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Biomedical subjects

P Herbison

Publications and source records attributed to P Herbison.

At least 19 recordsLinked to original sources
PubMed2006

Anticholinergic drugs versus placebo for overactive bladder syndrome in adults.

BACKGROUND: Around 16% of adults have symptoms of overactive bladder (urgency with frequency and/or urge incontinence). The prevalence increases with age. Anticholinergic drugs are commonly used to treat this condition. OBJECTIVES: To determine the effects of anticholinergic drugs for the treatment of overactive bladder syndrome. SEARCH STRATEGY: We searched the Cochrane Incontinence Group Specialised Trials Register (searched 14 June 2005) and the reference lists of relevant articles. SELECTION CRITERIA: Randomised or quasi-randomised trials in adults with overactive bladder syndrome that compared an anticholinergic drug with placebo treatment or no treatment. DATA COLLECTION AND ANALYSIS: Two reviewer authors independently assessed eligibility, trial quality and extracted data. Data were processed as described in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2005). MAIN RESULTS: Sixty -one trials, 42 with parallel-group designs and 19 crossover trials were included (11,956 adults). Most trials were described as double-blind but were variable in other aspects of quality. The crossover trials did not present data in a way that allowed inclusion in the meta-analysis. Nine medications were tested: darifenacin; emepronium bromide or carrageenate; oxybutynin; propiverine; propantheline; tolterodine; trospium chloride; and solifenacin. One trial included the newer, slow release formulation of tolterodine. At the end of the treatment period, cure or improvement (relative risk (RR) 1.39, 95% CI 1.28 to 1.51), difference in leakage episodes in 24 hours (weighted mean difference (WMD) -0.54; 95% CI -0.67 to -0.41) and difference in number of voids in 24 hours (WMD -0.69; 95% CI -0.84 to -0.54) were statistically significant favouring medication. Statistically significant but modest sized improvements in quality of life scores were reported in recently completed trials. There was three times the rate of dry mouth in the medication group (RR 3.00 95% CI 2.70 to 3.34) but no statistically significant difference in withdrawal (RR 1.11, 95% CI 0.91 to 1.36). Sensitivity analysis, while limited by small numbers of trials, showed little likelihood that the effects were modified by age, sex, diagnosis, or choice of drug. AUTHORS' CONCLUSIONS: The use of anticholinergic drugs by people with overactive bladder syndrome results in statistically significant improvements in symptoms. Recent trials suggest that this is associated with modest improvement in quality of life. Dry mouth is a common side effect of therapy but did not seem to have an effect on the numbers of withdrawals. It is not clear whether any benefits are sustained during long-term treatment or after treatment stops.

Adult↗
PubMed2006

Risk of herpes simplex virus type 2 acquisition increases over early adulthood: evidence from a cohort study.

UNLABELLED: DESIGN/ SETTING: A cohort study of 1037 people born in Dunedin, New Zealand, in 1972 or 1973. PARTICIPANTS: At assessment at age 32 years, 884 participants (432 women and 452 men; 87.1% of the surviving cohort) provided both sera and information on sexual behaviour. MAIN OUTCOME MEASURES: The proportion of participants with antibodies to HSV-2 infection at ages 26 and 32 years was measured, and the incidence rates from first coitus to age 26 years and from age 26 to 32 years calculated, adjusting for the number of sexual partners and same-sex contact in these age periods. RESULTS: At age 32 years, 14.6% of men and 22.5% of women had antibodies to HSV-2. The incidence rates for men and women from first coitus to age 26 years were, respectively, 6.5 and 14.3 per 1000 person-years. The incidence rates for men and women from age 26-32 years, respectively, were 14.3 and 15.8 per 1000 person-years. When adjusted for sexual behaviour, the incidence rate ratio, comparing the older with the younger age periods, was 2.9 (95% confidence interval (CI) 1.7 to 4.9) for men and 2.0 (1.2 to 3.4) for women. The adjusted incidence rate ratio when comparing women to men from first coitus to age 26 years was 2.5 (1.6 to 4.0), and from age 26-32 years was 1.3 (0.78 to 2.2). A test for interaction indicated that men and women had different patterns of incidence over time (p = 0.039). CONCLUSION: In the general population, the risk of acquiring HSV-2 infection seems to increase with age at least to the early 30s, and differences in risk of acquisition for women compared with men become less with age. Health promotion and treatment to control HSV-2 infection should be aimed at all ages, not just at the young.

