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Biomedical subjects

J Strobl

Publications and source records attributed to J Strobl.

9 recordsLinked to original sources
PubMed2006

Antidepressants for depressed elderly.

BACKGROUND: Depression is a relatively common experience in older adults. The syndrome is associated with considerable distress, morbidity and service commitment. Approximately two thirds of patients presenting with severe forms will respond to antidepressant treatment and the last twenty years has witnessed a great increase in the number of these drugs. Older, frail people are particularly vulnerable to side effects. OBJECTIVES: The aims of this review were to examine the efficacy of antidepressant classes, to compare the withdrawal rates associated with each class and describe the side effect profile of antidepressant drugs for treating depression in patients described as elderly, geriatric, senile or older adults, aged 55 or over. SEARCH STRATEGY: The Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (CCDANCTR-Studies) was searched (2003-08-13). Reference lists of relevant papers and previous systematic reviews were hand searched for published reports and citations of unpublished studies. SELECTION CRITERIA: Only randomised controlled trials were included. Trials had to compare at least two active antidepressant drugs in the treatment of depression. DATA COLLECTION AND ANALYSIS: Reviewers extracted data independently. In examining efficacy, the reviewers assumed that people who died or dropped out had no improvement. Withdrawal rates irrespective of cause and specifically due to side effects were compared between drug classes. Relative risk (RR) for dichotomous data and weighted mean difference for continuous data were calculated with 95% confidence intervals (CI). Qualitative side effect data were reported in terms of ratios of side effects and percentage of patients experiencing specific side effects. MAIN RESULTS: A total of 29 trials provided data for inclusion in the review. We were unable to find any differences in efficacy when comparing classes of antidepressants. However, as the trials contained relatively small numbers of patients, these findings may be explained by a type two error. Tricyclic antidepressants (TCAs) compared less favourably with selective serotonin reuptake inhibitors (SSRIs) in terms of numbers of patients withdrawn irrespective of reason (RR: 1.24, CI 1.04, 1.47) and number withdrawn due to side effects (RR: 1.30, CI 1.02, 1.64). Subgroup analyses demonstrated that TCA related antidepressants had similar withdrawal rates to SSRIs irrespective of reason of withdrawal (RR: 1.49, CI 0.74, 2.98) or withdrawal due to side effects (RR: 1.07, CI 0.43, 2.70). The qualitative analysis of side effects showed a small increased profile of gastro-intestinal and neuropsychiatric side effects associated with classical TCAs. AUTHORS' CONCLUSIONS: Our findings suggest that SSRIs and TCAs are of the same efficacy. However, we have found some evidence suggesting that TCA related antidepressants and classical TCAs may have different side effect profiles and are associated with differing withdrawal rates when compared with SSRIs. The review suggests that classical TCAs are associated with a higher withdrawal rate due to side effect experience, although these results must be interpreted with caution due to the relatively small size of the review and the heterogeneity of the drugs and patient populations.

Aged↗
PubMed2004

Newer hypnotic drugs for the short-term management of insomnia: a systematic review and economic evaluation.

OBJECTIVES: To assess the clinical and cost-effectiveness of zaleplon, zolpidem and zopiclone (Z-drugs) compared with benzodiazepines. DATA SOURCES: Electronic databases, reference lists of retrieved articles and pharmaceutical company submissions. REVIEW METHODS: Randomised controlled trials (RCTs) that compared either benzodiazepines to the Z-drugs or any two of the non-benzodiazepine drugs in patients with insomnia were included in the review. Data on the following outcome measures were considered: sleep onset latency, total sleep duration, number of awakenings, quality of sleep, adverse effects and rebound insomnia. A search was also undertaken for any study designs that evaluated issues related to adverse events (e.g. dependency and withdrawal symptoms). Full economic evaluations that compared two or more options and considered both costs and consequences including cost-effectiveness, cost-utility analysis or cost-benefit analysis undertaken in the context of high-quality RCTs were considered for inclusion in the review. RESULTS: Twenty-four studies, involving a total study population of 3909 patients, met the inclusion criteria. These included 17 studies comparing a Z-drug with a benzodiazepine and seven comparing a Z-drug with another Z-drug. The diversity of possible comparisons and the range of outcome measures in the review may be confusing. Outcomes were rarely standardised and, even when reported, differed in interpretation. In addition, variations in assessment and variety in the level of information provided make study comparisons difficult. As a result, meta-analysis has been possible on only a small number of outcomes. However, some broad conclusions might be reached based on the limited data provided. The existing published economic literature in this area is very limited. No relevant economic evaluations were identified for inclusion in the review. The industry submissions did not include detailed evidence of cost-effectiveness. Given the lack of robust clinical evidence, no economic model describing the costs and benefits of the newer hypnotic drugs for insomnia was developed. The systematic review provided in this report suggests that an agnostic approach to cost-effectiveness is required at this stage. In the short-term, no systematic evidence is available concerning significant outcome variations between either the different classes of drugs or between individual drugs within each class. Within this short-term horizon, the one element that does vary significantly is the acquisition cost of the individual drugs. CONCLUSIONS: The short-acting drugs seem equally effective and safe with minor differences that may lead a prescriber to favour one over another in different patients. There is no evidence that one is more cost-effective than any other. Analysis of the additional costs to the NHS, depending on the rate of change from benzodiazepine prescriptions to Z-drug prescriptions, at current levels of hypnotic prescribing, range from GBP2 million to GBP17 million per year. There are clear research needs in this area; in particular, none of the existing trials adequately compare these medications. It is suggested that further consideration should be given to a formal trial to allow head-to-head comparison of some of the key drugs in a double-blind RCT lasting at least 2 weeks, and of sufficient size to draw reasonable conclusions. We would also recommend that any such trial should include a placebo arm. It should also collect good-quality data around sleep outcomes and in particular quality of life and daytime drowsiness. We do not believe that any formal study of risk of dependency is feasible at present. Finally, the management of long-term insomnia is suggested for further investigation: considering the frequency of this symptom and its recurring course, the short-term trial of medication and lack of long-term follow-up undermine attempts to develop evidence-based guidelines for the use of hypnotics in this condition, or indeed for its whole management.

