1) protein was more abundant than cytochrome P450 1A2 (CYP1A2) protein. Treatment with beta-naphthoflavone (beta-NF) caused a slight decrease in the level of the former but induced the latter 5.8-fold. In the cerebellum, in contrast to the cerebral cortex, CYP1A1 protein was less abundant than CYP1A2 protein in untreated rats, and while beta-NF treatment caused a 3.3-fold induction of CYP1A1 protein, it resulted in a 10-fold decrease in CYP1A2 protein. The CYP1A-preferential activity EROD was 2.3-fold higher in the cerebellum than in the cerebral cortex, and was induced 1.5-fold and 1.9-fold in the cerebellum and cerebral cortex, respectively, by beta-NF treatment. The CYP1A2-preferential activity MROD was 3-fold higher in the cerebellum than in the cerebral cortex, and was repressed 2.2-fold in the cerebellum but induced 3.7-fold in the cerebral cortex following beta-NF treatment. The results show that CYP1A1 and CYP1A2 proteins and catalytic activities are constitutively expressed in brain but are differentially inducible in the rat cerebral cortex and cerebellum.

Animals↗
PubMed2000

Exercise in Heart Failure: A Synthesis of Current Research.

Exercise intolerance, as a hallmark symptom in patients with heart failure, has been the focus of numerous research initiatives in recent years. The purpose of this review is to synthesize the current literature in order to provide the clinician with an understanding of the state of knowledge regarding the role of exercise in treatment of heart failure. Many studies speak to the effect of exercise training in this population. While sample sizes have been small and restricted predominantly to male subjects with ischemic cardiomyopathies, strong support has been documented in favor of beneficial effects of exercise in heart failure. Future research should target more representative subject pools (i.e., females, non-ischemic cardiomyopathies, cultural minorities, frail elderly, and NYHA class IV), evaluation of impact on quality of life outcomes, exploration of different types and intensity of exercise, and formulation of specific activity prescription tools which can guide practitioners in making activity and/or exercise recommendations to those patients who have no access, or limited access, to cardiac rehabilitation programs.

Journal Article↗