Current Advice Research Articles

Development of a habit-based intervention to support healthy eating and physical activity behaviours for pregnant women with overweight or obesity: Healthy Habits in Pregnancy and Beyond (HHIPBe)

BackgroundThe number of women entering pregnancy with overweight or obesity is increasing. This can increase the risk for excessive gestational weight gain (GWG) which is associated with health complications for mother and baby. There are limited evidence-based interventions within antenatal care settings to encourage healthy eating and physical activity behaviours and support women with managing GWG.MethodsA previous habit-based intervention ‘Ten Top Tips for a Healthy Weight’ (10TT) was adapted and made suitable for pregnancy in line with the Medical Research Council’s (MRC) complex intervention development guidelines. It involved three key activities: (1) identifying the evidence base; (2) identifying appropriate theory; and, (3) modelling processes. A core element was integrating lived experience via personal and public involvement (PPI).ResultsThe original 10TTs were adapted with PPI in line with current advice on nutrition and physical activity in pregnancy. New intervention materials were devised, including a leaflet and a logbook and app for self-monitoring to be delivered alongside a brief 1:1 conversation. Behaviour change techniques (BCTs) included in the new materials were coded using a number of behavioural taxonomies. An E-learning resource was created to help standardise the approach to delivery of the intervention and avoid stigmatising conversations.ConclusionFollowing MRC guidance for the development of complex interventions alongside significant PPI allowed for the adaption of 10TT habit-based weight management intervention into the ‘Healthy Habits in Pregnancy and Beyond’ (HHIPBe) intervention. The feasibility and acceptability of implementing this intervention in the antenatal setting will be explored in a feasibility randomised controlled trial.Trial RegistrationThis study was registered on Clinical Trials as ‘Healthy Habits in Pregnancy and Beyond (HHIPBe)’ ClinicalTrials.gov Identifier: NCT04336878. The study was registered on 07/04/2020.

The Effect of Measurement Error on Hypothesis Testing in Small Sample Structural Equation Modeling: A Comparison of Various Estimation Approaches

Researchers seeking valid statistical inference in the presence of measurement error often apply approaches that ignore measurement error. This may result in biased estimates, inflated type I error rates, diminished power, and therefore, increases the risk of drawing erroneous conclusions. However, current advice on accounting for random measurement error is limited to large samples and traditional linear models. This article aims to address this gap for small samples and recent estimation approaches in structural equation modeling. Our results show substantial type I error rate inflation for approaches that ignore measurement error when the model contains correlated latent predictors.

The impact of restricted grazing systems on the behaviour and welfare of ponies.

Equine obesity is a growing concern. Much of the current management advice centres on dietary restrictions, including the removal or limitation of grazing. Little is known about the impact of these approaches on the welfare of the horse. This study investigates the effect of two commonly used grazing systems advocated for the control of weight-the 'strip-grazing' and the 'track' systems-on the behaviour and welfare of outdoor-living ponies. A within-subject cross-over experimental design with four groups of pasture-kept ponies experiencing each system for 4 weeks in a random order. Time budgets and behavioural indicators of welfare were measured using 24-h electronic surveillance, morphometric parameters including weight, body condition score and cresty neck score were measured weekly and activity levels were tracked. The effect of grazing system on movement and behaviour was tested using a general linear model. Ponies moved more [median (IQR) % time spent moving, track: 3.23% (2.08%), strip: 2.02% (0.90%); p = 0.001] and travelled a greater distance [median (IQR) metres/24 h, track: 7013.47 m (1761.49 m), strip: 5331.91 m (494.16 m); p < 0.001] and engaged in less overt agonistic behaviour on the track system compared with the strip system [median (IQR) prevalence per hour; track: 0.14 (0.30), strip: 0.21 (0.37) p = 0.02]. A relatively short time period of exposure to each grazing system. Ponies on strip systems moved less and exhibited increased agonistic interactions compared with the track system, maybe as a result of a perceived reduction in space or concentration of resources, although the accessible areas were matched. These results suggest that there may be physical as well as psychological health benefits to the track system.

