[In process]

Benzodiazepine hypnotics bear a higher risk of high dose dependence than benzodiazepine anxiolytics, according to a recent study in Luxemburg. This article summarizes the main indications of these molecules and the current treatment recommendations. It provides an overview of public health actions of the past and the future to reduce their excessive consumption.

Core Standards of the EUBIROD Project. Defining a European Diabetes Data Dictionary for Clinical Audit and Healthcare Delivery

BACKGROUND

A set of core diabetes indicators were identified in a clinical review of current evidence for the EUBIROD project. In order to allow accurate comparisons of diabetes indicators, a standardised currency for data storage and aggregation was required. We aimed to define a robust European data dictionary with appropriate clinical definitions that can be used to analyse diabetes outcomes and provide the foundation for data collection from existing electronic health records for diabetes.

METHODS

Existing clinical datasets used by 15 partner institutions across Europe were collated and common data items analysed for consistency in terms of recording, data definition and units of measurement. Where necessary, data mappings and algorithms were specified in order to allow partners to meet the standard definitions. A series of descriptive elements were created to document metadata for each data item, including recording, consistency, completeness and quality.

RESULTS

While datasets varied in terms of consistency, it was possible to create a common standard that could be used by all. The minimum dataset defined 53 data items that were classified according to their feasibility and validity. Mappings and standardised definitions were used to create an electronic directory for diabetes care, providing the foundation for the EUBIROD data analysis repository, also used to implement the diabetes registry and model of care for Cyprus.

CONCLUSIONS

The development of data dictionaries and standards can be used to improve the quality and comparability of health information. A data dictionary has been developed to be compatible with other existing data sources for diabetes, within and beyond Europe.

[Benzodiazepines : known risks and recent data]

Benzodiazepines have been considered the treatment of choice for a variety of neuropsychiatric disorders. They are currently much more controversial and drugs considered less dangerous are generally preferred. This article summarizes the characteristics of the different benzodiazepines present on the Belgian market. It describes abuse and dependence, as well as the risks of these substances in specific populations or situations. New data suggest that there is a much higher risk of decease in case of a chronic use. Finally, recommendations on rational use and withdrawal are given.

Effect of a previous sprint on the parameters of the work-time to exhaustion relationship in high intensity cycling

The relationships between both metabolic (E) and mechanical (W) energy expended and exhaustion time (t(e)), was determined for 11 well-trained subjects during constant load cycloergometric exercises at 95, 100, 110, 115 % maximal aerobic power performed both from rest and, without interruption, after an all-out sprint of 7 s. These relationships were well described by straight lines: y = a + bt(e), where b was taken as the critical power (metabolic and mechanical) that can be sustained for long periods of time. b was unaffected by the exercise conditions and amounted to 82 - 94 % of maximal aerobic metabolic and mechanical power. The constant a was taken as the anaerobic stores capacity in excess of the O2 deficit. When the test was preceded by the sprint, a (metabolic and mechanical) was reduced to about 60 - 70 % of control values. This reduction was essentially equal to the corresponding E and W output during the sprint. These data support the view that the slope of linear regressions of E and W on t(e) is indeed a measure of the critical power, whereas the y intercept of these same regressions is a measure of the anaerobic capacity.

Very short (15s-15s) interval-training around the critical velocity allows middle-aged runners to maintain VO2 max for 14 minutes

The purpose of this study was to compare the effectiveness of three very short interval training sessions (15-15 s of hard and easier runs) run at an average velocity equal to the critical velocity to elicit VO2 max for more than 10 minutes. We hypothesized that the interval with the smallest amplitude (defined as the ratio between the difference in velocity between the hard and the easy run divided by the average velocity and multiplied by 100) would be the most efficient to elicit VO2 max for the longer time. The subjects were middle-aged runners (52 +/- 5 yr, VO2 max of 52.1 +/- 6 mL x min(-1) x kg(-1), vVO2 max of 15.9 +/- 1.8 km x h(-1), critical velocity of 85.6 +/- 1.2% vVO2 max) who were used to long slow distance-training rather than interval training. They performed three interval-training (IT) sessions on a synthetic track (400 m) whilst breathing through the COSMED K4b2 portable metabolic analyser. These three IT sessions were: A) 90-80% vVO2 max (for hard bouts and active recovery periods, respectively), the amplitude= (90-80/85) 100=11%, B) 100-70% vVO2 max amplitude=35%, and C) 60 x 110% vVO2 max amplitude = 59%. Interval training A and B allowed the athlete to spend twice the time at VO2 max (14 min vs. 7 min) compared to interval training C. Moreover, at the end of interval training A and B the runners had a lower blood lactate than after the procedure C (9 vs. 11 mmol x l(-1)). In conclusion, short interval-training of 15s-15s at 90-80 and 100-70% of vVO2 max proved to be the most efficient in stimulating the oxygen consumption to its highest level in healthy middle-aged long-distance runners used to doing only long slow distance-training.

