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Self Care Pharmacy Blog

Archive for November, 2014

 

Tried everything for your headache?

Wednesday, November 5th, 2014

By Neal Fox, PharmD Student

One problem with treating headaches is that we don’t know exactly how they happen. Therefore, it is hard to know how to keep them from happening or even stop them once they start. When people have to deal with a headache on their own, they go to the pharmacy and buy something. They can take acetaminophen, ibuprofen, naproxen, or aspirin, which can potentially cause side effects if used too much. These drugs can also upset the stomach. For worse headaches prescription drugs are used, many of which have bad side effects and can be expensive. Melatonin can prevent and treat different types of headaches with few side effects and low cost.1,2 People who often get migraine headaches tend to not have enough melatonin inside of them.3 To fix this, melatonin can be taken as a pill.

A paper from India in September 2014, titled “Melatonin: functions and ligands”, detailed much about melatonin and all of the possible medical uses for it. Melatonin is created by the pineal gland, a part of the brain. Melatonin is related to sleep and it has been used to help people sleep better. There are many other things that melatonin can help with such as swelling, pain, and free radicals. This means that it could be involved in treating more diseases in the future.2 Right now, there is good evidence to support the use of melatonin for headaches. Using melatonin is very different from what Americas normally do. We use medications with unpleasant side effects that often work only in 50% of people who take them.4 Due to the research on melatonin being performed overseas, its benefits may not be well-known in America.

Around the world, scientists are looking at melatonin and headaches, and there are many studies supporting the use of melatonin in migraines as well.3 In a recent article from Turkey by researchers Karadas and Odabasi, 23 people were given 3 mg of melatonin before bed. This study found that, when taking melatonin, people had migraines less often. Plus, the migraines that they did have, hurt less. Because of this, the people taking melatonin needed to use other drugs less.5 Miano et al. found that melatonin 3 mg at bedtime was effective in reducing headache attacks in 22 children ages 6-16. However, 7 of the children reported no improvement.6 Melatonin has been used in other kinds of headaches, such as cluster headache. Cluster headache is a type of headache with really bad pain on one side of the head for a short time. This type also tends to mess up the body’s internal clock in different ways. Leone et al found that 10 mg of melatonin worked very well for half of people but another study by Pringsheim et al used only 2 mg and did not see any benefit.1,7 Finally, another type of headache called hemicrania continua (HC) is normally treated with a drug called Indomethacin, which has side effects including headache. HC is a type of headache that lasts for a long time and is usually on one-side of the head but not very bad. However, at times this headache can become much worse and the severe pain can last for hours or days.  Melatonin has been used to help people with HC and has been very successful.8,9 Finally, a Dutch group treating sleep patients found that 78.6% of them had a decrease in headaches with melatonin. However, 13.8% of patients who didn’t have headaches before, got them while on melatonin.10

We don’t know exactly how melatonin works for headache. A possibility suggested by some experts is all about the internal sleep clock that we have and melatonin’s effect on that. The research that has been done so far shows good things about melatonin. We know that it is highly safe and inexpensive. The only reported side effects of melatonin are that it can make people really sleepy and might cause headaches in some people with sleep disorders.10 If you think melatonin may be beneficial to you, talk with your doctor and make an informed decision together. Melatonin may not work for everyone, because of the complexity of headaches and the different kinds. But if it could work, is it worth it to try?

Kaitie’s Story

Since I was thirteen, I used to get terrible headaches 3-5 times a week. I started taking melatonin (3 mg before bed) in April of 2013 and have only had about 10 major headaches since then (currently October 2014). The main issue I have had with taking melatonin regularly is that it can be more difficult to get out of bed due to drowsiness; but this usually subsides within 30 minutes of actually getting up. I would definitely recommend trying melatonin for prevention of frequent headaches.

Have you tried everything for your headache? Are you willing to try melatonin?