Management strategy evaluation operating model conditioning: a swordfish case study

Evaluation of fish stock status is a key step for fisheries management. Tuna Regional Fisheries Management Organizations (t-RFMOs) are moving towards management strategy evaluation (MSE), a process that combines science and policy and depends on technical aspects, developed by scientists, designed to meet management objectives established by managers and other stakeholders. In the Indian Ocean, the current management advice for swordfish (Xiphias gladius) is based on an ensemble of 24 models considering four areas of uncertainty about the stock dynamics. There is an ongoing MSE process for swordfish, and this paper describes the methodology being applied for the conditioning of the operating model (OM), including model selection and validation. In the MSE, nine sources of uncertainty were considered, each being characterized by 2–3 levels. A partial factorial design was employed to reduce the number of models from a full factorial design to those needed to encompass the overall uncertainty. A selection and validation process was carried out, filtering models that converged, showed good predictive skills, and provided plausible estimates. Overall, the estimated spawning stock biomass (SSB) relative to SSB at maximum sustainable yield (MSY), and fishing mortality (F) relative to FMSY encompasses the estimates of the stock assessment ensemble at the most optimist area of the distribution. The MSE for swordfish is an ongoing process that is expected to provide more robust management advice in the future. Further developments to the OM can still occur, but the methods presented herein can be applied to this, or other species, MSE processes.

Developing management plans for sprat (Sprattus sprattus) in the Celtic Sea to advance the ecosystem approach to fisheries

Sprat are commercially valuable and are an important component of the North-East Atlantic ecosystem as major predators of zooplankton, competitors with herring, and prey for piscivorous fish, marine mammals, and seabirds. Despite this, insufficient information exists for Celtic Seas sprat, one of five North-East Atlantic stocks, to estimate stock status. To ensure the sustainable exploitation of sprat, the health of the Celtic Seas ecosystem, and the wider fisheries sector, we conduct a management strategy evaluation to stress test the current single-species advice framework. The aim is to evaluate whether ecosystem objectives can be achieved under single-species maximum sustainable yield and precautionary advice frameworks. An operating model was conditioned on life history theory and strategic information from ecosystem models. We showed that in-year advice using an empirical rule could achieve management objectives and help balance the trade-offs between fishing activities and ecosystem health. The approach allows ecosystem understanding to be incorporated within existing precautionary and maximum sustainable yield frameworks to provide a robust management framework that can meet multiple objectives despite uncertainty.

Menopause depression: Under recognised and poorly treated.

Menopause is a biological process experienced by all people assigned female at birth. A significant number of women experience mental ill health related to the major brain gonadal hormone shifts that occur in their midlife. There is poor understanding and management of the complex mental ill health issues, with the biological brain hormone changes receiving little formal attention. The current treatment advice is to manage this special type of mental ill health in the same way that all mental ill health is managed. This leads to poor outcomes for women and their families. Many women leave the workforce earlier than expected due to menopause-related depression and anxiety, with subsequent loss of salary and superannuation. Others describe being unable to adequately parent or maintain meaningful relationships - all ending in a poor quality of life. We are a large and diverse group of national and international clinicians, lived experience and social community advocates, all working together to innovate the current approaches available for women with menopausal mental ill health. Above all, true innovation is only possible when the woman with lived experience of menopause is front and centre of this debate.

