The Role of Knowledge and Attitudes About Nonsteroidal Anti-inflammatory Drugs in Determining Treatment Use.

OBJECTIVE: The objective of this study was to evaluate how patient knowledge and beliefs regarding nonsteroidal anti-inflammatory drugs (NSAIDs) may influence the use of NSAIDs for osteoarthritis (OA). METHODS: Surveys of 334 adults with knee and/or hip OA were analyzed in this cross-sectional study. Familiarity with and perceptions of benefits/risks of NSAID use were measured to assess associations with the use of prescription and nonprescription oral NSAIDs. Multinomial logistic regression models were adjusted for sociodemographic and clinical variables. RESULTS: In this sample, 35.9% and 35.6% reported use of oral prescription and nonprescription-only NSAIDs, respectively. Hispanic participants, compared with non-Hispanic White participants, had lower perceived benefit (P = 0.005) and risk (P = 0.001) of prescription NSAIDs. The following were associated with prescription NSAID use instead of no NSAID use: having family/friends who used prescription (relative risk ratio [RRR] 3.91; 95% confidence interval [CI] 2.05-7.47) and over-the-counter (OTC) (RRR 3.10; 95% CI 1.65-5.83) NSAIDs for OA, understanding the consequences of using both prescription (RRR 3.50; 95% CI 1.79-6.86) and OTC (RRR 2.80; 95% CI 1.39-5.65) NSAIDs, higher perceived benefit of both prescription (RRR 2.51; 95% CI 1.71-3.66) and OTC (RRR 1.44; 95% CI 1.01-2.06) NSAIDs, and lower perceived risk of both types of NSAIDs (prescription: RRR 0.63 [95% CI 0.46-0.87]; OTC: RRR 0.53 [95% CI 0.37-0.75]). Similar results were found when we assessed the relationship between these variables and OTC NSAID use versus no oral NSAID use. CONCLUSION: Adults with knee and/or hip OA were more likely to use NSAIDs if they were more familiar with, had an increased perceived benefit of, and had a decreased perceived risk of these drugs. Patients' perceptions and beliefs about NSAIDs should be evaluated when considering them for treatment.

Social & psychological factors associated with oral analgesic use in knee osteoarthritis management.

OBJECTIVE: Determine modifiable social and psychological health factors that are associated with use of oral opioid and non-opioid medications for OA. METHODS: Patients were categorized based on use of the following oral medications: opioids (with/without other oral analgesic treatments), non-opioid analgesics, and no oral analgesic treatment. We used multinomial logistic regression models to estimate adjusted relative risk ratios (RRRs) of using an opioid or a non-opioid analgesic (vs. no oral analgesic treatment), comparing patients by levels of social support (Medical Outcomes Study scale), health literacy ("How confident are you filling out medical forms by yourself?"), and depressive symptoms (Patient Health Questionnaire-8). Models were adjusted for demographic and clinical characteristics. RESULTS: In this sample (mean age 64.2 years, 23.6% women), 30.6% (n = 110) reported taking opioid analgesics for OA, 54.2% (n = 195) reported non-opioid use, and 15.3% (n = 55) reported no oral analgesic use. Opioid users had lower mean social support scores (10.0 vs 10.5 vs 11.9, P = 0.007) and were more likely to have moderate-severe depressive symptoms (42.7% vs 24.1% vs 14.5%, P < 0.001). Health literacy did not differ by treatment group type. Having moderate-severe depression was associated with higher risk of opioid analgesic use compared to no oral analgesic use (RRR 2.96, 95%CI 1.08-8.07) when adjusted for sociodemographic and clinical factors. Neither social support nor health literacy was associated with opioid or non-opioid oral analgesic use in fully adjusted models. CONCLUSIONS: Knee OA patients with more severe depression symptoms, compared to those without, were more likely to report using opioid analgesics for OA.

Stereotyping among providers and consumers of public mental health services. The role of perceived group variability.

The authors examine stigmatization and mental illness, focusing on the role of perceived group variability in stereotype use. Consumers' and providers' in-group and out-group stereotypes were assessed. Although providers had extensive experience, they judged consumers more stereotypically and just as negatively as did the consumers themselves. Consumers' education and involvement in services were weakly predictive of more stereotypic, less variable, and more negative views of providers, whereas providers' education and involvement in services predicted more stereotypic but also more variable views of both groups. Perceived group stereotypicality predicted more stereotypic judgments of individuals, whereas perceived variability predicted less confidence in judgments. Because providers perceived greater variability, they were less confident in applying the stereotype to individuals. We suggest that increasing perceptions of the variability among consumers may lead to more sensitive use of diagnostic criteria, more individualized treatment, and a decrease in the negative effects of stigmatization.

