Prescription Medicines Research Articles

Increased purchases of prescription medicines in offspring of women with type 1 diabetes: a Finnish register-based cohort study between 1995 and 2018.

This study aimed to assess whether in utero exposure to hyperglycemia influences prescription medicine purchases in the offspring of women with type 1 diabetes (exposed offspring). We identified all singleton exposed offspring born in the hospital district of Helsinki and Uusimaa, Finland, between 1988 and 2011 from the Finnish Medical Birth Register, maintained by the Finnish Institute for Health and Welfare. For each exposed offspring, we obtained five age- and province-matched offspring of women without diabetes (reference offspring), from the Finnish Medical Birth Register. By combining data from three national registers, this longitudinal cohort study assessed prescription medicine purchases in exposed offspring (n = 1,725) and reference offspring (n = 8,755) from seven to thirty years of age. Prescription medicine purchases were grouped according to the Anatomical Therapeutic Chemical (ATC) classification system. Between 1995 and 2018, a total of 211,490 prescription medicines were purchased. After a median follow-up of 10.9 (interquartile range 4.9,17.6) years, we observed higher incidence risk ratios (IRR) of prescription medicine purchases for several ATC main groups in exposed offspring compared to reference offspring, with the highest IRR of 4.06 (95% CI: 2.78 to 5.94) for medicines affecting metabolism (e.g. diabetes medicines). Our findings suggest that exposed offspring purchase more reimbursable prescription medicines than reference offspring from age seven to thirty years. More research is needed to examine the effects of intrauterine exposure to hyperglycemia on long-term health in offspring.

Prescription and nonprescription drug misuse and abuse in community pharmacies in Iraq: a cross-sectional survey.

There is little known regarding prescription and nonprescription medicine nonmedical use (abuse and misuse) in Iraq, with limited treatment. Pharmacists could be a valuable source of information in the absence of any national monitoring system. This study aimed to explore Iraqi community pharmacists' perspectives on prescription and nonprescription medicine abuse/misuse, including motives for use and how often they encounter people whom they think are misusing or abusing medicines. A cross-sectional survey was undertaken between November 2020 and February 2021. Community pharmacists in Iraq were asked to complete a prepiloted self-administered questionnaire, distributed through online social media platforms. 300 pharmacists completed the questionnaire. The most commonly reported nonprescription drugs suspected of abuse/misuse were cough and cold medications (n = 80, 26.6%), topical corticosteroids (n = 54, 17.9%), and allergy products (n = 33, 11%). The most common reported prescription drugs suspected of abuse/misuse were systemic antibiotics (n = 111, 36.9%), gabapentinoids (n = 56, 18.6%), and moderate-weak opioids (n = 34, 11.3%). The most commonly method used by pharmacists to limit access to such drugs was responding that the requested medication was unavailable (n = 273, 51.7%), followed by advising on risks (n = 152, 33.2%). Prescription/nonprescription medicine abuse and misuse are suspected in community pharmacies in Iraq. Current methods for controlling the problem are likely to be ineffective in the absence of prescription drug enforcement. Pharmacists could have a more proactive role in managing this issue, networking with other pharmacists, and referring suspected users to support.

Herbo-vitamin medicine Livogrit Vital ameliorates isoniazid induced liver injury (IILI) in human liver (HepG2) cells by decreasing isoniazid accumulation and oxidative stress driven hepatotoxicity

BackgroundTuberculosis (TB) is a leading cause of infection related mortality. Isoniazid is one of the frontline drugs for anti-TB therapy. Hepatotoxicity induced by isoniazid is a major cause of drug-discontinuation which may lead to development of resistant TB or increased mortality.PurposeTo characterize pharmacological properties of plant-based prescription medicine, Livogrit Vital (LVV) against isoniazid-induced liver injury (IILI) using HepG2 cells.MethodPhytometabolite characterization of LVV was performed by High-performance liquid chromatography (HPLC). The effects of LVV on cytosafety, IC50 shift, oxidative stress, ER stress, apoptosis, liver injury markers, and accumulation of isoniazid and hydrazine was performed on HepG2 cells induced with isoniazid. Silymarin was used as the positive control.ResultsHPLC based phytometabolite characterization of LVV revealed the presence of several anti-oxidant, anti-apoptotic, and hepatoprotective compounds. In isoniazid-induced HepG2 cells, LVV reduced cytotoxicity of isoniazid and shifted its IC50 value. Treatment with LVV reduced ROS generation and lipid peroxidation; enhanced GSH enzyme levels in isoniazid-induced HepG2 cells. As per the mechanistic evaluation, LVV modulated gene expression level of Caspase-3, FGF21, and IRE-1α. LVV treatment also normalized isoniazid-induced elevated Caspase-3 activity and cPARP1 protein levels, indicating its potentials to regulate liver cell apoptosis. Concomitantly, biomarkers of hepatotoxicity, ALT and GGT, also decreased by LVV treatment. Interestingly, LVV treatment reduced intracellular accumulation of isoniazid and its toxic metabolite hydrazine, in isoniazid-stimulated HepG2 cells.ConclusionTreatment of hepatic cells with the herbo-vitamin medicine, Livogrit Vital, regulates IILI by modulation of oxidative and ER stress, apoptosis, and bioaccumulation of isoniazid and hydrazine. Collectively, Livogrit Vital could well be explored as an adjuvant hepatoprotective agent alongwith anti-TB medicines.