 

References:

  1. Pringsheim T, Magnoux E, Dobson CF, Hamel E, Aubé M. Melatonin as adjunctive therapy in the prophylaxis of cluster headache: A pilot study. Headache. 2002;42(8):787-792.
  2. Singh M, Jadhav HR. Melatonin: Functions and ligands. Drug Discov Today. 2014;19(9):1410-1418.
  3. Vogler B, Rapoport AM, Tepper SJ, Sheftell F, Bigal ME. Role of melatonin in the pathophysiology of migraine: Implications for treatment. CNS Drugs. 2006;20(5):343.
  4. Peres M, Masruha M, Rapoport A. Melatonin therapy for headache disorders. Drug Development Research (USA). 2007;68:329-334.
  5. KARADAS Ö, ODABASI Z. Migrende melatonin proflaksisinin etkinligine yönelik açik uçlu klinik çalisma: Ön rapor. Archives of Neuropsychiatry / Noropsikiatri Arsivi. 2012;49(1):44-47.
  6. Miano S, Parisi P, Pelliccia A, Luchetti A, Paolino MC, Villa MP. Melatonin to prevent migraine or tension-type headache in children. Neurol Sci. 2008;29(4):285-287.
  7. Leone M, D’Amico D, Moschiano F, Fraschini F, Bussone G. Melatonin versus placebo in the prophylaxis of cluster headache: A double-blind pilot study with parallel groups. Cephalalgia. 1996;16(7):494-496.
  8. Hollingworth M, Young T, M. Melatonin responsive hemicrania continua in which indomethacin was associated with contralateral headache. Headache. 2014;54(5):916-919.
  9. Rozen TD. Melatonin responsive hemicrania continua. Headache. 2006;46(7):1203-1204.
  10. Rovers J, Smits M, Duffy JF. Headache and sleep: Also assess circadian rhythm sleep disorders. Headache. 2014;54(1):175-177.

An Aspirin a Day Keeps Breast Cancer Away?

Wednesday, November 5th, 2014

By Lauren Haines, Pharm.D. student

According to the American Cancer Society, one in eight U.S. women will develop breast cancer in their lifetime.1 Breast cancer involves cancer cells forming a tumor in the breast tissue. Risk factors include: women ages 65 and older, inherited genetic mutations, two or more close relatives diagnosed at an early age, postmenopausal obesity, use of combined estrogen and progestin menopausal hormones, cigarette smoking, alcohol consumption, and women who breastfed for a long time. Currently, breast cancer is treated with surgery, radiation therapy, systemic therapy, chemotherapy, hormone therapy, and targeted therapy. Treatment with surgery is the most common and involves removing cancer from the breast to determine the disease severity. However, other methods may also be used to kill the cancer cells such as chemotherapy and radiation. These methods have many side effects that women must choose to endure to treat their cancer, including increased risk of uterine cancer, pain, hair loss, nausea, vomiting, fatigue, increased risk of infections, and depression.1

A new method researchers are evaluating to help prevent death from breast cancer is the use of aspirin. In a recent article by Michelle Holmes and colleagues, researchers evaluated the relationship between aspirin use and breast cancer survival. Researchers identified women newly diagnosed with breast cancer and then assigned them one of three groups, which were either to not receive any daily dose (75mg to 160mg depending on where it was bought) of aspirin, receive less than one daily dose of aspirin, or receive one or more daily doses of aspirin. Patients were followed throughout the study, for up to five and a half years, to determine if they died from breast cancer. When the women taking at least one daily dose of aspirin were compared to those not taking any aspirin in the last six months of the study, there was about a 4% decreased risk of death from breast cancer in the women taking the aspirin. However, the women taking less than a daily dose compared to those not taking any aspirin had about a 3% increased risk of death from breast cancer. The limitations of this study included that aspirin could be bought over-the-counter, so anybody could buy it without pharmacy record; low dosages were only available through prescriptions; and researchers lacked additional clinical data on breast cancer characteristics and treatment.2

Although using aspirin is still being researched to determine its effect on breast cancer patients, it may be a good option for women aside from standard treatment options. Current methods involve aggressive strategies to destroy breast cancer and prevent future cases, which must be authorized by a doctor or surgeon.  Aspirin is available over-the-counter, which would provide easy access for patients who can’t receive other types of treatment. However, aspirin does have side effects of its own that patients should be aware of, including: nausea, vomiting, stomach pain, and heart burn. Aspirin can also cause decreased blood clotting, which may cause increased bleeding. Also, aspirin shouldn’t be used during pregnancy, and it has many drug interactions with blood pressure, water, and blood thinner medications.3

