Analysis of impact of life style, socio-economic factorsand health status on the use of medicines in pregnancy

Uvod i ciljevi. Upotreba lekova u trudnoći čest je razlog brige lekara koji ih propisuju i trudnica koje ih koriste. Iako bi bilo veoma korisno poznavati rizične populacije trudnica koje imaju veću verovatnoću upotrebe lekova u toku trudnoće, mali je broj studija koje su se bavile istraživanjima u ovoj oblasti. Uloga i doprinos farmaceuta u procesu izdavanja ili prodaje lekova trudnicama mogu biti ključni za bezbednu primenu lekova u trudnoći. Cilj disertacije bio je da se istraži upotreba lekova u periodu od šest meseci pre i tokom trudnoće, da se izvrši evaluacija upotrebljenih lekova prema anatomsko-terapijsko-hemijskoj (ATC) klasifikaciji, prema riziku za plod i režimu izdavanja (na recept i bez recepta (samomedikacija)), zatim, da se ispita da li postoji povezanost između faktora životnog stila, socio-ekonomskih faktora i zdravstvenog stanja ispitanica i upotrebe lekova pre i tokom trudnoće, kao i da se ispita na koji način pomenuti faktori utiču na upotrebu navedenih klasa lekova. Cilj je bio i da se ispita potencijalni doprinos farmaceuta kod upotrebe lekova u trudnoći. Metode istraživanja. Radi postizanja postavljenih ciljeva sprovedene su dve studije. Prva studija bila je multi-centrična i sprovedena je u šest domova zdravlja i pet apoteka na teritoriji opština Vračar, Voždovac, Lazarevac, Loznica, Čačak i Subotica, u periodu mart 2009 – mart 2010. Prikupljanje podataka sprovedeno je upitnikom specijalno dizajniranim za potrebe studije. Trudnice su upitnik popunjavale samostalno, bez pomoći zdravstvenih radnika, anonimno, dobrovoljno i volonterski. Prikupljeni su podaci o socio-ekonomskim karakteristikama, životnom stilu i zdravstvenom statusu ispitanica, kao i o upotrebi lekova u periodu od šest meseci pre i tokom trudnoće. Radi klasifikovanja lekova prema riziku za plod korišćena je klasifikacija američke Agencije za hranu i lekove (Food and Drug Administration - FDA). Upotreba lekova izražavana je kao proporcija žena izložena leku ili ATC grupi ili podgrupi lekova. Razlike u upotrebi lekova između različitih grupa analizirane su upotrebom McNemar-ovog testa. Univarijantna i multivarijantna logistička regresija korišćene su da bi se odredili faktori značajno povezani sa upotrebom lekova. Kao mere povezanosti između faktora i upotrebe lekova korišćeni su direktni odnos šansi (odds ratio – OR) i korigovan odnos šansi (adjusted odds ratio – aOR) uz prikazivanje 95% intervala pouzdanosti (confidence intervals - CI)...Background and Aims. Drug use in pregnancy is often a reason of concern for mothers and their physicians. However, only few studies investigated predictors of drug use in pregnancy. The role and contribution of pharmacists in the process of drug dispensing could be very important for improvement of safe drug use in pregnancy. The aim of dissertation was to investigate prescription and over the counter drug use among Serbian women in the 6 months before pregnancy and in the first 6 months of pregnancy, and to evaluate the drugs used according to anatomical-therapeutic-chemical classification, according to the risk for the fetus and according to dispensing status (proscription (Rx) or over-thecounter (OTC)). The aim was also to examine if a significant association between socio-economic factors, life style and health status of women and drug use exist, as well as to investigate how much these factors impact drug use before and during pregnancy. Finally, the aim was to investigate a potential contribution of pharmacist in safe drug use in pregnancy. Methodology. Two studies were carried out in order to gain all the aims. The first study was multi-center and performed in the six maternity care units and five community pharmacies (municipalities: Vračar, Voždovac, Lazarevac, Loznica, Čačak i Subotica) during the period from March 2009–March 2010. A selfreporting questionnaire was used as a data source. Participation in the study was voluntarily and anonymous. Data according to socio-economic characteristics, life style, health status and drug use six months before and during pregnancy were collected. Food and Drug Administration (FDA) risk classification system was used to determine the risk of used drugs for the fetus. Proportion of women exposed to drugs or class of drugs. Differences between subgroups were assessed using McNemar’s test on paired proportions. Logistic regression was used to identify factors associated with medication use. Adjusted odds ratios (aOR) and 95 % confidence intervals (CI) were used as association measures. Data analysis was performed using SPSS software package (SPSS 18.0 for Windows, SPSS Inc., Chicago, IL, USA). The study was performed after obtaining approval from The Board of Management and The Human Research Ethics Committee..