Adult↗
PubMed2006

Laparoscopic colposuspension and tension-free vaginal tape: a systematic review.

BACKGROUND: Advances in surgical techniques have led to the availability of a number of minimal-access procedures to treat urodynamic stress incontinence (USI). These procedures have been individually compared with the 'gold standard' open Burch colposuspension; however, it now seems appropriate to compare like with like and compare these minimal-access techniques with each other. OBJECTIVES: To determine the effectiveness of laparoscopic colposuspension with tension-free vaginal tape (TVT) for the treatment of USI. SEARCH STRATEGY: Randomised trials in woman with USI, which compared laparoscopic colposuspension with TVT in the arms of the trial, were identified from the Cochrane Incontinence Review Group's Specialised Register of Controlled Trials. SELECTION CRITERIA: The trials were evaluated for methodological quality and appropriateness for inclusion by the reviewers using the Incontinence Group's assessment criteria. DATA COLLECTION AND ANALYSIS: The data were extracted independently, and when appropriate, meta-analysis was undertaken to calculate pooled estimates and their confidence intervals (CI). The main outcomes measured were: subjective cure, objective cure, quality of life (QoL) measurements, surgical outcomes and health economic measures. MAIN RESULTS: Seven trials compare laparoscopic colposuspension (n= 264) with TVT (n= 290). There was no statistically significant difference in the reported subjective cure rate between laparoscopic colposuspension and TVT within 18 months (relative risk [RR] 1.12, 95% CI 0.98-1.29). However, within the same time period, the overall objective cure rate was statistically significantly higher for TVT (RR 1.16, 95% CI 1.07-1.25). There were no significant differences between the two procedures with regards to perioperative complication, de novo detrusor overactivity, voiding dysfunction, procedural costs and QoL scores. However, TVT procedure is quicker to perform and has a shorter hospital stay. CONCLUSIONS The evidence so far appears to be in favour of the TVT as the minimal-access technique of choice for USI in comparison with laparosopic colposuspension; however, long-tem data are needed. Further well-designed trials with standardized outcomes are required to draw accurate conclusions from this comparison.

Colposcopy↗
PubMed2005

Which anticholinergic drug for overactive bladder symptoms in adults.