Although the previous article doesn’t provide clear evidence that aspirin decreases death from breast cancer, other articles support its conclusions. In another article, researchers tested the effect of aspirin used with tamoxifen, a prescription drug used to treat breast cancer, to determine if the combination of the medications helped with the treatment. Researchers found that aspirin helped balance blood protein levels when used with tamoxifen, which improved treatment. However, research showed an increased risk of bruising and upset stomach with aspirin and tamoxifen therapy.4 Other research evaluated the use of aspirin while also using beta-blockers and ACE inhibitors, common drugs used to promote breast cancer patient survival.5 Results showed the use of aspirin with these drugs helped promote the survival process versus the use of the drugs without aspirin by increasing survival rate by more than 50%.5 Evidence also showed the use of aspirin greatly reduced the risk of developing breast cancer in women.6 However, the use of ibuprofen (Advil) and acetaminophen (Tylenol) didn’t reduce breast cancer risk like aspirin did. Ibuprofen had a slight reduction in breast cancer risk, but acetaminophen had no relationship with it. Aspirin especially showed a reduction in postmenopausal women.6 Research on the frequency of aspirin use and potential breast cancer diagnosis concluded that women using aspirin more than six times a week had a 23% decreased risk of developing breast cancer and was not associated with altering hormones.7

Thus, aspirin may be an appropriate choice for women with a high risk of developing breast cancer and women who have been diagnosed with it previously. Aspirin doesn’t require a prescription, so patients can easily buy it usually at a lower cost than many prescription medications. However, patients should consult their primary care physicians before taking aspirin to ensure they are not taking other medications that would interact with it, and that aspirin has potential to help them. Patients should also receive additional advice from loved ones to ensure they support their decision to use aspirin.  With both a decreased risk in developing breast cancer and an increased promotion of breast cancer survival, aspirin may be a good option for women.

Would you recommend aspirin to a friend diagnosed with breast cancer or who may have a risk of developing breast cancer?

 

References

 

  1. American Cancer Society- Breast Cancer. http://www.cancer.org/breastcancer/index. Updated 2014. Accessed October 3, 2014.
  1. Holmes MD, Olsson H, Pawitan Y, et al. Aspirin intake and breast cancer survival – a nation-wide study using prospectively recorded data in sweden. BMC Cancer. 2014;14(1):1150-1165.
  1. Aspirin. Aspirin: MedlinePlus Drug Information Web site. http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682878.html#side-effects. Updated 2014. Accessed October 3, 2014.
  1. Holmes CE, Jasielec J, Levis JE, Skelly J, Muss HB. Initiation of aspirin therapy modulates angiogenic protein levels in women with breast cancer receiving tamoxifen therapy. CTS: Clinical & Translational Science. 2013;6(5):386-390.
  1. Holmes MD, Hankinson SE, Feskanich D, Chen WY. Beta blockers and angiotensin-converting enzyme inhibitors’ purported benefit on breast cancer survival may be explained by aspirin use. Breast Cancer Res Treat. 2013;139(2):507-513.
  1. Chung CT. Association of frequency and duration of aspirin use and hormone receptor status with breast cancer risk. Women’s Oncology Review. 2004;4(4):279-281.
  1. Bardia A, Olson JE, Vachon CM, et al. Effect of aspirin and other NSAIDs on postmenopausal breast cancer incidence by hormone receptor status: Results from a prospective cohort study. Breast Cancer Res Treat. 2011;126(1):149-155.

Chew or Dip, Time to Quit

Wednesday, November 5th, 2014

By Tyler Michael, PharmD Student

Smokeless tobacco use is on the decline in adults and children.1 This is not necessarily a time to celebrate for healthcare providers though. As the focus has been shifted away from the dangers of smokeless tobacco, some professionals have wrongfully started encouraging smokeless tobacco as a safer alternative to smoking.1,2 Someone seeking to quit smoking or using any tobacco products should seek nicotine replacement therapy, Chantix, or a combination with education if they wish to quit smoking.3

An article recently published by the American Heart Association discusses the heart health effects of discontinuing smokeless tobacco use. The goal of the cohort study, which followed the patients for 4 years, was to track how cessation of smokeless tobacco affects heart health after a myocardial infarction (heart attack). According to the article the mortality rate per 1000 people is 9.7 for those who stopped using smokeless tobacco and 18.7 for those who continued using it.4 These numbers show that people who continue using smokeless tobacco after a heart attack are almost twice as likely to die within the next 4 years. Not only did stopping smokeless tobacco use lower cardiovascular disease risk, but also cancer mortality risk as well. This shows that quitting is very important to the health of those already at risk, and in no way could its use be a safer alternative to cigarette smoking.