Evolutionary sensemaking: a managerial metacognitive dynamic capability to reduce information asymmetry

PurposeHow can managers reduce information asymmetry in dyadic manager-external stakeholder relationships in a complex and evolving environment? Addressing this question has significant implications for firm survival, growth, and competitive advantage.Design/methodology/approachWe have adopted a multiparadigm approach to theory building, known as metatriangulation. We integrate the dynamic capabilities, sensemaking, and evolutionary theory literatures to theorize how managers can relate to stakeholders in a complex and evolving environment.FindingsWe propose, via a conceptual framework and three propositions, “evolutionary sensemaking” as the managerial metacognitive dynamic capability that helps managers hone their understanding based on the evolutionary changes in the stakeholder’s interpretations of information quality preferences. The framework unfolds across three evolutionary stages: sensing preferences' variation of the stakeholder, seizing preferences, and transforming for complexity alignment and retention. The propositions focus on managing complexity in stakeholder information quality preference, employing cognitive capabilities to simplify, interpret, and align interpretations for effective information asymmetry reduction.Practical implicationsTo develop the metacognitive dynamic capability of evolutionary sensemaking, managers need to train for and foster the underlying complex cognitive capabilities by enhancing their (1) perception and attention skills, (2) problem-solving and reasoning skills, and (3) language, communication, and social cognition skills, focusing specifically on reducing the complexity embedded in stakeholder cognition and diverse stakeholder preferences for information quality. Contrary to the current advice to “keep things simple” and provide “more” information to the stakeholders for opportunism reduction, trust-building, and superior governance, our framework suggests that managers hone their cognitive capabilities by learning to deal with the underlying complexity.Originality/valueThe proposed framework and propositions address research gaps in reducing information asymmetry. It enriches the dynamic capabilities literature by recognizing complexity (as opposed to opportunism) as an alternative source of information asymmetry, which needs to be addressed in this stream of research. It extends the sensemaking literature by identifying the complexity sources – i.e. stakeholder preferences for diverse information quality attributes and the associated cognitive preference interpretation processes. The article enhances evolutionary theory by delving into microprocesses related to information asymmetry reduction, which the existing literature does not thoroughly investigate.

The role of community pharmacists as oral health advisors in the management of oral effects of asthma medications: an exploratory survey.

To investigate community pharmacists' attitudes, confidence, practice, knowledge, and barriers towards the management of oral side effects of asthma medications. A paper-based questionnaire was developed from previous research, trialled, and validated. Convenience sampling through web search was used to identify pharmacy practices across Cairns, Queensland, Australia. Practices were contacted by email and phone before hand-delivering and collecting questionnaires. Thirty eight community pharmacist responses were descriptively analysed. Community pharmacists surveyed within the Cairns region feel that it is within their role to help manage the side effects of asthma medications. Many feel this is best conveyed during inhaler dispensing and instruction. Current advice is more prompted rather than preventative. Pharmacists routinely advise patients of mouth-rinsing following inhaler use, however the link to preventing side effects is not clearly communicated. Pharmacists are confident in recognizing and managing common side effects such as oral thrush and dry mouth, but fewer are aware of dental decay and gingivitis. Many identify a lack of guidelines as the largest barrier to providing preventive oral health advice. Cairns community pharmacists already self-perceive their role in the management of oral side effects of asthma medications. Advice given to patients is practical but does not clearly convey the causative associations between asthma medications and their potential oral side effects. Patient education is prompted more by enquiry rather than a preventative approach. The development of standardized practice protocols and integration within undergraduate degrees or continuing education may benefit the community-pharmacist delivered care.

The Potential Role of the Ketogenic Diet in Serious Mental Illness: Current Evidence, Safety, and Practical Advice.

The ketogenic diet (KD) is a high-fat, low-carbohydrate diet that mimics the physiological state of fasting. The potential therapeutic effects in many chronic conditions have led to the gaining popularity of the KD. The KD has been demonstrated to alleviate inflammation and oxidative stress, modulate the gut microbiota community, and improve metabolic health markers. The modification of these factors has been a potential therapeutic target in serious mental illness (SMI): bipolar disorder, major depressive disorder, and schizophrenia. The number of clinical trials assessing the effect of the KD on SMI is still limited. Preliminary research, predominantly case studies, suggests potential therapeutic effects, including weight gain reduction, improved carbohydrate and lipid metabolism, decrease in disease-related symptoms, increased energy and quality of life, and, in some cases, changes in pharmacotherapy (reduction in number or dosage of medication). However, these findings necessitate further investigation through larger-scale clinical trials. Initiation of the KD should occur in a hospital setting and with strict care of a physician and dietitian due to potential side effects of the diet and the possibility of exacerbating adverse effects of pharmacotherapy. An increasing number of ongoing studies examining the KD's effect on mental disorders highlights its potential role in the adjunctive treatment of SMI.

