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Andrew Goudie, Gillian Cooper, Jon Cole, Professor Harry Sumnall
Journal of Psychopharmacology. 21, 179-190, 2007.
Abstract: Cyproheptadine is a cheap, widely available anti-allergy drug with a broad receptor binding profile which resembles that of clozapine. In rats discriminating clozapine from vehicle cyproheptadine mimicked clozapine very closely. Acutely it induced full generalization in the absence of response suppression, as observed with clozapine. Chronic administration of clozapine and cyproheptadine induced tolerance and cross-tolerance respectively to the clozapine stimulus. This was characterized by circa 3.5-fold parallel shifts to the right in the clozapine generalization curves. Such tolerance and cross-tolerance was spontaneously reversible, suggesting that it was pharmacodynamic, and that clozapine and cyproheptadine induce similar neuroadaptations when administered chronically. Administration of chlordiazepoxide at a very high dose induced no cross-tolerance to the clozapine stimulus showing the pharmacological specificity of tolerance. The clozapine stimulus is a compound cue involving actions at various receptors, and various clozapine-like antipsychotic (APD) drugs generalize fully to it. These data demonstrate that in vivo cyproheptadine resembles clozapine both acutely and chronically. Our findings, in conjunction with other actions of cyproheptadine -- induction of weight gain, alleviation of clozapine withdrawal, anxiolytic actions, alleviation of 'typical' APD-induced motoric side effects, and some preliminary clinical findings -- suggest that further study of cyproheptadine in conjunction with a 'typical' APD for the possible treatment of schizophrenia is merited at both pre-clinical and clinical levels.
Monitoring the exposure of hospitality workers to second-hand smoke: establishing a base-line in advance of the smoke free legislation
Diane Black, Dr Ivan Gee, Helen Casstles
Journal of Environmental Health Research. 6(1), 3-12, 2007.
Abstract: Exposure to second hand smoke (SHS) has been linked with adverse health outcomes, with staff in hospitality premises being particularly at risk. This study measured the exposure to SHS for employees within hospitality settings in Liverpool, prior to the decision by the UK government to introduce comprehensive smoke-free legislation and thereby protect all workers. This legislation comes into force on 2nd April 2007 in Wales, 30th April in Northern Ireland and 1st July 2007 in England (with Scotland having already gone smoke free in March 2006). Fifty five premises were chosen at random from the ‘Flare’ database held by Liverpool City Council and testing was carried out on Friday and Saturday evenings. Monitoring equipment was positioned in the bar area and measurements of SHS were taken using validated equipment to standardised methods over a four-hour period. The personal exposure to SHS of nonsmoking employees, working for more than four hours at the time of testing, was measured via a saliva sample prior to and after their work shift and by wearing a non-invasive monitoring badge during their shift. SHS markers were only considered in the analysis: nicotine (vapour), 3-Ethenylpyridine, respirable suspended particulates and solanesol related particulate matter (SolPM). High levels of SHS were found in a number of bars, restaurants and social clubs compared to the non-smoking venues tested. In particular, the tobacco specific marker compounds (SolPM and nicotine) were found to be significantly higher in bars in comparison to restaurants, a reduction of 75% and 80% respectively. This study provides baseline data for levels of SHS within licensed premises in Liverpool. It demonstrates that the original proposal, to make only premises that served prepared food, smoke free had the potential to increase health inequalities. It also provides timely evidence for the recent Green Paper adopted by the European Commission, ‘Towards a Europe free from tobacco smoke: policy options at EU level’ (Commission of the European Communities, 2007).
The role of substance use in non-drug related deaths: a cross-sectional study of drug treatment clients in the North West of England
Dr Caryl Beynon, Jim McVeigh
Journal of Substance Use. 12, 39-47, 2007.
Abstract: Aims: (1) To identify all causes of death in a cohort of known problematic drug users; (2) to quantify the number considered drug‐related in accordance with the UK Drug Strategy definition; (3) to identify the possible role of substance use in the residual causes of mortality. Design: Cross‐sectional. Setting: North West of England, UK. Participants: All problematic drug users in contact with structured treatment services in 2003–2004. Measurements: All causes of mortality were identified from death certificates. Mann–Whitney U and chi‐squared tests were used to explore differences in subgroups (alive, drug related deaths (DRD), non‐DRD) by age and sex, respectively. Findings: Of 27,810 individuals, 103 (0.4%) were confirmed dead. Of the 102 for whom cause of death was available, 72 (70.6%) deaths were classified as non‐drug related. In addition to individual causes such as cellulitis, these non‐drug related deaths included 16 from infection (seven from pneumonia), seven from alcohol related liver disorders and seven suicides. Those dying from non‐DRDs were significantly older than those dying of DRD (p = 0.004). Conclusions: A considerable proportion of deaths classified as non‐drug related are the likely result of substance use, particularly through infection.
Dr Christian Blickem, Esther Priyadharshini
Journal of Interprofessional Care Volume 21, Issue 6, pages 619-632, 2007.
Abstract: The central theme of the paper is concerned with the educational potential that patient narratives may hold for improving patient-centred interprofessional care. It follows the processes of a research project that was required to provide an educational intervention in a multiprofessionally-staffed stroke rehabilitation ward. It discusses the evolution of the project, focusing on the ways in which patient narratives were constructed, the purposes they served, and the responses of professionals to the narratives in subsequent workshops. Along the way, the paper reflects on the responses of patients that problematise the notion of “patient-centred” care. Together with the responses of professionals to the narratives, the paper raises questions about the obstacles to and possibilities for such care.
