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PubMed2000

Long acting beta-agonists versus theophylline for maintenance treatment of asthma.

BACKGROUND: Theophylline and long acting beta2-agonists are bronchodilators used for the management of persistent asthma symptoms, especially nocturnal asthma. They represent different classes of drug with differing side-effect profiles. OBJECTIVES: To assess the comparative efficacy, safety and side-effects of long-acting beta-agonists and theophylline in the maintenance treatment of asthma. SEARCH STRATEGY: Randomised, controlled trials (RCTs) were identified using the Cochrane Airways Group register. The register was searched using the following terms: asthma and theophylline and long acting beta-agonist or formoterol or foradile or eformoterol or salmeterol or bambuterol or bitolterol. Titles and abstracts were then screened to identify potentially relevant studies. The bibliography of each RCT was searched for additional RCTs. Authors of identified RCTs were contacted for other relevant published and unpublished studies. SELECTION CRITERIA: All included studies were RCTs involving adults and children with clinical evidence of asthma. These studies must have compared oral sustained release and/or dose adjusted theophylline with an inhaled long-acting beta-agonist. DATA COLLECTION AND ANALYSIS: Potentially relevant trials, identified by screening titles and/or abstracts, were obtained. Two reviewers independently assessed full text versions of these trials to decided whether the trial should be included in the review, and assessed its methodological quality. Where there was disagreement between reviewers, this was resolved by consensus, or reference to a third party. Data were extracted by two independent reviewers. Inter-rater reliability was assessed by simple agreement. Study authors were contacted to clarify randomisation methods, provide missing data, verify the data extracted and identify unpublished studies. Relevant pharmaceutical manufacturers were also contacted. MAIN RESULTS: Six trials met the inclusion criteria. Five used salmeterol and one, biltoterol. They were of varying quality. There was a trend for salmeterol to improve FEV1 more than theophylline in three studies and salmeterol use was associated with more symptom free nights. Bitolterol, used in only one study, was reported to be less effective than theophylline. Subjects taking salmeterol experienced fewer adverse events than those using theophylline (Relative Risk 0.38; 95%Confidence Intervals 0.25, 0.57). Significant reductions were reported for central nervous system adverse events (Relative Risk 0.51; 95%Confidence Intervals 0.30, 0.88) and gastrointestinal adverse events (Relative Risk 0.32; 95%Confidence Intervals 0.17, 0.59). REVIEWER'S CONCLUSIONS: Salmeterol may be more effective than theophylline in reducing asthma symptoms including night waking and improving lung function. More adverse events occurred in subjects using theophylline when compared to salmeterol.

Adrenergic beta-Agonists↗
PubMed1986

[Dependence of energy maintenance requirements on nutrients in rats. 3. Effect of the protein levels of food on the energy maintenance requirements of growing rats].

In addition to earlier experiments with growing rats on the protein levels 10, 25 and 40% crude protein in the dry matter of the feed (Hoffmann et al., 1982 a), two groups of nine male Wistar rats each received feed mixtures with 6 or 25% crude protein resp. and energy metabolism on the energy maintenance level in an N equilibrium or with a positive N balance resp. were measured on 6 levels of live weight between 65 and 250 g and additionally also at subsequent fasting day. Energy maintenance requirement on average of the 6 periods amounted to 381 and 377 kJ metabolizable energy/kg W 0.75 X d on a low or middle protein level resp. and thus did not show changes at the decrease of N retention to values of about zero even with regard to different ATP formation capacities of the nutrients.

Animal Feed↗
PubMed1996

Maintenance requirement for valine and efficiency of its use above maintenance for accretion of whole body valine and protein in young chicks.

