ABSTRACT
Faldaprevir (FDV), a substrate of CYP3A/P-glycoprotein (P-gp), is a selective inhibitor of the hepatitis C virus (HCV) NS3/4 protease. FDV is currently under clinical development for application in interferon-free treatment regimens for patients with chronic HCV infection. Understanding the drug-drug interaction potential of FDV is critical, as certain drug combinations may facilitate the more rapid achievement of steady-state-that is, the ideal drug concentration and balanced metabolic cycle of absorption and elimination that optimize drug efficacy. We thus conducted this study to investigate the effect of itraconazole (ICZ), a strong inhibitor of CYP3A and a moderate inhibitor of P-gp, on the pharmacokinetics (PK) of FDV. Eighteen healthy male and female volunteers participated in this open-label, fixed-sequence study. FDV 120 mg twice daily (BID) was administered on Day 1, followed by 120 mg once daily (QD) from Day 2 until the end of the 10-day study; after 6 days of FDV alone, ICZ 200 mg was added to FDV for an additional 4 days (BID on Day 7 and QD from Day 8 to Day 10). Intensive PK sampling was performed after 6 days of FDV treatment and again after 4 days of combined FDV/ICZ treatment. The adjusted geometric mean (gMean) ratios (%) of area under the concentration curve over dosing interval at steady-state (AUCτ, ss) and maximal concentration at steady-state (Cmax, ss) for combined FDV/ICZ treatment vs. FDV treatment alone were 198.6% and 180.6%, respectively, with 90% confidence intervals (CIs) of 182.4-216.1 and 165.7-196.9. Administration of FDV alone or in combination with ICZ was observed to be safe and well-tolerated. Co-administration with ICZ, however, resulted in an approximately two-fold increase in FDV steady-state exposure. Furthermore, FDV required no dosage adjustment when co-administered with ICZ.
Subject(s)
Aminoisobutyric Acids/pharmacokinetics , Itraconazole/pharmacology , Leucine/analogs & derivatives , Proline/analogs & derivatives , Quinolines/pharmacokinetics , Thiazoles/pharmacokinetics , Adult , Drug Interactions , Female , Healthy Volunteers , Humans , Leucine/pharmacokinetics , Male , Middle Aged , Proline/pharmacokineticsABSTRACT
OBJECTIVE: Older people with depressive disorders access psychotherapy less frequently than younger ones. GPs play an important role in referring patients, particularly the elderly, to psychotherapeutic treatment. This paper presents the obstacles to and preconditions for referring older, depressed sick people to psychotherapy from the point of view of GPs. METHODOLOGY: Doctors who are training GPs were given a questionnaire on the care of the elderly (60+) with depressive disorders. In 2 open questions, they were requested to state their views on obstacles to and preconditions for referring older, depressed diseased people to psychotherapeutic treatment. RESULTS: Most statements related to obstacles perceived by patients followed by barriers on the part of the supply system. Especially obstructive attitudes and emotions, but also functional limitations on the part of patients were referred to as barriers. With regard to the supply system, structural aspects, such as lack of psychotherapy places, but also the actions of care providers and insufficient cooperation were listed. As preconditions, specific therapy for the elderly were mentioned CONCLUSIONS: Dealing with reservations about psychotherapy on the part of older people takes time, which usually is not reimbursed in general practice. Collaborations with psychotherapists are seen as an important precondition for referral. Especially for people with multiple illnesses, access is considered difficult.
