Neue Möglichkeit der hormonellen Notfallkontrazeption

Die europäische Arzneimittelbehörde EMA hat im Mai 2009 für ellaOne® (Inhaltsstoff  Ulipristalacetat, UPA) die Zulassung als Notfallkontrazeptivum erteilt. Die neue Hormonpille kann bis 5 Tage (120 Stunden) nach ungeschütztem Geschlechtsverkehr eingenommen werden. Der OTC-Verkauf durch den Apotheker ist noch nicht vorgesehen, die Pille untersteht im europäischen Raum der Rezeptpflicht. Ob und wann das Medikament in der Schweiz auch auf den Markt kommen wird, ist noch unbekannt

Therapiemöglichkeiten bei Schwangerschaftstübelkeit

Bis zu 85 Prozent der schwangeren Frauen leiden an Übelkeit in der Frühschwangerschaft, und weitere 25 Prozent zusätzlich an Erbrechen. Isabelle Arnet und Kurt Hersberger, beide im Departement für Pharmazeutik der Universität Basel tätig, und Ursula von Mandach, Präsidentin der Schweizerischen Arbeitsgemeinschaft für Perinatale Pharmakologie (SAPP), präsentieren aktuelle medikamentöse Therapieoptionen und die Mittel der ersten Wahl in der Selbstmedikation

Fundamental progress in investigating drug resistance with electronic multidrug compliance monitoring (e-MCM)

Current definitions of drug resistance are shaped by the pharmacotherapeutic fields they occurred in. They usually mention various contributing factors and refer either to the clinical or the biomarker level. Particular attention has been attracted by antiplatelet resistance, a phenomenon with clinical, cellular and pharmacogenetical contributors. However, the impact of every single factor to antiplatelet resistance in outpatients under prescribed antiplatelet therapy has not been comprehensively evaluated so far, neither has the temporal pattern of drug intake been studied as a possible contributor

Chylothorax in the neonate-A stepwise approach algorithm

Background: Chylothorax in neonates results from leakage of lymph from thoracic lymphatic ducts and is mainly congenital or posttraumatic. The clinical course of the effusion is heterogeneous, and consensus on treatment, timing, and modalities of measures has not yet been established. This review aims to present, along with levels of evidence and recommendation grades, all current therapeutic possibilities for the treatment of chylothorax in neonates. Methods: An extensive search of publications between 1970 and 2020 was performed in the PubMed, Cochrane Database of Systematic Reviews, and UpToDate databases. A stepwise approach algorithm was proposed for both congenital and traumatic conditions to guide the clinician in a rational and systematic way for approaching the treatment of neonates with chylothorax. Discussion and conclusion: The treatment strategy for neonatal chylothorax generally involves supportive care and includes drainage and procedures to reduce chyle flow. A stepwise approach starting with the least invasive method is advocated. Progression in the invasiveness of treatment options is determined by the response to previous treatments. A practical stepwise approach algorithm is proposed for both, congenital and traumatic chylothoraces

Ground and excited states Gamow-Teller strength distributions of iron isotopes and associated capture rates for core-collapse simulations

This paper reports on the microscopic calculation of ground and excited states Gamow-Teller (GT) strength distributions, both in the electron capture and electron decay direction, for $^{54,55,56}$Fe. The associated electron and positron capture rates for these isotopes of iron are also calculated in stellar matter. These calculations were recently introduced and this paper is a follow-up which discusses in detail the GT strength distributions and stellar capture rates of key iron isotopes. The calculations are performed within the framework of the proton-neutron quasiparticle random phase approximation (pn-QRPA) theory. The pn-QRPA theory allows a microscopic \textit{state-by-state} calculation of GT strength functions and stellar capture rates which greatly increases the reliability of the results. For the first time experimental deformation of nuclei are taken into account. In the core of massive stars isotopes of iron, $^{54,55,56}$Fe, are considered to be key players in decreasing the electron-to-baryon ratio ($Y_{e}$) mainly via electron capture on these nuclide. The structure of the presupernova star is altered both by the changes in $Y_{e}$ and the entropy of the core material. Results are encouraging and are compared against measurements (where possible) and other calculations. The calculated electron capture rates are in overall good agreement with the shell model results. During the presupernova evolution of massive stars, from oxygen shell burning stages till around end of convective core silicon burning, the calculated electron capture rates on $^{54}$Fe are around three times bigger than the corresponding shell model rates. The calculated positron capture rates, however, are suppressed by two to five orders of magnitude.Comment: 18 pages, 12 figures, 10 table

Handcycling: training effects of a specific dose of upper body endurance training in females