BACKGROUND: Around 16% to 45% of adults have overactive bladder symptoms (urgency with frequency and/or urge incontinence - 'overactive bladder syndrome'). Anticholinergic drugs are common treatments. OBJECTIVES: To compare the effects of different anticholinergic drugs for overactive bladder symptoms. SEARCH STRATEGY: We searched the Cochrane Incontinence Group specialised trials register (searched 17 January 2002) and reference lists of relevant articles. A search for full publications of abstracts identified in January 2002 was completed in July 2003. SELECTION CRITERIA: Randomised trials in adults with overactive bladder symptoms or detrusor overactivity that compared one anticholinergic drug with another, or two doses of the same drug. DATA COLLECTION AND ANALYSIS: Two authors independently assessed eligibility, trial quality and extracted data. Data were processed as described in the Cochrane Reviewers' Handbook. MAIN RESULTS: Forty nine trials, 39 parallel and 10 cross-over designs were included (11,332 adults). Most trials were described as double-blind, but were variable in other aspects of quality. Crossover studies did not present data in a way that could be included in the meta-analysis.Four trials collected quality of life data (the primary outcome measure) using validated measures; none reported useable data. Oxybutynin versus tolterodine: There were no statistically significant differences for patient perceive improvement, leakage episodes or voids in 24 hours, but fewer withdrawals due to adverse events (RR 0.57, 95% CI 0.43 to 0.75), and less risk of dry mouth (RR 0.60, 95% CI 0.54 to 0.66), with tolterodine. Different doses tolterodine: The usual recommended starting dose (2 mg twice daily) was compared with two lower (0.5 mg and 1 mg twice daily), and one higher dose (4 mg twice daily). The effect of 1 mg, 2 mg and 4 mg doses was similar for leakage episodes and micturitions in 24 hours, with greater risk of dry mouth with 2 and 4 mg doses.Extended versus immediate release preparations of oxybutynin and/or tolterodine: There were no statistically significant differences for cure/improvement, leakage episodes or micturitions in 24 hours, or withdrawals due to adverse events, but there were few data. Overall, extended release preparations had less risk of dry mouth. One extended release preparation versus another: There was less risk of dry mouth with oral extended release tolterodine than oxybutynin (RR 0.75, 95% CI 0.59 to 0.95), but no difference between transdermal oxybutynin and oral extended release tolterodine although some people withdrew due to skin reaction at the trandermal patch site. AUTHORS' CONCLUSIONS: Where the prescribing choice is between oral immediate release oxybutynin or tolterodine, tolterodine might be preferred for reduced risk of dry mouth. With tolterodine, 2 mg twice daily is the usual starting dose, but a 1 mg twice daily dose might be equally effective with less risk of dry mouth. If extended release preparations of oxybutynin or tolterodine are available, these might be preferred to immediate release preparations because there is less risk of dry mouth. There is little or no evidence available about quality of life, costs, or long-term outcome in these studies. There were insufficient data from trials of other anticholinergic drugs to draw any conclusions.

Adult↗
PubMed2005

The influence of context on students' approaches to learning: a case study.

This paper gives an account of a small-scale longitudinal study that examined changes in conceptions and approaches to learning as 14 students experience a problem-based learning (PBL) curriculum for the first time. The course in oral biology aimed to encourage conceptual understanding of the topic and improve student learning through its PBL curriculum and assessment method. Those who entered the course with a surface approach and fragmented conception of learning left with a deep-learning approach, cohesive conception and quality learning outcomes. There were no observable changes in the students who started the course with a deep-learning approach and cohesive conception, except for two who reported surface approaches and fragmented conceptions at the end. These two students also achieved the lowest examination scores. To help explain these findings we examine the wider context for student learning including student motivation.

Attitude↗
PubMed2004

Otago Glaucoma Surgery Outcome Study: long term results of cataract extraction combined with Molteno implant insertion or trabeculectomy in primary glaucoma.

BACKGROUND/AIMS: To describe the long term results of cases of cataract extraction combined with either Molteno implant insertion or trabeculectomy for primary open angle glaucoma. METHODS: This prospective case series followed cases which had cataract extraction and Molteno implant insertion (45 eyes) or trabeculectomy (94 eyes) followed up for a mean of 5.3 years and 3.9 years respectively. RESULTS: Cataract extraction and Molteno implant insertion or trabeculectomy controlled the intraocular pressure at 21 mmHg or less with a probability of 1.00 (95% CI 0.93 to 1.00) at 10 years or more after operation and 0.94 (95% CI 0.89 to 0.99) and 0.73 (95% CI 0.46 to 0.99) at five and 10 years after operation respectively. CONCLUSIONS: Cataract extraction combined with insertion of Molteno implants or trabeculectomy controlled the intraocular pressure in 100% (45/45) and 94% (88/94) of cases respectively.

Aged↗
PubMed2004

A randomized crossover trial of tenoxicam compared with rofecoxib for postoperative dental pain control.

Two non-steroidal anti-inflammatory drugs, tenoxicam and rofecoxib, were compared for the control of postoperative pain following surgical extraction of bilaterally and symmetrically impacted wisdom teeth performed under intravenous sedation and local anaesthesia. Thirty-five young fit adult patients received each analgesic treatment for four days in a randomized, crossover design. The results suggest statistically better pain relief for the selective COX-2 inhibitor rofecoxib compared to tenoxicam, a traditional NSAID. There were side-effects with both treatments. Abdominal discomfort was significantly more common following rofecoxib compared to tenoxicam. Both analgesics were acceptable to most participants in the trial.

