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Biomedical subjects

T Strasser

Publications and source records attributed to T Strasser.

At least 19 recordsLinked to original sources
PubMed1998

Hypertension: the East European experience.

Some differences (and similarities) between Eastern Europe and the rest of the Continent are presented regarding the treatment of hypertension. Based on data from the WHO Monitoring Trends and Determinants in Cardiovascular Diseases (MONICA) study, the prevalence of hypertension, and the proportion of uncontrolled hypertension, is clearly higher in Eastern Europe. According to one local long-term observer, a trend for further increases in prevalence is discernable. Comparative drug consumption studies are desirable. Regarding national experiences with hypertension and health care in general, there are also some important sociocultural differences; anecdotal observations are reported that support this assertion.

Antihypertensive Agents↗
PubMed1996

Assessing the quality and effects of hypertension control in populations.

The objectives of hypertension control include early detection, treatment and prevention of blood pressure (BP) elevations. In clinical situations, continuous evaluation of an Individual's treatment is an inherent part of normal follow-up. On the level of populations, however, evaluation of hypertension control calls for specially designed action. Evaluation is needed for several reasons; these are, inter alia, strategic (to improve the method); economic (to upgrade cost-effectiveness); and ethical reasons (to morally justify public action). Since hypertension control in populations is itself a complex process, its evaluation requires, multidimensional approaches. The methodologic experience from three WHO studies of this kind has been reported. These were done in different contexts: (1) evaluation of the effects of a special multicentre programme for hypertension control in populations; (2) long-term monitoring of cardiovascular disease incidence; and (3) a project for the assessment of levels and quality of hypertension control that is taking place spontaneously. In the first study, changes with time were compared in pairs of similar communities, of which one had been exposed to an organized programme for the control of hypertension ('intervention' vs 'reference' community). The second study uses an elaborate system of disease registers and surveys periodically a number of general populations. In the third study the actual level and quality of hypertension control was analysed in different, mostly European, populations; the findings related to the treatment of hypertension were compared with the standards suggested by WHO and ISH; other findings were assessed on the basis of common sense.

Community Medicine↗
PubMed1996

Auditing hypertension control and management: a position paper.

The categorical term "auditing" hypertension control is chosen on purpose, to emphasize the responsibility of health politicians for assessing the quality and effects of interventions in populations. Auditing of hypertension is needed for reasons of Efficacy, Economics and Ethics. An analysis of efficacy should test whether the local strategies of hypertension control are sufficiently adapted to the needs and characteristics of a given population. Economic analyses should consider hypertension control in the perspective of resources and priorities. The ethical imperative requires an assessment and follow-up of the effects of health measures on the population, by the same token as evaluation of treatment results is obligatory in clinical medicine. The WHO/WHL Hypertension Management Audit Project was an attempt to analyze the repercussions of hypertension control programs on selected population. Five approaches were taken: (i) assessment of the epidemiological situation; (ii) clinical analysis on a sample of patients; (iii) assessment of patient satisfaction and of (iv) physicians' knowledge and attitudes; and (v) drug utilization studies. The results showed (a) a mixture of under- and overdiagnosis of hypertension in populations; (b) undertreatment of various degrees; (c) mixed patient satisfaction; (d) partial compliance of physicians' concepts and attitudes with standards promulgated by WHO and ISH; and, (e) great differences (at the time of the study) between drug utilization patterns in different countries.

Humans↗
PubMed1994

Biocompatible membranes in acute renal failure: prospective case-controlled study.

