First-time pregnancy, an apparent motive for referral to a Zimbabwean district hospital.
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Adult↗
Biomedical subjects
H Petri
Publications and source records attributed to H Petri.
["I came as a stranger, will leave as a stranger." From alienation to hostility to foreigners in the young generation].
After a historical review of the discussion of the concept of strangeness and alienation since the beginning of the 19th century, the question of the background of the current discussion of "the alien" arises. The assumption is that the experience of strangeness and self-alienation took a qualitative and quantitative leap at the point in technological development when the dialectic between human and machine was resolved in favor of the machine's domination, and when the "mega-machine" made the end of the human species conceivable and probable. Findings from empirical research on children and youth support this assumption. The causes are traced why the younger generation in particular is affected by the structural violence of strangeness that permeates all areas of life. Its inflating influence on the development of the ego and self is depicted. In accordance with the assumption, hostility toward and hatred of foreigners are to be grasped as symptoms of a loss of identity, caused by experiences of alienation deeper and more comprehensive than current societal triggers reveal.
Adolescent↗
Channelling of controlled release formulation of ketoprofen (Oscorel) in patients with history of gastrointestinal problems.
STUDY OBJECTIVE: The aim was to determine if a new controlled release formulation (Oscorel) of the non-steroidal anti-inflammatory drug (NSAID) ketoprofen has been preferentially prescribed in patients with prior history of gastro-intestinal disturbances. DESIGN: The study was a pharmacy records based comparison of the rates of prior prescribing of drugs indicated for peptic ulcer treatment in first recipients of Oscorel in 1989 versus recipients of other NSAID products. SETTING: A representative panel of Dutch community pharmacies serving approximately 425,000 people was used. MAIN RESULTS: Oscorel was launched in January 1989. Data on prescriptions dispensed in 1987-1988 to a total of 837 first users of Oscorel were analysed and compared with the dispensing history of a reference population including 30,787 patients who did not receive a prescription for Oscorel during 1989. Compared to the reference population, first users of Oscorel included a greater proportion of females, of patients 75 years and older, of heavy users of NSAIDs, and of patients switching among different NSAIDs. A total of 24.1% of first users of Oscorel had received peptic ulcer therapy in 1987-1988, versus 15.7% of the reference population. The rate ratio was 1.54, with 95% confidence interval of 1.36-1.74. Adjustment for stratifying variables caused only minor changes in the rate ratio, which remained stable on 1.5. CONCLUSIONS: Oscorel appears to have been channelled into use in patients with recognised risk factors for gastrointestinal toxicity. This preferential prescribing probably resulted from expectations and claims that this product has a lower risk of such toxicity.
Community Pharmacy Services↗
Comparison of questionnaire information and pharmacy data on drug use.
Information on chronic drug use at any time in the past was collected with a self-administered questionnaire as part of a prospective cohort study on diet, other life-style factors and cancer among subjects aged 55-69 years. The validity of the questionnaire information on drug use was evaluated among 207 subjects by comparing it to pharmacy records of dispensed drugs. The comparison could be made for the 2.5-year period preceding the questionnaire administration. Since the study subjects did not mention prescription drugs that were not dispensed by their pharmacy, indicating no errors of commission, the analyses were focused on the estimation of sensitivity of drug recall and its correlates. Questionnaire recall of drug use amounted overall to 61.2% of drugs prescribed to the subjects for at least 6 months. Drug recall decreased with increasing age and with increasing number of prescribed chronic use of drugs per subject. No difference in recall was observed between men and women. Recall tended to improve with increasing duration of use and varied with type of drug. When only long-term drug use at the time of questionnaire administration was considered, overall recall of drug use was 68.8%.
Age Factors↗
Markers of adverse drug reactions in medication histories. An analysis of inhaled steroid utilization.
Prescription sequence analysis is based on the observation that a subset of adverse drug reactions are themselves indications for the prescription of another drug. We propose an approach to the analysis of clustering of prescriptions in medication histories that contain records of a presumed side-effect-causing drug A and a side-effect-alleviating drug B. This set of histories with records of both A and B is analysed in a logistic regression model that considers the start of B against exposure and non-exposure of A, stratified on the level of the individual histories. A correction is presented for the periods of B use, during which a new start of B cannot occur. Prescription sequence analysis is demonstrated with a set of histories of use of inhaled steroids (A) and topical oral anticandida drugs (B). A can cause oral candidiasis, B is therapy for this condition. An odds ratio of 1.43 was found for the association of A use and the initiation of therapy with B.
Administration, Inhalation↗
Channeling bias in the interpretation of drug effects.
