Differentiating withdrawal patterns between smokers and smokeless tobacco users.

The present study was designed to document smokeless tobacco withdrawal patterns and to examine differential withdrawal responses between smokers and smokeless users. Participants (N?=?19) were studied under deprivation and nondeprivation conditions, 1 condition per week. The Withdrawal Symptoms Checklist was administered to assess cognitive and affective changes. Both smokers and smokeless users experienced substantially more withdrawal at 48-hr deprivation compared to the 48-hr nondeprivation condition. Participants in both groups endorsed decreasingly fewer withdrawal symptoms from 0 hr to 48 hr on nondeprivation days. This downward trend suggests a need for stabilizing withdrawal responses before deprivation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ambulatory blood pressure monitoring in dialysis patients and estimation of mean interdialytic blood pressure

To define blood pressure (BP) patterns and control in dialysis patients, 48-hour ambulatory BP monitoring was performed in 36 hemodialysis and 18 peritoneal dialysis patients. Monitoring began during a dialysis session for hemodialysis patients. Data revealed significantly lower diastolic BP (DBP) and lower diastolic load (percentage of diastolic values > 90 mm Hg) in hemodialysis patients compared with peritoneal dialysis patients (80.6 mm Hg v 88.8 mm Hg, respectively, [P < 0.03] and 26% v 45%, respectively [P < 0.03]) for the 48-hour period. When the 2 days were analyzed separately, the difference in diastolic pressures and loads was significant only for the first (dialysis) day. Similarly, trends toward lower systolic BP (SBP) and systolic load in hemodialysis patients existed throughout monitoring and were greater in magnitude during the first day. BP data were fit to a random-coefficient growth curve model to detect periodicity. This sensitive model did not detect diurnal variation of BP in either group. The incidence of hypotension did not differ between the two groups (2.0% v 1.0% of total observations, hemodialysis v peritoneal dialysis). In the hemodialysis group, the proportion of hypotensive observations was significantly greater during the 4 hours postdialysis compared with other periods (5.6% v 1.6%; P < 0.02), a finding that likely reflects the practice of holding antihypertensives until after hemodialysis. However, patient diaries did not reflect hypotensive symptoms during this time. In the hemodialysis group, mean BP and predialysis BP did not correlate with interdialytic sodium load or weight gain. Predialysis and postdialysis BP (recorded by dialysis nurses) correlated significantly with mean BP. Predialysis SBP overestimated mean SBP by an average of 10 mm Hg, while postdialysis SBP underestimated mean SBP by an average of 7 mm Hg. To create formulas to estimate mean SBP and DBP in hemodialysis patients, multiple linear regression was used to model these variables against age, sex, race, and average prehemodialysis/posthemodialysis BP. The model achieved a high degree of fit (r2 = 0.72 for SBP; r2 = 0.65 for DBP), demonstrating that prehemodialysis and posthemodialysis BP can be used to predict mean BP in hemodialysis patients. In summary, our data show the absence of a diurnal variation of BP in dialysis patients and lower BP in hemodialysis patients compared with peritoneal dialysis patients. Among hemodialysis patients, more hypotension occurred after dialysis compared with other periods, and predialysis and postdialysis BP can be used to model mean BP levels.     

Long-term use of smokeless tobacco and physical performance in middle-aged men

Because of the discovery of potent interleukin-1 (IL-1) blocking effects by CK-103A (4,6-dihydropyridazino[4,5-c]pyridazin-5 (1H)-ones) on rat uveitis induced by IL-1, numerous derivatives of CK-103A have been synthesized and their efficacies on the same animal model studied. The uveitis was induced by injection of 1 ng IL-1/10 microliters intravitreally. The inflammation reached peak at 12 hr after the injection of IL-1. The prevention/blockade of IL-1-induced uveitis was measured at this peak inflammation time point. It was found that 8 out of 12 CK-analogs studied produced an effective blockade of IL-1-induced uveitis. Most of them were at least equipotent or even more potent than prednisolone in blocking IL-1-induced uveitis. It is concluded that most dihydropyridazinopyridazin derivatives are effective anti-uveitis compounds. Some could be found to be safe and useful for the treatment of this dreadful disease.     

