Medication usage in a spinal cord injured population.

The patterns of medication usage in persons with a spinal cord injury (SCI) in a residential facility have been studied. This population averaged over eight (8) medications per person, took 70% of this medication from five (5) therapeutic categories (MIMS) and thus took multiple medications from individual categories. This level of medication usage is higher than what has been published for elderly populations, who are considered 'at risk' of medication misadventure. The SCI population was predominantly young and as yet, taking few medications for treating age related conditions. Thus, the level of medication use might be expected to increase further in this population.

In pursuit of rational drug use and effective drug management: clinical and public health pharmacy viewpoint.

Drugs are major technology in preventing and combating disease both at the individual and community levels. Managing this valuable resource for optimum public health benefit is paramount. Pharmacists have been recognized by the World Health Organisation and others as having a key role to play in promoting rational drug use and strengthening effective drug management. However, the profession needs to answer some critical questions relating to effective communication of their clinical role. Factors associated with the primary care role of pharmacists are discussed and include education, social and political pressures and professional attitudes. There is evidence of an expanding role for pharmacy in the health sector and a number of new challenges for pharmacy's role in strengthening public health are emerging. These include the profession's involvement in overcoming chronic shortages of essential drugs, strategies to combat the fake and inferior quality drug problems, and increased efforts to educate the public in optimal drug therapy and compliance with recognized drug dosages. Pharmacists are urged to assist governments develop effective policies and legislations for the pharmaceutical sector, based on research findings of pharmaceutical issues affecting public health.

Bronchodilator treatment for partially reversible chronic obstructive airways disease.

The effect of six weeks' treatment with inhaled terbutaline (1 mg four times a day), optimised doses of theophylline (twice a day), the combination of theophylline and terbutaline, and placebo was studied in a randomised, double blind, crossover trial. Thirty patients with partially reversible chronic airflow obstruction and a mean forced expiratory volume in one second (FEV1) of 1.2 litres that improved by 25% were included in the study. Patients who developed non-infective exacerbations of airflow obstruction that required additional bronchodilator treatment were classed as "treatment failures." Such treatment failure occurred in 23 patients with placebo, in 22 patients with theophylline, in 12 patients with terbutaline, and in two patients taking the two drugs. Mean daily peak flow readings were highest with the combination of the two drugs, followed by terbutaline and then theophylline, and lowest with placebo. Thus a combination of terbutaline and theophylline was superior to either drug alone; inhaled terbutaline was superior to theophylline alone. Theophylline alone does not appear to have much place in the management of patients with partially reversible obstructive airways disease.

Iron uptake by immature erythroid cells. Mechanism of dependence on metabolic energy.

The mechanism by which the utilization of transferrin-bound iron is linked with cellular metabolism was investigated using rabbit reticulocytes and bone marrow cells. The rate of metabolism was altered by the use of inhibitors which act at different sites in the metabolic pathway (NaF, sodium fluoroacetate, rotenone, 2,4-dinitrophenol, NaCN) and by the addition of metabolic substrates (inosine, sodium pyruvate, sodium lactate). Measurements were made of the rates of iron and transferrin uptake and, in many of the experiments of cellular ATP and NADH concentrations. The results showed that there was a significant correlation between the rate of iron uptake and the ATP concentration of the cells, but no correlation was found with the NADH concentration. The rate of transferrin uptake was inhibited to a lesser degree than that of iron uptake, and only when the ATP concentration had fallen below that necessary to inhibit iron uptake. It is concluded that the rate of uptake of transferrin-bound iron by immature erythroid cells is dependent on the intracellular concentration of ATP but is independent of the NADH concentration.

Groote Eylandt studies. 2. Fluoridation of a small domestic water supply, C.M.S. Angurugu mission, Groote Eylandt, N.T., Australia. 1973-1974.

A system is described for fluoridation of a small community water supply. The design of the equipment is presented in relation to the requirements of a particular isolated region and in a basis for application to other similar areas. The problems found during the establishment of this system and their solution can be valuable as a guide for other communities.