Experiments were conducted with chicks during the period 10-20 d posthatching to assess valine accretion and protein accretion as a function of incremental valine intakes between 5 and 95% of its ideal level (requirement for maximal growth). Chemically defined crystalline amino acid diets were fed, and amino acids other than valine were maintained at minimized excess levels as valine was increased. With dietary valine concentrations representing 5, 10, 40, 55, 70 and 95% of the ideal level, weight gain (r2 = 0.98), protein accretion (r2 = 0.98) and valine accretion (r2 = 0.99) increased linearly (P < 0.01) as a function of valine intake. Slope of the valine accretion curve was 0.73 +/- 0.02, and there was no indication of decreased valine utilization as valine intake increased to 95% of its required level for maximal growth. Using the linear regression equation, i.e., valine accretion (Y) regressed on valine intake (X), the maintenance valine requirement (X at Y zero) was 18.4 mg/d or 48.8 mg/d per kg body weight3/4. Whole body valine was 4.72 g/100 g whole body protein accreted and was constant at all levels of valine intake. At zero protein accretion, however, valine accretion was negative (-3.8 mg/d). Thus, the valine requirement for zero valine accretion (48.8 mg/d per kg(3/4) was higher than the valine requirement for zero protein accretion (32.4 mg/d per kg3/4). In a subsequent experiment, also involving whole body valine and protein accretion, valine doses of 40, 55 and 70% of ideal were compared using amino acid-balanced diets (amino acids other than valine at 55, 70 and 85% of ideal levels, respectively) or imbalanced diets (amino acids other than valine at a constant 100% of their ideal levels). Straight-line (P < 0.01) valine and protein accretion responses occurred, but slope of the response curves (accretion vs. valine intake) was lower in the imbalanced series than in the balanced series. The results of these studies suggest a constant utilization above maintenance of absorbed valine over a wide range of valine intake.

Analysis of Variance↗
PubMed2003

Attributional biases in the service of stereotype maintenance: a schema-maintenance through compensation analysis.

Six experiments were conducted to test assumptions of a schema-maintenance through compensation analysis. The results of these experiments indicated that perceivers can compensate for the inconsistent action of one individual (the target) by altering their attribution concerning the action of a fellow group member. When the target performed an inconsistent behavior, perceivers compensated by making especially extreme stereotypically consistent attributions concerning a fellow group member's subsequent action. In addition, in Experiment 5, perceivers compensated via a fellow group member for a target's inconsistent action while maintaining their general view of group members. Experiments also provided tests of the capability and motivation assumptions of the schema-maintenance through compensation analyses.

Attitude↗
PubMed1985

Long-term depot maintenance of chronic schizophrenic out-patients: the seven year follow-up of the Medical Research Council fluphenazine/placebo trial I. Course of illness, stability of diagnosis, and the role of a special maintenance clinic.

A follow-up study of all patients entering the MRC double-blind trial of fluphenazine decanoate in chronic schizophrenic out-patients achieved a trace rate of 94%. In general, these patients were severely disabled, continued under the care of the maintenance clinic, and their diagnoses remained remarkably consistent; more than one-fifth were found to be in acute schizophrenic relapse and in over a half of these cases, the relapse was not known to the treatment agency. The maintenance clinic attenders were little different from those who no longer used such a facility.

Adult↗
PubMed2004

The effect of epidural bupivacaine on induction and maintenance doses of propofol (evaluated by bispectral index) and maintenance doses of fentanyl and vecuronium.