A scoping review of the integration of non-medical prescribing for acute common clinical conditions by community pharmacists

Abstract Introduction Non-medical prescribing enhances patient care, safety, and medication accessibility, while also maximising expertise1. Some evidence exists for a variety of factors at individual, organisational, regulatory, and policy levels impacting the implementation of PP in community pharmacy2. Common clinical conditions (CCC) can be defined as ‘a broad range of self-limiting conditions that are more complex in their diagnosis and treatment than minor ailments and management that often involves the need for prescription medicines’. Aim To collate and characterise literature on the integration of non-medical prescribing for acute common clinical conditions by community pharmacists. Method This scoping review followed the Arksey and O’Malley framework. The review team comprised a doctoral student (LK), a research fellow (TJ) and a professor of pharmacy (SC), all with experience of review methodology, community pharmacy research and /or practice. Eligibility criteria, search databases and terms were defined. Medline, International Pharmaceutical Abstracts, Cumulative Index to Nursing and Allied Health Literature and Google Scholar were searched for full text, English language, peer reviewed original papers, randomised controlled trials, cross-sectional and cohort studies, papers reporting empirical data from primary research and review articles including systematic reviews /scoping reviews /narrative reviews from January 2006 to October 2023. The (global) focus was on services delivered by pharmacists and pharmacy team members in community pharmacy for the management of CCC, using non-medical prescribing rights. Search terms included “independent prescrib*”, “pharm* independent prescri*”, “pharm* prescrib*”, “non-medical prescri*, “non-medical prescri*”, “pharm* supplementary prescri*” and “collaborative prescrib*”. Following screening and full text review a narrative synthesis approach3 was used to address the aim which involved: preliminary synthesis through data extraction and tabulation of key study characteristics, exploration of relationships and differences across the studies and finally evaluation of the robustness of the synthesis. The Consolidated Framework for Implementation Research provided a theoretical lens to support synthesis, identifying barriers and facilitators for integration. All steps were independently checked by two review team members. Ethics approval was not required because this was a scoping review. Results From a total 1018 records identified, 10 papers remained after removal of duplicates, title /abstract screening and full text review. The majority of studies were from Canada and the aims and linked outcomes of studies focused on pharmacists’ views and experiences, evaluation of safety, effectiveness, and patient satisfaction. A range of CCCs were included with a focus on antibiotic prescribing. A wide range of barriers and facilitators to implementation were identified including “regulatory constraints” and “fiscal challenges” at a macro socio-organisational level and a plethora of dichotomous challenges within organisations including a lack of clarity on the pharmacist’s scope of practice and linked consumer confusion, staffing levels and workload, with specific mention of paperwork and access to patient records. Conclusion The small number of studies included indicates that there is a paucity of research in this area. There is a need for increased efforts to consider this topic further and identify ways to address the challenges for further widespread implementation and uptake of such services.

The role of Pharmaceutical Marketing in Prescribing Decisions in a Developing Country: A Comprehensive Study Exploiting Theory of Planned Behaviour

Background: Prescription medicines have become a major component of health systems in both developed and developing countries contributing to, may be, more than half of the total health care expenditure in the developing countries. Although literature directly attributing rise in medicines expenditure to prescribers’ decision, but still only a few researches had employed studies with sound theoretical foundations to comprehensively examine prescribing decision behaviours. Our objective was to investigate potentially modifiable factors, which may influence prescribing decisions of physicians employing theory of planned behaviour. Method: A quantitative survey approach was used to investigate the proposed hypotheses. Population was physicians in outpatient clinics in both private and governmental hospitals in Sana’a, capital city of Yemen. A structured questionnaire was designed to measure the influence of drug-promoting marketing techniques on physicians’ prescribing decisions. Data was collected through an anonymous survey questionnaire. The hypotheses were tested by multiple regressions analysis. Ethical approval was obtained from the Ethical Committee of the Ministry of Public Health and Population (MoPHP), and participants provided written consent before enrolling in the study. Result: Physicians admitted the presence of promotional influence on their prescribing decision. The study revealed that receiving low-value promotional items, belief of physicians that it is appropriate to accept both low- and high-value promotional items, physicians’ exposure to company-direct sources of information, and drug promotion-related factor all are positively and significantly related to physicians’ prescribing decisions (? = 0.438, p <0.001; ? = 0.089, p =0.027; ? = 0.157, p <0.001; ? = 0.093, p =0.032; and ?= 0.118, p = 0.007 respectively). Conclusion: This research clarified the role played by pharmaceutical companies to influence prescribing decisions of physicians. Therefore, could provide theoretical framework for policymakers in Yemen, and other countries with similar conditions, to develop a suitable policy and strategy in terms of drug promotion.