Purpose: This study aims to evaluate a handcycling training protocol based on ACSM guidelines in a well-controlled laboratory setting. Training responses of a specific dose of handcycling training were quantified in a homogeneous female subject population to obtain a more in depth understanding of physiological mechanisms underlying adaptations in upper body training. Methods: 22 female able-bodied participants were randomly divided in a training (T) and control group (C). T received 7-weeks of handcycling training, 3 × 30 min/week at 65 % heart rate reserve (HRR). An incremental handcycling test was used to determine local, exercise-specific adaptations. An incremental cycling test was performed to determine non-exercise-specific central/cardiovascular adaptations. Peak oxygen uptake (peakVO2), heart rate (peakHR) and power output (peakPO) were compared between T and C before and after training. Results: T completed the training sessions at 65 ± 3 % HRR, at increasing power output (59.4 ± 8.2 to 69.5 ± 8.9 W) over the training program. T improved on handcycling peakVO2 (+18.1 %), peakPO (+31.9 %), and peakHR (+4.0 %). No improvements were found in cycling parameters. Conclusion: Handcycling training led to local, exercise-specific improvements in upper body parameters. Results could provide input for the design of effective evidence-based training programs specifically aimed at upper body endurance exercise in females

Compliance assessment of ambulatory Alzheimer patients to aid therapeutic decisions by healthcare professionals

<p>Abstract</p> <p>Background</p> <p>Compliance represents a major determinant for the effectiveness of pharmacotherapy. Compliance reports summarising electronically compiled compliance data qualify healthcare needs and can be utilised as part of a compliance enhancing intervention. Nevertheless, evidence-based information on a sufficient level of compliance is scarce complicating the interpretation of compliance reports. The purpose of our pilot study was to determine the compliance of ambulatory Alzheimer patients to antidementia drugs under routine therapeutic use using electronic monitoring. In addition, the forgiveness of donepezil (i.e. its ability to sustain adequate pharmacological response despite suboptimal compliance) was characterised and evidence-based guidance for the interpretation of compliance reports was intended to be developed.</p> <p>Methods</p> <p>We determined the compliance of four different antidementia drugs by electronic monitoring in 31 patients over six months. All patients were recruited from the gerontopsychiatric clinic of a university hospital as part of a pilot study. The so called medication event monitoring system (MEMS) was employed, consisting of a vial with a microprocessor in the lid which records the time (date, hour, minute) of every opening. Daily compliance served as primary outcome measure, defined as percentage of days with correctly administered doses of medication. In addition, pharmacokinetics and pharmacodynamics of donepezil were simulated to systematically assess therapeutic undersupply also incorporating study compliance patterns. Statistical analyses were performed with SPSS and Microsoft Excel.</p> <p>Results</p> <p>Median daily compliance was 94% (range 48%-99%). Ten patients (32%) were non-compliant at least for one month. One-sixth of patients taking donepezil displayed periods of therapeutic undersupply. For 10 mg and 5 mg donepezil once-daily dosing, the estimated forgiveness of donepezil was 80% and 90% daily compliance or two and one dosage omissions at steady state, respectively. Based on the simulation findings we developed rules for the evidence-based interpretation of donepezil compliance reports.</p> <p>Conclusions</p> <p>Compliance in ambulatory Alzheimer patients was for the first time assessed under routine conditions using electronic monitoring: On average compliance was relatively high but variable between patients. The approach of pharmacokinetic/pharmacodynamic <it>in silico </it>simulations was suitable to characterise the forgiveness of donepezil suggesting evidence-based recommendations for the interpretation of compliance reports.</p

Perceptions and Practices of Stimulating Children’s Cognitive Development Among Moroccan Immigrant Mothers

We explored the perceptions of children’s cognitive development among Moroccan Arabic and Berber immigrant mothers who cannot read, who are less educated, middle educated or highly educated in the Netherlands. A series of in-depth interviews was conducted with 22 mothers with young children (mean age = 5 years and 6 months). Qualitative data analyses revealed five major themes that are of significant importance to these mothers: moral attitudes, social values and religiousness; conversation, reading and playing as stimulating activities; importance attached to education; parental expectations; attributions of school success. The parental perceptions about the cognitive development of young children differed according to their own educational level. Mothers who cannot read and mothers with less education emphasized the development of moral, social and religious values for strengthening the cultural identity of their children. This sense of identity would enable them to function within their own cultural group and help them to perform well at school. School success was attributed in large part to a combination of the efforts of the child and the school. Middle and highly educated mothers, on the other hand, valued scholastic development and attributed school success to their own efforts and to the kind of support the child received. The ethnic background of the parents, whether Arabic or Berber, did not make a difference in the perceptions