M.A. (Clinical Psychology) / This study concerns itself with relaxation training and social support as alternative forms of treatment for hypertension in renal patients. following the success of these in the treatment of essential hypertension (Lagrone et al 1986). Three groups of renal dialysis patients were chased for the study. The first group underwent relaxation training, the second group participated in group therapy sessions whieh emphasized social support. and the last group acted as a control group. The following hypotheses were made: I. Renal dialysis patients that receive progressive muscle relaxation training will show a significantly lower systolic and diastolic blood pressure rate. 2. Renal dialysis patients that participated in a number of group therapy sessions will show significant decreases in both systolic and diastolic blood pressure.

Background. Hypertension carries a high risk of cardiovascular complications. Patient medication non-compliance has been identified to be an major factor for suboptimal blood pressure control in clinical practice. Different strategies have been proposed to improve patient medication compliance but their effects on clinical outcomes were inconsistent. Methods . A telephone survey was conducted to examine patient medication compliance with anti-hypertensive drugs in Hong Kong. I then established a Pharmacist-managed Compliance Clinic in a public out-patient setting and provided individualized patient education to non-compliant patients identified by physicians. A telephone follow-up was arranged at 4-week after intervention followed by a more in-depth reassessment on subsequent physician clinic visit day. The immediate endpoint was patient compliance rate. Intermediate endpoint was systolic and diastolic blood pressure control. Other outcome measures were control of other cardiovascular risk factors and level of healthcare resources utilization. / Conclusion. Pharmacist-managed Compliance Clinic is effective in improving patient medication compliance and has positive impact on clinical outcomes. (Abstract shortened by UMI.) / Results. A total of 853 patients were successfully contacted and completed the patient survey. According to our definition, 80.4% of patients interviewed were considered to be compliant. Factors associated with medication compliance included multiple drug therapy, presence of drug adverse effects, patient's awareness of preventive nature of medication, rapport between patient and physician, and full-time working status. A causal model was successfully established with latent factors identified for medication non-compliance. The factors included patient's functional status, provision of health advice and concern from physician, and patient's knowledge regarding reasons for drug taking. Another two hundreds hypertensive patients were followed at the Pharmacist-managed Compliance Clinic. On average, each patient attended 1.3 pharmacist visits. The non-compliance rate fell from 100% to 20% after a single pharmacist intervention. Significant improvement was observed in patients' mean blood pressures readings as well as the diabetic and lipid control. Positive impacts on healthcare resources utilization were also observed. / Chan Man Chi Grace. / "June 2005." / Adviser: Juliana C.N. Chan. / Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 3730. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 126-151). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract in English and Chinese. / School code: 1307.

The Doctor Interactive Group Medical Appointment (DIGMA) is a group health intervention that combines the services of behavioral health and primary care. The DIGMA was first invented by Edward Noffsinger in 1996, in response to his own difficulties with the overtaxed primary care system at Kaiser Permanente in California (Noffsinger, 1999). Integrating healthcare services in this way has practical implications such as efficient use of resources, treating multiple complaints at once, and beginning to view the mind and body as one (Noffsinger, 1999; Engel, 1977). The DIGMA at the Austin Veterans Outpatient Clinic was designed to address the specific needs of veterans with hypertension. It consists of 4 sessions of 1.5 hours each and addresses such varied topics as exercise, stress-management, nutrition, and medication adherence. These topics are discussed in a group format with the tenets of group psychotherapy (Yalom & Leszcz, 2005) as a backdrop. An exploratory study was warranted to determine whether programs of this sort would be effective on a broad scale. A pretest/posttest design was utilized to determine if the DIGMA was effective at reducing symptoms of hypertension; improving health promoting behavior; increasing self-efficacy to manage hypertension; and increasing internal health locus of control while decreasing chance and powerful others health locus of control. Groups were conducted over a period of seven months with a total of 73 male veterans enrolled in the study. The final n was 58. Findings indicated that both systolic and diastolic blood pressure readings were reduced significantly from pretest to posttest. Health promoting behavior increased significantly; hypertension self efficacy increased significantly; and locus of control did not change significantly from pretest to posttest. The exploratory study concluded that the DIGMA may be efficacious for a variety of aspects of the management of hypertension. It is suggested that further research be conducted but that integrating services in this way can lead to improved patient outcomes and can also be cost-effective. / text