Parents Perception on use of Antibiotics in Children

Objective: To determine parents’ perception on use of antibiotics in children. Study Design: Cross-sectional study. Place and Duration of Study: Department of Paediatrics, Combined Military Hospital, Kharian Pakistan, from Jul 2022 to Mar 2023. Methodology: Fifty parents aged 18-50 years were included in the study. Their parity, education levels, knowledge and attitudes on antibiotic use, including basic concepts of antibiotics, indications of antibiotic, administration of antibiotics, Antimicrobial Resistance and other side effects; parental experiences and practices around buying antibiotics without a prescription and parental experiences regarding using antibiotics to treat their children themselves were noted. Result: Sixteen respondents (32%) were male and 34(68%) were female. It was found that most parents used Cefixime 28(56%), followed by Amoxicillin, and Azithromycin. Twenty-three (46%) participants stated that antibiotics could cure infections caused by viruses. Eighty-eight percent participants knew that antibiotics should only be taken according to doctor’s prescription. Almost half of parents believed that antibiotics should be withdrawn as soon as the symptoms disappear. About 26% of parents believed that antibiotics could prevent the common cold. Thirty-six (72%) parents agreed that overuse of antibiotics exists in Pakistan. Conclusion: Poor knowledge or understanding of antibiotic usage persists among parents in Pakistan. A doctor's prescription for antibiotics may have an impact on how parents use those medicines on their children.

Legal Protection For Consumers Related To The Circulation Of Hard Drugs By Unlicensed Drug Stores In Indonesia

One of the aspects of welfare that must be achieved in line with the national aspirations of Indonesia is public health, which is acknowledged as a fundamental right governed by the 1945 Constitution. However, there is a growing risk of hard drug misuse due to people's inclination to self-medicate without a prescription. Government Regulation Number 51 of 2009 and Law Number 17 of 2023 stipulate that only pharmacists with a prescription from a doctor are authorized to administer hard substances. Nonetheless, it is still common for illicit drug outlets to offer strong pharmaceuticals to customers without a prescription, which puts their health at risk. This study employs a normative juridical methodology that combines a case-based and statutory approach. Despite the legal protections for consumers regulated in Law Number 8 of 1999 (UUPK), many consumers do not understand their rights and obligations, so they are vulnerable to fraud and health risks. The findings of this research indicate the need for increased public awareness and stricter law enforcement to protect consumers from the misuse of hard drugs. As well as supervision by BPOM and the Public Health Office as an effort to control the circulation of hard drugs without a doctor's prescription, which are sold in drug stores that do not have a business license.

Association of adverse childhood experiences with adult-onset cardiometabolic conditions and prescription medicine use

Abstract Association of adverse childhood experiences with adult-onset cardiometabolic conditions and prescription medicine use Background and importance Adverse childhood experiences are potentially preventable and traumatic events that occur during childhood. Childhood exposure to trauma is highly prevalent and adults who had adverse childhood experiences are at increased risk of developing physical conditions. However, effect of adverse childhood experiences on health outcomes remains underrecognized. Aim Here, we aimed to measure the association of cumulative adverse childhood experience with adult physical condition and use of prescription medicines in general population. Methods We conducted a cross-sectional analysis using the population-based health study including 21083 participants at age 40 years or older. Self-reported adverse childhood experiences before age at 18 years, present or previous cardiometabolic conditions, and present or previous use of medications prescribed for cardiometabolic conditions were used in our analysis. Cox proportional hazards regression was used to estimate age, sex, smoking, education, and income-adjusted risk of cardiometabolic condition and prescription medicine use after adverse childhood experiences. Association of multimorbidity and using multiple prescription medicines with adverse childhood experience was analyzed using generalized linear model with ordinal classification. Results We found that having a history of adverse childhood experience was associated with increased risk of subsequent cardiometabolic conditions; hazard ratios ranged from 1.117 (95% CI, 1.054 – 1.185) to 1.341 (95% CI, 1.181 – 1.522). Furthermore, adverse childhood experience was associated with multimorbidity of cardiometabolic conditions (odds ratio [OR], 1.195; 95% CI, 1.117 – 1.279) and increased risk of using multiple prescription medicines (OR, 1.131; 95% CI, 1.057 – 1.210). Notably, we observed the dose – effect relationships of cumulative adverse childhood experience to the increased risk of 5 among 6 cardiometabolic conditions and to the increased risk of using 4 among 6 prescription medicines. Furthermore, cumulative adverse childhood experience had the dose – effect associations with multimorbidity of cardiometabolic conditions (ORs ranged from 1.120 [95% CI, 1.033 – 1.214] to 1.526 [95% CI, 1.276 – 1.825]) and using multiple prescription medicines (ORs are 1.393 [95% CI, 1.195 – 1.624] and 1.572 [95% CI 1.315 1.879]). Conclusions and relevance: Our findings implicate cumulative adverse childhood experience as a risk factor for later cardiometabolic conditions and use of medicines prescribed for cardiometabolic conditions. Our results are significant by suggesting inquiry into adverse childhood experience exposure during clinical consultations, services to alleviate the burden and increasing resilience in addition to strategies aimed at prevention of cardiometabolic conditions might improve health outcomes.