Subject(s)
Attitude of Health Personnel , Depressive Disorder , Psychotherapy , Referral and Consultation , Aged , Aged, 80 and over , Depressive Disorder/diagnosis , Depressive Disorder/surgery , Germany , Humans , Surveys and QuestionnairesABSTRACT
AIM: For the health care of people with depressive disorders, general practitioners are important contact persons. Some investigations have shown an under-diagnosis of these patients in GPs' surgeries. The significance of the ICD-10 for the diagnosis of depression is disputed. The BMBF-funded study "PSYTIA - Psychotherapy in old age" engages, among others, with the treatment of older people with depression in GPs' surgeries. This study presents the strengths and shortcomings of the ICD-10 for diagnosis of depression from the point of view of GPs. METHODS: With the help of a questionnaire, 402 teaching GPs were asked how they diagnose and treat elderly people (60+) with depressive disorders in their practices. The response rate was 23.6%. 2 open-ended questions dealt with GPs' perceptions of strengths and shortcomings of ICD-10 for the diagnosis of depression. The responses were matched to inductively developed overarching categories. RESULTS: About three-quarters of the respondents answered the 2 questions. While nearly one-fifth of the respondents did not state any opinion about the suitability of ICD-10 as a diagnostic instrument for depressive disorders, 41% of the respondents mentioned the shortcomings and one-third the strengths of ICD-10. Shortcomings and strengths relate primarily to the complexity of the instrument and its manageability in everyday practice. CONCLUSIONS: The results show that application of ICD-10 in a GP's surgery depends on a holistic, hermeneutical approach to the case in family practice, a need for efficient practice management, and billing. These different perceptions explain the heterogeneous and ambivalent assessment of the suitability of ICD-10 for the diagnosis of depression.
Subject(s)
Depression , Depressive Disorder , General Practitioners , International Classification of Diseases , Aged , Aged, 80 and over , Attitude of Health Personnel , Depression/diagnosis , Depressive Disorder/diagnosis , Germany , HumansABSTRACT
Between 2007 and 2010 the Institut für Gerontologische Forschung e.V. investigated the "Primary Prevention Effects of the Märkisches Viertel Network" in the Berlin district "Märkisches Viertel". The study integrates, amongst others, various participatory methods to investigate the health promotion effects of the volunteer Märkisches Viertel Network, an organisation that brings together different local actors working to assist and encourage older people to live independent lives. Sustained active collaboration by a heterogeneous mixture of actors in a spatially defined quarter, engagement by the local housing association, and increasing acknowledgement of and participation by older residents were identified as success factors for a change in local structures.
Subject(s)
Health Promotion/organization & administration , Health Services for the Aged/organization & administration , Models, Organizational , Quality Improvement/organization & administration , Self Care/methods , Urban Health Services/organization & administration , Community Networks/organization & administration , Delivery of Health Care, Integrated/organization & administration , Germany , Health Policy , Organizational Objectives , Personal Autonomy , Program Evaluation/methods , Public Health Administration/methodsABSTRACT
The proportion of older prisoners increases with demographic change. The situation in prison and the release from prison are related with particular risks especially for elderly people. Systematically evaluated experiences and findings of the specific needs and requirements of elderly prisoners are rare. The Institute for Gerontological Research investigated the situation of older prisoners in the project AIBA--Older Prisoners: Particular Requirements--Special Offers? (funded by the Federal Ministry of Justice, August-December 2012). Their situation in everyday life, the preparation for and the experience of release were studied. The results show that the meaning of age in prison varies. Offers that focused on the individual needs were evaluated positively and a further need of special offers was apparent. Release is complicated by administrative barriers and improved preparation for release is needed.
Subject(s)
Ageism/statistics & numerical data , Freedom , Prisoners/statistics & numerical data , Prisons/statistics & numerical data , Social Discrimination/statistics & numerical data , Social Justice/statistics & numerical data , Age Distribution , Aged , Aged, 80 and over , Female , Germany/epidemiology , Humans , Male , Social Class , Social Environment , Socioeconomic FactorsABSTRACT
The project Neighbourhood examined the opportunities for self-determination of older people with care needs and their social, spatial, and individual requirements. This article is based on three case reports on women from lower social milieus living on their own. The case reports show on which individual resources women relay in their everyday life and which environmental conditions help to enable or limit self-determination. The synopsis of the three cases reveals opportunities to support social participation and self-determination of persons with care needs on a local level. The concluding recommendations focus on requirements for networking and fundamentals for an easy access to counseling, supply and participatory structures.
Subject(s)
Directive Counseling , Health Services for the Aged/statistics & numerical data , Personal Autonomy , Social Support , Aged, 80 and over , Female , Germany , HumansABSTRACT
After the introduction of computed tomography through G. Hounsfield and its clinical further development by J. Ambrose, this method of examination has proved its importance especially with regard to examination of the skull and brain. Our aim is to reflect the results of the first year of computed tomography in radiological specialist practice. Our radiological activity had covered the fields of general radiology and nuclear medicine at the time when computed tomography was introduced.