Some limitations of this study are that it only followed those who already had a heart attack, so it cannot be applied to the risks of those who have not previously had a heart attack.4 There were no exclusion criteria for this study so a patient could have had a terminal illness or another reason for death that would influence this data. There was a selection bias that did not allow patients over the age of 75 into the study, meaning it cannot be applied to anyone over that age.4

This article agrees with the current standard that smokeless tobacco poses a health risk. Siddiqui et al. shows in there research that those who use smokeless tobacco have higher blood pressure and cholesterol than those who do not use smokeless tobacco.5 Smokeless tobacco may have lower mortality risk than those who smoke over 15 cigarettes a day, but still a much greater mortality rate than those who do not use tobacco at all.6

Based on this article and the other articles on the topic, it is evident that smokeless tobacco is not healthy, and should not be viewed as a healthy alternative to smoking cigarettes. This article shows that smokeless tobacco use increases mortality risk and this research shows that it nearly doubles mortality risk in those who have already had a heart attack. I believe stopping use of all tobacco products is the safest route and nicotine replacement therapy can be used to help patients’ quit.3 Further research is needed to determine the best nicotine replacement therapy or smoking cessation medication in this population of patients with previous heart attack.

Stopping tobacco use is one of the best health decisions someone can make for themselves.  What method would you use to quit? If you have successfully quit, what worked for you?

 

References List

 

  1. Nelson D, Mowery P, Tomar S, Marcus S, Giovino G, Zhao L. Trends in Smokeless Tobacco Use  Among Adults and Adolescents in the United States. American Journal Of Public    Health [serial online]. May 2006;96(5):897-905. Available from: SPORTDiscus with  Full Text, Ipswich, MA.             Accessed October 1, 2014.
  2. Digard H, Proctor C, Kulasekaran A, Malmqvist U, Richter A. Determination of Nicotine Absorption  from Multiple Tobacco Products and Nicotine Gum. Nicotine & Tobacco Research [serial online]. January 2013;15(1):255-261. Available from: Consumer Health Complete – EBSCOhost,       Ipswich, MA. Accessed October 1, 2014.
  3. Heydari G, Masjedi M, Fadaizadeh L, et al. A Comparative Study on Tobacco Cessation Methods: A  Quantitative Systematic Review. International Journal Of Preventive Medicine [serial online]. June 2014;5(6):673-678. Available from: Academic Search Complete, Ipswich, MA. Accessed    November 2, 2014.
  4. Arefalk G, Hambreaus K, Lind L, Michaëlsson K, Lindahl B, Sundström J. Discontinuation of  Smokeless Tobacco and Mortality Risk after Myocardial Infarction. Circulation AHA. May 2014.  doi: 10.1161/CIRCULATIONAHA.113.007252
  5. Siddiqui S, Rana A, Singal S, Pandey D, Khan S. Assessment of Cardiovascular Risks of  Tobacco Chewers by Comparing it with Normal Human Beings. National Journal Of Physiology, Pharmacy & Pharmacology [serial online]. January 2014;4(1):76-79.   Available from: Academic Search Complete, Ipswich, MA. Accessed October 2, 2014.
  6. Bolinder G, Alfredsson L, Englund A, De Faire U. Smokeless Tobacco Use and Increased Cardiovascular Mortality among Swedish Construction Workers. American Journal Of Public Health [serial online]. March 1994;84(3):399-404. Available from: Business Source Complete, Ipswich, MA. Accessed October 2, 2014.