Effect of a prior intermittent run at vVO2max on oxygen kinetics during an all-out severe run in humans

BACKGROUND

The purpose of this study was to examine the influence of prior intermittent running at VO2max on oxygen kinetics during a continuous severe intensity run and the time spent at VO2max.

METHODS

Eight long-distance runners performed three maximal tests on a synthetic track (400 m) whilst breathing through the COSMED K4 portable telemetric metabolic analyser: i) an incremental test which determined velocity at the lactate threshold (vLT), VO2max and velocity associated with VO2max (vVO2max), ii) a continuous severe intensity run at vLT+50% (vdelta50) of the difference between vLT and vVO2max (91.3+/-1.6% VO2max)preceded by a light continuous 20 minute run at 50% of vVO2max (light warm-up), iii) the same continuous severe intensity run at vdelta50 with a prior interval training exercise (hard warm-up) of repeated hard running bouts performed at 100% of vVO2max and light running at 50% of vVO2max (of 30 seconds each) performed until exhaustion (on average 19+/-5 min with 19+/-5 interval repetitions). This hard warm-up speeded the VO2 kinetics: the time constant was reduced by 45% (28+/-7 sec vs 51+/-37 sec) and the slow component of VO2 (deltaVO2 6-3 min) was deleted (-143+/-271 ml x min(-1) vs 291+/-153 ml x min(-1)). In conclusion, despite a significantly lower total run time at vdelta50 (6 min 19+/-0) min 17 vs 8 min 20+/-1 min 45, p=0.02) after the intermittent warm-up at VO2max, the time spent specifically at VO2max in the severe continuous run at vdelta50 was not significantly different.

Influence of light additional arm cranking exercise on the kinetics of VO2 in severe cycling exercise

This study examined the influence of light additional arm cranking exercise on the VO2 slow component observed during severe cycling exercise. During incremental tests, eleven triathletes exercised to exhaustion cycling with leg, cranking with arm and combined arm and leg cranking and cycling (arm work-rates being set at the third of leg work rates) to determine arm, leg and combined arm and leg lactate threshold and VO2max. After these incremental tests subjects performed in random order severe exercises until exhaustion at work-rates corresponding to the lactate threshold + 50% of the difference to the work rate associated with VO2max and the lactate threshold, i.e., delta50: 1) with legs only (leg delta50) 2) leg delta50 plus a very light arm cranking exercise at 25 % of the arm lactate threshold (Ldelta50 + A25). VO2 slow component was the increase of VO2 (in ml x min(-1)) between the third and the sixth minute of exercise (deltaVO2 63 min). Results showed 1) Nine of the eleven triathletes had a VO2 slow component in arm delta50; 2) a light cycle arm exercise (25% of lactate threshold) added to a severe leg cycle exercise did not decrease time to exhaustion in severe exercise (493 +/- 154s vs 418 +/- 84, P=0.4); 3) For the five subjects who had a VO2 slow component in leg cycling, the addition of a light arm exercise (25% of arm LT) decreased the VO2 slow component significantly (from 457 +/- 173 ml x min(-1) for leg delta50 to 111 +/- 150 ml x min(-1) for Ldelta50 + A25, Z = -2.0, P = 0.04). In conclusion, light additional arm cranking decreases the VO2 slow component in severe cycling. Further studies are needed to confirm the hypothesis that extra work due to an increasing handgrip on the handlebars may contribute to the VO2 slow component in cycling.

Oxygen kinetics and modelling of time to exhaustion whilst running at various velocities at maximal oxygen uptake

The purpose of this study was to characterise the relationship between running velocity and the time for which a subject can run at maximal oxygen uptake (VO2max), (tlimVO2max). Seven physical education students ran in an incremental test (3-min stages) to determine VO2max and the minimal velocity at which it was elicited (vVO2max). They then performed four all-out running tests on a 200-m indoor track every 2 days in random order. The mean times to exhaustion tlim at 90%, 100%, 120% and 140% vVO2max were 13 min 22 s (SD 4 min 30 s), 5 min 47 s (SD 1 min 50 s), 2 min 11 s (SD 38 s) and 1 min 12 s (SD 18 s), respectively. Five subjects did not reach VO2max in the 90% vVO2max test. All the subjects reached VO2max in the runs at 100% vVO2max. All the subjects, except one, reached VO2max in the runs at 120% vVO2max. Four subjects did not reach VO2max in the 140% vVO2max test. Time to achieve VO2max was always about 50% of the time to exhaustion irrespective of the intensity. The time to exhaustion-velocity relationship was better fitted by a 3- than by a 2-parameter critical power model for running at 90%, 100%, 120%, 140% vVO2max as determined in the previous incremental test. In conclusion, tlimVO2max depended on a balance between the time to attain VO2max and the time to exhaustion tlim. The time to reach VO2max decreased as velocity increased. The tlimVO2max was a bi-phasic function of velocity, with a peak at 100% vVO2max.