GLP1-RA versus DPP4 inhibitors on cardiovascular outcomes: A three-year real-world analysis

Abstract Background Cardiovascular outcome trials of GLP1-RAs have massively impacted the clinical practice in the management of patients with type 2 diabetes. The cardiovascular protective properties of GLP1-RA compared to DPP4 have been demonstrated in an observational setting before, however recent methodological developments have enabled clinically relevant effect estimation. Aim This study aimed to evaluate the real-world cardiovascular outcomes of GLP1-RA versus DPP4 inhibitors in patients with type 2 diabetes and high cardiovascular risk. Methods In this study, we utilized the Danish nationwide registers to identify new users of GLP1-RA or DPP4 therapies from 2012 to 2022. Participants were required to be either at least 50 years of age and have one or more of the following conditions: hypertension, chronic obstructive pulmonary disease, cardiovascular disease, or chronic renal disease or be at least 60 years of age and have hypertension. Additionally, their glycated hemoglobin (HbA1c) levels needed to be 53 mmol/mol or higher within the year preceding their first prescription date for these therapies. The index date was defined as the initial prescription date, and comorbidities and medicine use were evaluated up to 10 years prior to this date. Individuals who had filled prescriptions for SGLT2 inhibitors within six months prior to their index date were excluded from the study. The outcome of interest was a composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke (MACE). Patients were followed for up to three years until MACE, all-cause mortality, emigration, or until the end of follow-up on December 31, 2022. To assess the three-year risk of MACE, the Aalen Johansson estimator was used. A casual inference framework was employed estimating the three-year average treatment effect using g-formula based on Cox regression with competing risk. Results A total of 26,190 individuals were included, with 19,494 initiating DPP4 inhibitor therapy and 6,696 initiating GLP1-RA therapy. The three-year risk of MACE was 8.56% (95% confidence interval [CI]: 8.11 to 9.00) for the DPP4 initiator group, compared to 4.76% (95% CI: 4.08 to 5.43) for the GLP1-RA initiator group. Emulating what would have happened had all included individuals initiated GLP1-RA treatment versus had all initiated treatment with DPP4, accounting for age, sex, income, education, degree of urbanization, diabetes duration, baseline hba1c level, co-medicine, and co-morbidities, we estimated an three-year average treatment effect of -2.05% (95% CI:-2.92;-1.18) , p-value<0.001) for GLP1-RA initiation versus DPP4 initiation for MACE. Conclusion Our findings suggest that GLP1-RA use is associated with a significantly lower risk of MACE compared to DPP4 inhibitors in a real-world population of patients with type 2 diabetes and high cardiovascular risk. This supports the cardiovascular protective role of GLP1-RA in clinical practice.

Cost differences between oral anticoagulation therapies in atrial fibrillation patients

Abstract Background Direct oral anticoagulants (DOACs) have largely replaced warfarin as the primary choice of oral anticoagulation (OAC) in atrial fibrillation (AF) patients. This study uses a nationwide registry data set to compare the health and social care costs of AF patients using different OAC therapies. We studied how these costs were distributed among different care services in the year following AF onset and how the costs develop in time before and after AF diagnosis. Methods This study is a part of the Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) research project, which includes data on patients with AF, combining registry data on primary and secondary care services as well as social services, drug purchases and laboratory data. We included all new-onset AF patients from 2011 to 2017 in Finland with an indication for OAC treatment. Patients were divided based on their first OAC purchase. Time in therapeutic range (TTR) values were assessed for warfarin patients, and they were divided into quartiles based on their TTR value. Standardized costs were determined for different health and social care contacts, accounting for hospital care, primary and ambulatory care, and long-term care. Drug costs were acquired from the Reimbursement for Prescription Medicines registry. Results A total of 130,745 patients (66,610 on warfarin, 32,996 on DOACs) were included. First-year total costs after onset of AF were €10,412 for rivaroxaban (n=13,320), €12,631 for apixaban (n=11,886), €10,706 for dabigatran (n=7,514) and €10,689 for edoxaban (n=366). Costs of care clustered near the diagnosis of AF (Figure 1). Costs for warfarin patients increased inversely with TTR, ranging from €10,945 in the highest TTR quartile (TTR over 82%) to €21,387 in the lowest (TTR under 57%). Average first-year costs for warfarin patients were €15,689, higher than DOAC patients by €3,058-€5,277 (Figure 2). Patients without any OAC had the highest first-year costs, €17,898. Patients with high risk of stroke had higher total costs both in patients using DOACS (€7,271 for patients with a CHA2DS2VA score of 1 vs €11,947 for patients with CHA2DS2VA 2+) and warfarin (€9,933 for CHA2DS2VA 1 vs €16,354 for CHA2DS2VA 2+). Drug costs averaged €1,541 for rivaroxaban, €1,659 for apixaban, €1,495 for dabigatran and €1,540 for edoxaban, and €986 warfarin users. Hospital care was the largest cost driver with 64% of total costs across the whole cohort, followed by primary care (19%), drug purchases (7%), social service costs (6%) and reimbursements for travel and private care (4%). Conclusions DOACs were superior to warfarin in a broad range of social and healthcare cost measures despite higher drug expenses. Patients on warfarin with low TTR and patients without any OAC had the highest cost of care.