The growing interest in combining local and general anesthesia has led to studies investigating possible interactions between general anesthesia and local anesthetics administered via spinal, epidural, IV, or IM routes. However, no study has evaluated the effect of local anesthetics on all three components of balanced anesthesia, i.e., hypnosis, analgesia, and muscle relaxation. In this prospective, randomized, double-blind study, we investigated the effect of epidural bupivacaine on the dose requirement of propofol (as evaluated by using the bispectral index [BIS]), fentanyl, and vecuronium for general anesthesia. This study consisted of 30 adults, ASA physical status I and II, undergoing Whipple's pancreaticoduodenectomy for periampullary carcinoma lasting >4 h. An epidural catheter was placed between T9-10. Depending on the group allocation, 10 mL of the study drug was administered as a bolus followed by an infusion at 6 mL/h via the epidural catheter. Patients were divided into 2 groups of 15 each. Patients in the control group received epidural normal saline whereas those in the bupivacaine group received epidural bupivacaine 0.1%. Induction of anesthesia was performed with IV fentanyl 2 mug/kg and propofol titrated to achieve BIS between 40-50. Endotracheal intubation was facilitated by the IV administration of vecuronium 0.1 mg/kg and patient's lungs were ventilated with 66% nitrous oxide in oxygen. After intubation, infusion of propofol 1% was titrated to maintain BIS between 40-50. Inadequate analgesia was defined as an increase in systolic blood pressure and/or heart rate by >20% of baseline values in response to surgical stimulus and was treated with bolus fentanyl 0.5 mug/kg. Neuromuscular monitoring was used to assess the need for additional doses of vecuronium. Data were analyzed by using the Student's t-test and P </= 0.05 was considered significant. The requirement of propofol for induction and maintenance of anesthesia in the bupivacaine group was 1.3 +/- 0.3 mg/kg and 2.4 +/- 0.9 mg . kg(-1) . h(-1), respectively, compared with 2.4 +/- 0.6 mg/kg and 4.4 +/- 1.6 mg . kg(-1) . h(-1) observed in the control group (P < 0.05). Significant reduction was also observed in the requirement of vecuronium and fentanyl during maintenance in the bupivacaine group (P < 0.05). We conclude that epidural bupivacaine given before induction of anesthesia reduces the requirement of propofol, fentanyl, and vecuronium during general anesthesia.

Adult↗
PubMed2001

Differences in the kinds of problems consumers report in staff/group health maintenance organizations, independent practice association/network health maintenance organizations, and preferred provider organizations in California.

BACKGROUND: Little is known about the extent to which consumers have specific problems with their managed care organizations (MCOs) or whether these problems differ by type of MCO. OBJECTIVE: To estimate the prevalence at which consumers in managed care report specific problems and to assess whether rates in preferred provider organizations (PPOs), independent practice association (IPA)/network health maintenance organizations (HMOs), and staff/group HMOs differ. DESIGN: Random probability sample of insured adults weighted to reflect the underlying population in California. A computer-assisted telephone interview survey was conducted in September 1997. Logistic regression models estimate the adjusted odds of reporting each problem in the last year in IPA/network HMOs versus PPOs, IPA/network HMOs versus staff/group HMOs, and staff/group HMOs versus PPOs. SUBJECTS: One thousand two hundred one insured adults who had resided in California for > or = 12 months. MEASURES: Prevalence of 11 consumer problems in MCOs. RESULTS: Forty-two percent of adult Californians in managed care in our sample reported > or = 1 problem with their MCO in the last year. Adjusted odds that adults in IPA/ network or staff/group HMOs reported delays in getting needed care, not receiving the most appropriate or needed care, and being forced to change doctors were higher than for adults in PPOs. Adjusted odds that adults in IPA/network HMOs reported difficulty getting a referral to a specialist and difficulty selecting a doctor or hospital were higher than for adults in PPOs and staff/group HMOs. Adjusted odds that adults in staff/ group HMOs reported misunderstandings over benefits and coverage; important benefits not covered; and problems with claims, billing, or payments were lower than for adults in PPOs and IPA/network HMOs. Adjusted odds that consumers in HMOs in our sample reported any problem with their health plan was higher for those in IPA/network HMOs compared with staff/group HMOs. No differences were seen by MCO type in the rates at which consumers reported being denied care or treatment, forced to change medications, or language and communication barriers. CONCLUSIONS: Rates at which consumers report problems with managed care and the kinds of problems they report differ significantly across different types of MCOs. These findings have important implications for federal and state policy for consumer protections in managed care.

Adult↗
PubMed2006

Mental health in F-111 maintenance workers: the study of Health Outcomes in Aircraft Maintenance Personnel (SHOAMP) general health and medical study.