Adolescent↗
PubMed2003

Effect of X-ray beam angulation and intraradicular contrast medium on radiographic interpretation of lower first molar root canal anatomy.

AIMS: To compare evaluator radiographic interpretation of noncontrasted and contrasted root canal anatomy on radiographs taken at a 0 or 30 degrees mesial angle to the orthoradial orientation. METHODOLOGY: Pulp tissue was removed from 20 mandibular first molar teeth using NaOCl irrigation and hand files. Standardized radiographs at 0 and 30 degrees angulation were obtained of each tooth positioned in a dried mandible. Contrast medium (iohexol) was injected passively into the canals and a second pair of corresponding radiographs was obtained. A third pair of radiographs was taken after infusing canals under vacuum with contrast medium. Using set criteria, three evaluators assessed the canal anatomy of the mesial root on radiographs: (i) the number of visible canals, (ii) whether the canal(s) was visible along the entire length of the root, (iii) the location of the canal terminus in relation to the radiographic apex, (iv) configuration of canal(s), (v) level of multiple canals merging and (vi) the presence of lateral canals. The teeth were then cleared for visual assessment. The data were compared using logistic regression and the intra- and interevaluator reliability assessed with the Kappa test. RESULTS: Noncontrasted 0 degrees images were significantly better (P < 0.05) than noncontrasted 30 degrees images for detecting the number of visible canals, whether the canal(s) was visible along the entire length of the root, the location of the canal terminus in relation to the radiographic apex and level of multiple canals merging. The 0 degrees images contrasted by vacuum or passive injection were significantly better (P < 0.05) than 30 degrees images only for assessing whether the canal(s) was visible along the entire length of the root, whilst the 0 degrees image contrasted by passive injection was also better (P < 0.05) at assessing the location of the canal terminus in relation to the radiographic apex. At 30 degrees, contrast medium passively or vacuum introduced improved (P < 0.05) the detection of the number of visible canals, whether the canal(s) was visible along the entire length of the root and configuration of canal(s), whilst vacuum also improved (P < 0.05) the location of the canal terminus in relation to the radiographic apex. Overall, there was no significant difference (P > 0.05) between images contrasted by passive injection or vacuum. CONCLUSIONS: Under the conditions of this study, conventional radiographs taken at a 0 degrees orientation provided more information than 30 degrees radiographs. Contrast medium improved radiographic interpretation of canal anatomy, especially when used with 30 degrees radiographs.

Contrast Media↗
PubMed2002

Interventions for relieving the pain and discomfort of screening mammography.

BACKGROUND: Pain of mammography is recognised as a significant deterrent to breast screening and therefore may effect the success or failure of any screening programme. OBJECTIVES: To review research of interventions related to any aspect of breast screening to reduce or relieve the pain and discomfort of screening mammography. SEARCH STRATEGY: The Cochrane Breast Cancer Group conducted a search of their specialised register in the Cochrane Library. In addition a wide variety of databases and websites were searched using keywords 'mammography' and 'pain', along with handsearching selected journals. Information was requested from a wide range of interested people and organisations. SELECTION CRITERIA: Randomised controlled trials and non-randomised trials with a comparison group were considered. Studies had to include assessment of both pain and quality of mammograms. DATA COLLECTION AND ANALYSIS: Identified studies were independently reviewed by two reviewers to determine if they met the inclusion criteria. Additional information was sought from investigators as necessary. Each study was reviewed for quality, including concealment of the allocation sequence, generation of the allocation sequence, comparability between groups at the baseline, inclusion of all randomised participants in the analysis and blinding after allocation. MAIN RESULTS: Three RCTs were identified for inclusion. A well designed study found that patient controlled breast compression gave a significant reduction in discomfort. However, the quality of mammograms was only maintained if the technologist controlled the first compression. Another study involved the technologist reducing compression force for one view. This study was poorly designed and showed no significant differences. The result was the same in a well designed study of the use of acetoaminophen as a premedication. The differences in interventions, and the inconsistency in measures and validation of pain scales and assessment of quality of mammograms, mean that the results of the studies cannot be combined. REVIEWER'S CONCLUSIONS: The only intervention suggesting significant reduction in the pain and discomfort was of patient controlled compression. Further research is required to determine if these findings can be replicated. Reducing technologist applied compression force did not result in significant reduction in pain suggesting that more than actual compression force is involved in pain and discomfort. However, the poor design of this study could have influenced the results. Premedication with acetoaminophen has no effect on the pain of mammography. More research into interventions to reduce the pain of mammography is needed if this is to continue as the preferred screening method in the detection of breast cancer.