Construction of age-related reference limits for 24-h blood pressure pattern

Blood pressure (BP) is recursively variable during the day-night cycle because of a physiological circadian rhythm. The aim of this study is, therefore, to show how to construct the population reference limits (desms) for BP in its time varying 24-h pattern, starting from a small sample, in order to facilitate their use in a local context. The sample for standardization comprised 427 clinically healthy subjects (211 males and 216 females), ranging in age from 16 to 100 years, attending their routine activities. The procedure begins with the statistical biometry related to the sample, and proceeds with the computation of the BP desms related to (1) the time-qualified discrete values; (2) the parameters of circadian rhythm; (3) the daily pressure load. The pertaining rules are explained step by stop, allowing each one to prepare the proper local desms for BP 24-h pattern. These standards may be useful for validating the individual BP monitoring according to the upper limits of the circadian physiological variability in the diagnostic procedure for identifying hypertensive subjects.     

Effects of behavioral and pharmacological treatment on smokeless tobacco users.

The purpose of this study was to examine the effects of 2 mg of nicotine polacrilex versus placebo gum and of group behavioral treatment versus minimal contact on cessation of smokeless tobacco use. Participants (N?=?210) were randomly assigned 1 of the 4 treatment conditions. Withdrawal symptoms were assessed throughout the treatment. Follow-up assessments were made at 1, 6, and 12 months posttreatment. Survival curve analysis showed that any of the 3 treatment groups involving group behavioral therapy or placebo gum were equally effective and superior to the minimal contact plus 2 mg of nicotine gum treatment in terms of abstinence. On the other hand, withdrawal symptoms were significantly reduced by nicotine gum, compared with placebo during the initial phases of cessation. The ineffectiveness of nicotine gum on treatment outcome may be attributed to its similarity with smokeless tobacco. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ambulatory blood pressure, nocturnal blood pressure reduction and plasma catecholamines

OBJECTIVE AND DESIGN: Controversial data have been reported on plasma catecholamines in hypertensives. Aims of this study were to find whether 24-hour ambulatory blood pressure was correlated with circulating catecholamines and to investigate whether nocturnal blood pressure reduction was associated with baseline plasma catecholamines. Samples for catecholamine determination were obtained in 34 consecutive male subjects after a 30-minute rest and before ambulatory blood pressure monitoring. RESULTS: Hypertensive patients (n = 22; 24-hour blood pressure: 145 +/- 14/94 +/- 6 mm Hg) showed similar norepinephrine and epinephrine levels when compared with normotensives (n = 12; 24-hour blood pressure: 124 +/- 6/81 +/- 6 mm Hg), and higher dopamine values (hypertensives: 64.6 +/- 58; normotensives: 26.2 +/- 31 pg/ml; p < 0.05). A positive correlation was observed between dopamine and diastolic nocturnal blood pressure (p < 0.05) while a negative correlation was found between dopamine and nocturnal diastolic blood pressure reduction (p < 0.025). No significant relationship was observed between both norepinephrine and epinephrine, and 24-hour blood pressures. CONCLUSIONS: Since previous reports have documented malfunctioning of dopaminergic system in hypertension, the higher levels of circulating plasma dopamine found in hypertensive patients in the present study may account for a peripheral compensatory increase. The correlation between dopamine and nocturnal blood pressure fall seems to indicate that the impairment of dopaminergic system may influence the 24-hour blood pressure profile, affecting the nocturnal blood pressure reduction.     