Includes 4 published papers by the author as part of appendix 9 / Bibliography: leaves 1-19 (second sequence) / System requirements for accompanying computer disk: IBM-compatible computer. Other requirements: Dbase. / 1 v. (various pagings) ; / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Summary: describes and evaluates an economical method of collecting a large amount of data on thousands of patients suffering from essential hypertension and establishes the reliability of the data collected in this way. Also provides information on the tolerability and effectiveness of nifedipine / Thesis (M.D)--Dept. of Clinical and Experimental Pharmacology, University of Adelaide, 1993

Angiotensin-converting enzyme (ACE) inhibitors are some of the most commonly prescribed medications for hypertension. They are cited in many papers as the treatment most often recommended by guidelines and favoured over other antihypertensive drugs as first-line agents especially when other high-risk conditions are present, such as diabetic nephropathy. The development of captopril (CPT) was amongst the earliest successes of the revolutionary concept of structure-based drug design. Due to its relatively poor pharmacokinetic profile or short half-life of about 1 hour, the formulation of sustained-release microcapsule dosage form is useful to improve patient compliance and to achieve predictable and optimized therapeutic plasma concentrations. Currently, CPT is mainly administered in tablet form. One of the difficulties of CPT formulation has been reported to be its instability in aqueous solutions. CPT is characterized by a lack of a strong chromophore and, therefore, not able to absorb at the more useful UV–Vis region of the spectrum. For this reason, an accurate, simple, reproducible, and sensitive HPLC-ECD method was developed and validated for the determination of CPT in dosage forms. The method was successfully applied for the determination of CPT in commercial and developed formulations. Possible drug-excipient and excipient-excipient interactions were investigated prior to formulating CPT microcapsules because successful formulation of a stable and effective solid dosage form depends on careful selection of excipients. Nuclear magnetic resonance spectroscopy, Fourier transform infra-red spectroscopy (FT-IR), differential scanning calorimetry (DSC) and thermogravimetric analysis (TGA) were used for the identification and purity testing of CPT and excipients. The studies revealed no thermal changes during stress testing of binary and whole mixtures which indicate absence of solid state interactions. There were no shifts, appearance and disappearance in the endothermic or exothermic peaks and on the change of other associated enthalpy values on thermal curves obtained with DSC method. Characteristic peaks for common functional groups in the FT-IR were present in all the mixtures indicating the absence of incompatibility. The techniques used in this study can be said to have been efficient in the characterization and evaluation of the drug and excipients. The technique of microencapsulation by oil-in-oil was used to prepare CPT microcapsules. The effects of polymer molecular weight, homogenizing speed on the particle size, flow properties, morphology, surface properties and release characteristics of the prepared CPT microcapsules were examined. In order to decrease the complexity of the analysis and reduce cost response surface methodology using best polynomial equations was successfully used to quantify the effect of the formulation variables and develop an optimized formulation thereby minimizing the number of experimental trials. There was a burst effect during the first stage of dissolution. Scanning electron microscopy (SEM) results indicated that the initial burst effect observed in drug release could be attributed to dissolution of CPT crystals present at the surface or embedded in the superficial layer of the matrix. During the preparation of microcapsules, the drug might have been trapped near the surface of the microcapsules and or might have diffused quickly through the porous surface. The release kinetics of CPT from most formulations followed Fickian diffusion mechanism. SEM photographs showed that diffusion took place through pores at the surface of the microcapsules. The Kopcha model diffusion and erosion terms showed predominance of diffusion relative to swelling or erosion throughout the entire test period. Drug release mechanism was also confirmed by Makoid-Banakar and Korsmeyer-Peppas models exponents which further support diffusion release mechanism in most formulations. The models postulate that the total of drug release is a summation of a couple of mechanisms; burst release, relaxation induced controlled-release and diffusional release. Inspection of the 2D contour and 3D response surfaces allowed the determination of the geometrical nature of the surfaces and further providing results about the interaction of the different variables used in central composite design (CCD). The wide variation indicated that the factor combinations resulted in different drug release rates. Lagrange, canonical and mathematical modelling were used to determine the nature of the stationery point of the models. This represented the optimal variables or stationery points where there is interaction in the experimental space. It is difficult to understand the shape of a fitted response by mere inspection of the algebraic polynomial when there are many independent variables in the model. Canonical and Lagrange analyses facilitated the interpretation of the surface plots after a mathematical transformation of the original variables into new variables. In conclusion, these results suggest the potential application of Eudragit® / Methocel® microcapsules as suitable sustained-release drug delivery system for CPT.

