Use of generic medicines in Latvia : Awareness, opinions and experiences of the population

Funding Information: Funding was provided by EEA Financial Mechanism and Latvian state (award number 2012.EEZ/DAP/MIC/183). The project is financially supported by Iceland, Liechtenstein and Norway. Publisher Copyright: © 2019 The Author(s).Background: To stimulate use of generic medicines a combination of supply and demand side mechanisms are employed in the Latvian reimbursement system. It is reported that patients have high out-of-pocket pharmaceutical spending and that they overpay by not choosing generic medicines. Patient preferences may be an important obstacle in implementing generic policy. Objective of this study was to assess awareness, opinions and experience of the Latvian population regarding use of generic medicines. Methods: Survey of representative sample of the population of Latvia (n = 1005) aged 18-74 was conducted in March 2015. The survey was distributed in Latvian and Russian languages using Computer Assisted Web Interviews. Associations between experience with generic medicines, preference for medicines, and sociodemographic variables were tested with Pearson Chi-square statistics. Associations between the previous experience and information given by different sources versus choice between medicines were tested with Spearman's correlation test. Results: 72.3% of the population were informed about generic medicines. Men (66.9%) and respondents with primary or secondary education (58.3%; 69.3%) were less informed compared to total (72.3%). From those who recalled using generic medicines (n = 441), 94.4% evaluated their experience as positive or neutral. Despite this, only 21% of the population would opt for generic medicines. The strongest preference for brand-name medicines was in the age group > 55 (40.5%). Opinion of a physician was the most important factor when choosing between generic and brand-name medicines (88.7%). The more positive the information provided by general practitioners, physician specialists, pharmacists, family members, friends and internet is perceived, the more likely respondents are to choose generic medicines (p < 0.001). Conclusion: This study demonstrates that people in Latvia are aware of generic medicines but only a minority of the population would choose them when presented with a choice. It is therefore important that health care professionals provide objective and unbiased information about generic medicines to their patients. Interventions should aim to reach groups that are less informed and to improve providers' understanding and communication with patients about generics.publishersversionPeer reviewe

Similarities and differences in the autonomic control of airway and urinary bladder smooth muscle

The airways and the urinary bladder are both hollow organs serving very different functions, i.e. air flow and urine storage, respectively. While the autonomic nervous system seems to play only a minor if any role in the physiological regulation of airway tone during normal breathing, it is important in the physiological regulation of bladder smooth muscle contraction and relaxation. While both tissues share a greater expression of M2 than of M3 muscarinic receptors, smooth muscle contraction in both is largely mediated by the smaller M3 population apparently involving phospholipase C activation to only a minor if any extent. While smooth muscle in both tissues can be relaxed by β-adrenoceptor stimulation, this primarily involves β2-adrenoceptors in human airways and β3-adrenoceptors in human bladder. Despite activation of adenylyl cyclase by either subtype, cyclic adenosine monophosphate plays only a minor role in bladder relaxation by β-agonists; an important but not exclusive function is known in airway relaxation. While airway β2-adrenoceptors are sensitive to agonist-induced desensitization, β3-adrenoceptors are generally considered to exhibit much less if any sensitivity to desensitization. Gene polymorphisms exist in the genes of both β2- and β3-adrenoceptors. Despite being not fully conclusive, the available data suggest some role of β2-adrenoceptor polymorphisms in airway function and its treatment by receptor agonists, whereas the available data on β3-adrenoceptor polymorphisms and bladder function are too limited to allow robust interpretation. We conclude that the distinct functions of airways and urinary bladder are reflected in a differential regulation by the autonomic nervous system. Studying these differences may be informative for a better understanding of each tissue

Medical humanities at Ghent University: a student\u27s point of view

Context: Defining and understanding the concept of Medical Humanities\u27 is a difficult, neverending task, in which consensus hasn\u27t been reached yet. Around the world, medical schools teach Medical Humanities in different courses, with different idealistic goals, albeit not accurately defined. Objectives: At Ghent University (Belgium), Medical Humanities is part of the horizontally integrated \u27exploration-continuum\u27, in which ethics, alternative medicine, etc. are included. Description contains vague objectives rather than a narrow definition. We, students, will acquire insight into issues related to, but slightly outside the educational package and own living environment. We learn about the interaction between medicine, patients, culture, society, etc. We often describe the goals as follows: the ultimate aim is to demonstrate that medical practice is not isolated from all other aspects of humanity, but an integral part of it. Design: Training in Medical Humanities is evolving continuously at our faculty. Presently, it has two parts. From year 1 to 4, we attend lectures about social, political or philosophical topics. This way, we learn to develop a critical way of thinking. In year 5, there are three options. Option 1: we approach a general theme (e.g. pain) from a humane point of view and write a paper about it. Option 2: in cooperation with literature students and the Museum Dr. Guislain, we prepare an interdisciplinary discussion between a \u27humanist\u27 and bioscientist (e.g. poet and anaesthetist). Option 3: we make a presentation about e.g. pain and literature, together with literature students. Through these exercises, we are stimulated to reflect about links between medicine and humanities. Conclusion: The ultimate goal of Medical Humanities in our education is to deliver doctors with human and humane understanding, knowledge, skills and experience. However, we, students are still in doubt about the concept and its sense, but more importantly about whether the content meets the objectives.\u2