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[Educating the diabetic patient as a basis for therapy].

Since the late 1970's, diabetes therapy has been revolutionized and, in fact, new treatment strategies have been initiated by patient education and the resulting self-monitoring of the patient. The modern management of the chronic lifelong disease diabetes mellitus not only requires the prescription of the appropriate nutritional and pharmacologic regimen by the physician, but also intensive education and counselling of the patient. It is the diabetic himself who ultimately has to secure the treatment as given by the physician in daily life and--in so doing--has to provide a great deal of self-care and self-control. Meeting the individual treatment goal is largely dependent upon the cooperation and motivation of the patient, with the physician as both the sympathetic and critical counterpart. Today, education is the indispensible prerequisite for the limited well-being and health of diabetics and, at this end, education is equal to therapy.

Combined Modality Therapy↗

[Poor promotional practices in pharmaceutical communication: the anti- medical visit, International experience].

We start with a short introduction about the concept of "bad promotional practices" within the Pharmaceutical Industry's (PHI) communication, giving rise to the birth of so-called "un-representatives" (un'rep). Taking the self-control model from the "Association of the British Pharmaceutical Industry" (ABPI), based upon the "code of practice" as a paradigma, we comment about those who notify presumed code's breaches besides the assessment process and penalties that are usually imposed. We also considered the possibility that sometimes the physician instead of being a prosecutor is accused, by the PHI, of supposed "Medical Deonthological Code's" Infringement. The several modalities of malpraxis during the un-rep visit are classified into four categories: product un-information; unloyal competition; echonomical temptations addressed toward physicians; and disregarding stablished visit planning. We devote most of the text to exemplarize five common and very well documented situations; promotion of non-registered indications; influence of prescriptions through prebends to doctors; doubtful payments to compensate clinical trials and drug surveillance studies; the use of exagerated claims; and the abuse of the qualification "drug of choice". We end with a self-critism, from the phi's outlook on the prudence that a "good pharmaceutical communicator" must respect. As an excellent model of wisdom, we propose doctors, Because they follow the classical good-sense picture that illustrates the process of adoption of a new drug. We emphasize the fact that product over-estimation, creating false expectatives, is--together with the lak of informative liability--one of major reasons for a drug innovation to fail.

Advertising↗

Drug development history, "overview," and what are GCPs?

History shows that regulation of the pharmaceutical industry came about as a result of unfortunate incidences in which self-control by the industry was insufficient. All facets of drug manufacturing and preclinical laboratory research and development are regulated by GMPs and GLPs. Only part of the GCPs, as proposed, have become regulations. The pharmaceutical industry has an attrition rate of NCEs, from discovery to product, of 10,000 : 2. Research and development to market a product consumes 12 years (approximately 71% of patent life) and costs more than +250 million. The industry will be well served to closely monitor itself through conformance to GCP guidelines and regulations to avoid further government regulation.

Clinical Trials as Topic↗

[The correlations between psychological indices and cardiac variance].

Correlative links between psychologic and psychologic indicators were studied in subjects occupied either in airline transportation or in the chemical industry. Investigations covered three groups of persons: managers of airline traffic (57 subjects); workers at "Vratsa" Chemical plant (14 subjects); and operators at "Vratsa" Chemical plant (14 subjects). The psychologic parameters measured included indicators of cardiac variance: mean--mean value of successive cardiac intervals, SD--standard deviation of mean value of cardiac intervals (R-R), AMo--amplitude of the mode, HI--homeostatic index, Pt--spectral power of R-R related to thermoregulation, Pp--spectral power of R-R related to respiration, IBO--index of centralization; psychologic parameters included: extrovertiveness, introvertiveness, neuroticism, psychoticism, interpersonality conflicts, self-control, social support, self-confidence, work satisfaction, psychosomatic complaints. There was evidence of significant and highly significant correlative links between indicators of cardiac variance and psychologic indicators. There thus appeared to exist certain relationships between the psychologic and psychologic levels during lengthy stressful occupational exposure.

Adult↗

[The cardiological progression under scrutiny of medicometrics. The case for cardiovascular prevention].