Acetaminophen↗
PubMed2002

Physical therapies for prevention of urinary and faecal incontinence in adults.

BACKGROUND: Physical therapies, particularly pelvic floor muscle training, have been recommended for prevention of incontinence associated with childbearing, and prostate surgery. OBJECTIVES: To assess the effectiveness of physical therapies in preventing incontinence in adults. SEARCH STRATEGY: The Cochrane Incontinence Group trials register was searched to September 2001. Trials were also sought from the Reference Lists of relevant articles and from experts in the field. SELECTION CRITERIA: Randomised and quasi-randomised trials in adults without incontinence symptoms that compared a physical therapy with no treatment, or any other treatment to prevent incontinence. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed eligibility, trial quality and extracted data. Data were processed as described in the Cochrane Collaboration Handbook. MAIN RESULTS: Two trials in men (155 men) and 13 trials in women (4661 women) were included. As most trials recruited regardless of continence status, and there was much heterogeneity, only a qualitative synthesis was undertaken. Three of seven trials in childbearing women reported less urinary incontinence after pelvic floor muscle training compared to control treatment three months postpartum. Two trials selected women at higher risk of postnatal incontinence. The third used an intensive training programme. Four trials did not find any difference between the groups at the primary endpoint. Two trials compared pre-prostate surgery pelvic floor muscle training with control treatment, and no difference in the occurrence of postoperative urinary incontinence was reported between the groups. REVIEWER'S CONCLUSIONS: There is insufficient evidence to determine whether physical therapies can prevent incontinence in childbearing women, or men following prostate surgery. Further, better quality research is needed.

Adult↗
PubMed2002

Anticholinergic drugs versus placebo for overactive bladder syndrome in adults.

BACKGROUND: Around 16% of adults have symptoms of overactive bladder (urgency with frequency and/or urge incontinence). The prevalence increases with age. Anticholinergic drugs are commonly used to treat this condition. OBJECTIVES: To determine the effects of anticholinergic drugs for the treatment of overactive bladder syndrome. SEARCH STRATEGY: The Cochrane Incontinence Group trials register was searched to January 2002. SELECTION CRITERIA: Randomised or quasi-randomised trials in adults with overactive bladder syndrome that compared an anticholinergic drug with placebo treatment or no treatment. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed eligibility, trial quality and extracted data. Data were processed as described in the Cochrane Collaboration Handbook. MAIN RESULTS: Fifty one trials, 32 parallel designs and 19 crossover designs were included (6713 adults). Most trials were described as double-blind, but were variable in other aspects of quality. The crossover trials did not present data in a way that allowed inclusion in the meta-analysis. Seven medications were tested: darifenacin; emepronium bromide or carrageenate; oxybutynin chloride; propiverine; propantheline; tolterodine; and trospium chloride. One trial included the newer, slow release, formulation of tolterodine. After treatment, cure/improvement (RR 1.41, 95%CI 1.29 to 1.54), changes in leakage episodes in 24 hours (WMD -0.56, 95%CI -0.73 to -0.39), number of voids in 24 hours (WMD -0.59, 95%CI -0.83 to -0.36), maximum cystometric volume (WMD 53.85 ml, 95%CI 42.28 to 65.41), and volume at first contraction (WMD 52.25 ml, 95%CI 37.45 to 67.06), were significantly in favour of medication. Medication was associated with significantly higher residual volumes (WMD 4.06 ml, 95%CI 0.73 to 7.39) and more than two and a half times the rate of dry mouth (RR 2.61, 95% CI 2.27 to 3.00). Sensitivity analysis, while limited by small numbers of trials, showed little likelihood that these effects were modified by age, sex, diagnosis, or choice of drug. REVIEWER'S CONCLUSIONS: The use of anticholinergic drugs by people with overactive bladder syndrome results in statistically significant improvement in symptoms. However, the clinical significance of these differences is uncertain, and the longer-term effects are not known. Dry mouth is a common side effect of therapy.