The mortality of critically ill patients with acute renal failure has been halved through intervention by haemodialysis. However, several reports suggest that the course of the disorder may be prolonged by this procedure. Our prospective randomised study was done to see whether the generation of inflammatory mediators by bio-compatible membranes has an adverse effect on the outcome of acute renal failure. 52 patients, similar in age, severity of acute renal failure, general disease status (APACHE II), and management of acute renal failure or its related conditions, were divided into two groups. Haemodialysis was done with cuprophane or polyacrylonitrile membranes. Cuprophane membranes induced intense activation of the complement system (as judged by measurement of C3a) and lipooxygenase pathway (leukotriene B4) resulting in alterations of neutrophil kinetics and function. The cuprophane group had a lower survival rate (38 vs 65%), a higher proportion of patients dying from sepsis (71 vs 40%), required more haemodialysis sessions (12 vs 9), and demonstrated delayed resolution and recovery from acute renal failure than the polyacrylonitrile group. The difference in mortality regarding lethal sepsis as cause of death was statistically significant. Our observations indicate that the outcome of critically ill patients with acute renal failure may be influenced by bio-incompatibility reactions to the dialysis membrane. These results have direct implications for such patients on haemodialysis.

Acrylic Resins↗
PubMed1994

The ethics of health communication.

The scope of application of ethical principles in health communication is discussed with particular reference to the influence of the mass media on people's perceptions of benefit and risk in the field of health care.

Biomedical Research↗
PubMed1993

WHO-WHL Hypertension Management Audit Project.

The quality of the control of hypertension has been assessed in 18 European population groups, in a multicentre cooperative project. Five approaches were taken: epidemiological survey, clinical evaluation of samples of patient records, assessment of patient satisfaction, exploration of physicians' attitudes and knowledge, and drug utilisation studies. The participating centres could choose any or all of the above approaches; a total of 31 subprojects was carried out. Undiagnosed hypertension varied in different centres from 17% to 34% of all hypertension, and not more than 29% of all treated hypertensive patients had attained normal BP. Diuretics were the most commonly prescribed drugs, followed by beta-blockers. Although physicians expressed their concern about other cardiovascular risk factors and declared that they considered nonpharmacological treatment important, the findings in the patient survey did not confirm such attitudes. Finally, an analysis of patient satisfaction showed a mixed pattern. In conclusion, the control of hypertension in populations, through detection and treatment, as well as patient education and physician information, was studied.

Adolescent↗
PubMed1992

Impediments to the control of hypertension. Hypertension Management Audit Group.

Despite the great therapeutic advances, the control of hypertension in populations is far below the achievable level, even in populations with highly developed health care. By the end of the 1980's, in selected European centres, 18-34% of cases of hypertension were undetected, and among those previously known, 22-38% were untreated. The cooperative WHO/WHL Hypertension Management Audit Project aimed at assessing some of the impediments to better control of hypertension. The concepts and attitudes of 2,215 physicians were surveyed. In various centres and at various patient ages, 25-45% of physicians would not start drug treatment below 100 mm Hg. When inquiring into the perceived reasons why hypertension had not been detected earlier, among other reasons, physicians tended to incriminate their workload, while patients often felt that there was a lack of interest on the doctor's part to take a blood pressure reading. In general, patient satisfaction seemed suboptimal. Physician's sources of information were varied; neither WHO, nor ISH or WHL seemed to play an important role in informing the physicians.

Adult↗
PubMed1992

Equal blood pressure levels carry different risks in different risk factor combinations.

It is well known that combinations of risk factors result in higher risk than their mere sum. The present paper describes, in quantitative terms, the differences between risks pertaining to equal blood pressure elevations at different constellations with other risk factors (smoking and hypercholesterolaemia). From the practical point of view, this concept of 'constellation risk' convincingly underscores the need for controlling, in hypertensive patients, coexisting hypercholesterolaemia and smoking. Also, at equal blood pressure elevations, smoking and hypercholesterolaemic patients are in greater need of antihypertensive medication. This applies in particular to the range of mild hypertension, where individual decisions have to be taken whether to initiate drug treatment.

Antihypertensive Agents↗
PubMed1991

Generation of leukotriene B4 by hemodialyzer membranes: a novel index of biocompatibility.