REOPERATION-FREE SURVIVAL OF COMMON FEMORAL STEM TYPES IN PRIMARY TOTAL HIP ARTHROPLASTY FROM A LARGE NATIONAL DATASET: TIME TO RETHINK GIRFT GUIDANCE? A NATIONAL COHORT STUDY USING AN INTEGRATED NATIONAL JOINT REGISTRY AND HES DATASET

Current advice regarding implant choice is based on estimates of cost-benefit derived from implant survival to an endpoint of revision. Current estimates do not account for many implant failures which are treated with non-revision surgery and may not be accurate. The aim of this study was to estimate survival of major stem implant design groups to an endpoint of reoperation.Primary total hip replacement and linked revision form the National Joint Registry (NJR) and Hospital Episode Statistics (HES) data linked by unique identifier were used. Survival of femoral implant groups (cemented stainless steel polished taper [PTSS], cemented cobalt chrome polished taper [PTCC], cemented composite beam [CB], collarless cementless [NCOL] and collared cementless [COL]) was estimated using Kaplan-Meier method.809,832 patients with valid NJR and HES data from England, were included. Cumulative failure at ten years for PTSS increased overall from 2.9% (95%CI 2.8–2.9) to 3.6% (95%CI 3.6–3.7) after inclusion of reoperations. Cumulative failure at ten years for PTSS increased from 2.5% (95%CI 2.5–2.6) to 3.3% (95%CI 3.2–3.4), for PTCC increased from 3.8% (95%CI 3.5–4.0) to 5.4% (95%CI 5.1–5.6), for CB increased from 3.1% (95%CI 2.9–3.3) to 4.1% (95%CI 3.8–4.3), for NCOL increased from 3.4% (95%CI 3.3–3.5) to 3.9% (95%CI 3.8–4.0), and for COL increased from 2.5% (95%CI 2.4–2.6) to 3.1% (95%CI 2.9–3.2), after inclusion of reoperations.Re-operation for internal fixation is as significant life event for the patient as revision. When a more inclusive metric is used, the patient and clinician's perspective on what constitutes a GIRFT implant may not be the same. Further work is required to update implant selection guidance in view of the change in implant performance.

IDENTIFYING THE CURRENT PRACTISE IN PHYSICAL ACTIVITY ADVICE GIVEN TO WOMEN FOLLOWING A MISCARRIAGE AND THEIR ATTITUDES TOWARDS PHYSICAL ACTIVITY

INTRODUCTION &amp; AIMS Miscarriage is the most common adverse pregnancy outcome, with up to 36% of women reporting a miscarriage by 40-45 years old. While physical activity is known for its benefits on physical and mental health in various population, the evidence in women following a miscarriage is lacking. Therefore, the aim of the study is to identify current practice and advice on physical activity following a miscarriage, assess current physical activity levels and to identify women’s attitudes to physical activity following a miscarriage. Women’s willingness to participate in future studies on the benefits of physical activity following miscarriage was also examined. METHODS A cross-sectional survey consisting of 21 questions across 5 subsections including demographics, pregnancy loss experience, physical activity advice, physical activity participation and research participation was used. Participation was opened to all Australian women who had ever experienced a miscarriage. RESULTS A total of 77 surveys were complete and suitable for analysis. Most participants (82%, n=63) reported receiving no physical activity guidance following their miscarriages and said they would like physical activity advice specific to their experiences (84%, n=65). The proportion of women who do not meet the recommended physical activity guideline increase from pre-pregnancy (32%) to following a miscarriage (83%) and continues to be higher (58%) than it was pre-pregnancy. The most frequently identified barriers to physical activity was feeling mentally/emotionally unprepared (34%, n=51). Majority of participants (68%, n=52) were willing to participate in future studies on the benefits of physical activity for women post-miscarriage. CONCLUSION This study strongly supports the need for further research into appropriate physical activity guidelines for women following a miscarriage. There is a clear unmet need in this population who are being disadvantaged by the current lack of support and guidance.