Channeling is a form of allocation bias, where drugs with similar therapeutic indications are prescribed to groups of patients with prognostic differences. Claimed advantages of a new drug may channel it to patients with special pre-existing morbidity, with the consequence that disease states can be incorrectly attributed to use of the drug. For the study of adverse drug reactions, large databases supply information on co-medication and morbidity of patients. For diseases with a stepped-care approach, the drug history of patients, as available from some databases, can show channeling of drugs to patients with markers of relatively severe disease.
Asthma↗
[Psychoanalytic aspects of the poisoned childhood].
The primary assumption of the paper is that the destruction of the environment, in particular the physical poisoning of the human being himself, simultaneously produces a creeping psychological destruction of the subject's inner world, especially in children and youth. On the basis of Melanie Klein's theory, the fate of the mother as persecuting object is examined. Further, the generation change that can be expected through the ecological situation is worked out on the basis of Boszormenyi-Nagy and Spark's family theory concept of loyalty. Using unsystematic materials, the inner object world of the child in the face of the destroyed environment can be depicted, which in turn allows the fear of the future to be interpreted as fear of disintegration.
Child↗
[The efficacy of drug therapy in structural lesions of the hair and in diffuse effluvium--comparative double blind study].
Growth and quality of hair was studied after treatment with Pantogar, another prescription (Verum-2) and placebo for four months in 60 patients with diffuse effluvium capillorum and agnogenic structural alternations of hair. Efficacy was assessed by measurements of swelling, dye-binding and thickness for hair-quality and evaluation of hair-density and trichograms for hair-growth. Statistical analysis of swelling properties and trichogram data indicated that Pantogar was effective, the second preparation improved quality of hair and retarded hair loss. Placebo was ineffective judged by the used parameters. Tolerance of the treatment was good and adverse effects could not be substantiated.
4-Aminobenzoic Acid↗
Do prescribed drugs always follow the patients to hospital?
The reliability was measured with which out-patient medications were identified at the time of a patient's admission to a Dutch hospital. The hospital-pharmacy records and the community-pharmacy records of 205 patients have been reviewed with the help of an expert panel. We established that 15 inadvertent drug discontinuations of a serious nature occurred among 12 patients. While the results are not necessarily representative of the overall Dutch situation, they indicate errors that can be reduced. Improvement is suggested by transmission of computerized data from the community pharmacy to the hospital whenever a patient is admitted and agrees with this transmission.
Adult↗
Rapid method for estimating the risk of acutely controversial side effects of prescription drugs.
When controversy suddenly erupts about the risk of using a prescription drug, there is an urgent need for fast methods of risk estimation. Some unexpected side-effects of prescription drugs are indications for the prescribing of another kind of drug. If the risk of such a side-effect is high, it should be reflected in clustered prescribing of the side-effect-alleviating drug in sequence with the side-effect-causing drug. The risk of drug-attributable side-effects can be estimated by comparing average incidences of initial prescriptions for the side-effect-alleviating drug before, during, and long after the dispensing of the presumed side-effect-causing drug. We monitored computerized, complete drug dispensing records of anonymous outpatients for use of flunarizine, an anti-vertigo/anti-migraine drug that case reports had suggested causes mental depression and/or Parkinsonism. Among 1284 patients who eventually got flunarizine during a 31 month period, 1 in 7 was started on an anti-depressant before or long after flunarizine; only 1 in 82 might be said to have been started on an anti-depressant because of flunarizine. There was no evidence that anti-Parkinson drugs were started because of flunarizine, though the numbers are small. The analysis takes only a few days, and can help set bounds on risks of the subset of adverse drug reactions that are themselves indications for use of other drugs.
Aged↗
[Extrapyramidal movement disorders following the use of flunarizine].
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Aged↗
[A massively dilated ductus choledochus in choledocholithiasis following cholecystectomy and choledochojejunostomy].
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Adult↗
[Bloch-Sulzberger incontinentia pigmenti with associated neurologic and ophthalmologic complications].
A female infant showing linear skin lesions arranged in an irregular way with bullae, vesicles, and erythema, which had predominantly affected her extremities since her birth, was examined by us at the age of one week. Histologic and immunofluorescence findings confirmed the preliminary diagnosis of incontinentia pigmenti. Electron microscopic investigations were additionally made. In the course of the disease, we observed the characteristic development of a warty and a pigmented stage. The disease was complicated by epileptic seizures, motor disturbances, and ocular defects. EEG, CT, and ultrasound revealed anomalies. Since her mother reports on similar skin lesions during her own childhood, we suspect an X-chromosomal genetic defect.
Brain↗
Prescription sequence analysis: a new and fast method for assessing certain adverse reactions of prescription drugs in large populations.