The utility of a new global approach to public health planning, "medicometry", is demonstrated using the example of cardiovascular prevention with its costs and benefits. Although cost-benefit analyses have become plethoric in recent years, they do not give the answers to the right questions asked by a society concerned by the explosion of investments in health care. Medicometry illustrates the complexity of the choices in cardiology and proposes alternative solutions different from simplistic proposals for short term budget cuts. For this demonstration several examples are used: the monetary gains of secondary and primary prevention; the impact of the geographical distribution of physicians on medical utilization; self-control of quality; and the impact of scientific and technologic developments on future costs. The impact of health care choices on the whole of society is stressed. The global feed-back of all medical branches, such as cardiology, is explained taking into account quality-of-life targets and economic, demographic and social constraints.

Cardiovascular Diseases↗

[Prevention of smoking from the psychological medicine perspective].

Smoking is a complex socio-psycho-biological behavior with high prevalence and high risk for several diseases. Referring to a widely accepted concept of prevention, the review presents recent psychological and pharmacological strategies to cease smoking with respect to theory, application, and evaluation. Primary prevention, which includes appropriate settings in schools, families, and social groups, seems adequate in preventing people from health problems associated with tobacco-smoke. Although evaluations are rarely found, curricula starting at childhood and intensive training programs for adolescents can be presently recommended. These programs have to take into account specific group characteristics and should focus on active and self-controlled behavior without smoking. Additionally, negative short-term effects of smoking should be emphasized more clearly instead of longterm risks of smoking. The broad diversity of secondary prevention programs for smoking cessation and relapse prevention includes well established and efficient psychological and pharmacological treatments. Flexible combinations of psychotherapeutic and pharmacological strategies (e.g. behavioral skill training programs and nicotine replacement therapy), which also consider the strength of nicotine dependence and withdrawal symptoms, are most promising. For smokers, who continue to smoke despite of health damages (e.g. cardiovascular diseases, cancer), intensive psychotherapeutic regimens (tertiary prevention) are suggested. However, evaluation on this issue is almost missing. In summary, smoking prevention programs can be considered to be cost-effective. Nevertheless, 1 year abstinence rates range only between 20-30%. Furthermore, there is a strong need for psychobiological research on the development of smoking behavior, on long-term follow-up of prevention programs, and on outcome prediction.

Combined Modality Therapy↗

Isokinetic cycle ergometer--application in sports medicine.

Paper deals with application of fully computerized isokinetic cycle ergometer with on-line registration of effective crank force in sports medicine, namely in functional diagnostic and rehabilitation. The system allows to carry out the time and position course analyses of effective pedal force and power produced at various revolution rates. Maximal or mean values of force and power produced by action of right and left leg may be used for the estimation of strength as well as for detection and quantitative assessment of lateral functional deficit for example due to injury. Short term bouts on isokinetic cycle ergometer may be applied as an effective means for the improvement of strength of lower extremities in patients as well as in competitive cyclists. The estimation of individual fluctuation of effective force (i.e. differences between maxima at horizontal and minima at vertical crank position) may be used for the evaluation of pedalling technique. Short term all-out efforts at various cadences allow to register not only peak and mean force and power at particular revolution rates, but also to estimate an optimal individual revolution rate, i.e. those allowing to produce highest power output. Such information can be employed for diagnostic assessment of anaerobic capabilities, namely in cyclists. Isokinetic cycling with self-controlled effort may be also used as a comfortable aerobic exercise. It may be concluded that isokinetic cycle ergometer represents a valuable diagnostic as well as therapeutic tool, which may be utilized in several areas of sports medicine.

Adult↗

Educational program on ophthalmology.

To minimize the learning problems, related to the present teaching method, we developed the Educational Program on Ophthalmology, that offers an interactive and self-controlled way of learning, through the multimedia and hypertext (hypermedia) resources to the students. The software has 200 images (pictures and photos), 40 minutes of digitized voice (.WAV), 50 minutes of video animation (.AVI) and more than 200 links. The first evaluation demonstrated a great interest from the medical graduated students, who feel motivated with the utilization of the software.

Animals↗

[Personality determinants of effectiveness in performing duties by soldiers in active service in the landing-shock brigade].

After studies in the Brigade the authors identified and qualified personality traits which co-determine effectiveness in performing duties in active service. The efficiency of performing duties is determined by: high emotional resistance, high level of ability to logical conclusion, high level of self-control, low extroversion level, lack of antisocial tendencies. The authors worked out some indications concerning choice and selection for this military formation.

Adolescent↗

[Spinal analgesia for labor].