Maternal-Fetal Compatibility in Recurrent Pregnancy Loss.

Nowadays, recurrent pregnancy loss (RPL) is an undesirable condition suffered by many patients of reproductive age. In this scenario, certain immune cell populations and molecules, involved in maternal-fetal compatibility, have emerged as factors related with the pathogenesis of RPL. Among them, uterine Natural Killer cells (uNKs) appear to be of great relevance. These cells are involved in numerous processes during pregnancy, such as the remodeling of uterine spiral arteries or the control of trophoblast invasion. These functions are regulated by the interactions that these cells establish with the extravillous trophoblast, mainly through their Killer Immunoglobulin-like Receptors (KIRs) and the Human Leukocyte Antigen-C (HLA-C) molecules expressed by the embryo. A high level of polymorphism has been reported for both molecules involved in this interaction, with some of the possible KIR-HLA-C combinations being associated with an increased risk of RPL. However, the complexity of the maternal-fetal interface goes beyond this, as other HLA molecules also appear to be related to this reproductive pathology. In this review, we will discuss the role of uNKs in pregnancy, as well as the polymorphisms and clinical implications of KIR-HLA-C binding. We will also address the involvement of other, different HLA molecules in RPL, and the current advice on the appropriate management of patients with 'immunological mismatch', thus covering the main aspects regarding the involvement of maternal-fetal compatibility in RPL.

Human Rights with Focus on Gender, Race, and Religion: A Comparative Study Between Jordanian Legislation and International Human Rights Acts

This study sheds light on the role of Jordanian legislation in implementing human rights. It focuses on the development of Jordanian laws to adjust with the current advice to help put an end to discrimination within its society. In addition to discussing the atrocities people of minorities suffer from because of their race, sex, and religion, this research focuses on the root issues that lead to discrimination. This research also focuses on the psyche behind discriminatory acts to further establish what could cause these gaps between the population of people in our current time. It includes the different treaties and laws that punish crimes fueled by hate towards those who are considered different and introduces the possible solutions to assist in eliminating this problem.

Time of day and glycaemic response in pregnant women: A gap in current guidelines?

Advice to monitor and distribute carbohydrate intake is a key recommendation for treatment of gestational diabetes, but fails to consider circadian regulation of glucose homeostasis. In the non-pregnant state, glucose responses to a meal at night-time are significantly higher than during the day and are associated with an increased risk of developing type 2 diabetes. However, the impact of night time eating on postprandial glucose in pregnancy is uncertain. Using a systematic approach we explored postprandial glucose responses to dietary intake at night compared to during the day in pregnant women. Searches were conducted in four databases (Ovid MEDLINE, Ovid Embase, CINAHL plus and Scopus), in September 2022 (updated, June 2023). Eligible studies reported on postprandial glucose at a minimum of two times a day, after identical meals or an oral glucose tolerance test, in pregnant women with or without gestational diabetes. Publication bias was assessed using the ROBINS-I tool. Four eligible studies were retrieved. Two studies reported within group comparison of two timepoints, and observed reduced glucose tolerance in the afternoon compared to the morning in pregnant women, irrespective of diabetes status. The other two studies meeting inclusion criteria did not report time of day comparisons. It is unclear as to whether the higher (and extended) postprandial glucose levels observed at night in non-pregnant populations are observed in pregnancy. Clinical studies are needed to explore the impact of circadian rhythmicity on glucose metabolism during pregnancy, and the implications of current dietary advice on when and what to eat for management of gestational diabetes.

Linezolid-Induced Thrombocytopenia in Patients with Renal Impairment: A Case Series, Review and Dose Advice.