Adult↗
PubMed2002

Bladder neck mobility and urethral closure pressure as predictors of genuine stress incontinence.

Two hundred and seventy-five consecutive patients with symptoms of lower urinary tract dysfunction underwent urodynamic evaluation, including multichannel urodynamics, urethral pressure profilometry, X-ray and ultrasound imaging. After women with previous incontinence or prolapse surgery or pelvic radiotherapy and those with evidence of urethral kinking on ultrasound had been excluded, 179 datasets were analyzed. Both bladder neck descent ( P<0.0001) and maximum urethral closure pressure ( P<0.0001) were strongly associated with a fluoroscopic diagnosis of GSI. Only weak correlations between bladder neck mobility and urethral pressure parameters (highest r = -0.17) were observed. Regression analysis yielded a mathematical model that demonstrated a wide spread of odds ratios for GSI for the measured values (from <0.2 to >100). Bladder neck descent explained 29% and urethral closure pressure 12% of overall variability. Both bladder neck mobility and maximum urethral closure pressure are strong predictors of the diagnosis of GSI, provided major confounders are excluded. Bladder neck mobility appears to be the stronger predictor.

Female↗
PubMed2002

Sumatriptan challenge in bipolar patients with and without migraine: a neuroendocrine study of 5-HT1D receptor function.

An association between bipolar disorder and migraine has been lately recognized and an abnormality of central serotonergic function is suggested as the underlying neurophysiological disturbance. To examine the role of serotonin in bipolar disorder and migraine, we used the neuroendocrine challenge paradigm, and we chose sumatriptan, a 5HT1D agonist, as the pharmacological probe. We studied nine bipolar patients with migraine, nine bipolar patients without it, seven migraine patients, and nine matched normal controls. A post-hoc analysis showed subsensitivity of serotonergic function, reflected in a blunted growth hormone response to sumatriptan challenge in bipolar patients who also suffered from migraine.

Adult↗
PubMed2002

Long term follow up of bone derived hydroxyapatite orbital implants.

AIMS: To document the long term experience of bone derived hydroxyapatite orbital implants and compare results using scleral wrapped implants with those not using sclera. METHODS: This retrospective case series reviewed the long term follow up of 118 patients with 120 eyes which had undergone enucleation and bone derived hydroxyapatite orbital implant insertion at Dunedin Hospital from 1977 until 2000. Patient details were obtained from theatre records, case note review, patient interview and examination, interview of patient relatives, and family general practitioner records. RESULTS: Of the 120 eyes 84 had bone derived hydroxyapatite orbital implants with sclera and 36 without sclera. Follow up was 0.5-25 years (mean 8.9 years). 25 (19.3%) suffered minor complications of limited exposure of the implant which resolved spontaneously, with implant drilling or wound resuture. Nine (7.5%) suffered major complications requiring explantation. Major complications were more likely in cases with major tissue disruption, ischaemia, or inflammation. There were significantly fewer complications in the group where a bone derived hydroxyapatite orbital implant was implanted without a scleral covering (p<0.05). CONCLUSIONS: The placement of a bone derived hydroxyapatite orbital implant in the socket was associated with a low rate of long term complications and good cosmesis in most cases. The omission of a scleral covering over the hydroxyapatite sphere had some advantages and may prove to be the procedure of choice.