Leukotriene B4 (LTB4) plays an important role in acute and chronic inflammatory and hypersensitive reactions. We studied the time course of LTB4 biosynthesis in whole blood in 18 patients with end-stage renal failure maintained on regular hemodialysis with two different membranes, cuprophane and polyacrylonitrile (AN 69). The basal levels of LTB4 from dialysis patients did not differ significantly from a normal control group. Compared to predialytic values, the cuprophane membrane caused a maximal release of LTB4 by a factor of about 4.5 (p less than 0.01) within the first 10 to 20 minutes. Thereafter the level fell and returned to baseline range at the end of the hemodialysis session. With the use of the AN 69 membrane no significant increase of LTB4 could be demonstrated. The changes in LTB4 concentration showed a close temporal correlation to the alterations in white blood cell count. We conclude that (1) LTB4 is a biologically important mediator of neutrophil activation during hemodialysis, and (2) LTB4 may be a sensitive marker of biocompatibility in vivo.

Acrylic Resins↗
PubMed1991

Is prevention of vascular dementia possible? The Syst-Eur Vascular Dementia Project.

Vascular dementia (VD) is the second most common cause of dementia in the elderly after Alzheimer's disease (AD). Prevalence estimates from community surveys indicate that, on average, 5% of persons over 65 and 15 to 20% of people over 80 suffer from "severe dementia". Clinico-pathological studies have shown that AD accounts for 50 to 60% of the cases and VD for about 10 to 20%; 20% of the patients have both disorders. The incidence rate of VD ranges from 7 per 1,000 person-years in normal volunteers to 16 per 1,000 person-years in subjects with risk factors for strokes, particularly high blood pressure. The only effective therapeutic approach to VD is the prevention of strokes, mainly through the treatment of hypertension; however, none of the therapeutic trials has included VD prevention as one of its treatment goals. Syst-Eur Study is a European placebo controlled trial which aims to determine whether morbidity and mortality are changed when elderly patients (60 years and over) with isolated systolic hypertension are treated. In this trial, the incidence of VD will be carefully recorded during the five year follow-up of the expected 3,000 patients. The present side project to the Syst-Eur trial will specifically address the following questions: does antihypertensive treatment reduce the incidence of VD?, and how do the cognitive functions of elderly patients change when treated with active or placebo treatment? The protocol is based on the administration of the MMS (Folstein) once a year to all patients. If the MMS score is 23 or less, a set of criteria will be used to establish the diagnosis of vascular dementia. A pilot study has demonstrated the feasibility of the trial. The main study is in progress.

Aged↗
PubMed1991

Hemodialysis-related leukotriene B4 generation and neutropenia during calcium channel blockade.

Cuprophane membranes elict intense blood-surface interactions during clinical hemodialysis. The goal of the present studies was to determine whether calcium channel blockade may alter hemodialysis-related leukotriene B4 (LTB4) generation and neutropenia in 12 patients with end-stage renal failure. The patients were randomized to receive either placebo or nitrendipine for six weeks. Compared with untreated patients, the calcium channel blocker treatment group had significantly lower predialysis plasma LTB4 levels, Nitrendipine reduced both the magnitude of LTB4 generation and of neutropenia during the early phase of hemodialysis, but did not alter the close temporal relation of LTB4 accumulation and neutrophil activation. Therefore, the generation and release of LTB4 by neutrophils may be a calcium-dependent event. Furthermore, these results suggest that activation of neutrophil 5-lipoxygenase may contribute to the alterations in neutrophils of hemodialysis patients.

Aged↗
PubMed1990

Leukotriene B4 is involved in hemodialysis-associated neutropenia.

Biosynthesis of leukotriene B4 (LTB4) was studied in ten patients with end-stage renal failure undergoing chronic hemodialysis with a cuprophane membrane. As compared to healthy subjects the low basal plasma levels of LTB4 quantified by radioimmunoassay after extraction and purification by HPLC showed no significant difference. The time-course of LTB4 release after contact of the blood with the dialysis membrane without further in vitro stimulation was characterized by a rapid increase by about 500% within the first 10 min, appearing approximately at the same time as the known fall of white blood cell count which reaches its nadir after 20 min. Analysis of further release showed a decline of LTB4 biosynthesis to basal levels at the end of hemodialysis. These results indicate that activation of the 5-lipoxygenase pathway is involved in hemodialysis-associated leukopenia and may contribute to the alterations in neutrophils of patients with chronic dialysis therapy.

Arachidonate 5-Lipoxygenase↗