From Morisky to Hill-Bone; Self-reports Scales for Measuring Adherence to Medication

There are a number of approaches to studying medication-taking behavior. Self-report measures that have the benefits of being cheap, easy to administer, non-intrusive, and able to provide information on attitudes and beliefs about medication. Potential limitations to self-report are that ability to understand the items, and willingness to disclose information, can affect response accuracy and thus questionnaire validity. A computerized systematic search of the PubMed databases identified articles on scales for medication adherence measuring using the MeSH terms medication adherence, compliance, and persistence combined with the terms questionnaire self-report. Adherence scales are identified mostly in the last few years (2005-2012). One of the main sources was article (Lavsa et. al) which evaluated literature describing medication adherence surveys/scales to gauge patient behaviors at the point of care. Articles were included if they evaluated or reviewed self-reported adherence medication scale applicable at chronic diseases and with good coefficient of internal consistency reliability (Cronbach\u27s α (alpha). Articles that contained data about self-report medication adherence scales use were included. A total of about hundred articles were identified. Of the articles, 20% (20 of 100) were included in the review because of their relevance to the article topic. This article describes various self-report scales by which to monitor medication adherence, their advantages and disadvantages, and discusses the effectiveness of their application at different chronic diseases. There are many self-report scales for measuring medication adherence and their derivatives (or subscales). Due to the different nature of the diseases, there is no gold-standard scale for measuring medication adherence. It can be nevertheless concluded that the nearest to gold-standard is a Medication Adherence Questionnaire (MAQ) scale by Morisky et.al

From Morisky to Hill-Bone; Self-reports Scales for Measuring Adherence to Medication

There are a number of approaches to studying medication-taking behavior. Self-report measures that have the benefits of being cheap, easy to administer, non-intrusive, and able to provide information on attitudes and beliefs about medication. Potential limitations to self-report are that ability to understand the items, and willingness to disclose information, can affect response accuracy and thus questionnaire validity. A computerized systematic search of the PubMed databases identified articles on scales for medication adherence measuring using the MeSH terms medication adherence, compliance, and persistence combined with the terms questionnaire self-report. Adherence scales are identified mostly in the last few years (2005-2012). One of the main sources was article (Lavsa et. al) which evaluated literature describing medication adherence surveys/scales to gauge patient behaviors at the point of care. Articles were included if they evaluated or reviewed self-reported adherence medication scale applicable at chronic diseases and with good coefficient of internal consistency reliability (Cronbach\u27s α (alpha). Articles that contained data about self-report medication adherence scales use were included. A total of about hundred articles were identified. Of the articles, 20% (20 of 100) were included in the review because of their relevance to the article topic. This article describes various self-report scales by which to monitor medication adherence, their advantages and disadvantages, and discusses the effectiveness of their application at different chronic diseases. There are many self-report scales for measuring medication adherence and their derivatives (or subscales). Due to the different nature of the diseases, there is no gold-standard scale for measuring medication adherence. It can be nevertheless concluded that the nearest to gold-standard is a Medication Adherence Questionnaire (MAQ) scale by Morisky et.al

Morbidity and Mortality in the City of Zagreb, Croatia – Health Needs and Demands

The aim of the study was to assess health indicators in the city of Zagreb in order to evaluate the population health status and health needs. A descriptive method was used to analyze data from regular health statistics. In the population of Zagreb, the life expectancy at birth is longer than the European average but shorter than that recorded in Austria and Slovenia. The standardized mortalitay rates of tracheal, bronchial and lung cancer, and of malignant diseases in the Zagreb population exceed the European average, whereas those of ischemic heart disease, cerebrovascular disease, uterine cervix carcinoma and breast cancer are lower than the European average. Circulatory diseases and neoplasms, the two most important groups of death causes, showed a constant rise during the 30-year period (1971–2001). The highest index of primary health care utilization (98.8%) was recorded for the ≥65 age group, with a mean of 7.5 primary health care visits per capita. The prevalence of hypertensive disorders and of intervertebral disk diseases and other dorsopathies was significantly higher in the oldest population group (x2=27.3 and x2=13.43, respectively, p<0.05 both). Considering the predominance of chronic widespread diseases that substantially influence the patient’s quality of life, public health actions should primarily be focused on preserving personal autonomy of the old and sick man for as long as possible. As the standardized mortality rates of ischemic heart disease, cerebrovascular diseases, tracheal, bronchial and lung cancer, and malignant diseases exceed those reported from some neighboring countries, the highest priority and needs are now related to coping with unhealthy behavior of the population such as smoking, physical inactivity, and dietary issues that should be modified and controlled through implementation of preventive programs, along with appropriate organization and management of public health services