OBJECTIVE: We sought to contrast mood disorder symptoms in F-111 aircraft Deseal/Reseal maintenance personnel with appropriate comparisons. METHODS: Participants completed a comprehensive health assessment, including measures of mood disorder, self-reported mood symptom questionnaire items, and review of anxiolytic and depression medication. Multiple logistic regression was conducted for each outcome using exposure group and potential confounders as explanatory variables. RESULTS: There was high agreement between self-reported mood disturbance and objective tests. The exposed group was more likely to self-report previous diagnoses of depression/anxiety, had higher use of antidepressant medications, and had increased risk of diagnosis of depression/anxiety. Results were consistently strong against both comparison groups, with the exposed more likely to have mental distress and social dysfunction when compared with the Australian population. CONCLUSIONS: There is robust evidence for an association between F-111 Deseal/Reseal exposure and impaired mental health.

Aircraft↗
PubMed2006

Do patients with sleep maintenance insomnia have a problem with sleep maintenance?

Do patients with primary insomnia differ from good sleepers with respect to the number or duration of awakenings or to the stages from which awakenings occur? To address this question, polysomnography (PSG) records were evaluated in 10 good sleepers (GS) and 10 primary insomnia patients (PI). PSG records were evaluated for occurrence and duration of awakenings and for the stage immediately preceding each awakening. PIs woke more frequently and for longer durations than did GSs. PIs' awakenings tended to occur from Stages 1 or 2; GSs' occurred from epochs scored as movement times. The data from this study represent the first attempt to characterize the stages from which awakenings occur in sleep maintenance insomnia.

Adult↗
PubMed1980

Public Health Service--Information regarding requirements for health maintenance organizations. Notice, information regarding requirements for qualified health maintenance organizations.

This notice contains information relating to the requirements for federally qualified health maintenance organizations (HMOs) as set out in Title XIII of the Public Health Service Act (the Act), as amended, and its implementing regulations at 42 CFR Part 110. This information, which includes a number of interpretive rulings, is being published in response to significant questions that have been raised regarding those requirements.

Health Maintenance Organizations↗
PubMed1980

Public Health Service--Health maintenance organizations; requirements for a health maintenance organization. Final regulations.

This rule amends the Public Health Service regulations by setting forth revised requirements for the organization and operation of federally qualified health maintenance organizations (HMOs). These amendments are made as a result of (1) public comments on the interim regulations published on July 18, 1979, and (2) public comments on the notice of proposed rulemaking (NPRM) governing relationships between federally qualified HMOs and other parties, also published on July 18, 1979.

Facility Regulation and Control↗
PubMed1985

Information regarding requirements for health maintenance organizations--HRSA. Notice; information regarding requirements for qualified health maintenance organizations.

This notice amends information relating to the requirements for federally qualified health maintenance organizations (HMOs) that was published in the Federal Register on April 29, 1980. The amendment deletes the requirement for a cancellation clause in contracts between an HMO and another party performing the HMO's marketing activities.

Health Maintenance Organizations↗
PubMed2000

Lupus nephritis outcomes: health maintenance organizations compared to non-health maintenance organizations.

OBJECTIVE: Patients with systemic lupus erythematosus (SLE) in USA increasingly have their care centered in health maintenance organizations (HMO). We examined whether HMO and non-HMO SLE patients with renal involvement, who had the same university rheumatologist, differed in their utilization of health care or renal outcomes. METHODS: Consecutive patients with SLE with renal involvement (n = 24), 10 enrolled in an HMO, 14 not, were studied. Laboratory values were prospectively determined. RESULTS: At the first visit to the rheumatologist, there was no significant difference between HMO and non-HMO patients in laboratory values. There was no difference in the 2 groups in the final prednisone dose (HMO 12 mg vs non-HMO 15.9 mg) or use of azathioprine (20% vs. 57%; p = 0.07) or cyclophosphamide (60% vs. 57%). The serum creatinine was higher in the HMO patients (HMO 1.1 mg/dl vs. non-HMO 0.78 mg/dl; p = 0.05). No difference was found in the number of rheumatology visits. There was a significant difference in the number of communications from the rheumatologist to the HMO versus the HMO to the rheumatologist (p = 0.026). CONCLUSION: Other than the serum creatinine, there are no differences in the treatment or renal outcomes for HMO compared to non-HMO patients with SLE seeing the same rheumatologist. There is a potential barrier in physician communication, however, with the majority of communications going from the rheumatologist to the HMO provider.

Adult↗