Evaluation of a new percutaneous stainless steel Greenfield filter.

PURPOSE: To evaluate a new percutaneous Greenfield filter with an alternating hook design and over-the-wire delivery system. MATERIALS AND METHODS: The alternating hook stainless steel Greenfield filter was evaluated in a prospective clinical trial between March 10, 1994, and January 27, 1995. Filters were placed in 75 patients in nine clinical centers and follow-up with radiographs and ultrasound scans was carried out at 30 days. RESULTS: Clinical trial results revealed successful placement in all patients. There were four cases of filter limb asymmetry (5.3%) without clinical sequelae, with one incidence of failure to span the cava. No significant migration was found. There were no clinically suspected pulmonary emboli, but one instance of probable caval penetration (1.7%) did occur. Caval occlusion was documented in three patients (5%). CONCLUSION: The percutaneous stainless steel Greenfield filter provides ease of insertion and improved deployment while maintaining the high standards of efficacy and safety associated with the standard and titanium Greenfield filters.

[Long-term prevention of duodenal ulcer with cimetidine. Effect of the rhythm of ingestion and drug compliance on the incidence of recurrence]. / Langzeitprophylaxe des Ulcus duodeni mit Cimetidin. Einfluss von Einnahmerhythmus und Medikamenten-Compliance auf die Rezidivhäufigkeit.

The long term effect of 400 mg cimetidine ingested at various times on ulcer recurrence and drug compliance was investigated in 66 patients with severe course of duodenal ulcer, now healed. Patients were randomised in 3 treatment groups: group A (n = 29) received 400 mg cimetidine in the evening, group B (n = 23) 200 mg both morning and evening, group C (n = 14) no treatment. Follow up examinations were at 3 month intervals. Ulcer recurrence was observed in 10 out of 14 patients in group C and in 12 out of 52 patients of groups A and B within the first 6 months. Due to the highly significant difference between the treated and untreated groups (P less than 0.001) the control group was discontinued. The recurrence rate after 12 months was identical in groups A and B (51 and 52%). Comparison of patients with and without recurrences showed no differences as regards length of history, maximal acid secretion, cimetidine compliance or endoscopic findings such as duodenitis, circular constriction of the bulbus or antral erosions. However, it was noticeable that smokers with 63% recurrent ulceration had a worse prognosis than the non-smokers with 37% (P = 0.06).

[Rheology, metabolism and oxygen transport in old and young erythrocytes in arterial occlusive disease]. / Rheologic, Stoffwechsel und Sauerstoff-transport alter und junger Erythrozyten bei arterieller Verschlusskrankheit.

Red blood cell (RBC) rheological and metabolic functions were studied in 10 diabetics with peripheral vascular disease (PAD) following separation of RBC according to cell age by density layer centrifugation. Decreased levels of ADP, ATP, 2,3-DPG and GSH were observed in dense layers of RBC containing older cell fractions. Further, raised lactate/pyruvate ratios were obtained from the same RBC fractions. O2-function was markedly impaired in all patients with PAD. Thus, metabolic disorder of RBC associated with reduced red cell deformity by retarding blood flow through the microcirculation may be important factors in states of peripheral vascular insufficiency in diabetics.

[On the effect of etofylline clofibrate on serum lipids and lipoproteins in patients with hyperlipoproteinemia of various degrees (author's transl)]. / Zur Wirkung von Etofyllinclofibrat auf Serumlipide und Lipoproteine bei Patienten mit verschiedenen Formen der Hyperlipoproteinämie.

Efficacy and tolerance of 1-(theophyllin-7-yl)-ethyl-2-[2-(p-chlorophenoxy)-2-methylpropionate] (etofylline clofibrate, Duolip) was investigated in 54 out-patients, 18 of whom were of Fredrickson-Types IIa, IIb and IV, over a therapeutical period of 4 months, in comparison to initial and final placebo phases of 4 weeks each. In type IIa etofylline clofibrate shows a good effect on total cholesterol and on the cholesterol fractions, both with regard to the collective treated and to the low dosage of 750 mg/d etofylline clofibrate compared to the usual dosage of 1500 mg clofibrate. The activity of etofyllineclofibrate on type IIb is inconsistent. Decreases of total cholesterol, i.e., of VLDL cholesterol along with high decreases of triglycerides in VLDL and LDL are measurable, but not significant. In type IV total cholesterol is distinctly decreased, along with high decreases of VLDL cholesterol and particularly so of the relevant VLDL triglycerides. Subjective and objective tolerability of etofylline clofibrate was most favourable.