Intermittent runs at the velocity associated with maximal oxygen uptake enables subjects to remain at maximal oxygen uptake for a longer time than intense but submaximal runs

Interval training consisting of brief high intensity repetitive runs (30 s) alternating with periods of complete rest (30 s) has been reported to be efficient in improving maximal oxygen uptake (VO2max) and to be tolerated well even by untrained persons. However, these studies have not investigated the effects of the time spent at VO2max which could be an indicator of the benefit of training. It has been reported that periods of continuous running at a velocity intermediate between that of the lactate threshold (vLT) and that associated with VO2max (vVO2max) can allow subjects to reach VO2max due to an additional slow component of oxygen uptake. Therefore, the purpose of this study was to compare the times spent at VO2max during an interval training programme and during continuous strenuous runs. Eight long-distance runners took part in three maximal tests on a synthetic track (400 m) whilst breathing through a portable, telemetric metabolic analyser: they comprised firstly, an incremental test which determined vLT, VO2max [59.8 (SD 5.4) ml.min-1; kg-1], vVO2max [18.5 (SD 1.2) km.h-1], secondly, an interval training protocol consisting of alternately running at 100% and at 50% of vVO2max (30 s each); and thirdly, a continuous high intensity run at vLT + 50% of the difference between vLT and vVO2max [i.e. v delta 50: 16.9 (SD 1.00) km.h-1 and 91.3 (SD 1.6)% vVO2max]. The first and third tests were performed in random order and at 2-day intervals. In each case the subjects warmed-up for 15 min at 50% of vVO2max. The results showed that in more than half of the cases the v delta 50 run allowed the subjects to reach VO2max, but the time spent specifically at VO2max was much less than that during the alternating low/high intensity exercise protocol [2 min 42 s (SD 3 min 09 s) for v delta 50 run vs 7 min 51 s (SD 6 min 38 s) in 19 (SD 5) interval runs]. The blood lactate responses were less pronounced in the interval runs than for the v delta 50 runs, but not significantly so [6.8 (SD 2.2) mmol.l-1 vs 7.5 (SD 2.1) mmol.l-1]. These results do not allow us to speculate as to the chronic effects of these two types of training at VO2max.

A parametric copula model for analysis of familial binary data

Modeling the joint distribution of a binary trait (disease) within families is a tedious challenge, owing to the lack of a general statistical model with desirable properties such as the multivariate Gaussian model for a quantitative trait. Models have been proposed that either assume the existence of an underlying liability variable, the reality of which cannot be checked, or provide estimates of aggregation parameters that are dependent on the ordering of family members and on family size. We describe how a class of copula models for the analysis of exchangeable categorical data can be incorporated into a familial framework. In this class of models, the joint distribution of binary outcomes is characterized by a function of the given marginals. This function, referred to as a "copula," depends on an aggregation parameter that is weakly dependent on the marginal distributions. We propose to decompose a nuclear family into two sets of equicorrelated data (parents and offspring), each of which is characterized by an aggregation parameter (alphaFM and alphaSS, respectively). The marginal probabilities are modeled through a logistic representation. The advantage of this model is that it provides estimates of the aggregation parameters that are independent of family size and does not require any arbitrary ordering of sibs. It can be incorporated easily into segregation or combined segregation-linkage analysis and does not require extensive computer time. As an illustration, we applied this model to a combined segregation-linkage analysis of levels of plasma angiotensin I-converting enzyme (ACE) dichotomized into two classes according to the median. The conclusions of this analysis were very similar to those we had reported in an earlier familial analysis of quantitative ACE levels.

Pharmacokinetics of ofloxacin after single and multiple intravenous infusions in healthy subjects

The pharmacokinetics of ofloxacin were investigated in eight healthy male volunteers. A single infusion (200 mg over 0.5 h) was performed on day 1, followed by a washout period of 2 weeks. Repeated administrations were performed for 4 days (200 mg every 12 h). Pharmacokinetic parameters were determined from the plasma decay curves of the single and the last of the multiple administrations. Ofloxacin kinetics after the single dose were best described by a two-phase curve with a total body clearance of 241.6 +/- 43.3 ml min-1, a volume of distribution of 112 +/- 23.1 liters, and an elimination half-life of 5.4 +/- 0.8 h. The extrapolated area under the curve (AUC0-infinity) was 14 +/- 2.3 mg.h liter-1. The pharmacokinetics were not significantly modified by repeated administration, demonstrated mainly by the AUC0-12 value of the last infusion (13.4 +/- 2.2 mg.h liter-1). We conclude that, with intravenous multiple doses every 12 h, the steady state is reached within 24 to 36 h and no abnormal accumulation or changes in pharmacokinetic parameters occur.