New research finds acetaminophen use during pregnancy is associated with ADHD in offspring

Tuesday, November 4th, 2014

By: Jeremy Flikkema Cedarville University PharmD Student

Acetaminophen is a commonly recommended over the counter medication given to pregnant women for treating mild pain. Recently however, the safety of this medication was put under investigation after JAMA Pediatrics published a study that found links between acetaminophen use and attention deficit/hyperactivity disorder (ADHD).1 This is alarming because acetaminophen is preferred over other pain killers. Non-steroidal inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, and aspirin are not recommended during pregnancy due to potential birth defects in the offspring.2

ADHD is characterized as a behavioral disorder affecting 5-10% of the school age population.1 Symptoms include inability to concentrate, impulsivity, and/or hyperactivity all of which can impact performance at work and school. Acetaminophen use during pregnancy led to an increase probability of their offspring taking ADHD medications and developing a hyperkinetic disorder.3 To clarify, hyperkinetic disorders are a more severe form of ADHD.

The recently published Danish prospective cohort interviewed 64,322 live-born children and mothers from 1996-2002.1 They did three telephone interviews during pregnancy followed by a fourth interview six months after giving birth. In this study, over half of the women had admitted to taking acetaminophen at some point during pregnancy. The characteristics of interest were hyperkinetic disorders, use of ADHD medications, and/or having ADHD-like behaviors at age 7. All three of these variables were found to be significantly increased due to acetaminophen use. Increased frequency of use and long duration (more than 1 trimester) both increase the associations that were observed. This study’s strength was the large sample size, prospective study design that eliminated recall bias by the mothers, and because it measured more than one variable. However, the limitation of this study was the design type.3 Cohort studies only infer association not causation. Therefore, results must be interpreted cautiously until further research is done.

Additional research has been done regarding this topic. A Norwegian prospective cohort found that acetaminophen use for more than 28 days or more correlated with reduced gross motor skills, delay in walking, increased activity, reduced communication skills, and attention-seeking behavior.4 This study supports the association between acetaminophen use and ADHD. Another study tested the effect of other drugs (aspirin, antacids, and antibiotics) and found no correlation in regards to behavioral difficulties at age 7.3 These strengthen the evidence that acetaminophen use increases the risk of ADHD.

Before this research, acetaminophen was considered safe to use throughout all trimesters of pregnancy for pain, fever, and colds and was used by 55 to 65% of pregnant women.5 These new research findings suggest potential changes to the standard of care, further prospective research is required to determine if acetaminophen is the true cause. Until then acetaminophen during pregnancy should be used with caution and only when necessary. There are many different ways to relieve pain in a non-pharmacological manner such as; sleeping with lots of pillows for support, drinking lots of water, gentle exercise, massages, and taking warm baths, music, and yoga can increase the health of your baby.6 There are many harmful effects that medications can have on our bodies that may still be unknown. If however, the medication is used, it is of uttermost importance to limit the duration and frequency.

Knowing the potential risk with Acetaminophen use and ADHD, do you think the risk outweighs the benefit?

 

Bibliography:

  1. Liew Z, Ritz B, Rebordosa C, Lee PC, Olsen J. Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders. JAMA Pediatr. 2014;168(4):313-320.
  2. CAZACU I, FARCAŞ A, MOGOŞAN C, BOJIŢĂ M. Safety of over-the-counter medication in pregnancy. sometimes a dilemma. Clujul Medical. 2011;84(3):348-354.
  3. Thompson JMD, Waldie KE, Wall CR, Murphy R, Mitchell EA. Associations between acetaminophen use during pregnancy and ADHD symptoms measured at ages 7 and 11 years. PLoS ONE. 2014;9(9):1-6.
  4. Brandlistuen RE, Ystrom E, Nulman I, Koren G, Nordeng H. Prenatal paracetamol exposure and child neurodevelopment: A sibling-controlled cohort study. Int J Epidemiol. 2013;42(6):1702-1713.
  5. Blaser JA, Allan GM. Acetaminophen in pregnancy and future risk of ADHD in offspring. Can Fam Physician. 2014;60(7):642-642.
  6. Pritham U, McKay L. Safe Management of Chronic Pain in Pregnancy in an Era of Opioid Misuse and Abuse. JOGNN: Journal Of Obstetric, Gynecologic & Neonatal Nursing [serial online]. September 2014;43(5):554-567. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed November 3, 2014.

 

 

Can Ginger Cure Rheumatoid Arthritis?