Adolescent↗
PubMed2002

Anti-inflammatory fibrosis suppression in threatened trabeculectomy bleb failure produces good long term control of intraocular pressure without risk of sight threatening complications.

AIMS: To determine the long term outcome of systemic anti-inflammatory fibrosis suppression in cases of threatened trabeculectomy bleb failure in open angle glaucoma. METHODS: This prospective non-comparative case series followed 77 eyes of 63 patients which showed signs of threatened early bleb failure and were treated with oral anti-inflammatory fibrosis suppression of prednisone, a non-steroidal anti-inflammatory agent, and colchicine taken for a mean period of 6 weeks, in addition to standard postoperative topical treatment, for a mean follow up of 6 years. RESULTS: Trabeculectomy with anti-inflammatory fibrosis suppression controlled the IOP at < or =21 mm Hg with a probability of 0.91 (95% CI: 0.81 to 1.0) at 8 years and 0.89 (95% CI: 0.56 to 1.1) at 12 years. There were no reported cases of endophthalmitis, hypotonous maculopathy, late bleb leak, or serious systemic side effects. CONCLUSION: Anti-inflammatory fibrosis suppression provided good control of bleb fibrosis without risk of sight threatening complications in a patient group at high risk of bleb failure.

Adult↗
PubMed2002

Exhaled NO and assessment of anti-inflammatory effects of inhaled steroid: dose-response relationship.

Exhaled nitric oxide (eNO) is an easily measured marker of airway inflammation. This study was undertaken to evaluate the usefulness of serial eNO in investigating the dose-response relationship for inhaled beclomethasone (BDP), and to compare eNO with other markers of airway inflammation. Following withdrawal of inhaled corticosteroid (ICS) therapy, 65 patients entered a double-blind, parallel-group, placebo-controlled trial of 50, 100, 200 or 500 microg x BDP x day(-1) for eight weeks. eNO and spirometry were performed weekly and a hypertonic saline challenge with sputum induction was performed at the beginning and end of treatment. The relationship between the dose of ICS and changes in eNO and forced expiratory volume in one second (FEV1) was linear at 1 week and at the end of treatment. A linear dose-response relationship was also seen for sputum eosinophils. Changes in eNO correlated significantly with changes in sputum eosinophils. Changes in the provocative dose of saline causing a 15% fall in FEV1 saline did not differ across the treatment groups nor did they correlate with changes in other measurements. Exhaled nitric oxide may be used to assess the dose-response relationship for the anti-inflammatory effects of inhaled beclomethasone. The relationship found in this study was linear over the dose range 0-500 microg x day(-1) soon after commencing therapy and continued over time.

Administration, Inhalation↗
PubMed2001

Health of farmers in southland: an overview.

AIM: To describe the health of farmers in Southland. METHODS: Coss-sectional study of a random sample of farmers in Southland. RESULTS: 586 individuals were interviewed from 286 farms with a response rate of 65.4%. The prevalence of at least one injury in the last twelve months which prevented normal farm work was 17.1%. Low back pain was common with 54.6% reporting such an episode in the last twelve months. Noise-induced hearing loss was prevalent among men with 28.7% of those 45 years and over being affected. Levels of asthma appeared low with a point prevalence of 6.8%, with 4.6% on medication. There were 19.3% of male farmers who were obese. The prevalence of alcohol use disorder among men aged 15-24 years was 57.4%, and 39.0% among farm workers. Similarly, 32.0% of men in this age-group smoked, with 35.6% of farm workers being smokers. CONCLUSIONS: Farmers experienced high levels of injury, low back pain and noise-induced hearing loss. Community intervention programmes to prevent injury remain a priority for farmers, although lifestyle factors should also be addressed, particularly among farm workers.

Adolescent↗