Quo vadis, the leading arrhythmia? Projecting the prevalence of atrial fibrillation up to 2070

Abstract Introduction The prevalence of atrial fibrillation (AF) is strongly associated with age, and with increasing life expectancy worldwide, the number of AF patients has been steadily rising. However, long-term projections of AF prevalence are scarse. Purpose To predict the prevalence and the number of patients with AF in Finland from 2021 until 2070. Methods In the Finnish Anticoagulation in Atrial Fibrillation (FinACAF) study we gathered data of all AF patients from all national health care registers (hospitalizations and outpatient specialist visits, primary health care contacts, and reimbursements for prescription medicines) from 2004 to 2018. The prevalence of AF on December 31st 2018 was calculated as the number of patients alive with AF divided by the number of Finnish population. We utilized age- and sex-specific prevalences on year 2018 to predict the prevalence by sex and 5-year age groups, using a 1-year time interval of AF in Finland between years 2021 and 2070. We obtained the projection for population structure in Finland between 2021 and 2070 from Statistics Finland. The prevalences in 2070 are provided for population ≥20 years as well as for populations ≥65 years, ≥75 years, and ≥85 years. Results In 2018, a total of 226 847 patients with the diagnosis of AF were documented in Finland. The number of adult patients with AF is predicted to increase strongly up to 2040 with a slower increase from 2040 to 2060, and again a faster increase is estimated from 2060 up to our final estimation of 2070. In total, the number of AF patients will increase with 60% until the year 2070. In 2021, prevalence of AF was 5.5% in adults and prevalence rate will increase to 8.6% in 2070. Proportion of men will be from 54.7 % to 56.0%, and the prevalence will be higher in men compared to women in all age groups with the exception in the age group ≥85 years. Among the population ≥65 years the prevalence in 2070 will be 19.7 %, and in the elderly, ≥75 years, the prevalence of AF will 25.6% and in the oldest, ≥85 years, 31.7%. In 2070 73.3 % of patients with AF are over 75 years, and 38.8% are over 85 years old. Conclusions Drawing upon extensive nationwide data covering all levels of care, our estimates indicate a continual rise in the number of AF patients in Finland until the year 2070. Notably, throughout the projected period, there is a discernible increase in the proportion of older and the oldest patients, highlighting the demographic shift in AF prevalence.Patients with AF 2021-2070 in Finland

INCREASING PUBLIC AWARENESS IN DRUG USE THROUGH SMART COMMUNITY MOVEMENT USING DRUGS (SCMUD)

The community tends to try to overcome health problems through easier and more cost-efficient methods. This triggers the tendency of the community to self-medicate. Self-medication is the use of drugs by individuals, not based on a doctor's prescription, but based on the individual's initiative. This community service aims to increase awareness of using drugs through Smart Community Movement Using Drugs (SCMUD) in the Bulakdawung community, Parang village, Banyakan district, Kediri regency. The activity was carried out on May 17, 2024, by providing Health Counseling to mothers who accompany their children to study groups, with lecture and question and answer methods, the media used was the leaflet of awareness of using drugs. The results of the activity were 21 mothers with most elementary school education backgrounds (80.95%), work as housewives (95.23%), less knowledge about awareness of using drugs (71.42%), good attitudes awareness of using drugs (66.67%) and drug use behavior in the family (80.9%) and those lacking 19.1%. After being given health education regarding the safe use of drugs through the Smart Community Movement Using Drugs, the community increasingly understands and carries out awareness to avoid the negative impacts of self-medication and provide appropriate treatment for family members who are sick and utilize health service centers appropriately. It was concluded that the activity can increase public awareness in the use of drugs through health counseling.

Cost-Related Medication Behaviors for Patients With and Without Systemic Autoimmune Rheumatic Diseases.