Tuesday, November 4th, 2014

by R. Brandon Kime, PharmD Candidate

Rheumatoid arthritis is a disease that causes the breakdown of joints throughout the body due to the body’s immune system attacking these tissues. As the joints degrade, they become less able to support and lubricate the bones that they attach. Eventually, the bones can rub together, causing erosion of the bone and possibly deformity of the joint. This entire process results in a considerable amount pain for those affected, as well as difficulties in day-to-day functioning. Unlike other types of arthritis, rheumatoid arthritis can occur in people of all ages. Rheumatoid arthritis is usually treated by prescription drugs that decrease inflammation or decrease immune system activity. Some of these drugs may have significant side effects, including increased chance for infection for those that suppress the immune system, or increased chance for ulcers and bleeding for anti-inflammatory drugs. Physical therapy may also be used to increase joint flexibility and decrease stress and degradation of the joints. One European study estimated the total cost of rheumatoid arthritis in the US as 42 billion euros,1 or over 53 billion dollars.

Plants have been used since ancient times for medicinal purposes,2 and traditional medicine is growing acceptance in developed countries.3  An article written by Al-Nahain and colleagues evaluated the potential of the ginger plant (Zingiber officinale) in treating rheumatoid arthritis.4 The root of the ginger plant is most often used in food because of its unique taste, but it also has several medicinal properties that have been observed. Ginger has been well-studied for its anti-inflammatory effects (it is similar in action to aspirin or ibuprofen).5,6 The plant contains many drug-like compounds that may be useful in either treating rheumatoid arthritis outright or developing new anti-inflammatory drugs.2 One study tested both ginger extract as well as several chemicals isolated from ginger in an animal model of rheumatoid arthritis and found ginger to have “profound antiarthritic efficacy.”7 This means that ginger is capable of treating arthritis on multiple levels. While ginger may have potential in treating arthritis, it would not be without disadvantages. There is a lack of precise dosing information for this application of ginger. Furthermore, since it is considered a dietary supplement insurance companies would be unlikely to cover it.

While “cure” is far too strong of a word at this time, what does all this mean for those struggling with rheumatoid arthritis? First, it gives them a potential option when standard therapies do not work well enough to treat their symptoms. Individuals suffering from the disease can talk to their doctors and discuss whether using or adding a ginger supplement to their regimen could be beneficial in treating their symptoms. Second, it gives them hope for future research to find more effective treatments for rheumatoid arthritis. The Al-Nahain article is optimistic that further research into the chemical functions of ginger components, “may make it possible to stop further progress or even reverse the damage caused by [rheumatoid arthritis].”2 Finally, if new research into ginger prompts further research into the benefits of other substances marketed as dietary supplements, I think that is good for the world of healthcare as a whole. Selecting healthcare products should be based on evidence rather than advertising. I would recommend that consumers become proactive in discovering the benefits of both mainstream and alternative treatments. In this way, consumers can make more informed decisions and progress can be made in treating various diseases.

Has anyone you have known taken a ginger supplement for their rheumatoid arthritis? How well did his or her treatment work?

References

  1. Lundkvist J, Kastäng F, Kobelt G. The burden of rheumatoid arthritis and access to treatment: Health burden and costs. The European Journal of Health Economics. 2008;8(, Supplement 2: The Burden of Rheumatoid Arthritis and Patient Access to Treatment):S49-S60.
  2. Phillipson JD. Phytochemistry and medicinal plants. Phytochemistry. 2001;56(3):237-243.
  3. World Health Organization. WHO traditional medicine strategy 2002-2005. 2002.
  4. Al-Nahain A, Jahan R, Rahmatullah M. Zingiber officinale: A potential plant against rheumatoid arthritis. Arthritis. 2014;2014:8.
  5. Grzanna R, Lindmark L, Frondoza CG. Ginger-an herbal medicinal product with broad anti-inflammatory actions. Journal of medicinal food. 2005;8(2):125-132.
  6. Mascolo N, Jain R, Jain SC, Capasso F. Ethnopharmacologic investigation of ginger (zingiber officinale). J Ethnopharmacol. 1989;27(1–2):129-140.
  7. Funk JL, Frye JB, Oyarzo JN, Timmermann BN. Comparative effects of two gingerol-containing zingiber officinale extracts on experimental rheumatoid arthritis⊥. J Nat Prod. 2009;72(3):403-407.