Ambulatory blood pressure monitoring is a useful clinical tool in nephrology

Hypertension is a key factor in the genesis and deterioration of many renal diseases and is also a risk factor for death in patients with end-stage renal disease. However, the standard methods of measurement are prone to variability, especially in patients undergoing dialysis. The technique of ambulatory blood pressure monitoring allows a better assessment of overall blood pressure levels and promises to assume a bigger role in the care of renal patients. Ambulatory blood pressure monitoring is widely used in hypertension trials, and the reports of several consensus meetings on the clinical uses of ambulatory blood pressure monitoring have been published. Two similar validation protocols now exist for ambulatory blood pressure monitors, and tables of population-based normal blood pressures for age and gender are available. The available evidence suggests that ambulatory blood pressure compared with blood pressure measured in the physician's office is better correlated to left ventricular mass in subjects with chronic renal disease. Furthermore, studies in subjects with chronic renal disease and those undergoing renal replacement therapy show that blood pressure control is suboptimal in many patients and that nocturnal blood pressure is generally higher than in control subjects. Further insights into overall blood pressure behavior in this population will certainly emerge in the future.     

Ambulatory blood pressure monitoring in pregnancy: what is normal?

This paper aims to explore the meaning of spirituality in relation to nursing care using concept synthesis. Walker and Avant give three ways in which concept synthesis can occur: discovering new dimensions to old concepts, searching for similarities and discrepancies among sets of related concepts, and observing previously undescribed phenomena. It is the first two of these methods which have been used here. The phenomena that emerged from a reading of the literature around spirituality were meaning, presencing, empathy/compassion, giving hope, love, religion/transcendence, touch and healing. These phenomena were studied in order to sort them into fewer categories. They all appeared to be products of a relationship, some physical (presencing, touch and healing), and others emotional (meaning, empathy/compassion, hope, love, and religion/transcendence). Some of the phenomena appeared to fit in both categories, especially healing, which could be of a physical or emotional/spiritual nature. Once the two main categories had been arranged, it was obvious that a split between psyche and soma was not appropriate for labelling the spiritual dimensions of nursing care, as the original definition of spirit was something which motivated the body. Spiritual care is inseparable from physical, social and psychological care because together they form the whole (Bradshaw 1994 p. 282). The two categories were then collapsed into one and given the label 'connection'.     

Ambulatory blood pressure monitoring during pregnancy. Comparison with mercury sphygmomanometry

There is little information concerning the relationship between blood pressures obtained by standard mercury sphygmomanometry and ambulatory blood pressure monitoring (ABPM) in pregnancy. We compared readings obtained with these two methods using an Hawksley random zero mercury sphygmomanometer and an Accutracker II ABPM device. Blood pressures were compared over 90 min with the pregnant woman seated and, in a separate study, over 30 min during standing and ambulation. When pregnant women were seated, the ABPM overestimated the systolic blood pressure (BP) by 5 (3,6) mm Hg (mean, 95% confidence limits) (P < .001) and underestimated diastolic phase IV readings by 7 (-9, -6) mm Hg (P < .001) and phase V readings by 3 (-5, -1) mm Hg (P < .01). Eighty-three percent of systolic readings agreed within 10 mm Hg. Seventy-six percent of diastolic phase V (but only 45% of phase IV) readings agreed within 6 mm Hg. When pregnant women were ambulatory, the ABPM overestimated systolic BP by 7 (4,10) mm Hg (P < .001) and underestimated diastolic phase IV readings by 6 (-8, -4) mm Hg (P < .001) and phase V readings by 4 (-6, -2) mm Hg (P < .01). Eighty percent of systolic readings agreed within 10 mm Hg. Fifty-five percent of diastolic phase V and 50% of diastolic phase IV readings agreed within 6 mm Hg. The Accutracker II blood pressure readings are reasonably comparable to those of mercury sphygmomanometry in pregnant women, particularly when assessing group data.(ABSTRACT TRUNCATED AT 250 WORDS)     

Ambulatory blood pressure and Holter monitoring of emergency physicians before, during, and after a night shift

