Idioms of resilience: Mental health and migration in India.

Background: Resilience has proved to be a versatile notion to explain why people are not defeated by hardship and adversity, yet so far, we know little of how it might apply to communities and cultures in low to middle income countries.

Aim: This paper aims to explore the notion of resilience in cross-cultural context through considering the lived experience of internal migration.

Methods: A sample of 30 participants with experience of migration was recruited from a low-income slum dwelling neighbourhood in the city of Pune, India.

On the need for an ecologically dimensioned medical humanities.

Increasing calls from medical professionals and scholars suggest an urgent need for better and more widespread understandings of the ecological dimensions of health. Such calls have included: two recent special commissions on impacts of climate change on health; and recognition by senior figures from the WHO and United Nations of relationships between human impacts on the natural world and disease pandemics, with some suggesting prevention of future pandemics may require a radical reassessment of modernity's relationship with the natural world.Among the medical humanities as a whole, however, calls for better and more widespread understandings of the ecological dimensions of health have not always been as prominent, or urgently expressed, as they might be.

Hypertension in the Very Elderly Trial (HYVET): protocol for the main trial.

A number of trials and meta-analyses have demonstrated clear benefits of blood pressure (BP) reduction in patients aged <80 years with regard to the reduction in stroke and cardiovascular events. However, a variety of studies have suggested that the positive relationship between BP and cardiovascular mortality is weakened or indeed reversed in the very elderly. Most intervention trials to date have either excluded or not recruited sufficient patients aged > or =80 years to determine whether there is a significant benefit from treatment in this age group.

The preparation of a new "safety catch" ester linker for solid-phase synthesis.

A new "safety catch" linker for esters has been synthesized on polystyrene resin. This 2-tert-butoxyphenol resin 10 may be acylated to give a relatively stable ester that will allow nucleophilic chemistry without reaction at the linking ester group. Removal of the tert-butyl group with acid unmasks a highly reactive 2-hydroxyphenyl ester that reacts readily with nucleophiles to cause release of the product from the resin.

Risks of untreated and treated isolated systolic hypertension in the elderly: meta-analysis of outcome trials.

Background: Previous meta-analysis of outcome trials in hypertension have not specifically focused on isolated systolic hypertension or they have explained treatment benefit mainly in function of the achieved diastolic blood pressure reduction. We therefore undertook a quantitative overview of the trials to further evaluate the risks associated with systolic blood pressure in treated and untreated older patients with isolated systolic hypertension

Methods: Patients were 60 years old or more. Systolic blood pressure was 160 mm Hg or greater and diastolic blood pressure was less than 95 mm Hg.

Identification of risk factors in hypertensive patients: contribution of randomized controlled trials through an individual patient database.

Background: Predicting individual risk is needed to target preventive interventions toward people with the highest probability of benefit over a given time period. We assessed which prognostic factors should be used in predicting risk for hypertensive patients and in searching for treatment modifiers.

Methods And Results: Data from 24 390 hypertensive participants who constituted the control groups from 8 controlled trials (1726 deaths over 5 years) were analyzed in multivariate survival models.

Antihypertensive drugs in very old people: a subgroup meta-analysis of randomised controlled trials. INDANA Group.

Background: Beneficial clinical effects of treatment with antihypertensive drugs have been shown in middle-aged patients and in those hypertensive patients over 60 years old, but whether treatment is beneficial in patients over 80 years old is not known.

Methods: We collected data from all participants aged 80 years and over in randomised controlled trials of antihypertensive drugs through direct contact with study investigators. Our primary outcome was fatal and non-fatal stroke.

Effect of antihypertensive treatment in patients having already suffered from stroke. Gathering the evidence. The INDANA (INdividual Data ANalysis of Antihypertensive intervention trials) Project Collaborators.

Background And Purpose: Drug treatment of high blood pressure has been shown to reduce the associated cardiovascular risk. Stroke represents the type of event more strongly linked with high blood pressure, responsible for a high rate of death or invalidity, and with the highest proportion of events that can be avoided by treatment. Hypertensive patients with a history of cerebrovascular accident are at particularly high risk of recurrence.

Effect of antihypertensive drug treatment on cardiovascular outcomes in women and men. A meta-analysis of individual patient data from randomized, controlled trials. The INDANA Investigators.

Background: Trials of drug therapy for hypertension have shown that such therapy has a clear overall benefit in preventing cardiovascular disease. Although these trials have included slightly more women than men, it is still not clear whether treatment benefit is similar for both sexes.

Objective: To quantify the average treatment effect in both sexes and to determine whether available data show significant differences in treatment effect between women and men.

Hormonal and non-hormonal interventions for menopausal symptoms.

Recent cohort studies confirm that only flushes, night sweats and vaginal dryness are provenly associated with ovarian failure. Experiments nave demonstrated that these symptoms and insomnia associated with nocturnal vasomotor symptoms are more effectively controlled by oestrogen than placebo. Hormonal interventions include a variety of oestrogen or oestrogen/progestogen regimes.

HRT, a general practice approach: how to reach the most vulnerable.

Hormone replacement therapy has been shown to be effective in the preservation of bone density and its use should lead to a substantial reduction in the fracture rate of older women. Observational studies have also suggested that it may lead to a reduction in the incidence of coronary heart disease. Both effects are relevant to preventive care in general practice and have been applied within the framework of health promotion clinics.

Is cardiovascular screening in primary care worthwhile?

Recent studies have demonstrated little benefit from multifactorial screening for coronary heart disease risk factors in family practice. The evidence in favour of a high risk approach, however, particularly for cholesterol lowering in the 5% of the population with known coronary heart disease is now stronger than ever. More effort will also be needed to find the older patients with levels of hypertension that need treatment in accordance with present guidelines.

INDANA: a meta-analysis on individual patient data in hypertension. Protocol and preliminary results.

The overall effect of antihypertensive drug treatment has been well documented. The proportion of patients who benefit varies according to their baseline cardiovascular risk, and is small for the majority of people treated. Some investigators propose limiting the treatment target population to patients at high cardiovascular risk, but several assumptions must be made to justify this procedure.

The Hypertension in the Very Elderly Trial (HYVET). Rationale, methodology and comparison with previous trials.

The Hypertension in the Very Elderly Trial (HYVET) is a multicentre, open, randomised, controlled trial. The aim of this trial is to investigate the effect of active treatment on stroke incidence in hypertensive patients over the age of 80 years. Secondary end-points include total cardiovascular mortality and morbidity.

Can we improve compliance with long-term HRT?

In order to increase awareness of strategies to prevent osteoporosis and heart disease we designed a clinic offering education and screening to all women aged 40-60 years on our practice list of 8600 patients, starting in January 1988. Screening and supervision of HRT users occurred at a weekly clinic run by the doctor and nurse. Audit in August 1991 showed that there were 260 present users of HRT (20%) of our population of 1322 women aged 40-60 years.