Long-term treatment of hyperlipoproteinemia with etofibrate: clinical observations.

We investigated the changes in serum lipid concentrations of patients treated with Etofibrate as part of their routine management in the metabolic ambulatory care unit of the Medical Policlinic at the University of Marburg. In our study, 26 patients who had not responded well to prior treatment for Types IIa, IIb, III and IV hyperlipoproteinemia were given a daily dose of 900 mg Etofibrate for up to 48 months. As a result to this treatment, serum total cholesterol levels fell by up to 17,6% and triglyceride levels by up to 47,8%. We observed no tachyphylaxis toward Etofibrate. The results of standard laboratory parameters measured in parallel with drug treatment reflect a good tolerance for Etofibrate. This substance is highly suited as a potent lipid-lowering agent.

Clinical experience with bezafibrate.

We report on 41 patients with primary hyperlipoproteinemia (type IIa, IIb and IV) treated with 450 to 600 mg of bezafibrate for 12 months. Placebo periods of 8 weeks surrounded the treatment period. In types IIa and IIb total cholesterol decreased by up to 18,7%, triglycerides to 34,6%. In type IV serum triglycerides decreased up to 48,2 and cholesterol by 12,2%. In a second investigation we differentiated the cholesterol- and triglyceride-values of 16 patients regularly controlled. We found a significant decrease during the treatment period. Bezafibrate is a potent lipid-lowering agent of the new generation.

[Current aspects of rheumatoid arthritis]. / Aktuelle Aspekte der rheumatoiden Arthritis.

According to recent investigations two factors might play an essential role in the pathogenesis of rheumatoid arthritis (R.A.). Besides genetic components, i.e. the HLA-system and familial aggregation, the immune processes, mediating tissue inflammation and injury, are acknowledged as having established roles in the pathogenesis of R.A. The present report reemphasizes recent data concerning the autoimmunity and the immunologic network with trends of therapy in R.A. In view of the effectiveness of new nonsteroidal antiinflammatory drugs, a double-blind study of suxibuzon vs. indomethacin in 30 patients with active R.A. is described in detail. Both drugs were active and similar in their efficacy at 4 weeks as judged by clinical and laboratory measurements. No serious toxic side-effects were observed in both treatment regimens.

[Inherited hemolytic anemia due to pyruvate kinase deficiency: II. Density-layer centrifugation of erythrocytes (author's transl)]. / Familiäre hämolytische Anämie durch Pyruvatkinasedefekt. II. Nachweis der Enzyminstabililät durch Dichtezentrifugation der Erythrozyten.

Heterogeneous clinical features of inherited hemolytic anemia due to pyruvate kinase (PK) deficiency were observed in three related homozygous patients. Erythrocytes were separated into old and young cells by means of density-layer centrifugation using a new supporting medium: Stractan-Urografin gradients. Those fractions containing older RBC disclosed defective PK which resulted in an impaired metabolism. Following an intake of chloramphenicol the clinical course of one female family member converted to acute monocytic leukemia. Thus, the report of a PK instability trait, in one family member associated with pancytopenia which converted in leukemia, suggests that inherited red cell enzyme deficiency might be also an expression of the vulnerability of the hematopoietic stem cells.

[Ileus with endometriosis of the large intestine (author's transl)]. / Ileus bei Endometriose des Dickdarms.

Dispersed endometrium tissue can be observed in 10% of all laparotomies. In some rare instances the endometriosis also appears within the region of the intestinal canal. It is reported on a 48 year old woman observing diarrhoea tinged with blood at four weekly intervals. With the clinical picture of a mechanical ileus she was admitted to hospital. In the laparotomy a big stenosing sigmoidotumor showing histological endometriosis seats was found.

Effect of polyenyl phosphatidyl choline on clofibrate-induced increase in LDL cholesterol.

