The effect of high indoor temperatures on self-perceived health of elderly persons.

INTRODUCTION: Exposure to high ambient temperatures leads to an increase in mortality and morbidity, especially in the elderly. This relationship is usually assessed with outdoor temperature, even though the elderly spend most of their time indoors. Our study investigated the relationship between indoor temperature and heat-related health problems of elderly individuals. MATERIAL AND METHODS: The study was conducted in the Netherlands between April and August 2012. Temperature and relative humidity were measured continuously in the living rooms and bedrooms of 113 elderly individuals. Respondents were asked to fill out an hourly diary during three weeks with high temperature and one cold reference week, and a questionnaire at the end of these weeks, on health problems that they experienced due to heat. RESULTS: During the warmest week of the study period (14-20 August), average living room and bedroom temperatures were approximately 5°C higher than during the reference week. More than half of the respondents perceived their indoor climate as too warm during this week. The most reported symptoms were thirst (42.7%), sleep disturbance (40.6%) and excessive sweating (39.6%). There was a significant relationship between both indoor and outdoor temperatures with the number of hours that heat-related health problems were reported per day. For an increase of 1°C of indoor temperature, annoyance due to heat and sleep disturbance increased with 33% and 24% respectively. Outdoor temperature was associated with smaller increases: 13% and 11% for annoyance due to heat and sleep disturbance, respectively. The relationship between outdoor temperature and heat-related health problems disappeared when indoor and outdoor temperatures were included in one model. CONCLUSIONS: The relationship with heat-related health problems in the elderly is stronger with indoor (living room and bedroom) temperature than with outdoor temperature. This should be taken into account when looking for measures to reduce heat exposure in this vulnerable group.

Comparison of various measures for assessing medication refill adherence using prescription data.

BACKGROUND: Several measures using prescription data have been developed for estimating medication refill adherence. Few studies have made direct comparisons, and little is known about the accuracy of these measures in patients on a multiple-drug regimen. PURPOSE: To compare different calculation methods using prescription data for assessing refill adherence. METHOD: An observational cohort study among type 2 diabetes patients was conducted. Adherence to oral glucose-lowering, antihypertensive and lipid-lowering medication was assessed for 2004. We calculated medication possession ratios in a flexible period (MPRF), per calendar year (MPRY) and gaps between refills (GAP) at drug class and therapeutic level. Individual review of drug prescription profiles was conducted to validate identified cases of suboptimal refill adherence. Differences in Area Under the Curve (AUC) of ROC-curves were calculated to compare the methods. RESULTS: Of the 3877 patients, 2969 (77%) patients received oral glucose-lowering medication, 2715 (70%) antihypertensives and 1797 (46%) lipid-lowering medication. Using cutoffs for MPR < 80% and GAP > 30 days, overall rates of suboptimal adherence for these drug classes were 32, 35 and 23% respectively. AUC for measures calculated at drug class level (range 0.85-0.90) were significantly larger than those calculated at therapeutic level (0.72-0.90). For oral glucose-regulating medication and antihypertensives, AUCs were largest for the MPRY and GAP measures (0.87-0.88). For lipid-lowering medication, the AUC was largest for the GAP measure (0.90). CONCLUSIONS: Differences between adherence measures were small and favoured calculation on drug class level. For multiple drug use, both MPRY and GAP were good measures for identifying suboptimal refill adherence.

The effects of interleukin-3, GM-CSF, and G-CSF on the growth kinetics of colony-forming cells in myelodysplastic syndromes.

In order to obtain more insight into the nature of the abnormal in vitro colony formation in myelodysplastic syndromes (MDS), we investigated the kinetics of the colony formation of 23 MDS cases in response to recombinant human interleukin-3 (IL-3), Granulocyte-macrophage colony-stimulating factor (GM-CSF), granulocyte colony-stimulating Factor (G-CSF), and giant cell tumor cell line conditioned medium (GCT-CM). The kinetics of GCT-CM-induced colony formation were comparable to that of G-CSF-induced colony growth, both in MDS and in normal bone marrow cultures. Colony formation was found to be delayed in MDS. The delay in colony formation was most apparent in the GCT-CM (G-CSF) responsive progenitor cell compartment. In MDS cases with clinical features of high risk disease, this delay was more pronounced as compared with low risk cases (7 and 3 days, respectively, in response to GCT-CM). The delay in colony formation was found to be caused by an increase in the time interval before progenitor cells had begun to divide. These results suggest that a prolongation of the time spent in G0 of myeloid progenitor cells in MDS may be the cause of the indolent in vitro colony formation observed in this disease.

The combined effects of Il-3, GM-CSF and G-CSF on the in vitro growth of myelodysplastic myeloid progenitor cells.

The decreased or absent in vitro colony formation in response to single recombinant haematopoietic growth factors has been reported previously. Here we report on the effects of the combination of interleukin 3 (Il-3), granulocyte-macrophage colony-stimulating factor (GM-CSF) and granulocyte-CSF (G-CSF) and the effect of the conditioned medium of the giant tumour cell line (GCT-CM) on the proliferation of myelodysplastic (MDS) marrow myeloid progenitor cells and normal bone marrow (NBM) controls. Colony growth was most effectively sustained by GCT-CM and G-CSF in normal bone marrow (NBM) cultures. GM-CSF and Il-3 were less effective in inducing myeloid granulocytic colony growth, whereas the effects of Il-3 and GM-CSF were found to be approximately additive. The number of NBM granulocytic colonies induced by G-CSF and GCT-CM stimulation were comparable, whereas this granulocyte colony stimulating activity could be neutralized by anti-G-CSF antibodies. In addition GCT-CM was found to contain burst promoting activity, which could be neutralized by anti-Il-3 antibodies. Il-3 did not enhance the G-CSF activity in NBM cultures. No additive effect of stimulation with the combination of Il-3 and GM-CSF was observed in MDS marrow cultures, suggesting that these growth factors act on an identical progenitor cell population in MDS. G-CSF stimulated the growth of significantly lower colony numbers than GCT-CM, in contrast to NBM cultures. The decreased granulocytic colony formation of MDS marrow cells could clearly be enhanced by co-stimulation with Il-3. These results suggest that MDS myeloid progenitor cells require the exposure to both a pluripotent colony stimulating factor, like Il-3, and a lineage specific factor, like G-CSF, for optimal proliferation.

Nitrous oxide selectively reduces the proliferation of the malignant cells in experimental rat leukemia.

A considerable reduction of hepatosplenomegaly and leucocytosis in leukemic rats of the Brown Norway Myeloid Leukemia (BNML) can be achieved by exposure to 50% nitrous oxide/50% oxygen. In this study the differential antiproliferative effect of nitrous oxide, inactivating vitamin B12, on normal and leukemic hemopoiesis was investigated in this rat model. Rats injected with leukemic cells and exposed to nitrous oxide for 10 days showed 30% reduction of hepatosplenomegaly and 50% reduction of leukocytosis. Similarly treated healthy rats showed no signs of impaired hemopoiesis as measured by peripheral blood parameters. Clonogenic assays of erythroid and myeloid progenitors from both healthy and leukemic rats revealed that exposure to nitrous oxide did not suppress normal bone marrow functioning. On the contrary, the reduction of leukemic proliferation by nitrous oxide retarded the leukemic infiltration of the bone marrow compartment.