Metabolički sindrom Ortner Hadžiabdić, Maja
Medicus (Zagreb, Croatia : 1992),
11/2015, Letnik:
24, Številka:
2 ASK niske doze
Journal Article
Recenzirano
Odprti dostop
Metabolički sindrom (MetS) podrazumijeva skup metaboličkih poremećaja koji povećavaju rizik od šećerne bolesti tipa 2, srčanožilnih bolesti, moždanog udara, masne jetre, određenih malignih i nekih ...drugih bolesti. U ovome preglednom radu raspravljeni su koncept, definicija i terapija MetS pri čemu su uzete u obzir trenutačne smjernice i dostupni dokazi u liječenju stanja povezanih s MetS. U liječenju MetS ključno je rano prepoznavanje osoba s MetS i poduzimanje mjera koje će smanjiti prisutnost rizičnih čimbenika. Najvažnija terapijska intervencija je promjena životnih navika (zdrava prehrana i povećanje tjelesne aktivnosti), dok je terapiju lijekovima (primjerice antihipertenzivima, antidijabeticima, hipolipemicima) potrebno uvesti tek ako nefarmakološkim mjerama nisu postignute ciljne vrijednosti individualnih komponenata MetS.
To explore how adult patients perceive deprescribing in a country with developing pharmaceutical care.
This was a multicenter cross-sectional study conducted in ten community pharmacies across ...Croatia. Community-dwelling adults 40 years and older, taking at least one prescription medication long term, were invited to participate. The revised and validated Patients' Attitude Towards Deprescribing Questionnaire was used to investigate community-dwelling adults' opinions on potential medication discontinuation. Questions regarding the patients' perception of pharmacist competences and involvement as well as patients' preferences in deprescribing were added. Collected data were analyzed using IBM SPSS Statistics using descriptive and inferential statistical analysis. Binary logistic regression was used to explore potential predictive factors of willingness to have medication deprescribed. All tests were performed as two-tailed and a p < 0.05 was considered statistically significant.
A total of 315 adults aged 40 years and older completed the questionnaire. Majority of participants, 83.81% (95% CI, 79.72% to 87.90%) stated that they were satisfied with their medications, and 83.81% (95% CI, 79.72% to 87.90%) would be willing to deprescribe one or more medications. Participants expressed a positive attitude toward pharmacists' competences (68.89%, 95% CI, 63.75% to 74.03%) and involvement in deprescribing (71.11%, 95% CI, 66.08% to 76.14%). Participants who stated specific medication as deprescribing preference were more likely show dissatisfaction with current medication and show greater willingness to have medication deprescribed. Three factors were found to be associated with a positive attitude towards deprescribing: low concerns about stopping factor score (aOR 0.54, 95% CU=0.35-0.84; p=0.006), low appropriateness factor score (aOR 0.62, 95% CI=0.39-0.98; p=0.039), and a positive opinion on pharmacist involvement (aOR 2.35, 95% CI=1.18-4.70; p= 0.016).
This study showed the patient's willingness for deprescription as well as their positive attitude towards pharmacists being involved in the process. Results favour transition to a patient-centred care and shared-decision making model.
In most countries, antibiotics for oral administration are put on the market in fixed packages. When there is no exact unit dispensing of antimicrobials, drug pack size may influence prescribers’ ...choice of treatment duration. The aim of this study was to investigate the accordance of approved antibiotic packages with national guidelines for the treatment of community-acquired pneumonia (CAP). For the purpose of this study, criteria were developed to determine the accordance of approved antibiotic packages for treating CAP (criteria), which are based on recommendations from national guidelines for treating CAP. Subsequently, the accordance of approved antibiotic packages with the number of antibiotic doses resulting from the specified criteria was determined. Of 39 identified therapeutic option-package size combinations, 11 were found to be matched (28.2%), meaning there were no leftover medication units after completing therapy, and 28 were mismatched combinations (71.8%), indicating that there were excess doses of antibiotics remaining at the end of therapy. The results of this research showed a significant non-accordance of the approved antibiotic packages with the national guidelines for the treatment of CAP and, consequently, the creation of a large amount of residues of unit doses of antibiotics in the community.
Abstract
Exposure to toxic metals and metalloids is a significant public health concern and can seriously affect human health. The aim of this study was to establish the presence of toxic metals and ...metalloids in the urine of non‐professional sportsmen who participated in a mountain ultramarathon using a benchtop total reflection x‐ray fluorescence (TXRF) system. TXRF allows for easy and rapid sample preparation and is therefore a potential candidate for simple and cost‐effective analysis. In this work, the TXRF‐Mo system was used for multielement analysis of the urine samples of 21 non‐professional athletes who ran a 53 km mountain ultra‐marathon. Urine samples were collected at four time points, at the beginning of the race (pre‐race samples), immediately, and 12 and 24 h post‐race. Al, As, Ba, Ni, Pb, Rb, Sr, V, and Tl were detected in the collected urine samples. The accuracy and precision of the proposed methods were verified by the analysis of reference materials (Seronorm™ Trace Elements Urine Level 2). The TXRF results were in agreement with the reference values and no significant differences were observed at the 95% confidence level. The detection limits for the elements of interest were also reasonable considering their concentration ranges in real samples. Changes were observed over time with increasing average urinary metals and metalloids levels, but only two significant results, were an increase in As and Rb. The results indicate a high degree of inter‐subject variability. The results obtained show that the content of toxic metals and metalloids increases in the urine samples collected after the race, which could confirm the statement that physical activity can increase the excretion of toxic metals and metalloids from the body. The simplicity of the TXRF method as well as its fast performance make it suitable for routine analysis.