BACKGROUND: Patients with a mutation in the LDL receptor gene (familial hypercholesterolemia, or FH) are characterized by substantial elevations in plasma LDL cholesterol and are at higher risk of developing coronary artery disease (CAD). Correlates of abdominal obesity may also contribute to the risk of ischemic cardiac events. Whether the hyperinsulinemic-insulin-resistant state of abdominal obesity affects coronary atherosclerosis among FH patients has not been determined. METHODS AND RESULTS: The relation of abdominal adiposity and hyperinsulinemia to angiographically assessed CAD was evaluated in a sample of 120 French Canadian men aged <60 years who were heterozygotes for FH and in a group of 280 men without FH. In the present study, the risk of CAD associated with abdominal obesity, as estimated by the waist circumference, was largely dependent on the concomitant variation in plasma lipoprotein and insulin concentrations. In contrast, the association between fasting insulin and CAD was independent of variations in waist girth, triglyceride, HDL, and apolipoprotein B concentrations (odds ratio, 1.86; P=.0005). However, the most substantial increase in the risk of CAD was observed among abdominally obese (waist circumference >95 cm) and hyperinsulinemic FH patients (odds ratio, 12.9; P=.0009). This increase in risk remained significant even after adjustment for LDL cholesterol or apolipoprotein B concentrations. CONCLUSIONS: Results of the present study provide support for the notion that the hyperinsulinemic-insulin-resistant state of abdominal obesity is a powerful predictor of CAD in men, even in a group of patients with raised LDL cholesterol concentrations due to FH.     

24 hour monitoring of blood pressure in premature and full-term new born babies

Using a 24 hour monitoring of the systo-diastolic blood pressure, 127 new born babies were studied in the first five days of life. 45 of these new born babies were premature (35 +/- 1 week) and 82 full-term. The results showed an overlap in the systo-diastolic blood pressure in the 2 groups of subjects with a rise and fall in pressure in the 24 hour period and no fall in pressure during the night typical to a healthy adult.     

Ambulatory blood pressure and heart rate in healthy male paramedics during a workday and a nonworkday.

[Correction Notice: An erratum for this article was reported in Vol 11(3) of Health Psychology (see record 2008-10739-001). On page 52, the sentence "For example, the paramedics stood 16.44 times more while home than while at the station" should read "For example, the paramedics stood more while home than while at the station."] Compared ambulatory blood pressure (BP) and heart rate (HR) in 30 White male paramedics (aged 20–43 yrs) during a 24-hr workday and a 24-hr nonworkday. During the 24-hr period as a whole, there were no BP differences between the workday and the nonworkday, but HR was higher during the nonworkday than during the workday. Systolic BP (SBP) recorded in the ambulance on the workday was elevated 9.8 mm Hg, compared with SBP recorded in a car on the nonworkday; it was also 7.2 mm Hg higher at the scene of an accident and at the hospital than during nonworkday activities. Ratings of moods in diaries indicated that paramedics felt more unhappiness, stress, and sadness and less feelings of pleasantness at work than at home. Rather than being elevated for the entire 24-hr period, work BP seemed to reflect the relatively high stress associated with specific situations in the work of a paramedic. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Oral mucosal changes and nicotine disposition in users of Swedish smokeless tobacco products: a comparative study

A survey was conducted to assess the knowledge of 30 oral hygiene (OH I & II) and 79 dental students (BCHD III & VI) on HIV infection and AIDS. A questionnaire consisting of twenty-nine questions based on the 'agree-disagree' format was prepared for this study. Clinical slides were projected to assess students' ability to identify oral manifestations of HIV infection. Most students agreed that HIV-sero-positive people were entitled to the same dignity and respect as those who were suffering from other illnesses. Students were concerned about treating sero-positive patients. They would preferably receive training in the management of these patients in a controlled environment. They had a poor perception of the risk of infection following needle-stick injury and whether HIV could be transmitted through contact with saliva. Most students felt that they had insufficient lectures on HIV/AIDS and had practically no clinical exposure to HIV-sero-positive patients.     

