Monitoring acetylcholinesterase levels in migrant agricultural workers and their children using a portable test kit.

The EQM Research, Inc., portable test kit was evaluated as a surveillance tool for blood cholinesterase levels among migrant workers and their children. Laboratory validation demonstrated a linear relationship between the reference Ellman and kit methods (Ellman = 0.95 x kit result + 0.82, r2 = 0.98). Pre- and post-season cholinesterase levels measured in 70 farm workers were within normal ranges, but significantly different at 28.5 and 29.7 U/g Hb, respectively (paired t-test, p = 0.014). Results from 98 migrant farm worker children and a comparison group of 53 age-matched non-agricultural children showed that cholinesterase levels were not significantly different between the agricultural and non-agricultural children (ANOVA, p = 0.69). These data demonstrate that a portable test kit can provide useful data pesticide exposures when measurements are made in a temperature-controlled setting.

Impact of pharmacist interventions on medication management by the elderly: a review of the literature.

OBJECTIVE: To review the impact of pharmacist interventions designed to assist older people in managing their medication regimens. DATA SOURCES: A computer search of literature published between 1975 and 1990 was conducted using MEDLINE. References were also identified from the bibliographies of pertinent articles. STUDY SELECTION: Studies included in the review were those evaluating pharmacist interventions that were designed to assist in medication management by people over 65 years of age. Only nine studies were identified by these criteria. Interventions that have not been evaluated are discussed briefly. The studies included were chosen by consensus of the authors. DATA EXTRACTION: A data extraction form was used to summarize the information in each study. RESULTS: This was a qualitative review. Some studies evaluating the effects of short verbal medication counseling episodes showed positive benefits; others showed no benefit. Written medication information, some memory devices, and audiovisual techniques have also been found to be of limited use. Self-medication programs for hospitalized elderly people need to be evaluated. CONCLUSIONS: This review identified the lack of published evaluations of pharmacist interventions in medication management by elderly people. Well-designed studies need to be performed to determine the effects of individualized advice and counseling. The cost-effectiveness of such interventions should be assessed, with consideration of long-term outcomes, such as readmission rates to the hospital and cost savings accruing from increased duration of independent living.

gamma-Aminobutyric acid antagonism produced by an organophosphate-containing combustion product.

Results from [35S]t-butylbicyclophosphorothionate (TBPS) binding and gamma-aminobutyric acid (GABA)-dependent 36Cl- uptake indicated that the pyrolysis product of liquid trimethylol propane (TMP) containing organic phosphates interacts with the GABA/benzodiazepine receptor chloride ionophore complex (GBRC) producing a receptor-mediated reduction in 36Cl- flux. The pyrolysate-ligand interaction was competitive and directly proportional to the trimethylol propane phosphate (TMPP) content of the combustion product. TBPS displacement demonstrated that TMPP had less affinity than did TBPS and picrotoxin, but greater affinity than GABA, racemic dimethylbutyl barbituric acid (DMBB), clonazepam, and phenobarbital for their respective recognition sites. Addition of exogenous GABA was a necessary condition for demonstrating clonazepam-induced ligand displacement, thus being indicative of an allosteric interaction. The same rank order held for altering GABA-dependent 36Cl- uptake with the caveat of inhibitors vs enhancers, and noting that pentobarbital was less potent than DMBB. Concentration-dependent ligand displacement by GBRC agonists and antagonists quantitatively correlated with alterations in GABA-dependent 36Cl- uptake. The median convulsant dose (CD50) of pyrolysate TMPP was higher than that of synthetic TMPP. The presence of combustion by-products altering the dispositional kinetics of the former is felt to be the reason for this difference. Under our experimental conditions, phenobarbital was the most effective antidote for pyrolysate (TMPP) toxicity. The inhalant convulsant, flurothyl, was found not to displace [35S]TBPS binding, not to affect GABA-dependent 36Cl- uptake, and not to respond to the anticonvulsants in a manner consistent with a strict GABAA receptor phenomenon.