Combined spinal epidural (CSE) analgesia for labour is usually performed with sufentanil (or fentanyl) which provides powerful and fast onset pain relief (< or = 5 min). Dose reduction of sufentanil from 10 to 5 micrograms may be recommended and has little influence on the 1.5-2 hours of analgesia usually obtained. This mean duration of action may be prolonged by half an hour with the addition of a low dose of bupivacaine (< or = 2.5 mg). CSE analgesia using this association has an elective indication when labour is advanced (cervical dilation > or = 6 cm) because intrathecal sufentanil alone becomes insufficient at this stage and standard epidural analgesia has the drawback of delayed onset. Motor blockade is also very uncommon during intrathecal analgesia and this benefit partly persists while using the epidural. In contrast, intrathecal analgesia and standard epidural analgesia carry a comparable risk of maternal hypotension. Mild pruritus is the sole side-effect often encountered. The only real concern during intrathecal analgesia is the reliability of the epidural location of the catheter when an emergency Ceasarean section is needed. Major improvement will be to prolong the excellent pain relief provided by intrathecal analgesia throughout the whole labour. This will require prolonging substantially the intrathecal analgesia duration and/ or influencing positively the epidural analgesia used afterwards. However, women prefer CSE technique to standard epidurals because of faster onset, less motor block, and feelings of greater self-control.

Adult↗

Phosphate supplementation prevents a decrease of triiodothyronine and increases resting metabolic rate during low energy diet.

Thirty overweight women participated in 8 week slimming program consisting of a self-controlled low-energy diet (4.2 MJ/day) supplemented with highly viscous fibres and mineral tablets containing calcium, potassium and sodium phosphates (Redusan Combi, Biokraft Pharma AB, Sweden). Half of the patients received in double blind manner mineral tablets during first 4 weeks and placebo (without phosphates) during next 4 weeks (group 1) while the remaining patients were treated (cross-over) with placebo first and mineral tablets in the final period (group 2). The rate of weight loss was similar in groups 1 and 2 (4.7 vs 5.2 kg during the first 4 weeks and 2.7 vs 3.0 kg in the further 4 weeks). During periods of phosphate supplementation, the resting metabolic rate (RMR) increased by approx. 12% (p < 0.05) in group 1 and 19% (p < 0.05) in group 2. Phosphate supplementation ameliorated also a decrease in plasma triiodothyronine level and a decrease in thyroxine to triiodothyronine ratio. There were no differences between groups in the plasma insulin, catecholamine, growth hormone, cortisol and testosterone levels. Phosphate supplementation did not affect plasma lipids or blood glucose concentration. It is concluded that phosphate supplementation in obese patients on a low-energy diet enhances RMR irrespectively of the rate of weight loss. This effect seems to be, at least partly, due to an influence of phosphates on peripheral metabolism of thyroid hormones.

Adult↗

The behavioral-cognitive model of pain.

In the elderly patient, for whom pain can be quite complex and multidimensional, a careful assessment of sensory and psychosocial contributions to the pain experience is important. This analysis will allow for the selection of a comprehensive pain regimen that includes behavioral-cognitive techniques. When carefully chosen, and presented in a manner consistent with the patient's cognitive capabilities, psychological techniques afford the elderly patient enhanced self-esteem and self-control without the addition of potentially harmful side-effects. A discussion focused on normal and abnormal aging processes is intended to assist the clinician in determining the patient's mental status. In normal aging situations, elderly pain patients have been shown to benefit equally to younger populations from behavioral-cognitive techniques, as long as the information is presented in a concrete, well-organized format in relatively brief sessions. Situations involving delirium or dementia pose significant challenges for clinicians and need to be assessed on a case-by-case basis.

Aged↗

Initiation of cigarette smoking among children with and without learning disabilities.

The goals of this study were to determine if: (1) children with learning disabilities should be included in school-based smoking prevention programs and (2) existing prevention curricula are appropriate for children with learning disabilities. Initiation of cigarette smoking and several correlates of smoking, including personal attribute, peer influence, and parent influence variables, were measured in a sample of 1470 3rd and 5th grade children. The rates of smoking initiation were 17% and 15% for children with and without learning disabilities, respectively. In addition, several of the known correlates of smoking among youth, including low self-control, negative orientation toward school, and peer smoking, were also significantly associated with smoking by children with learning disabilities. Children with learning disabilities are as much in need of smoking prevention programs as children without learning disabilities. Although current smoking prevention curricula address issues relevant to children with learning disabilities, additional research is needed to identify the special needs of these children and to determine the type of smoking prevention program most likely to be effective with them.

Age Factors↗

HIV risk among Latino gay men in the Southwestern United States.