24-h blood pressure and autonomic function is related to albumin excretion within the normoalbuminuric range in IDDM patients

A retrospective review was performed to determine "crankshaft" prevalence in 86 immature patients who underwent posterior spinal fusion for idiopathic scoliosis. Tanner stage, chronologic age, bone age, and epiphyseal status were used as maturity indicators. Overall, 62 (72%) patients progressed < or = 10 degrees, 18 (21%) patients progressed 11-15 degrees, and six (7%) patients progressed > or = 16 degrees in the coronal plane. Tanner I patients with open triradiate cartilage had the highest rate of crankshaft occurrence; nine (75%) of 12 patients progressed >10 degrees (p < 0.05). Fifty-two percent of Tanner I, 26% of Tanner II, 11% of Tanner III, and no Tanner IV patients progressed >10 degrees (p < 0.05). Cobb angle increases of >10 degrees degrees occurred in 54% of patients with open triradiate cartilage (p < 0.05) and in 48% of patients with open capital femoral epiphyses (p < 0.05). Anterior and posterior spinal fusion should be considered in prepubertal (Tanner I) patients with open triradiate cartilage.     

Ambulatory systolic blood pressure patterns in elderly hypertensives

In a recent study we found that patients with isolated systolic hypertension (ISH) had two patterns of systolic blood pressure (SBP) elevations by ambulatory BP monitoring (ABPM), sustained (S) and intermittent (I), the prognostic significance of which seems to be different. In the present study we tried to determine whether such patterns of SBP elevations may be detected among other hypertensives as well. Twenty-eight elderly patients (mean age 65.5+/-5.1 years), nine with ISH, 10 with systolodiastolic hypertension (SDH), and nine with white coat hypertension (WCH), underwent ABPM. Average clinic BP in the ISH group was 184/83 mm Hg, in the SDH group 172/101 mm Hg, and in the WCH group 166/91 mm Hg, where as the ABPM averages were 169/80, 167/95 and 132/73 mm Hg, respectively, and differences held true for both daytime and night-time. Five ISH and four SDH patients had S patterns on ABPM, while the other four ISH and six SDH patients exhibited I patterns; none of the nine WCH subjects had either S or I patterns. ECG revealed left ventricular hypertropy (LVH) and/or ischaemic changes in eight patients with S patterns (ISH and SDH groups combined), as opposed to two patients with I patterns and only one patient of the WCH group. This seems to further suggest that an S pattern of SBP elevation on ABPM may have worse prognostic implications than either an I pattern or no SBP elevation.     

Effects of 24-hour ambulatory blood pressure monitoring on daily activities.

Compared the self-monitored activities, locations, and postural positions of 28 hypertensives while they wore an alarm watch and then while they wore a 24-hr ambulatory blood pressure monitor (ABPM) to see if wearing the ABPM led to alterations in behavior. Significant differences were found in frequency of being at home or in miscellaneous settings; in standing and reclining positions; and in mental, physical, and miscellaneous activities between the 2 occasions. For the most part, differences were in the direction of showing lower overall blood pressure while wearing the ABPM than would have been found at the same time while wearing the watch. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing hypertension management: the role of 24-hour blood pressure monitoring

BACKGROUND: The first fully automatic portable invasive blood pressure recorder was developed 30 years ago. Today, portable noninvasive ambulatory blood pressure devices are capable of measuring blood pressure intermittently for periods of 24 to 48 hours. OBJECTIVE: To discuss the utility of automatic ambulatory blood pressure recording in assessing antihypertensive therapy. SUMMARY: Ambulatory blood pressure monitoring is helpful in assessing the pharmacodynamics and the clinical efficacy of antihypertensive drugs. It is superior to office blood pressure measurement in predicting hypertensive end-organ disease. In clinical trials, ambulatory blood pressure monitoring permits a more varied population to enter a study, the number of subjects required is often reduced, and a placebo control group may be unnecessary. CONCLUSIONS: The various methods of analyzing ambulatory blood pressure data should be used in a complementary fashion to evaluate antihypertensive drug therapy. We believe that this technique will soon become much more commonly used for hypertension management.