Adverse effects of the antimalaria drug, mefloquine: due to primary liver damage with secondary thyroid involvement?

BACKGROUND: Mefloquine is a clinically important antimalaria drug, which is often not well tolerated. We critically reviewed 516 published case reports of mefloquine adverse effects, to clarify the phenomenology of the harms associated with mefloquine, and to make recommendations for safer prescribing. PRESENTATION: We postulate that many of the adverse effects of mefloquine are a post-hepatic syndrome caused by primary liver damage. In some users we believe that symptomatic thyroid disturbance occurs, either independently or as a secondary consequence of the hepatocellular injury. The mefloquine syndrome presents in a variety of ways including headache, gastrointestinal disturbances, nervousness, fatigue, disorders of sleep, mood, memory and concentration, and occasionally frank psychosis. Previous liver or thyroid disease, and concurrent insults to the liver (such as from alcohol, dehydration, an oral contraceptive pill, recreational drugs, and other liver-damaging drugs) may be related to the development of severe or prolonged adverse reactions to mefloquine. IMPLICATIONS: We believe that people with active liver or thyroid disease should not take mefloquine, whereas those with fully resolved neuropsychiatric illness may do so safely. Mefloquine users should avoid alcohol, recreational drugs, hormonal contraception and co-medications known to cause liver damage or thyroid damage. With these caveats, we believe that mefloquine may be safely prescribed in pregnancy, and also to occupational groups who carry out safety-critical tasks. TESTING: Mefloquine's adverse effects need to be investigated through a multicentre cohort study, with small controlled studies testing specific elements of the hypothesis

Coal and Climate Change

This overview adopts a critical social science perspective to examine the state of play and potential futures for coal in the context of climate change. It introduces key trends in coal consumption, production and trade, before appraising the relevant literature. Finding surprisingly little literature directly focussed on coal and climate change compared with related fields, it appraises existing work and highlights key areas for future work. In addition to established bodies of work on the situated politics of coal and the political economy of coal, new work calling for demand side policies to be supplemented with supply side policies highlights the increasing importance of how normative contestations drive debates over coal, suggesting that future work needs to engage not only much more directly with climate change as an issue, but particularly with the place of coal in a just transition. Because of coal’s mammoth contribution to climate change and the complex political economy which drives its production and consumption, it is likely that coal will remain at the centre of difficult questions about the relationship between climate action and development for some time

Predicting discharge and long-term outcome patterns for frail elders

Objectives: Using the framework of environmental press theory to examine the predictive value of medical rehabilitation team assessments for both functional abilities and long-term living arrangements of early return home and late return home elders. Participants: One hundred thirty-five older adults (72% women, 84% African American; mean age ϭ 73 years) who lived alone prior to hospitalization for medical rehabilitation. Methods: Competency measures were collected during the hospitalization. Living arrangements were determined by phone follow-up at 3, 6, and 18 months after discharge. Multivariate analysis of variance identified early return and late return patient groups. Logistic regression analyses then determined the clinical utility of the prediction model. Chi-square analyses addressed group differences in stability of living arrangements. Results: Medical burden, functional abilities, and cognition were significant predictors of group membership. Among late return patients, 27% continued to live alone at the 18-month follow-up; 59% of the early return patients did so. Conclusions: Interdisciplinary assessments (including psychological measures) completed in the hospital provide valuable data for discharge planning for older medical rehabilitation patients and are clearly related to successful long-term adjustment

Impact of grandchild caregiving on African American grandparents

The aim of this study was to describe the context and impact of caregiving for grandchildren with health concerns on grandparents. The study sample comprised 391 African American grandparents aged 55 or older. Logistic regression analysis indicated that grandparent caregivers of grandchildren with psychiatric or behavioral problems were more likely to experience a negative impact on their health (AOR = 7.86, p =.008) and leisure (AOR = 14.31, p =.024) than grandparent caregivers of grandchildren with no or other types of health problems. The findings underscore the need to support African American grandparent caregivers, particularly those raising grandchildren with mental health problems