Made available in DSpace on 2014-11-10T11:09:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-02-17Bitstream added on 2014-11-10T11:57:49Z : No. of bitstreams: 1 000785132.pdf: 846444 bytes, checksum: e62ceaf45dd300613619d2fc1b769d3d (MD5) / Objetivo: Avaliar o crescimento neonatal dos descendentes de ratas espontaneamente hipertensas (SHR) submetidas a exercício em esteira motorizada. Metodologia: Ratas SHR e Wystar Kyoto (WKY) foram distribuídas em: sedentárias (SHR e WKY), exercitadas durante a prenhez (SHR EXP e WKY EXP) e exercitadas previamente – antes e durante a prenhez (SHR EXPP e WKY EXPP). Durante a prenhez, pesos corpóreos, glicemia e nível de lactato e triglicérides e pressão arterial foram determinados. No 10º dia de vida pós-natal, peso, glicemia e comprimento corporal e cranial dos filhotes e triglicéride hepático foram analisados. Resultados: Não houve diferença no peso e lactato durante a prenhez e no número de filhotes entre os grupos. O grupo WKE EXPP apresentou maior pressão arterial comparado aos grupos WKY EXP E WKY. SHR EXPP e WKY EXPP apresentaram maior nível de triglicéride que os grupos exercitados na prenhez e sedentários. SHR EXPP apresentou menor glicemia que os SHR EXP e SHR. Não houve diferença nos parâmetros dos filhotes, mas o comprimento corpóreo foi maior nos grupos WKY EXPP e SHR EXPP. Conclusão: O exercício prévio foi exaustivo para a linhagem WKY. O exercício durante a prenhez não foi prejudicial para as ratas SHR e beneficiou o comprimento corpóreo dos filhotes / Purpose: To evaluate the neonatal growth of the offspring of spontaneously hypertensive rats (SHR) subjected to treadmill exercise. Methods: SHR and Wystar Kyoto (WKY) rats were distributed into: sedentary group (SHR and WKY), exercised during pregnancy (SHR EXP and WKY EXP) and exercised previously and during pregnancy (SHR EXPP and WKY EXPP). During pregnancy, body weight, blood glucose, lactate and triglycerides levels and blood pressure were determined. At 10th day of life, body weight, blood glucose, and body and cranial length and hepatic triglycerides were analyzed. Results: There was no difference in body weight and lactate level during pregnancy, and number of pups among groups. The WKY EXPP group presented higher blood pressure than WKY and WKY EXP groups. SHR EXPP and WKY EXPP showed higher triglyceride level compared to groups trained in pregnancy and sedentary. SHR EXPP showed lower blood glucose than SHR and SHR EXP. There was no difference in the parameters of the newborns. In addition, body length was higher in WKY EXPP and SHR EXPP groups. Conclusion: The previous exercise was exhausting for the WKY strain. Exercise during pregnancy is not harmful to SHR rats and benefited the body length of offspring