Medication nonadherence challenges the management of systemic autoimmune rheumatic diseases (SARDs). We investigated cost-related medication behaviors among patients with SARDs, and compared them to those of patients without SARDs, in a large diverse cohort across the United States. As part of the All of Us (version 7), a nationwide diverse adult cohort with linked electronic health records begun in 2017, participants completed questionnaires concerning cost-related medication behaviors. Chi-square tests compared responses between patients with SARDs, by disease and medication type, and to those without SARDs. Logistic regression analyses were used to calculate odds ratios (95% confidence intervals [CIs]). We analyzed data from 3,997 patients with SARDs and 73,990 participants without SARDs. After adjustment, patients with versus without SARDs had 1.56 times increased odds of reporting unaffordability of prescription medicines (95% CI 1.43-1.70), 1.43 times increased odds of cost-related medication nonadherence (95% CI 1.31-1.56), and 1.23 times increased odds of using cost-reducing strategies (95% CI 1.14-1.32). Patients with SARDs who reported unaffordability were 16.5% less likely to receive a disease-modifying drug (95% CI 0.70-0.99) but 18.1% more likely to receive glucocorticoids (95% CI 0.99-1.42). In addition, unaffordability of prescription medicines was likely to have 1.27 times increased odds of one to two emergency room visits per year (95% CI 1.03-1.57) and 1.38-fold increased odds of three or more emergency room visits per year (95% CI 0.96-1.99). In this large diverse cohort, patients with versus without SARDs had more self-reported cost-related medication behaviors, and those who reported medication unaffordability received fewer disease-modifying drugs and had more emergency room visits.

Prodromal Phase of Idiopathic Generalized Epilepsy: A Register-Based Case Control Study.

Idiopathic generalized epilepsy (IGE) is associated with distinct behavioral traits, symptoms of frontal lobe dysfunction, and psychiatric comorbidity. Whether psychiatric symptoms are part of the IGE endophenotype or secondary to the burden of chronic disease is unknown. In this study, we aimed at describing the sequence of appearance of psychiatric and epilepsy symptoms in patients with IGE. Inclusion criteria for this cohort study were diagnosis of IGE with age at diagnosis at 10-25 years. We created 2 mutually exclusive cohorts, 1 based on ICD-10 codes in Danish registers with a first IGE diagnosis from January 1, 2005, to December 31, 2018, and a second patient cohort treated at Odense University Hospital and the Danish Epilepsy Centre in the same period. Each case was matched with 10 age-matched, sex-matched, and geography-matched normal population controls from the Danish registers. We compared social status, health care utilization, and psychiatric diagnoses between the groups in the 5 years preceding epilepsy diagnosis, at diagnosis, and at the end of the study period using the Wilcoxon rank-sum test and confirmatory logistic regression models. We identified 1,009 patients for the register-based cohort (55.1% female; mean age at diagnosis [SD]: 15.9 [±3.8] years) and 402 patients for the hospital-based cohort (56.2% female; mean age at diagnosis [SD]: 18.3 [±7.4] years) and matched them to 10,090 and 4,020 controls, respectively. IGE cohorts and controls did not differ at birth. In the 5 years before their IGE diagnosis, register patients had an increasing number of contacts with hospitals (mean visits [SD]: cases: 8.3 [±5.6], controls: 6.6 [±4.5]) and their general practitioners (mean visits [SD]: cases: 48.7 [±26.3], controls: 45.3 [±24.5]) and received more prescriptions for psychiatric medications (prescriptions: cases: 4.2%, controls: 2.5%, p = 0.003) compared with controls. Patients had a higher rate of psychiatric comorbidity (comorbidity: cases: 26.5%, controls: 17.8%, p < 0.0001) at the end of the study than controls. Data were similar in the hospital-based cohort. Our data suggest a prodromal phase of IGE detectable approximately 5 years before the first seizure characterized by increased health care utilization and greater use of prescription medicine for psychiatric symptoms.

LEGAL CONSEQUENCES OF SELLING ANTIBIOTICS DRUGS WITHOUT DOCTOR’S PRESCRIPTION IN PHARMACIES

The use of antibiotic drugs is subject to statutory regulations, which require a doctor's prescription for purchase. Antibiotic drugs are classified as "list G drugs" or "hard drugs," and they can only be submitted with a doctor's prescription. The objective of this investigation is to examine the legal liability of pharmacies as sellers of antibiotics without a doctor's prescription and the legal repercussions for purchasers of antibiotics without a prescription. This research employs a form of normative legal research. This research employs a normative legal research method that employs primary data sources and secondary data, or data obtained through a statutory and conceptual approach. The results of this study are that the Pharmacist, as a pharmacy supervisor, is fully responsible for the delivery and collection of drugs to prevent unwanted events. Patients will not receive legal protection if they fail to comply with the Pharmacist's instructions to refrain from purchasing antibiotics without a doctor's prescription.

Po-Ge-Jiu-Xin decoction alleviate sepsis-induced cardiomyopathy via regulating phosphatase and tensin homolog-induced putative kinase 1 /parkin-mediated mitophagy