GNSS and SAR Signal Delay in Perturbed Ionospheric D-Region During Solar X-Ray Flares

We investigate the influence of the perturbed (by a solar X-ray flare) ionospheric D-region on the GNSS and SAR signals. We calculate a signal delay in the D-region based on the low ionospheric monitoring by very low frequency (VLF) radio waves. Results show that the ionospheric delay in the perturbed D-region can be important and, therefore, should be taken into account in modeling the ionospheric influence on the GNSS and SAR signal propagation and in calculations relevant for space geodesy. This conclusion is significant because numerous existing models ignore the impact of this ionospheric part on the GNSS and SAR signals due to its small electron density which is true only in quiet conditions and can result in significant errors in space geodesy during intensive ionospheric disturbances

Examining Quality, Use and Impact of Psychotropic (Use) in older adults with intellectual disabilities (EQUIP): study protocol

Widespread, and sometimes inappropriate use of psychotropics in adults with intellectual disability has been an international concern. These medicines have been used to treat mental health conditions, but also, controversially, some types of behaviours not necessarily associated with the diagnosis or in the absence of a relevant diagnosis. Results from the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA) study of older adults with intellectual disability in Ireland revealed that 60% were taking psychotropics in 2010. In the intervening decade changes in regulations, policy, and increased decongregation of people with intellectual disability have taken place likely influencing the use of psychotropics. The HSE National Clinical Programme for People with Disability (NCPDD) established in the 2020 has medicines optimisation as a key priority. Existing multi-wave data from the IDS-TILDA study and the HSE national prescribing database offers an opportunity to better understand psychotropic use and prescribing patterns. This is a novel collaboration on lived experience, research, practice and policy. The aim of this research is to examine the quality and trends of psychotropic use of older adults with intellectual disability over a ten-year period in Ireland to evaluate the effects of and to inform both practice and policy to optimise medicines use and health outcomes. Health and medication data from ten years (four waves) of the IDS-TILDA study and corresponding medicines data from the HSE-PCRS prescribing database are available. Descriptive and longitudinal analysis will examine association between long-term psychotropic use, changes in trends of use, and the impact of decongregation on medicines use. This research will inform the development of national guidance on medicines optimisation for older people with intellectual disability and has the potential to change prescribing practices and improve health and wellbeing for older people with intellectual disability.</ns4:p

Women’s beliefs about medicines and adherence to pharmacotherapy in pregnancy: Opportunities for community pharmacists?

Background During pregnancy women might weigh benefits of treatment against potential risks to the unborn child. However, non-adherence to necessary treatment can adversely affect both mother and child. To optimize pregnant women’s beliefs and medication adherence, community pharmacists are ideally positioned to play an important role in primary care. Objective This narrative review aimed to summarize the evidence on 1) pregnant women’s beliefs, 2) medication adherence in pregnancy, and 3) community pharmacists’ counselling during pregnancy. Method Three search strategies were used in Medline and Embase to find original studies evaluating women’s beliefs, medication adherence and community pharmacists’ counselling during pregnancy. All original descriptive and analytic epidemiological studies performed in Europe, North America and Australia, written in English and published from 2000 onwards were included. Results We included 14 studies reporting on women’s beliefs, 11 studies on medication adherence and 9 on community pharmacists’ counselling during pregnancy. Women are more reluctant to use medicines during pregnancy and tend to overestimate the teratogenic risk of medicines. Risk perception varies with type of medicine, level of health literacy, education level and occupation. Furthermore, low medication adherence during pregnancy is common. Finally, limited evidence showed current community pharmacists’ counselling is insufficient. Barriers hindering pharmacists are insufficient knowledge and limited access to reliable information. Conclusion Concerns about medication use and non-adherence are widespread among pregnant women. Community pharmacists’ counselling during pregnancy is insufficient. Further education, training and research are required to support community pharmacists in fulfilling all the opportunities they have when counselling pregnant women

Significance of prick test in asthma diagnosis

Asthma presents large health issue around world. In last few decades, rise of asthma prevalence and incidence was observed in pediatric age. It is chronic inflammatory disease which is clinically characterized by recurrent respiratory symptoms, dyspnea, chest contraction and coughing. Symptoms are often accompanied with reversible restriction of air flow through respiratory system. In routine clinical practice, diagnostics of asthma in childhood is based on anamnesis, physical exam, bronchodilators response, allergological tests and exam of lungs functions. Allergological tests are primary diagnostic method in allergology. In clinical diagnostics, prick test (PT) is most common, due to his sensitivity, specificity, reproducibility and good correlation with IgE levels and bronchial responsiveness. Aim of undertaken research is determination of positive allergological tests frequency in children with asthma, considering that allergological test are one of criterion for asthma diagnose. Twenty-five children from control group and seventy-five children with asthma were examined. Group distribution has been done according to severity of asthma, forming three groups: children with easy, severe and very severe asthma. Positive skin tests were observed in 44% of children in control group, 84% children with easy asthma case, 88% children with severe asthma and all children with very severe asthma diagnose. Positive probes on Dermatophagoides are most common: 92,0% in group of children with very severe asthma, 75,0% children with severe asthma and 63,3% children with easy asthma, while positive tests on other alergens were presented in smaller percentage