HARMFUL HABITS IN PREGNANCY

SAŽETAK. Cilj rada bio je utvrditi učestalost primjene alkohola, nikotina i opojnih droga u trudnoći, kao i učestalost kongenitalnih malformacija kod djece koja su in utero bila izložena djelovanju ovih ksenobiotika. Jedan dio istraživanja obavljen je u Novom Sadu u Klinici za ginekologiju i akušerstvo, Genetskom savetovalištu i Zavodu za patologiju i histologiju. Drugi dio istraživanja obavljen je u četiri zagrebačka rodilišta. Metode. Istraživanje je provođeno putem jednostavno strukturiranog standardiziranog upitnika koji se sastojao od dva dijela: intervjua majke i bolničkih podataka. Analizirane su samo one trudnice koje su koristile alkohol, nikotin i opojne droge tijekom trudnoće. Konačna analiza je obuhvatila 855 (707+148) trudnica. Nakon poroda ili pobačaja, novorođenčad i fetusi su detaljno pregledani te je praćena pojava minor ili major malformacija. Rezultati. Analizom podataka ustanovljeno je da je od 6992 (6099+893) ispitivanih trudnica 855 (12,2%) koristilo navedene ksenobiotike u trudnoći. Alkohol je koristila 21 (0,3%) trudnica, cigarete 829 (11,8%) i opojne droge 5 (0,1%) trudnica. Malformacije su nađene u 105 (12,3%) fetusa i novorođenčadi. Zaključak. Na osnovu ovih rezultata ne možemo sa sigurnošću tvrditi što je pravi uzrok nađenih malformacija, ali primjenu alkohola, ¬nikotina i opojnih droga tijekom trudnoće u svakom slučaju treba izbjegavati.Objective. The aim of the study was to assess the prevalence of alcohol, nicotine and opioid substance use in pregnancy, and the rate of congenital malformations in children at in utero exposure to these xenobiotics. Methods. One part of the study (one year study) was performed at University Department of Gynecology and Obstetrics, Genetic Counseling Unit, and Department of Pathology and Histology in Novi Sad, Serbia. The other part of the study (one month study) was performed at four maternity hospitals in Zagreb, Croatia. Only pregnant women using alcohol, nicotine and opioid substances during pregnancy were included in the study. Final analysis included data on 855 (707+148) pregnant women. Following delivery or abortion, the newborns and fetuses were thoroughly examined and followed-up for the occurrence of minor or major malformations. Pregnant women were studied by questionnaire at the moment of birth. Questionnaire was consisted by two types of data: interview of parturient woman and hospital records. Results. Data ¬analysis showed the use of studied xenobiotics during pregnancy in 855 (12,2%) of 6992 (6099+893) women: alcohol in 21 (0,3%), cigarette smoking in 829 (11,9%) and opioid substances in 5 (0,1%) women. Malformations were found in 105 (12,3%) fetuses and newborns. The rate of congenital malformations exceeded their prevalence in the general population. Conclusion. Based on these results, the true cause of these malformations could not be definitely identified; however, the use of alcohol, nicotine and opioid substances during pregnancy should be avoided

COMPARISON OF TWO DIFFERENT METHODS (PATIENT QUESTIONNAIRE AND MEDICATION POSSESSION RATIO - MPR) FOR MEASURING THE CHRONIC PATIENT’S BEHAVIOR

