Problems with the Administration of Antipsychotic Drugs in Depot Formulations in the Treatment of Schizophrenia

© 2018 Anica Ranković et al., published by De Gruyter Open 2018. The aim of this study was to investigate problems with the administration of antipsychotic long-acting injections (LAIs) in patients with schizophrenia. Besides many benefits, long-acting injections have been associated with a number of complications at the site of the injection. The qualitative study included four medical workers and five patients who had been treated with fluphenazine, haloperidol, risperidone given in the form of a long-acting depot injection. The data were collected by direct observation, analysis of the history of the disease and used semi-structured interview. Interviews completed by patients, psychiatrists and nurses were analyzed and condensed into nine key categories: Competence and training of the medical workers, Sites and technique, Registration of complications, Care of patients and privacy, Availability and evidence, Duration and frequency of treatment, Burden for the patients, The choice of formulation therapy, and Sense of stigma. Monitoring of side-effects of LAIs was not extensive and doctors did not write adverse effects. The nurses who administered the injections were competent. Not enough attention is paid to the choice of the needle diameter and the patient was not given a choice to decide on the sites of the administraton of injection. Three out of five patients did not feel any changes at the injection site, but another patient had severe pain, redness, and induration. The exchange of information, a possibility of choosing the site of administration, and monitoring of the effects of treatment are all positive strategies that doctors and nurses can use to help patients in the compliance to the treatment with antipsychotic long-acting injections

Synthesis, characterization, biological activity, DNA and BSA binding study: novel copper(II) complexes with 2-hydroxy-4-aryl-4-oxo-2-butenoate

A serie of novel square pyramidal copper(II) complexes [Cu(L)(2)H2O] (3a-d) with O,O-bidentate ligands [L = ethyl-2-hydroxy-4-aryl-4-oxo-2-butenoate; aryl = 3-methoxyphenyl-2a, (E)-2-phenylvinyl-2b, (E)-2-(4-hydroxy-3-methoxyphenyl)vinyl-2c, 3-nitrophenyl-2d, 2-thienyl-2e] were synthesized and characterized by spectral (UV-Vis, IR, ESI-MS and EPR), elemental and X-ray analysis. The antimicrobial activity was estimated by the determination of the minimal inhibitory concentration (MIC) using the broth micro-dilution method. The most active antibacterial compounds were 3c and 3d, while the best antifungal activity was showed by complexes 3b and 3e. The lowest MIC value (0.048 mg mL(-1)) was measured for 3c against Proteus mirabilis. The cytotoxic activity was tested using the MTT method on human epithelial carcinoma HeLa cells, human lung carcinoma A549 cells and human colon carcinoma LS174 cells. All complexes showed extremely better cytotoxic activity compared to cisplatin at all tested concentrations. Compound 3d expressed the best activity against all tested cell lines with IC50 values ranging from 7.45 to 7.91 mu g mL(-1). The type of cell death and the impact on the cell cycle for 3d and 3e were evaluated by flow cytometry. Both compounds induced apoptosis and S phase cell cycle arrest. The interactions between selected complexes (3d and 3e) and CT-DNA or bovine serum albumin (BSA) were investigated by the fluorescence spectroscopic method. Competitive experiments with ethidium bromide (EB) indicated that 3d and 3e have a propensity to displace EB from the EB-DNA complex through intercalation suggesting strong competition with EB [K-sv = (1.4 +/- 0.2) and (2.9 +/- 0.1) x 10(4) M-1, respectively]. K-sv values indicate that these complexes bind to DNA covalently and non-covalently. The achieved results in the fluorescence titration of BSA with 3d and 3e [K-a = (2.9 +/- 0.2) x 10(6) and (2.5 +/- 0.2) x 10(5) M, respectively] showed that the fluorescence quenching of BSA is a result of the formation of the 3d- and 3e-BSA complexes. The obtained K-a values are high enough to ensure that a significant amount of 3d and 3e gets transported and distributed through the cells