Recent meta-analysis shows that adherence to a Mediterranean diet (MD) can significantly decrease the risk of overall mortality, mortality from cardiovascular diseases, as well as incidence of ...mortality from cancer, and incidence of Parkinson's and Alzheimer's disease. All of these diseases could be linked to oxidative stress (OS) as antioxidative effect of MD is getting more attention nowadays. Although a lot of research has been done in this area and it suggests antioxidative protective role of MD, the presented evidence is still inconclusive. The aim of this paper is to review studies investigating the effect of MD on OS, as well as to identify the areas for further research.
Background
Adverse reactions to warfarin may be serious and can lead to hospitalisation or death. Minimising the risk of adverse drug reactions through the intervention of community pharmacists is ...important for patients receiving warfarin, especially for elderly (≥ 65 years) patients living in rural areas.
Objective
To evaluate the impact of an intervention by community pharmacists on the risk of adverse drug reactions in elderly rural patients receiving warfarin. Setting: A community pharmacy in a rural area of Croatia.
Method
We conducted a prospective randomised trial. Eligible patients were recruited at the pharmacy and randomised into one of two groups. The participants were followed up every month for 6 months. Main outcome measure: The incidence and type of adverse drug reactions caused by warfarin and the time-to-event.
Results
In total, 140 patients were randomized and 131 patients completed the study; 65 patients were in the intervention group. The median age of patients was 73 years of age. The cumulative incidence of adverse drug reactions was significantly lower in the intervention group (6-months rate 29% vs. 85% for intervention and control, respectively; hazard ratio = 0.17,
p
< 0.001) than in the control group. Factors multivariately associated with the development of adverse drug reactions related to warfarin (
p
< 0.05) were the absence of pharmaceutical intervention, higher time in therapeutic range, change of warfarin dose, changes in dietary vitamin K intake, and marital status other than married.
Conclusion
Overall, the pharmacist’s intervention significantly prolonged the time to occurrence of adverse drug reactions and reduced their incidence.
To measure Croatian community pharmacists’ progress in competency development using the General Level Framework (GLF) as an educational tool in a longitudinal study.
Patient care competencies of 100 ...community pharmacists were evaluated twice, in 2009 and in 2010 in a prospective cohort study. During this 12-month period, tailored educational programs based on the GLF were organized and conducted, new services and standard operating procedures were implemented, and documentation of contributions to patient care in the pharmacist’s portfolio became mandatory.
Pharmacists’ development of all GLF patient care competencies was significant with the greatest improvements seen in the following competencies: patient consultation, monitoring drug therapy, medicine information and patient education, and evaluation of outcomes.
This study, which retested the effectiveness of an evidence-based competency framework, confirmed that GLF is a valid educational tool for pharmacist development.
Objectives. To assess Croatian community pharmacists' patient care competencies using the General Level Framework (GLF).
Methods. The competencies of 100 community pharmacists working in 38 community ...pharmacies were evaluated using an adapted version of the GLF.
Results. Pharmacists demonstrated the best performance in the competency areas drug specific issues and provision of drug products; the poorest performance was in the competency areas evaluation of outcomes and monitoring drug therapy. Pharmacists' behavior varied the most in the following areas: ensuring that the prescription is legal, prioritization of medication management problems, and identification of drug-drug interactions.
Conclusions. Competencies were identified that need to be developed to improve pharmacist interventions in community settings. This study provides the first data on pharmacists' performance in Croatia and serves as a starting point for future studies and actions.
Objective: The aim of this work was to evaluate the combined effect of physical activity and 1 and 12 months' adherence to Mediterranean diet (MD) on serum total antioxidant capacity (TAC) in obese ...patients, as well as factors contributing to TAC.
Methods: One hundred twenty-four patients were randomly assigned to either MD combined with physical activity or standard hypolypemic diet (SHD) with physical activity. Both groups received counseling and education during the initial week and were invited for the follow-up visits, where data on body weight and blood samples were collected. TAC was determined by Trolox equivalent antioxidant capacity and urate was determined using a uricase spectrophotometric method at the initial visit and after 1 and 12 months.
Results: Eighty-four patients finished the 12-month program and were analyzed. The baseline and 1- and 12-month mean (±SD) TAC values in the MD group (n = 40) were 2.38 ± 0.48, 2.51 ± 0.47, and 2.47 ± 0.45 mmol Trolox equivalent (TE)/L, respectively. In the SHD group (n = 44), TAC values were 2.37 ± 0.49, 2.48 ± 0.49, and 2.31 ± 0.51 mmol TE/L, respectively. There was a statistically significant main effect for time (p < 0.001), as well as statistically significant time-diet interaction effect (p = 0.009). There was no statistically significant correlation between TAC and uric acid after 1 month (p = 0.733) or 12 months (p = 0.844) of the intervention. Based on the regression model, which included gender, diet, physical activity level, and percentage body weight change, the type of diet was the only significantly contributing factor to TAC change after the 12-month period, F = 3.867, df = 3, p = 0.012, R = 0.358, R
2
= 0.128.
Conclusion: This randomized controlled trial with diet and physical activity intervention and TAC as a primary outcome demonstrated initial antioxidant improvement in both MD and SHD groups and a long-term beneficial effect of MD. The results imply that diet composition-olive oil, nuts, and fish in particular-combined with physical activity modify antioxidant capacity.
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