In a double-blind, randomised, cross-over trial clofibrate and a combination of polyenyl phosphatidyl choline (PPC) plus clofibrate were tested in 67 patients with hyperlipoproteinemia. Each treatment lasted for 4 weeks and was separated by a 4 week placebo period. The daily doses were clofibrate 1.2 g and PPC 1.8 g + clofibrate 1.2 g. respectively. The results revealed that polypenyl phosphatidyl choline prevented the elevation of LDL-cholesterol induced by clofibrate treatment, and that the lipid-lowering potency of the combination did not differ significantly from that of clofibrate. Since elevation of LDL-cholesterol is considered to increase the risk of coronary heart disease, the combination appears to offer a therapeutic advantage. Despite the significance of this clinical observation, a final decision may only be obtained from a prospective, long term investigation in patients with coronary heart diseases and hyperlipoproteinemia.

[Coronary artery reserve in patients with hyperlipoproteinemias (author's transl)]. / Untersuchungen zur koronaren Durchblutungsreserve bei Patienten mit essentiellen Hyperlipoproteinämien.

The coronary reserve was measured in 119 patients with different types of primary hyperlipoproteinemia. Cardiovascular diseased with clinical manifestation were excluded. 90 patients of same age with normal serum lipids served as controls. The groups did not differ in other risk factors as blood pressure or overweight (the latter excluded in hyperlipoproteinemia type IV). The controls showed decreased coronary reserve in 8%, type IIa patients in 36%, IIb patients in 18% and type IV patients in 23%. The frequency of restriction in coronary flow increased with age: in hyperlipoproteinemic patients of 50 years and more it was found in nearly 40%. Further interesting results were the significantly higher systolic and diastolic blood pressures reached during exercise in our hyperlipoproteinemic patients.

[Insulin and pro-insulin secretion following intravenous administration of tolbutamide, glisoxepide and glibenclamide]. / Untersuchungen zur Insulin- und Proinsulinsekretion nach intravenöser Gabe von Tolbutamid, Glisoxepid und Glibenclamid.

12 metabolically healthy subjects were i.v. administered equipotent doses (ED30) of tolbutamide (7.5 mg/kg), glisoxepide (0.02 mg/kg) and glibenclamide (0.006 mg/kg). Prior to and 2, 5, 8, 10, 20, 40, 60 and 120 min after the injection the following serum parameters were determined: blood glucose, immunologically measurable insulin (IMI) with the double-antibody method (Hales and Randle) and proinsulin (IMP) enzymatically (ISP-method). The maximum level of insulin follows the injection of tolbutamide with a value of 70.5 micronU/ml after 2 min, of glisoxepide after 5 min (67.0 micronU/ml) and of glibenclamide after 20 min (32.3 micronU/ml). The proinsulin fraction of the total insulin shows a level of 12.5 micronU/ml before the test. After the administration of the three compounds proinsulin increases, too, but reaches only 20-40% of the total immunoreactive insulin. The amount of secreted insulin and proinsulin during the 120-min test is rather the same for the three substances. The average increase of insulin is nearly identical for tolbutamide and glisoxepide, whereas it is less for glibenclamide. Both the mean blood sugar depression and the highest mean increase of proinsulin is reached after glisoxepide. The significance of the one-chain precursor of insulin as a part of the sulfonylurea stimulated total insulin for glucose depression is discussed.

Plasma lipids, triglyceride/fatty acid pattern, and plasma insulin in fasted healthy volunteers during continuous ingestion of ethanol. Influence of lipolysis inhibited by nicotinic acid.

Healthy fasted volunteers were subjected to an acute oral ethanol load over 12 h after a diet of 3 days with high linolenic acid content. Free fatty acids, triglycerides, glycerol, phospholipids, cholesterol and insulin, as well as the fatty acid pattern of triglycerides in the plasma, were determined during the test. The test was repeated with nicotinic acid added. The lipid values obtained and the comparisons of fatty acid composition both indicate that the predominant role of peripheral lipolysis in the genesis of acute ethanol-induced hypertriglyceridemia, in spite of the possibility of enhanced synthesis of palmitic acid in the liver.

[Beta-sitosterin in the treatment of essential type II hyperlipoproteinemias]. / Beta-Sitosterin in der Behandlung essentieller Hyperlipoproteinämien vom Typ II.

The effect of Beta-Sitosterol (Sitosterin Delalande) on plasma lipids in 20 pretreated patients with type IIa and IIb familial hyperlipoproteinemia is reported. 6-18 g of the drug were given for a time of two to twelve months. In 11 patients the plasma cholesterol level decreased between 10 and 30%. Since Beta-Sitosterol has no effect on plasma triglycerides, an additional hypertriglyceridemia must be taken care of and treated if necessary. Beta-Sitosterol can be called an effective substance in the treatment of hypercholesterinemia. In addition the diet cure becomes easier.