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Pain is a universal experience with profound effects on the physiology, psychology, and sociology of the population. Orofacial pain (OFP) conditions are especially prevalent and can be severely debilitating to a patient's health-related quality of life. Evidence-based clinical trials suggest that pharmacologic therapy may significantly improve patient outcomes either alone or when used as part of a comprehensive treatment plan for OFP. The aim of this article is to provide therapeutic options from a pharmacologic perspective to treat a broad spectrum of OFP. Clinical-based systemic and topical applied pharmaceutical approaches are presented to treat the most common OFP syndromes.

Concern about potential harmful effects of early maternal hypothyroidism (MH) on fetal brain development has led to calls for universal screening early in, or even before, pregnancy. However, evidence in humans that adverse effects are irreversible if thyroid hormone replacement is initiated after the first trimester is limited. Severe MH due to thyrotropin (TSH) receptor blocking antibodies (Abs) is associated with profound cognitive delay in the offspring if MH is untreated or inadequately treated; here, we sought to determine the outcome if treatment is given in early pregnancy.We identified three women who had TSH receptor blocking Ab-induced MH during pregnancy and were treated with L-thyroxine (L-T4), starting at 27 weeks, 5 weeks, and the first month of gestation. The corresponding pretreatment serum TSH levels in the two women in whom data were available were 68 and 65 mU/L, falling to 6 mU/L at 25 and 24 weeks of gestation, respectively. The third woman with MH required 0.5 mg of L-T4 to normalize her thyroid hormone levels by 4 months of gestation. Their infants were also treated with L-T4 after neonatal screening that identified congenital hypothyroidism (CH). Neuropsychological tests to assess intelligence, language, memory, and visual-motor performance were administered to these three infants at 5.4 years of age (range 5.1-6.1) and to three sibling controls at 6.8 years (range 9.1-3.0).Children born after MH had average or above average results on all parameters. Comparative scores of the neuropsychological tests in sibling pairs for full-scale intelligence quotient (IQ) and performance IQ were variable; some scores were higher and some were lower in CH children.Although the findings do not exclude a subtle impact of MH during early gestation on intellectual function, the normal cognitive outcome despite overt MH should provide data with which to counsel mothers who have overt hypothyroidism early in pregnancy. Aggressive thyroid hormone replacement as soon as possible is important, but early termination of the pregnancy because of fear that the baby will have significant cognitive delay is not warranted.

To explore factors that influence how informal caregivers manage medications as part of caring for hospice patients.Semistructured, open-ended interviews were conducted with 23 informal caregivers and 22 hospice providers from 4 hospice programs in the Chicago metropolitan areas. Qualitative analysis was conducted consistent with the grounded theory approach.In general, informal caregivers and hospice providers identified similar key factors that facilitated or impeded caregivers' process in managing medications. Caregivers' life experience and self-confidence were considered assets that facilitated medication management. Limitations impeding the process included caregivers' negative emotional states, cognitive and physical impairments, low literacy, other competing responsibilities, as well as patients' negative emotional states and complex medication needs. Furthermore, the social context of medication management emerged as a salient theme: caregivers' good interpersonal relations with patients facilitated medication management, whereas poor communication/relations among caregivers within a support network impeded the process. While both study groups discussed the positive attributes of good caregiver-patient relations and support from multiple caregivers, hospice providers were cautious about the potential adverse influence of close relations with patients on caregivers' decision making about medications and discussed poor communication/relations among informal and privately hired caregivers that often resulted from family conflicts and/or a lack of long-standing leadership.Our findings suggest additional intervention points, beyond knowledge and skill building, that could be addressed to support caregivers in executing medication responsibilities at home for hospice patients.

Background: Cost-related medication non-adherence may be influenced by patients’ perceived importance of their medications. Objectives: This exploratory pilot study addresses three related but distinct questions: Do patients perceive different levels of importance among their medications? What factors influence perceptions of medication importance? Is perceived importance associated with perceived worth of medications, and does expense impact on that association? Methods: Study participants included individuals aged ≥60 years who were taking three or more prescription drugs. Semi-structured, in-person interviews were conducted to measure how patients rated their medications in terms of importance, expense and worth. Factors that influenced medication importance were identified using qualitative analysis. Ordinal logistic regression analyses were employed to examine the association between perceived importance and perceived worth of medications, and the impact of expense on that association. Results: For 143 prescription drugs reported by 20 participants, the weighted mean rating of medication importance was 8.2 (SD 1.04) on a scale from 0 (not important at all) to 10 (most important). Patients considered 38% of these medications to be expensive. The weighted mean rating of worth was 8.4 (SD 1.46) on a scale from 0 (not worth it at all) to 10 (most worth). Three major factors influenced medication importance: drug-related (characteristics, indications, effects and alternatives); patient-related (knowledge, attitudes and health); and external (the media, healthcare and family caregivers, and peers). Regression analyses showed an association between perceived importance and perceived worth for inexpensive medications (odds ratio [OR] 2.23; p = 0.002) and an even greater association between perceived importance and perceived worth for expensive medications (OR 4.29; p < 0.001). Discussion: This study provides preliminary evidence that elderly patients perceive different levels of importance for their medications based on factors beyond clinical efficacy. Their perception of importance influences how they perceive their medications’ worth, especially for medications of high costs. Understanding how patients perceive medication importance may help in the development of interventions to reduce cost-related non-adherence.