Using two different methods-bar and community household sampling-159 Latino gay men were recruited in the city of Tucson, Arizona. In addition to demographics, the study questionnaire assessed participants' sexual activity during the last 30 days with primary and nonprimary partners, condom use in the last year, and eight psychosocial constructs that have been predictive of HIV risk in different studies of (mostly white) gay/bisexual men. Questionnaires were available only in English; this Latino sample is thus likely to overrepresent highly acculturated, English-speaking men. Results show that 22% of the sample engaged in unprotected anal intercourse with nonmonogamous partners during the last 30 days; 51% of the sample reported at least one instance of unprotected anal intercourse during the last year. Of those men who practiced any anal intercourse during the last 30 days, 67% practiced unprotected anal intercourse with primary partners and 44% practiced unprotected intercourse with casual partners. Thus, the majority of Latino gay men who practiced anal intercourse in the month prior to the interview were not using condoms. Men who practiced unprotected intercourse with nonmonogamous partners reported lower annual incomes and were less educated. Two cognitive variables (behavioral intentions and perceptions of self-efficacy and self-control) and two behavioral variables (sex under the influence of alcohol and/or drugs and sex in public environments) emerged as the most important correlates of HIV risk.

Adult↗

AIDS-relevant condom use by gay and bisexual men: the role of person variables and the interpersonal situation.

This study examined the relative ability of selected person variables (interpersonal self-efficacy, self-control, attitudes about the effect of condoms on sex, normative beliefs) and interpersonal-situational variables (partner preference, partner serostatus) to explain gay and bisexual males' (N = 267) condom use during insertive and receptive intercourse. Partner preference accounted for a large amount of variance in condom use by itself and when controlling for the effects of the remaining variables. Exploratory hierarchical regression analyses suggested that the receptive partner's preference influenced condom use decisions to a greater extent than did the insertive partner's. Partner serostatus alone explained little variance in condom use. However, partners serostatus interacted with subject serostatus such that dyads with concordance serostatus (i.e., both partners HIV positive or both HIV negative) used condoms the least, and dyads with discordant serostatus used condoms the most. Results suggest that the interpersonal situation plays an important role in condom use decisions.

Acquired Immunodeficiency Syndrome↗

[Mechanism of aspartic proteinase action. I. Theory and method].

Starting from experimental results and contemporary theories of biocatalysis, stereochemistry of aspartic protease functioning was discussed. A general theory of biocatalysis was suggested, which is based on the structural and functional organization of enzyme and substrate molecules and allow a quantitative description of a catalytic act as a continuous, spontaneous, and self-controlled process.

Aspartic Acid Endopeptidases↗

[Formation of a unified system of mental regulation of activities and functional state of the flyer during effects of piloting strain].

The article describes the method of improving professional dependability of pilot impacted by aerobat g-loads through formation of a unified system for psychic regulation of his activity and status of the psychological function in the process of training on flight simulator. To this end, the simulator was retrofitted with an adaptive training circuit to establish functional and correction feedback by changing the intensity of display brightness proportionally to the degree of "g-load" and effectiveness of countermeasures applied to simulate visual disorders due to hypergravity. Data from real flights with high aerobat g-loads proved effectiveness of the proposed training scenarios as judged by increased probability of administration of breathing (0.9 vs. 0.4) and muscular (1.0 vs. 0.8) countermeasures by members of the experimental group against their controls. Besides, the trained pilots had no visual disorders, whereas this was the case in 28% of their controls. Possible mechanisms of how to form a unified system for psychic regulation in which implementation of a task is kept under permanent conscious control and self-control of the psychological function is essentially accomplished on the level of automated habits are the subject of the authors' discussion.

Aerospace Medicine↗

On Kibarashi-gui (binge eating).

The authors presented 16 cases that displayed episodes of pathological over-eating, i.e. kibarashi-gui (binge eating). The cases were divided into three groups, and symptomatology of the eating bouts and associated psychiatric symptoms were described. Constellations of symptoms differed from group to group. The first group, Group A, was concluded as the pure kibarashi-gui (binge eaters), and Group B can be regarded as a variant of anorexia nervosa. Discussion was focused on the similarities and differences between kibarashi-gui and anorexia nervosa. Kibarashi-gui is explained as a defeat of self-control or competition. Discussions on the origin of the sex difference of eating disorder were done. And, the concept of slimness or beauty in women was assumed as the most important factor in eating disorders.

Adolescent↗