Background: Medication adherence is the extent to which patients take medications as prescribed by their health care providers. There are a number of approaches to study medication-taking behavior. The aim was to compare two most common methods for measuring adherence: Patient Adherence Questionnaire and Medication Possession Ratio (MPR). They belong to the indirect methods. Methods: In this article four adherence studies were analysed and the results were compared, two wherein the patient questionnaire was applied and other two with medication possession ratio applied. Results: The obtained results reveal that more than half of respondents (58.9%) experienced constant nonadherence behavior according to the prescribed therapy. The main reason of nonadherence is oblivion, suggesting that it is necessary to pay more attention to this problem. Conclusions: Nonadherence with therapy has negative consequences on the health of the individual, and an adverse impact on the community health and wealth. Patients should be informed of the importance of regularly taking prescribed therapy. The main problem of long-term therapy is significantly decreased of adherence to medication in a very short time. It is important to stress that almost all the interventions effective for improving patient adherence in long-term care are complex and should be repeated after a while

Risk of Pneumonia Recurrence in Patients Previously Hospitalized for Pneumonia – A Retrospective Study (1998–2000)

Although elderly hospitalized patients, irrespective of the cause of hospitalization, are known to be at a high risk of subsequent development of pneumonia, some studies suggest the risk to be even higher in those hospitalized for pneumonia than in those hospitalized for other diseases. The aim of this retrospective study was to determine the association of hospitalization for pneumonia and some other diseases with subsequent pneumonia morbidity and mortality. The risk of recurrent pneumonia in patients hospitalized for pneumonia was investigated. Rehospitalization of pneumonia patients previously hospitalized for the same disease was followed-up and compared with rehospitalization of patients hospitalized for other diseases during the same study period. The study included patients aged over18, initially hospitalized in 1998 for pneumonia (J12–J18), or for some particular gastrointestinal (K20–K31) and urogenital diseases (N10–N12, N30–N39). All rehospitalizations for pneumonia in nine Zagreb hospitals were followed-up during a 3-year study period (1998–2000). Out of 975 patients followed-up for rehospitalization, 227 (23.3%) had initially been hospitalized for pneumonia, and 748 (76.7%) for other diagnoses. During the 3-year period, 30 patients were rehospitalized for pneumonia, out of which number 22 had initially been hospitalized for pneumonia, yielding a statistically significant difference between the two study groups (x2=34.780, p<0.001). The mortality directly caused by pneumonia was also significantly higher in the group of patients with the initial diagnosis of pneumonia than in the group of patients with other diagnoses (x2=15.82, p<0.001)

ICTs, data and vulnerable people: a guide for citizens

ICTs, personal data, digital rights, the GDPR, data privacy, online security… these terms, and the concepts behind them, are increasingly common in our lives. Some of us may be familiar with them, but others are less aware of the growing role of ICTs and data in our lives - and the potential risks this creates. These risks are even more pronounced for vulnerable groups in society. People can be vulnerable in different, often overlapping, ways, which place them at a disadvantage to the majority of citizens; Table 3 in this guide presents some of the many forms and causes of vulnerability. As a result, vulnerable people need greater support to navigate the digital world, and to ensure that they are able to exercise their rights. This guide explains where such support can be found, and also answers the following questions: - What are the main ethical and legal issues around ICTs for vulnerable citizens? - Who is vulnerable in Europe? - How do issues around ICTs affect vulnerable people in particular? This guide is a resource for members of vulnerable groups, people who work with vulnerable groups, and citizens more broadly. It is also useful for data controllers1 who collect data about vulnerable citizens. While focused on citizens in Europe, it may be of interest to people in other parts of the world. It forms part of the Citizens’ Information Pack produced by the PANELFIT project, and is available in English, French, German, Italian and Spanish. You are welcome to translate this guide into other languages. Please send us a link to online versions in other languages, so that we can add them to the project website

Efficiency of hypertonic and isotonic seawater solutions in chronic rhinosinusitis