Controlled trials to evaluate mass screening programs for cancer detection have been singularly lacking. High cost, lack of medical manpower, and low yield have contributed to this problem. A new program in cancer detection (CAN-SCREEN) has been developed jointly by The Fox Chase Cancer Center in Philadelphia and the Preventive Medicine Institute in New York City. This program attempts to provide a quality cancer-detection examination with increased cost effectiveness. Features include: 1) a self-administered questionnaire on medical history, symptoms, and risk factors; 2) nonphysician examiners; 3) risk-factor analysis with a predetermined decision logic to determine type and periodicity of examination; and 4) primary intervention (health education). This collaborative program between two institutions in two cities demonstrates the feasibility of introducing similar programs elsewhere. A data base shared by cooperating centers permits information on all patients to be used for evaluation of new techniques, end results, etc. A randomized controlled trial has been designed to evaluate the effectiveness and efficiency of the questionnaire alone and of the questionnaire and examination.

Radioimmunoassay (RIA) and immunocytochemistry (ICC) were used to study the effect of hypophysectomy (H) on the distribution and quantity of luteinizing hormone-releasing hormone (LH-RH) in the brains of sham-operated-saline-injected, H-saline-injected and H-gonadotropin (GTH)-injected mature female platyfish (Xiphophorus maculatus). In fish hypophysectomized for 5 weeks, there was a decrease in the LH-RH content of the brain (mean +/- S.E. = 446 +/- 31 pg, H-saline-injected; 649 +/- 28 pg, sham-operated-saline-injected). The administration of five 10-micrograms injections of salmon GTH on alternate days beginning in the fifth week of H resulted in a small but significant (P less than 0.05) decrease in LH-RH beyond H-saline-injected group levels (362 +/- 36 pg). The ICC analysis of H fish indicated a decrease in immunoreactive (ir)-LH-RH in the nucleus preopticus periventricularis (NPP) and nucleus lateralis tuberis pars posterioris (NLT), but a marked increase in the immunoreactivity of the neurons in the nucleus olfactoretinalis (NOR). The H fish which received GTH showed a decrease in ir-LH-RH in the NOR, but a slight increase in the NPP and NLT. The results demonstrate that although there is a general decrease in the LH-RH content of brains in H fish as determined by RIA and ICC, one of 3 ir-LH-RH-containing centers of the brain, the NOR, shows a marked increase in ICC-demonstrable LH-RH, indicating that these 3 regions may differ in their roles in the regulation of the reproductive system. The drop in RIA-measurable LH-RH in the brain, along with the enlarged perikarya observed in all 3 regions, suggests that an increase in the synthesis and release of LH-RH occurs in response to removal of the pituitary. The functional significance of the NOR and the feedback mechanisms between brain, pituitary and gonads are discussed.

The structural and functional link between olfactory reproductive systems in male and female platyfish (Xiphophorus maculatus) is demonstrated by the connection of receptors in the nasal epithelium to a center in the brain that has a primary role in the development and functioning of the reproductive system. Profound morphological changes occur in the nasal epithelium, and LH-RH content increases in tracts of the olfactory lobe, at specific stages of sexual maturation and not according to chronological age. Our study provides new insight into the development of the mechanisms by which chemical environmental cues are received.

The study of senescence is, essentially, a science in its infancy. As a result, there is a paucity of fundamental information available on the aging of basic physiological processes, including reproductive phenomena. Concepts about what leads to the faltering of neuroendocrine mechanisms and subsequent demise of the individual are, for the most, hypotheses that are only beginning to be tested.

Immunoreactive serotonin (ir-5HT) containing cells were localized in the brain and pituitary gland of the platyfish by use of immunoperoxidase procedures. In the brain, ir-neurons were found lining the wall of the third ventricle and in its lateral and posterior recesses. More caudally, ir-perikarya were found in the valvular portion of the cerebellum and in the raphe region. Ir-5HT was also localized within the pineal gland in fish that had been sacrificed before 1:00 p.m. Within the pituitary gland, ir-5HT was localized in periodic acid Schiff-positive cells of the pars intermedia of all fish while, in only a few animals, less intense immunoreactivity was also present in gonadotrophs of the caudal pars distalis.

The existence of a structural and functional axis between the olfactory and reproductive systems has long been suspected and is now becoming better understood because of increased interest and study. As a result, exciting new information is now available which clearly demonstrates that changes in olfactory epithelium can be directly related to naturally occurring and experimentally induced events in the neuroendocrine system of vertebrates (e.g., menstrual and estrous cycles, castration, and sex steroid administration). The frequency of studies in these areas decreases, however, as one descends the phylogenetic scale. In addition, there is a patent paucity of temporal analyses of the olfactory system during the postnatal development and senescence of the reproductive system for vertebrates in general.