Oral linezolid is often used as alternative therapy for intravenous vancomycin. According to the current guidelines, no dose adjustment has to be made in case of renal impairment. Nevertheless, in our hospital we have seen several patients with renal impairment who developed linezolid-induced thrombocytopenia when linezolid was taken in the standard dose. In this case series and review we want to emphasize the necessity of reviewing the Dutch and international guidelines. We describe five cases with renal impairment that developed linezolid-induced thrombocytopenia in our hospital. A PubMed literature review was conducted to identify other cases and find the optimal dosing regimen for these patients. Our cases join a long list of cases and available literature about linezolid-induced thrombocytopenia in patients with renal impairment. Less linezolid-induced thrombocytopenia was found, both in our cases and in the literature, after dose reduction of 50%. High linezolid trough concentrations were associated with a higher risk of linezolid-induced thrombocytopenia. Besides renal impairment, other risk factors for developing linezolid-induced thrombocytopenia were also identified, such as low body weight, high daily dose/kg, higher age, longer duration of therapy, low baseline count, malignity, low-dose aspirin and interacting co-medication. Re-evaluation of the current dose advice is necessary. We advocate for a standard dose reduction to 50% after 2days of standard dosing for all patients with an estimated glomerular filtration of <60mL/min/1.73m2. Besides this, therapeutic drug monitoring and thrombocytes monitoring may be executed weekly when patients have renal impairment or other risk factors for developing linezolid-induced thrombocytopenia.

Genetically proxied low-density lipoprotein cholesterol lowering via PCSK9-inhibitor drug targets and risk of congenital malformations.

Current guidelines advise against the use of lipid-lowering drugs during pregnancy. This is based only on previous observational evidence demonstrating an association between statin use and congenital malformations, which is increasingly controversial. In the absence of clinical trial data, we aimed to use drug-target Mendelian randomization to model the potential impact of fetal LDL-lowering, overall and through PCSK9 drug targets, on congenital malformations. Instrumental variants influencing LDL levels overall and through PCSK9-inhibitor drug targets were extracted from genome-wide association study (GWAS) summary data for LDL on 1 320 016 individuals. Instrumental variants influencing circulating PCSK9 levels (pQTLs) and liver PCSK9 gene expression levels (eQTLs) were extracted, respectively, from a GWAS on 10 186 individuals and from the genotype-tissue expression project. Gene-outcome association data was extracted from the 7th release of GWAS summary data on the FinnGen cohort (n = 342 499) for eight categories of congenital malformations affecting multiple systems. Genetically proxied LDL-lowering through PCSK9 was associated with higher odds of malformations affecting multiple systems [OR 2.70, 95% confidence interval (CI) 1.30-5.63, P = 0.018], the skin (OR 2.23, 95% CI 1.33-3.75, P = 0.007), and the vertebral, anorectal, cardiovascular, tracheo-esophageal, renal, and limb association (VACTERL) (OR 1.51, 95% CI 1.16-1.96, P = 0.007). An association was also found with obstructive defects of the renal pelvis and ureter, but this association was suggestive of horizontal pleiotropy. Lower PCSK9 pQTLs were associated with the same congenital malformations. These data provide genetic evidence supporting current manufacturer advice to avoid the use of PCSK9 inhibitors during pregnancy.

The Art of Chewing: Optimizing Early Life Sensory Exposure to Develop Healthy Eating Behavior.

Eating behavior and food preferences are shaped in early life and contribute to lifelong food choices. Much of the current dietary advice for infants and toddlers focuses on the nutritional quality of foods, with less emphasis on food sensory qualities. However, exposure to age-appropriate sensory properties, such as tastes and textures, are key in shaping early-life eating behaviors and food preferences. During weaning, new-borns rely on reflexes such as sucking and rooting to get sufficient nutrient intake. Around 6 months of age infants transit from dependent feeding with liquid foods such as breast or bottle feeding, to independent feeding with solid foods. During this rapid learning period, the infant must learn to sit upright and balance their head and quickly develop in terms of oral anatomy, emerging of teeth as well as the muscle coordination needed to orally process food. Different product textures require unique oral processing skills that have to be acquired through experience with food oral breakdown and swallowing. These early food experiences shape the eating behaviors that become habitual and are carried forward into later childhood. Early life feeding strategies vary widely across populations but become all the more challenging in specific child populations such as children who received early life tube-feeding and children with developmental challenges are further complicated by anatomical issues and acquired negative associations with food. Due to the significance of early life food sensory exposure in shaping dietary behavior, there is a need for science-based recommendations to help guide this sensory learning to inform dietary behaviors in both healthy and clinical child populations.