Can health campaigns make people ill? The iatrogenic potential of population-based cannabis prevention
Professor Harry Sumnall, Professor Mark Bellis
Journal of Epidemiology and Public Health. 61, 930-931, 2007.
Problematic drug use, ageing and older people; trends in the age of drug users in contact with drug treatment and syringe exchange programmes
Dr Caryl Beynon, Jim McVeigh, Brenda Roe
Ageing and Society. 27(6), 799-810, 2007.
Abstract: In the United Kingdom (UK) and elsewhere, little is known about problematic drug use among older people (defined here as aged 50–74 years), either because few older drug users exist or because they represent a ‘hidden’ population. In this paper, we show that the average age of drug users in contact with treatment services and agency-based syringe exchange programmes (SEPs) in the counties of Cheshire and Merseyside in northwest England is rising. Between 1998 and 2004–05, the number of older male drug users in treatment increased from 80 to 310, and the number of older females rose from 46 to 117. Consequently, the median age rose from 30.8 years in 1998 to 34.9 years in 2004–05. Similarly, between 1992 and 2004, the number of older injectors accessing SEPs increased from three to 65 men and from one to nine women. The median age of SEP attenders was 27.0 years in 1992 and 34.9 years in 2004. Drug use amongst older people is associated with poor physical and psychological health and longer hospital stays. The future cost of the ageing of drug users may be considerable. Detailed research is needed to identify the characteristics and health needs of this vulnerable population.
Olanzapine withdrawal/discontinuation-induced hyperthermia in rats. Progress in Neuro-Psychopharmacology and Biological Psychiatry
Andrew Goudie, Jon Cole, Professor Harry Sumnall
Progress in Neuro-Psychopharmacology and Biological Psychiatry. 31, 1500-1503, 2007.
Abstract: In female rats olanzapine (4 mg/kg b.i.d., i.p.) induced acute hypothermia, followed by very rapid full tolerance. With more prolonged treatment (over > 10 days) the hypothermic effect of olanzapine was reinstated. Subsequent withdrawal after 18 days of treatment induced very rapid onset (within 1 day) hyperthermia, which was time limited, dissipating completely over 3–4 days. These findings are similar to previous findings with clozapine [Goudie A Smith J Robertson A Cavanagh C (1999). Clozapine as a drug of dependence. Psychopharmacology; 142: 369–374.]. Although the mechanism(s) involved in the secondary hypothermic effect of olanzapine are, at present, unclear; the withdrawal hyperthermia observed represents the first report of a clear discontinuation effect of olanzapine. Such discontinuation effects are probably observed with many antipsychotic drugs. Since they have been suggested to facilitate relapse to psychosis and to interfere with subsequent clinical responses to antipsychotics, they merit further detailed analysis in both clinical and preclinical studies.
Effectiveness and safety of chest pain assessment to prevent emergency admissions: ESCAPE cluster randomised
Steve Goodacre, Elizabeth Cross, Cath Lewis, Jon Nicholl, Simon Capewell
BMJ, 335, 2007.
Abstract: Objective: To determine whether introducing chest pain unit care reduces emergency admissions without increasing reattendances and admissions over the next 30 days. Design: Cluster randomised before and after intervention trial. Setting: 14 diverse acute hospitals in the United Kingdom. Participants: Patients attending the emergency department with acute chest pain during the year before and the year after the intervention started. Intervention: Establishment of chest pain unit care compared with continuation of routine care. Main: outcome measures Proportion of chest pain attendances resulting in admission; reattendances and admissions over the next 30 days; daily emergency medical admissions (all causes); and proportion of emergency department attendances with chest pain. Results: The introduction of chest pain unit care was associated with weak evidence of an increase in emergency department attendances with chest pain (16% v 3.5%; P=0.08); no change in the proportion of chest pain attendances resulting in admission (odds ratio 0.998, 95% confidence interval 0.940 to 1.059; P=0.945); small increases in the proportion reattending (odds ratio 1.10, 1.00 to 1.21; P=0.036) or being admitted (1.30, 0.97 to 1.74; P=0.083) over the next 30 days; and evidence of increased daily medical admissions (1.7 per day, 95% confidence interval 0.8 to 2.5; P<0.001). However, this last finding was highly sensitive to changes in the method used to handle missing data. Conclusion: The introduction of chest pain unit care did not reduce the proportion of patients with chest pain admitted and may have been associated with increased emergency department attendances with chest pain. Trial registration Current Controlled Trials ISRCTN55318418.
Health status and health needs of the orphan children in Kathmandu, Nepal: The findings of a pilot study
Sumita Singh, Edwin van Teijlingen, Professor Padam Simkhada
Stupa: Journal of Health Sciences 3 (1&2), 44-54, 2007.
Health status and health needs of the orphan children in Kathmandu, Nepal: The findings of a pilot study
Sumita Singh, Professor Padam Simkhada, Rajendra Kumar, Edwin van Teijlingen
Stupa: Journal of Health Sciences 5 (2), 39-48, 2007.