Pharmaceuticals in drinking water and resources for drinking water

Geneesmiddelen komen in zeer lage concentraties voor in drinkwater en drinkwaterbronnen. De hoeveelheden zijn echter zo laag dat effecten op de volksgezondheid zijn te verwaarlozen. Dit blijkt uit een inventarisatie van RIVM in opdracht van het ministerie van VROM. De meest voorkomende medicijnen in drinkwater en drinkwaterbronnen zijn slecht afbreekbaar in het milieu en/of worden veel gebruikt. De inventarisatie is een vervolg op onderzoek van vier waterinstituten in 2003 (RIVM rapport 703719004). Het RIVM heeft destijds vier geneesmiddelen in drinkwater aangetoond. Nu heeft het RIVM van 22 geneesmiddelen onderzocht in welke hoeveelheden ze voorkomen in drinkwater en drinkwaterbronnen. Hiervoor is een meetprogramma tweemaal uitgevoerd bij 22 drinkwaterproductielocaties. Ondanks de lage concentraties blijkt dat geneesmiddelen waarschijnlijk vaker voorkomen in drinkwater dan enkele jaren geleden. De medicijnen die in 2003 zijn aangetroffen zijn ook in het huidige onderzoek aangetoond. De pijnstillers acetylsalicylzuur (overwegend afkomstig van aspirine) en fenazon en het epilepsiemiddel carbamazepine werden het vaakst aangetroffen. Het synthetisch hormoon van de anticonceptiepil is niet aangetoond. Van het antidepressivum prozac is in enkele gevallen een spoortje aangetroffen. Om de verspreiding van humane en diergeneesmiddelen naar water te verminderen heeft het kabinet begin 2007 een pakket aan beleidsmaatregelen voorgesteld. Voorbeelden van deze maatregelen zijn het beperken van geneesmiddelgebruik, het inzamelen en vernietigen van ongebruikte medicijnen, en het ontwikkelen van geneesmiddelen die beter worden opgenomen in het lichaam en makkelijker worden afgebroken in milieu. Volgens dit onderzoek zijn de aangekondigde beleidsmaatregelen nuttig en nodig om het watermilieu en het drinkwater nu en in de toekomst te beschermen tegen verontreiniging met medicijnen.Pharmaceuticals are present in drinking water and drinking water resources in very low concentrations. However, the amounts are so low that effects on public health are negligible. This was shown in an RIVM investigation performed under the authority of the Dutch Ministry for Housing, Spatial Planning and the Environment (VROM). The most frequently detected medicines in drinking water are almost non-degradable in the environment and/or are frequently used. This investigation represents a follow-up to the research done by four water research institutes in 2003(Report 703719004); at that time RIVM detected four pharmaceuticals in drinking water. Recently, RIVM has investigated 22 pharmaceuticals for amounts present in drinking water and drinking-water resources. For this, a monitoring programme was conducted at 22 drinking-water production sites. In spite of low concentrations, detected pharmaceuticals are probably more frequently found in drinking water compared with several years ago. Medicines detected in 2003 were also found in this current investigation. The analgesics, salicylic acid (mainly from aspirin), phenazon and the anti-epileptic carbamazepin were detected most frequently. The synthetic hormone from the contraceptive pill was not found, while traces of the tranquilizer, prozac, were found in a few samples. At the beginning of 2007 the Dutch government proposed a package of policy measures to decrease the discharge of human and veterinary pharmaceuticals to water. Examples of these measures are reducing the use of pharmaceuticals, collecting and destroying unused pharmaceuticals, and developing pharmaceuticals which are better absorbed in the body and better degradable in the environment. This investigation supports the announced policy measures as being useful and necessary to protect the aquatic environment and drinking water against pollution by pharmaceuticals now and in the future.VROM-Inspecti

Erythropoietin induces neovascularization and improves cardiac function in rats with heart failure after myocardial infarction

ObjectivesWe assessed the effects of erythropoietin (EPO) treatment in a rat model of post-myocardial infarction (MI) heart failure.BackgroundErythropoietin, traditionally known as a hematopoietic hormone, has been linked to neovascularization. Whereas administration of EPO acutely after MI reduces infarct size and improves cardiac function, its role in the failing heart is unknown.MethodsRats underwent coronary ligation or sham surgery. Rats with MI were randomly assigned to: untreated (MI), a single bolus of EPO immediately after MI induction (MI-EPO-early), EPO treatment immediately after MI and once every three weeks (MI-EPO-early+late), and EPO treatment starting three weeks after induction of MI, once every three weeks (MI-EPO-late). After nine weeks, hemodynamics, infarct size, myosin heavy chain (MHC) isoforms, myocyte hypertrophy, and capillary density were measured.ResultsErythropoietin treatment started immediately after MI (MI-EPO-early and MI-EPO-early+late) resulted in a 23% to 30% reduction in infarct size (p < 0.01) and, accordingly, hemodynamic improvement. Erythropoietin treatment, started three weeks after MI (MI-EPO-late), did not affect infarct size, but resulted in an improved cardiac performance, reflected by a 34% reduction in left ventricular end-diastolic pressure (p < 0.01), and 46% decrease in atrial natriuretic peptide levels (p < 0.05). The improved cardiac function was accompanied by an increased capillary density (p < 0.01), an increased capillary-to-myocyte ratio (p < 0.05), and a partial reversal of beta-MHC (p < 0.05) in all treated groups.ConclusionsIn addition to its effect on infarct size reduction, EPO treatment improves cardiac function in a rat model of post-MI heart failure. This observation may be explained by neovascularization, associated with an increased alpha-MHC expression

Feasibility of Narrative Exposure Therapy in an outpatient day treatment program for refugees: Improvement in symptoms and global functioning