The use of antibiotics and their influence on course and outcome of bacterial meningitis in children before diagnosing it

Bacterial meningitis is a severe infective disease caused by different bacteria during which purulent pyorrhea is created in a subarachnoid space. In clinical terms, it is represented with the appearance of meningeal symptoms and signs. Neither recent years' success accomplished in treatment of bacterial meningitis nor the best organized treatment provide an optimistic prognosis in sick children. Our research was conducted in 91 children with bacterial meningitis. Before diagnosing bacterial meningitis, 50 patients ( 54.9% ) were treated with antibiotic therapy. In this group, 21 patients ( 42% ) showed complications in disease manifested with convulsions in 13 patients (26 % ). In the same group, 29 patients ( 58 % ) had a complete recovery after the treatment while 8 patients ( 16 % ) had sequele. In 41 patients ( 45 % ) without previous antibiotic treatment, complications are registered in 25 patients ( 60.9 % ) as follows: 18 patients ( 43.9 % ) had early complications while 7 patients ( 17.1 % ) had sequele. 16 patients ( 39 % ) had a complete recovery in this group. Complications and sequele are more common in the group of sick children without antibiotic therapy before diagnosing bacterial meningitis. However, the presence of sequele in the group of children which were treated with antibiotics before completed diagnostics showed that treatment of bacterial meningitis must be done in a more effective way as well as an early antibiotics treatment

Risk factor for febrile seizures

Febrile seizures are the most frequent neurological disorder in the childhood. According to American Academy of Pediatrics (AAP), they have been defined as seizures provoked by high temperature in children aged between 6 months and 5 years, without previous history of afebrile seizures, intracranial infections and other possible causes of seizures. Seizures can be typical and atypical, according to the characteristics. Pathogenesis of this disorder has not been clarified yet, and it is believed to be a combination of genetic factors, high body temperature and brain maturation. The risk factors for recurrence of febrile seizures are: age in which seizures appeared for the first time, epilepsy in the first degree relative, febrile seizures in the first degree relative, frequent diseases with fever and low body temperature on the beginning of seizures. The frequency of recurrent seizures The risk for occurrence of epilepsy in children with simple seizures is about 1-1.5%, which is slightly higher compared to general population, while it increases to 4-15% in patients with complex seizures. However, there is no evidence that therapy prevents occurrence of epilepsy. When the prevention of recurrent seizures is considered, it is necessary to separate simple from complex seizures. The aim of this paper was to analyze the most important risk factors for febrile seizures, and to evaluate their impact on occurrence of recurrent seizures. Our study included 125 children with febrile seizures, aged from 6 months to 5 years. The presence of febrile seizures and epilepsy in the first degree relative has been noted in 22% of children. Typical febrile seizures were observed in 76% of cases, and atypical in 24%. Most patients had only one seizure (73.6%). Children, who had seizure earlier in life, had more frequent recurrences. Both risk factors were present in 25% of patients, while 68% of patients had only one risk factor. For the children with febrile disease, primary risk factors were the level of body temperature and a family history of febrile seizures. The risk for febrile seizures in these children was 10,4%, which is more than a twice as high compared to general population, which is 4%. Is between 10% in children without risk factors and 50-100% in children with three or more risk factors

Reasons for inadequate vaccination after splenectomy

© 2016 Acta Facultatis Medicae Naissensis. The aim of this study was to analyze the reasons why the guidelines for post-splenectomy vaccination are not being followed. Considering that vaccination reduces the risk of overwhelming post-splenectomy infection, it is important to determine the reasons for inadequate vaccination after splenectomy. Our research was a qualitative study based on interviews with six surgeons, one general practitioner and three patients who underwent splenectomy, and on the review of patient's medical charts and discharge summaries. This study has shown that health care team and patients lack sufficient knowledge about postsplenectomy vaccination. In addition, the study has shown that splenectomy registers, medical bracelets and up-to-date vaccination cards still have not become part of our current practice. Our study has shown that patient education and health care team education is crucial to follow the guidelines for post-splenectomy vaccination, which is similar to most other reports. In order to increase the level of post-splenectomy vaccination, we need to upgrade the education of health care teams and patients. Moreover, we need to start using splenectomy registers, medical bracelets and up-to-date vaccination cards

Sleep opstructive apnea syndrome in children

Sleep opstructive apnea syndrome (SOAS) is respiration disorder which leads to partial or complete opstruction of upper respiratory pathways, preventing normal lung aeration and obstructing normal sleep pattern. Clinically, it's manifested by habitual snoring, often joined with sleep malfunction, and signs of strenuous breathing during sleep, and also with different neurobehavioral problems which occurs during daytime. Unrecognized and untreated SOAS can leads to permanent, even life-threatening consequences. Every patient with respiration problems during sleep should be subjected to polysomnographic (PSG) examination during night