Ethnopharmacological relevanceSepsis is a life-threatening systemic syndrome usually accompanied by myocardial dysfunction. Po-Ge-Jiu-Xin decoction (PGJXD), a traditional Chinese prescription medicine, has been used clinically to treat cardiovascular disease including heart failure, sepsis-induced cardiomyopathy (SIC) and even septic shock. Previous clinical studies suggested PGJXD has shown promising results in improving cardiac function and treating heart failure in sepsis. However, more research is needed to elucidate the mechanisms underlying PGJXD's therapeutic effects in sepsis-induced cardiomyopathy. Materials and methodsInitially, we identified the major compounds of PGJXD through ultra-performance liquid chromatography-mass spectrometry technology analysis. We established in a SIC rat model using cecal ligation and puncture(CLP) and treated by PGJXD and levosimendan. We evaluated pathological damage by hematoxylin and eosin staining and measured serum myocardial injury biomarkers. Myocardial apoptosis was detected by Tunel staining and quantifying specific biomarker protein levels. Subsequently, we evaluated myocardium mitochondrial quality using Transmission electron microscope (TEM), antioxidant stress indexes and tissue adenosine triphosphate(ATP) content. We detected the expression of phosphatase and tensin homolog (PTEN)-induced putative kinase 1 (PINK1), parkin, LC3, and p62 using Western blotting and Quantitative real time polymerase chain reaction(qRT-PCR). (Lipopolysaccharides, LPS)-induced H9c2 cell model was established to further explore the mechanism of PGJXD on SIC. In addition to measuring cell viability, we measured mitochondrial membrane potential using JC-1 staining. Additionally, Parkin-siRNA transfected into H9c2 cells to validate whether PGJXD conducted protective effects against SIC through PINK1/Parkin-mediated mitophagy. ResultsIt has been demonstrated that PGJXD reduced mortality in septic rat, contributed to ameliorating myocardium injury, suppressed inflammatory response and ameliorated the myocardial apoptosis. PGJXD could also alleviate mitochondrial structural abnormality, mitigated oxidative stress injury and promoted energy synthesis in CLP models. Western blotting and qRT-PCR have further confirmed that PGJXD can activate PINK1/parkin pathway-mediated mitophagy, resulting in preserving mitochondrial quality in the myocardium. Furthermore, Parkin siRNA partially reversed the beneficial effect of PGJXD on mitochondrial fission/fusion and mitophagy in vitro. Therefore, the cardioprotective effect of PGJXD is achieved by inducing PINK1/Parkin-mediated mitophagy in maintaining mitochondrial homeostasis. ConclusionsThese results suggest that the potential therapeutic effect of PGJXD on cardiac dysfunction during sepsis and support its mechanism of targeted induction of PINK1-Parkin-mediated mitophagy.

Dispensing antibiotics without a prescription in Various pharmacies

Background: An important factor that leads to improper antibiotic use and an increase in antibacterial resistance is the dispensing of medicines over-the-counter. Objective: The purpose of this study is to examine the beliefs and behaviors of medical staff regarding the non-prescription dispensing of antibiotics. Methods: This is a cross-sectional study that used a questionnaire survey with 107 medical staff members from various places in Iraq between November 11, 2020, and May 8, 2021. Results: A total of 107 participants filled out the form and took part in the study. The age of participants ranged from 68% (21–25 years old) to 20% (26–35 years old), 4% (18–20 years), 4% (36–45 years old), 3% (above 55 years old), and 1% (46–55). The most prevalent condition treated with antibiotics without a doctor's prescription is urinary tract infection (21.6%), which was followed by otitis media (17.3%), sore throat (14.8%), skin infection (12.7%), fever (12%), cough (11%), runny nose (4.9%), and other conditions (5.7%). Cold and flu are the most infections that did not respond to antibiotics (30.1%) followed by runny nose (23.9%), sore throat (15.4%), bronchitis (10.4%), cough (10%), and other (10%) while the most frequently dispensed antibiotics was amoxicillin followed by azithromycin, amoxicillin plus clavulanic acid, ciprofloxacin, cephalexin, clindamycin, and meropenem. About 56.6% of patients requested or received antibiotics for obvious infections. About 29.25% requested antibiotics for family members while 14.15% requested them for no reason. The most common age of patients who request an antibiotic was young people (46.3%), elderly (38.3%) and children (15.4%). Whether consulting a doctor before dispensing antibiotics, participants answered yes (56%) and no (44%). In conclusion, the incidence of using antibiotics without prescription was high for skin infections, otitis media, sore throats, and urinary tract infection.

Burden of disease and cost of illness of infants less than 6 months of age hospitalised with respiratory syncytial virus in Denmark – a 10-year national register-based study