Household water sharing: Implications for disaster recovery and water policy

•Water security − reliable access to adequate and safe water − is critical in defining the health status of communities.•Water insecurity can heighten psychosocial stress and increase exposure to infectious diseases, violence, and injury, being a major contributor to the global burden of health inequalities.•Water sharing is an emergent, self-guided practice for coping in which households arrange and make transfers of water between themselves.•Water sharing strategies may act as a common and potentially effective self-organized disaster response and an important way to address post-disaster water needs.•Disaster agencies and scholars should recognize that household water sharing is likely a bedrock response during disasters that disrupt water security. Access to safe water is vital for community health, especially during disaster and recovery periods when standard solutions may be slow or politically stalled. Water sharing, an informal and self-guided coping mechanism, becomes critical during disasters when standard water infrastructure is damaged or destroyed. Drawing on diverse literature, we highlight the prevalence and importance of household water sharing in disaster contexts, emphasizing its potential benefits and trade-offs. We explain why these systems–while often invisible–are important and relevant to disaster recovery. Our review identifies five key observations and implications for disaster intervention, emphasizing the need for tailored support for economically marginalized groups and the integration of water sharing practices as a short-term coping mechanism into disaster response and recovery agendas We advocate for further research to evaluate the long-term impacts of water sharing and inform policy and intervention strategies while recognizing that such community-level coping mechanisms alongside formal water services may effectively address water insecurity and bolster resilience in disaster-affected communities

Do Health Reforms Impact Cost Consciousness of Health Care Professionals? Results from a Nation-Wide Survey in the Balkans

Background: Serbia, as the largest market of the Western Balkans, has entered socioeconomic transition with substantial delay compared to most of Eastern Europe. Its health system reform efforts were bold during the past 15 years, but their results were inconsistent in various areas. The two waves of global recession that hit Balkan economies ultimately reflected to the financial situation of healthcare. Serious difficulties in providing accessible medical care to the citizens became a reality. A large part of the unbearable expenses actually belongs to the overt prescription of pharmaceuticals and various laboratory and imaging diagnostic procedures requested by physicians. Therefore, a broad national survey was conducted at all levels of the healthcare system hierarchy to distinguish the ability of cost containment strategies to reshape clinician’s mindsets and decision-making in practice. Aims: Assessment of healthcare professionals’ judgment on economic consequences of prescribed medical interventions and evaluation of responsiveness of healthcare professionals to policy measures targeted at increasing cost-consciousness. Study Design: Cross-sectional study. Methods: A nationwide cross-sectional survey was conducted through a hierarchy of medical facilities across diverse geographical regions before and after policy action, from January 2010 to April 2013. In the middle of the observed period, the National Health Insurance Fund (RFZO) adopted severe cost-containment measures. Independently, pharmacoeconomic guidelines targeted at prescribers were disseminated. Administration in large hospitals and community pharmacies was forced to restrict access to high budget-impact medical care. Economic Awareness of Healthcare Professionals Questionnaire–29 (EAHPQ-29), developed in Serbian language, was used in face-to-face interviews. The questionnaire documented clinician’s attitudes on: Clinical-Decision-Making-between-Alternative-Interventions (CDMAI), Quality-of-Health-Care (QHC), and Cost-Containment-Policy (CCP). The authors randomly and anonymously recruited 2000 healthcare experts, with a total of 1487 responding; after eliminating incomplete surveys, 649 participants were considered before and 651 after policy intervention. Results: Dentists (1.195±0.560) had a higher mean CDMAI score compared to physicians (1.017±0.453). The surgical group compared to the internist group had a higher total EAHPQ-29 score, CCP score and CDMAI score. Policy intervention had a statistically significant negative impact on the QHC score (F=4.958; df=1; p=0.027). There was no substantial impact of policy interventions on professional behavior and judgment with regard to the CDMAI, CCP, and total EAHPQ-29 scores. Conclusion: Although cost savings were forcibly imposed in practice, the effects on clinical decision-making were modest. Clinicians’ perceptions of quality of medical care were explained in a less effective manner due to the severely constrained resources allocated to the providers. This pioneering effort in the Balkans exposes the inefficiency of current policies to expand clinicians’ cost consciousness