Orientador: José Carlos Peraçoli / Coorientador: Débora Cristina Damasceno / Banca: Ana Carolina Inhaz Kiss / Banca: Renato Rocha / Resumo: Objetivo: Avaliar o crescimento neonatal dos descendentes de ratas espontaneamente hipertensas (SHR) submetidas a exercício em esteira motorizada. Metodologia: Ratas SHR e Wystar Kyoto (WKY) foram distribuídas em: sedentárias (SHR e WKY), exercitadas durante a prenhez (SHR EXP e WKY EXP) e exercitadas previamente - antes e durante a prenhez (SHR EXPP e WKY EXPP). Durante a prenhez, pesos corpóreos, glicemia e nível de lactato e triglicérides e pressão arterial foram determinados. No 10º dia de vida pós-natal, peso, glicemia e comprimento corporal e cranial dos filhotes e triglicéride hepático foram analisados. Resultados: Não houve diferença no peso e lactato durante a prenhez e no número de filhotes entre os grupos. O grupo WKE EXPP apresentou maior pressão arterial comparado aos grupos WKY EXP E WKY. SHR EXPP e WKY EXPP apresentaram maior nível de triglicéride que os grupos exercitados na prenhez e sedentários. SHR EXPP apresentou menor glicemia que os SHR EXP e SHR. Não houve diferença nos parâmetros dos filhotes, mas o comprimento corpóreo foi maior nos grupos WKY EXPP e SHR EXPP. Conclusão: O exercício prévio foi exaustivo para a linhagem WKY. O exercício durante a prenhez não foi prejudicial para as ratas SHR e beneficiou o comprimento corpóreo dos filhotes / Abstract: Purpose: To evaluate the neonatal growth of the offspring of spontaneously hypertensive rats (SHR) subjected to treadmill exercise. Methods: SHR and Wystar Kyoto (WKY) rats were distributed into: sedentary group (SHR and WKY), exercised during pregnancy (SHR EXP and WKY EXP) and exercised previously and during pregnancy (SHR EXPP and WKY EXPP). During pregnancy, body weight, blood glucose, lactate and triglycerides levels and blood pressure were determined. At 10th day of life, body weight, blood glucose, and body and cranial length and hepatic triglycerides were analyzed. Results: There was no difference in body weight and lactate level during pregnancy, and number of pups among groups. The WKY EXPP group presented higher blood pressure than WKY and WKY EXP groups. SHR EXPP and WKY EXPP showed higher triglyceride level compared to groups trained in pregnancy and sedentary. SHR EXPP showed lower blood glucose than SHR and SHR EXP. There was no difference in the parameters of the newborns. In addition, body length was higher in WKY EXPP and SHR EXPP groups. Conclusion: The previous exercise was exhausting for the WKY strain. Exercise during pregnancy is not harmful to SHR rats and benefited the body length of offspring / Mestre

M.A. (Clinical Psychology) / Hypertension is a current health science priority. This is because it is associated with chronic diseases such as coronary disease. Further it is known to cause end organ damage. It has been clearly established over the last 20 years that antihypertensive drug therapy decreases mortality in those with moderate or severe hypertension. However, the use of drugs for long-term prophylaxis carries with it the risk of long-term side effects. It is for this reason that the need for non-pharmacological treatment of hypertension has risen. The wider acceptance of a more cautious. conservative approach towards drug therapy in general seems necessary. Biobehavioral approaches to the treatment of hypertension have been a 'promising' aItemative or adjunct to drug treatment programmes. However. these approaches have been met with limited success due to the fact that they fail to take into account the effect of family systemic variables as a contributing factor in the causation and maintenance of hypertension. This study investigated the possibility that biopsychosocial techniques offer an added dimension to the biobehavioral approach to the treatment of hypertension by taking into account the familial systemic variables which may contribute to maintaining hypertension. The biopsychosocial techniques may playa significant adjunctive role in permitting control of blood pressure to be maintained without the side-effects seen with the chronic use of medication. An exploratory study was conducted in which a single-subject. AS design was utilized in order to determine whether the added component of a systemically based family intervention would add to decrease or increase the effects obtained with the Fahrion Mayo-protocol. In this context five subjects were consecutively Subjected to health information. muscle relaxation training and biofeedback-assisted training. The systems-based family intervention occurred-throughout the procedure. There was significant decrease across all five subjects of baseline to follow-up systolic blood pressure. This could indicate that the programme as a whole provided an effective decrease in systolic blood pressure. Of particular interest is the possibility that the biofeedback-assisted training intervention could be a placebo intervention associated with the technological nature of the intervention. It is therefore quite clear that the data would be indicative of a non-biofeedback, but relaxation. health information and systemic family intervention to be effective in the treatment of hypertension.

D.Litt. et Phil.. (Psychology) / Please refer to full text to view abstract

This study evaluated the efficacy of cognitive therapy and biofeedback training in lowering Dlood pressures of normotensives under no-stress and stress conditions. A cognitive therapy group was compared to biofeedback and habituation control groups with 32 normotensives. Subjects were taught to use the electronic sphygmomanometer that served as the device to measure blood pressure during pretreatment and posttreatment phases of the study. These measurement phases each consisted of three 19 minute periods. Trie first period consisted of no-stress, and then a stress period followed. Return-to-no-stress was the final period. Subjects in the cognitive therapy and biofeedbacK groups received five sessions of self-control training of 66 minutes each between the pre- and posttreatment phases. The cold pressor was the analogue stressor used to induce bxood pressure elevations,