BackgroundRespiratory syncytial virus (RSV) is the most common cause of hospitalisation in infants aged ≤ 6 months in Western countries. Nearly 1,500 infants under six months of age are hospitalised with RSV annually in Denmark. This nationwide study describes the healthcare resource utilisation and costs related to RSV hospitalisation in this vulnerable age group.MethodsRSV cases were identified in the Danish National Patient Register. Infants were included if they at the age of 0–5 months had a (1) respiratory related hospital admission (duration > 12 h), (2) within 10 days of a positive RSV test, (3) between January 2013 and December 2022. Each case was matched with five individuals never diagnosed with RSV on age, sex, region of residence, birth (pre/full term), number of siblings < 7 years old, and parents’ education. An episode of RSV was defined as the seven days prior to hospitalisation to 30 days after initial hospitalisation. Study outcomes included contacts with hospital and primary care, and total healthcare costs defined as the sum cost of hospital care, primary care, and prescription medicine. Cost and contacts attributable to RSV was calculated in a diff-in-diff framework, as the difference between case and reference group.ResultsThe study population comprised of 8,428 RSV cases and 41,725 reference individuals. Cases generated 1.58 (p < 0.001) attributable inpatient contacts, 0.84 (p < 0.001) outpatient contacts, and 1.19 (p < 0.001) primary care contacts during their RSV episode. An additional 0.6 (p < 0.001) inpatient, 1.08 (p < 0.001) outpatient and 2.42 (p < 0.001) primary care contacts were attributed to RSV in the year following the RSV episode. Total cost of an RSV episode was EUR 2,997 (p < 0.001) with an additional EUR 1,428 (p < 0.001) in the following year.ConclusionRSV hospitalisations of infants are associated with substantial healthcare utilisation and costs. The same pattern was observed in the year following the RSV episode. If the new RSV prevention options are introduced nationwide, the overall burden of RSV is expected to be substantially reduced in the future.

Characteristics of Health-Preserving Behavior of Parents Raising Children with Disabilities

The article presents the results of a study devoted to the study of health-preserving behavior of parents raising children with disabilities aged 6-10 years. The study was conducted in April-May 2024 in the Borovsky District of the Kaluga Region. The research method was a questionnaire survey of parents. The questions touched upon the implementation of such important areas of child health-preservation in the family as home nutrition, daily routine, sleep, hygiene, control over the safe use of gadgets for the child's health, the psychological climate in the family, the attitude of parents to their own health, etc. The process of interaction between parents and a medical institution and medical workers as subjects of child health-preservation was also studied. It was found that the majority of parents (85%) fully comply with the doctor's advice and prescriptions. Most parents (68%) know the specifics of the child's disease and treatment. According to 54% of parents, their children willingly follow the doctor's recommended prescriptions. 15% of parents failed to develop the skill of following doctors' recommendations in their children with disabilities. In 30% of parents, the child does not follow the doctor's orders or follows them thanks to the parents. In every third family, the sick child's sleep schedule is not followed. Only a third of parents (31%) have children who attend exercise therapy classes. Parents have a low level of health-preserving competence in the issue of healthy nutrition. The materials of the article can be used in the work of specialists in medical and social institutions, educational and public organizations, and can also be useful for researchers interested in the problem of health preservation of children with disabilities.

The role of pharmaceutical care in the use of rifaximin for the treatment of diarrhea

the management of diarrhea represents a prevalent issue within the realm of healthcare. Rifaximin is recommended to treat traveler's diarrhea and irritable bowel syndrome. At the same time, it is important to rationally use an antimicrobial drug to prevent the development of antimicrobial resistance. Aim: to evaluate the role of pharmaceutical care in using rifaximin to treat diarrhea, based on a questionnaire. A questionnaire survey was done among 55 pharmacy professionals and 42 pharmacy visitors regarding the dispensing and use of rifaximin for diarrhea treatment. The survey of pharmacy visitors revealed that rifaximin was used for the treatment of small intestinal bacterial overgrowth syndrome (32 cases), traveler's diarrhea (7 cases), and irritable bowel syndrome with diarrhea (3 cases). Patients did not undergo stool culture before rifaximin prescription, which could have prevented antimicrobial resistance and ruled out other causes of diarrhea. It was found that 14% of respondents reported improvement the next day, while 83.3% reported improvement within three days. Pharmacists can educate visitors about the importance of completing the treatment course. Five percent of respondents reported nausea as an adverse reaction. Pharmacists dispensed rifaximin for the treatment of diarrhea in adults almost three times more often than in children. The tablet form of the drug was used in 94.5% of cases, while the oral suspension was used in 5.5% of cases. The majority of pharmacy visitors (89.0%) received rifaximin with a doctor's prescription, and 10.9% without a prescription, which emphasizes the importance of pharmaceutical care to prevent irrational use of the drug. The results of the study show that 92.7% of pharmacists provide recommendations on the safety of rifaximin use, and 78.2% recommend abstaining from alcohol during treatment. Only 21.8% of pharmacists warn about the possible staining of urine, which can cause concern for patients. The majority of pharmacists (89.1%) systematically ask women about possible pregnancy, which indicates their awareness of safe pharmacotherapy. Pharmacists also clarify the simultaneous use of rifaximin with other drugs: 32.7% ask about taking oral contraceptives, 7.3% – antiarrhythmic drugs, and 3.6% – warfarin. mailto:https://meshb.nlm.nih.gov/record/ui?ui=D002648Pharmacists can enhance the effectiveness of rifaximin treatment by preventing its uncontrolled use, emphasizing the importance of completing the treatment course and informing about possible adverse reactions. When providing pharmaceutical care to visitors taking rifaximin, pharmacists should educate them about potential changes in urine color. Additionally, pharmaceutical workers advise women taking oral contraceptives to use additional contraceptive methods while taking rifaximin.