Aim To compare the efficiency of isotonic and hypertonic seawatersolutions used for nasal lavage and quality of life of the patientswith chronic rhinosinusitis. Methods A random and controlled clinical study was performed. The study included 60 patients with history of chronic rhinosinusitis. At the beginning of the study, each subject was given a Patient Lobook, which needed to be filled ut daily during the 15-day tudy period. There were three visits per each patient during the study. Results Patient Logbook notes showed significant statistical differences inall symptoms in the group of patients using hypertonic seawater solution. However, while the notes showed significant statistical differences in congestion and rhinorrhea, in the group of patients using isotonic seawater solution, other symptoms showed no major changes during the study period. Conclusion Hypertonic seawater solution has been proven to bebetter than isotonic seawater solution in eliminating the symptomsof nasal congestion, rhinorrhea, cough, headache and waking up duringthe night

Resistance of uropathogenic strains of Escherichia coli in pregnant women and other women in generative ages in comparison with antibiotics consumption in Zagreb

Aim To compare resistance of uropathogenic strains of Escherichia coli (UPEC) to antibiotics in women in generative ages and pregnant women during two year period (2004 and 2008) in Zagreb, andcomparison of resistance and the consumption of antibiotics. Methods The standard disk-diffusion method was used for sensitivity testing to 16 different antibiotics.Data on antibiotic utilization were used to calculate the number of defined daily doses (DDD) and DDD per 1000 inhabitants using Anatomical-Therapeutic-Chemical/DDD methodology.Data on antibiotic consumption during pregnancy were collected using a questionnaire filled in by 893 women after delivery.Results During 2004 resistance of UPEC to antimicrobial drugs was not different in pregnant and in non-pregnant women, with the exception of amoxicillin and nitrofurantoin, with statistically higher resistance in pregnant women (p <0.01). Four years later the statistically higher resistance to norfloxacin was observed in non-pregnant women (p <0.01). Comparing the resistance in 2004 and 2008, in the both groups of women a statistically significant decrease of resistance to cefalexin and nitrofurantoin was detected (p <0.01). Outpatient utilization of antimicrobial drugs in Zagreb increased significantly, from 32 to 39 DDD/1000 inhabitants per day. The most used antibiotic was co-amoxiclav, and its utilization increased from 9.6 to 12.2 DDD/1000/day. Amoxicillin and co-amoxiclav were used during pregnancy by 9.6% interviewed women. Conclusion The observed significant decrease of resistance to cefalexin makes that antibiotic the drug of choice for treatment of urinary tract infections in women in generative ages, and together with coamoxiclavcan be administered in pregnancy. Constant monitoring of urinary tract pathogens resistance to antimicrobial agents ensures the effectiveness of empirical therapy, whose versatile use is limited due the potentially harmful effects of antimicrobial drugs on fetus

PHARMACIST COMPETENCES AND IMPACT OF PHARMACIST INTERVENTION ON MEDICATION ADHERENCE: AN OBSERVATIONAL STUDY

Background: The aim of this study is to determine the results of pharmacist interventions on patient\u27s adherence to drugs in community settings. Subjects and methods: The study was designed using a standard EQ-SDQ questionnaire and a Culig questionnaire about the adherence to drug. General Level Framework (GLF) was used as a tool for competence assessment among community pharmacists. Participants were pharmacists that issued the medication on repeat prescription in the pharmacy. They interviewed the patient at the first visit to the pharmacy and the next time when the patient came to refill the prescription. The survey was conducted during a twomonth period in the Atlantic Pharma pharmacy chain. A total of 152 patients were included at the first visit and 87 patients at the second visit. Results: About two thirds of patients (65.5%) identified themselves as adherent during the first survey, and this number increased slightly during the second interview (by 3.5%), but not statistically significant (p=0.75). A total number of drugs prescribed during the first and second survey was 252 and 253 respectively. The percentage of the advices given to the patients increased during the second survey, but not statistically significant (p=0.62). Conclusion: It is definitely important to check that a patient understands current disease and what are doubts and difficulties in taking a therapy. The reasons for possible nonadherence are different: fears, worsening of the clinical state or other negative treatment outcomes. Enough time should always be left to clarify anything that is unclear and to listen. Application of GLF program for improving pharmacist competences resulted in slightly increased patient adherence to medication. For further development of competences, pharmacist intervention should include some other contents, i.e. tailoring the dosage scheme, counselling about drugdrug and drug-food interactions. The pharmacist counseling should be reimbursed by the Croatian Health Insurance Fund