Background  Refugees are at high risk for developing post-traumatic stress disorder (PTSD). Narrative exposure therapy (NET) is an evidence-based treatment of PTSD, designed for patients exposed to (multiple) traumatic events and recommended for patients with culturally diverse backgrounds. In clinical practice, adherence to the NET-protocol has been challenged because of psychosocial complexities and comorbid disorders.  Objective:  The current study investigated the feasibility of NET embedded in an outpatient day treatment programme for refugees and examined reduction in PTSD symptoms and improvement of global functioning as well as correlates of change.  Method Participants were patients who consecutively entered an outpatient daytreatment programme from 2013-2017. The majority had a history of prior unsuccessful treatment. PTSD was assessed with the Clinically Administered PTSD Scale (CAPS) before and after finishing NET. Global Assessment of Functioning (GAF) was used to examine changes in functioning. Changes in PTSD scores and functioning were analyzed using paired t-tests and reliable change indices. Patients showing significant improvement were compared to those who did not, on patient and treatment characteristics, including sex, age, region of origin, childhood trauma and treatment duration and dosage of NET.  Results:  Of 97 patients, 76 (78.4%) completed NET. Completers had a longer residency and were more likely to have a partner. Significant reductions in PTSD symptoms and improvements in global functioning were observed. Twenty-eight percent showed reliable improvement with large effect sizes. Four patients did no longer meet the criteria for PTSD. No strong moderators for changes were found. Patients who did not improve more often had a history of childhood trauma. Conclusions NET embedded in an outpatient day treatment programme appears to be feasible. In those who improved, a substantial decline in symptoms and improvement of functioning were observed. The findings suggest that a socially supportive living environment enhances acceptability of trauma-focused treatment in refugees

A 7-year follow-up of sacral anterior root stimulation for bladder control in patients with a spinal cord injury: quality of life and users' experiences\ud

Study design: Cross-sectional descriptive study.\ud \ud Objectives: To assess long-term effects and quality of life (QoL) of using sacral anterior root stimulation (SARS) in spinal cord injured patients.\ud \ud Setting: Neurosurgical and Urological Departments of a large teaching hospital and a large rehabilitation centre in the Netherlands.\ud \ud Methods: In all, 42 patients with complete spinal cord injury (SCI) implanted between 1987 and 2000 were included. A questionnaire was constructed to determine complications, technical failures and personal experiences of the patients. The Qualiveen questionnaire was used and the outcome was compared with data obtained from a reference group of 400 SCI patients with neurogenic bladder problems not using the bladder controller. The Qualiveen questionnaire measures disease-specific aspects in four domains with respect to limitations, constraints, fears and feelings and general QoL aspects, suitable for use in SCI patients with urinary disorders.\ud \ud Results: The results of 37 patients are presented. Our results with the bladder controller with respect to medical and technical complications and infection rates are similar to the results presented by others. From users' experiences, the most important advantages reported were a decreased infection rate (68%), improved social life (54%) and continence (54%). Comparison of the obtained results of our patient group with the Qualiveen questionnaire with a reference group not using the bladder controller indicates that the specific impact of urinary disorders in the four domains on QoL is reduced and that general QoL is improved.\ud \ud Conclusion: SARS is effective and safe for neurogenic bladder management in patients with complete SCI. Users' experiences are positive. Furthermore, this therapy seems to reduce the effects of urinary-disorder-specific QoL aspects, and to increase the QoL in general\u

Oxytocin administration suppresses hypothalamic activation in response to visual food cues

The aim of this study was to use functional neuroimaging to investigate whether oxytocin modulates the neural response to visual food cues in brain regions involved in the control of food intake. Twenty-four normal weight volunteers received intranasal oxytocin (24 IU) or placebo in a double-blind, randomized crossover study. Measurements were made forty-five minutes after dosing. On two occasions, functional MRI (fMRI) scans were performed in the fasted state; the blood oxygen level-dependent (BOLD) response to images of high-calorie foods versus low-calorie foods was measured. Given its critical role in eating behaviour, the primary region of interest was the hypothalamus. Secondary analyses examined the parabrachial nuclei and other brain regions involved in food intake and food reward. Intranasal oxytocin administration suppressed hypothalamic activation to images of high-calorie compared to low-calorie food (P = 0.0125). There was also a trend towards suppression of activation in the parabrachial nucleus (P = 0.0683). No effects of intranasal oxytocin were seen in reward circuits or on ad libitum food intake. Further characterization of the effects of oxytocin on neural circuits in the hypothalamus is needed to establish the utility of targeting oxytocin signalling in obesity

Genetic Influences on Individual Differences in Exercise Behavior during Adolescence

The aim of this study was to investigate the degree to which genetic and environmental influences affect variation in adolescent exercise behavior. Data on regular leisure time exercise activities were analyzed in 8,355 adolescent twins, from three-age cohorts (13-14, 15-16, and 17–19 years). Exercise behavior was assessed with survey items about type of regular leisure time exercise, frequency, and duration of the activities. Participants were classified as sedentary, regular exercisers, or vigorous exercisers. The prevalence of moderate exercise behavior declined from age 13 to 19 years with a parallel increase in prevalence of sedentary behavior, whereas the prevalence of vigorous exercise behavior remained constant across age cohorts. Variation in exercise behavior was analyzed with genetic structural equation modeling employing a liability threshold model. Variation was largely accounted for by genetic factors (72% to 85% of the variance was explained by genetic factors), whereas shared environmental factors only accounted for a substantial part of the variation in girls aged 13-14 years (46%). We hypothesize that genetic effects on exercise ability may explain the high heritability of exercise behavior in this phase of life