Influences on older people’s decision making regarding choice of topical or oral NSAIDs for knee pain: qualitative study

Objective To explore the factors that influence older people’s decision making regarding use of topical or oral ibuprofen for their knee pain.Design Qualitative interview study nested within a randomised controlled trial and a patient preference study that compared advice to use oral or topical non-steroidal anti-inflammatory drugs (NSAIDs) for knee pain in older people.Setting 11 general practices.Participants 30 people aged ≥50 with knee pain. Results Participants’ decision making was influenced by their perceptions of the associated risk of adverse effects, presence of other illness, nature of their pain, advice received, and practicality. Although participants’ understanding of how the medications worked was sometimes poor their decision making about the use of NSAIDs seemed logical and appropriate. Participants’ model for treatment was to use topical NSAIDs for mild, local, and transient pain and oral NSAIDs for moderate to severe, generalised, and constant pain (in the absence of other more serious illness or risk of adverse effects). Participants showed marked tolerance and normalisation of adverse effects.Conclusion Participants had clear ideas about the appropriate use of oral and topical NSAIDs. Taking such views into account when prescribing may improve adherence, judgment of efficacy, and the doctor-patient relationship. Tolerance and normalisation of adverse effects in these patients indicate that closer monitoring of older people who use NSAIDs might be needed.     

Same-sex sexual behavior in birds: expression is related to social mating system and state of development at hatching

We report the findings of a phylogenetic comparative analysisexamining patterns and frequency of occurrence of same-sex courtshipand mounting behavior in birds. Our analysis has shown associationsbetween same-sex sexual behavior and both mating system anddegree of precociousness at hatching. The patterns of expressionand frequency of occurrence of same-sex sexual behavior differedmarkedly for males and females. Patterns of same-sex sexualexpression reflected the competitive sexes that actively solicitsexual interactions in heterosexual encounters. Male–male(MM) sexual behavior occurred across all mating systems, butMM mounting was significantly more prevalent in those specieswith facultative polygamy. The frequency of MM sexual behaviorincreased with degree of polygamy. Female–female (FF)sexual behavior (especially courtship) occurred most frequentlyin socially monogamous species and rarely occurred in speciesthat display obligate polygamy (predominantly polygynous species).Both expression and frequency of FF sexual behavior was stronglyrelated to the precocial state of development at hatching. FFsexual behavior is more likely to occur in species in whichmonogamy occurs together with the production of precocial offspring;that is, in monogamous species that are exceptions to the morecommon altricial mode of development. We suggest that requirementof biparental care in monogamous species may influence the greaterexpression of FF sexual behavior and longer term associations.Both spatial and behavioral dispersion of females and engagementin uniparental care may be important in explaining the lowerincidence of FF sexual behavior in polygynous species. Socialcontexts where males congregate at communal leks or displayareas may influence the greater expression and frequency ofMM sexual behavior in polygynous species.     

Anti-HIV ribozymes

HIV is an RNA virus that replicates intracellularly through various RNA intermediates. Several of these can be targeted by ribozymes (catalytic RNA molecules), and a number of investigators, including this group, have demonstrated the ability of ribozymes to suppress HIV replication in this way. It is argued that this gene therapy approach may be viewed as an adjunct to chemotherapeutic drugs, which may allow not just viral suppression, but also immune restoration. This can only finally be tested in clinical trials, and several are planned. The basic ribozyme unit, the potential of which was described less than 10 years ago, is about to be tested in an amenable disease state.