Prescription sequence analysis (PSA) uses pharmacy-based prescription drug histories to detect a subset of drug effects: those that are themselves indications for changes in the prescribing of another drug. Dutch pharmacy practice ensures virtually complete drug histories. With a database of 25,000 patients, we used PSA to test an alleged link between the use of the anti-vertigo drug flunarizine and mental depression. The temporal sequence of anti-depressant use among flunarizine users shows no clustering that would suggest a causal link. PSA can be run within a few days, which may make it helpful in resolving certain of the periodic controversies about adverse drug reactions.
Antidepressive Agents↗
The effects of verapamil and propranolol on exercise tolerance in hypertensive patients.
In a single-blind, placebo-controlled crossover study the effects of verapamil (450 +/- 30 mg/day) and propranolol (160 +/- 20 mg/day) on endurance time during submaximal exercise were compared in eight patients with essential hypertension. The drugs were given in randomized order. Each active drug period was preceded by a placebo phase. Endurance tests were performed during both placebo periods and treatment with verapamil and propranolol by bicycle ergometry. Both drugs were equally effective in decreasing resting blood pressure. Verapamil and propranolol reduced exercise heart rate, the effect of propranolol being more pronounced. With placebo, endurance time during exercise was 57 +/- 11 minutes; with propranolol it was 32 +/- 7 minutes (P less than 0.05). Verapamil had no influence on endurance time. The study demonstrates that in contrast to propranolol, verapamil has no influence on exercise tolerance during submaximal work in patients with hypertension.
Adult↗
The effect of verapamil on cardiovascular and metabolic responses to exercise.
In a double-blind cross-over study, the effects of verapamil on the cardiovascular and metabolic changes during a progressive maximal exercise test were studied in 12 healthy volunteers. Each subject was treated with placebo and verapamil in 3 different dosages: 3 X 40, 3 X 80 and 3 X 120 mg X d-1 in random order. Drugs were administered for 2 days; on the 3rd day, 2 h after the last dose, a progressive exercise test until exhaustion was performed on a bicycle ergometer. No significant differences in maximal exercise capacity were found between the 4 groups of medication. VO2, VCO2, and VE were also unaffected by verapamil administration. Heart rate during exercise was reduced dose-dependently (p less than 0.001). With the highest dose of verapamil, maximal heart rate was reduced by 13 +/- 1 beats X min-1. No effect could be shown on parameters of carbohydrate and fat metabolism. Perceived exertion, estimated by the Borg scale, did not differ between placebo and the 3 medication groups. The study shows that despite a distinct reduction of heart rate, maximal exercise capacity remains unaffected after verapamil use.
Adult↗
Efficacy of enoxacin in the treatment of bacterial infections of the skin with regards to photosensitization.
Thirty-four patients suffering from various skin infections caused by gram-positive and gram-negative pathogens were treated with enoxacin (400 to 800 mg/day) for 8 to 14 days. A marked abatement of clinical symptoms, accompanied by eradication of the causative pathogens was observed in all 34 patients. Enoxacin was well tolerated. The minimal erythema dose of UVA light was reduced by a mean of 45% in three of the twenty patients receiving the 800 mg daily dosage of enoxacin. No positive reactions could be provoked in a subsequently applied photopatch test, allergic reactions were not observed. These mild reactions seen in a small percentage of patients appear to indicate further specific tests to determine a possible photosensitization effect of enoxacin.
Adult↗
[Therapy of ventricular arrhythmias with propafenone].
In 16 patients with angiographically-documented coronary artery disease and repetitive ventricular responses the effects of oral propafenon 300 mg t.i.d. on the continuous 24-hour ECG were analyzed in a study carried out according to a double-blind, randomized, crossover, placebo-controlled protocol. Comparisons were made for the number of couplets (Lown IVa) and ventricular tachycardias (Lown IVb) as well as the overall incidence of ventricular premature beats during the two last days of a five-day placebo phase and on the second and third day of treatment with propafenon. In 15 further patients with electrocardiographically-documented sustained ventricular tachycardias, the effect of intravenous propafenon (1.5 mg/kg in three minutes) was also investigated. Repeat electrophysiologic studies were performed in eight of the 15 patients after two to 13 days of continuous treatment with oral propafenon 300 mg t.i.d. The stimulation protocol incorporated delivery of a maximum of four extra stimuli during sinus rhythm and during apical right ventricular stimulation at each of four basic intervals (600, 500, 400 and 330 ms) as well as burst stimulation with intervals between 300 and 250 ms. Stimulation was terminated after induction of sustained ventricular tachycardia. In patients in whom ventricular tachycardia could be induced prior to medication with one or two stimuli, after propafenon no more than two extra stimuli were applied. As compared with placebo, propafenon led to a more than 90% reduction in couplets in 56% of the patients and in 64% of the patients there was a complete suppression of ventricular tachycardia.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