Challenges in Using Progestin to Prevent Singleton Preterm Births: Current Knowledge and Clinical Advice.

Preterm birth is the leading cause of infant morbidity and mortality in children younger than 5 years old and accounts for approximately 35% of newborn deaths worldwide. The use of progestogen therapy for prevention of preterm birth has been one of the most controversial topics in modern obstetrics. Progestogens can be classified as natural or synthetic. Progesterone is a natural progestogen while progestins such as 17-alpha-hydroxyprogesterone caproate (17OHP-C) are synthetic steroid hormones. Evidence supporting the use of progestogens varies by formulation and populations studied. After more than a decade, the US Food and Drug Administration has withdrawn accelerated approval of 17OHP-C for the prevention of recurrent preterm birth in pregnant individuals with a singleton gestation. With this decision, there is no current FDA-approved treatment for prevention of spontaneous preterm birth. In this review, we provide a historical context behind the rise and fall of 17OHP-C clinical application, highlight the challenges behind the data supporting progestogen use, and offer suggestions on how to make an impact on preterm birth moving forward.

Overview on remogliflozin SGLT-2 inhibitor in the management of type-2 diabetic mellitus in human beings

Sodium-glucose transport protein 2 inhibitors have become a significant category of oral medications in order to manage type 2 diabetic mellitus, particularly in people with heart disease or kidney disease, and have been highly advised overall current studies advice on how to treat. They can reduce blood pressure and help people lose weight, but they also come with drawbacks like genitourinary infections. The newly approved remogliflozin combinations are the product study of the pharmaceutical business for a new pharmaceutical class and novel drug combination with a view to managing diabetes. Remogliflozin etabonate is the term for the remogliflozin ester form. This study examines the clinical effectiveness, safety profile, pharmacokinetics, and pharmacodynamics of remogliflozin etabonate. However, itsanalytical profiling using RP-HPLC, UV, RP-UPLC, HPTLC, and LC/MS. this review addresses the individual experiments conducted during the development of analytical method for remogliflozin etabonate.

Psychotropic medicine use without current or prior medical advice, storage at home and association with perceived stress in a primary health care setting in Greece

ObjectivePsychotropic medicines use alters according to socio-economic factors and perceived stress. The study aimed to assess the prevalence of use of psychotropic medicines and supplements (PMS) without medical advice, including storage at home, and its relationship with socio-demographic characteristics and perceived stress in primary care patients. Materials and methodsA cross-sectional sample of adult attendees in an urban primary care unit in Crete, Greece, were surveyed during regularly scheduled appointments during a three-week period in October 2020. A questionnaire was distributed to investigate PMS use during the last 12 months. The validated Greek version of Perceived Stress Scale (PSS-14) was adopted to measure perceived stress. ResultsOf 263 respondents (mean age 46.3±14.5 years; 66.5% females), 101 (38.4%; 95%CI 33.1–43.7%) recalled having psychotropic medicines stored at home cabinets and 72 (27.4%; 95%CI 22.4–32.3%) reported using PMS without medical advice in the last 12 months. ConclusionsThis study revealed a high prevalence of PMS use without medical advice, including storage at home. People>59 years of age, experiencing irregular sleep and scoring high in PSS, displayed increased prevalence of storing PMS at home or using them without medical advice. The findings could potentially inform primary care providers to focus on patients most likely to be users of PMS without medical advice.