Adult↗
PubMed1999

[Genotoxicity of stack gas condensates of Bavarian waste incineration plants. I. Stack gas condensate--sample collection techniques].

Investigations into the toxicity and the chemical analytics of stack gas condensates from 21 waste incineration plants (locations in Bavaria) were undertaken in the years 1990 to 1995. A decisive prerequisite was the development of a simple, standardizable technique for sample collection. It was done by condensating stack gases at 0 to 5 degrees C in an intensive glass condensator. Certain types of compounds showed a different behaviour of separation at the temperatures which were used. Whereas bivalent ionic mercury and chlorophenols were comparatively well separated with amounts of 60 to 95% and the polychlorinated dioxins, furans and biphenyls (PCBs) were sufficiently separated with 20 to 60%, less than 10% of the chlorobenzenes and polycyclic aromatics (PAHs) were found in the condensates. Sufficiently sensitive biological test procedures must be chosen for a biomonitoring of the condensates on geno- and immunotoxic effects to keep the required quantity of the condensates within practicable limits. The concentration of organic wastes was done through a solid phase extraction for the genotoxicity testing in the period from 1990 to 1991, and uniformly through a dichloromethane extraction for the biological and the simultaneous chemical analytical investigations from 1992 to 1995.

Air Pollutants↗
PubMed1998

Qualified nurse smokers' attitudes towards a hospital smoking ban and its influence on their smoking behaviour.

This study explored the effects of a complete smoking ban in a large British teaching hospital on nurses' smoking behaviour and their attitudes and views on the current policy and compliance with it. Questionnaires were distributed to a convenience sample of nurse smokers and ex-smokers 9 months after the introduction of the smoking ban. A response rate of 64.7% (n = 33) was achieved. The reported reduction in work-time cigarette consumption following the ban was not statistically significant (Wilcoxon test: P = 0.069). No reduction outside work was recorded. Six (21.4%) smokers claimed that the ban had been a reason for them to try to give up smoking. Two of three ex-smokers reported that the ban had played a role in their giving up. The respondents showed considerable agreement with their health educator and role model function. Support for the policy was, however, very limited and compliance with it was reported to be poor among patients as well as staff. Twenty (76.9%) of current smokers indicated their wish to give up, 11 (39.3%) of them believed their own determination to be an effective way to achieve this. These results would seem to indicate that smoking policies currently have limited impact on smoking behaviour. It is suggested that in future policies should aim at strengthening nurses' determination to give up as well as secure their support for the restrictions in order to assist them in changing their smoking behaviour.

Attitude to Health↗
PubMed1989

[Tumor markers in malignant choroid melanoma].

Antibodies against tumor-associated antigens ("tumor markers") can be used for the diagnosis of malignant tumors. Eight different monoclonal antibodies, that can recognize tumor-associated antigens of dermal melanomas, were tested in cryostat sections of uveal melanomas. The uveal melanomas showed antigenic differences (e.g., gangliosides) and common antigens (e.g. high molecular weight melanoma-associated antigen) in comparison to dermal melanomas. The implications of these results for diagnosing and even treating uveal melanomas are discussed.

Alkaline Phosphatase↗
PubMed1988

Extinction of growth hormone expression in somatic cell hybrids involves repression of the specific trans-activator GHF-1.

Growth hormone (GH) expression in pituitary-derived cells has been attributed to the presence of a positive trans-activator, GHF-1, which binds to two sites on the GH promoter. Somatic cell hybridization of non-GH-expressing L cells with pituitary-derived GH3 cells usually results in extinction of GH production. While previous studies showed that extinction occurs at the level of GH transcription, the exact mechanism remained elusive. We therefore characterized two parental cell lines and three hybrids, two of which extinguish GH expression and one in which GH is reexpressed after loss of mouse chromosomal material. Using in vivo transfections, in vitro transcription, DNAase I footprints, and immunoblotting experiments, no evidence for a direct repressor of GH transcription was found. Rather, extinction of GH expression in fibroblast x pituitary hybrids was accompanied by loss of GHF-1 protein and mRNA expression, suggesting that extinction occurs by repression of this trans-activator.

Animals↗