The present study aimed at determining the use of physician-prescribed medication in a large number of elite athletes compared with a representative control sample of the general population. Of all the athletes (N = 494) financially supported by the National Olympic Committee, 446 completed a structured questionnaire (response rate 90.3 %) in 2002. A control group (N = 1503, response rate 80.1 %) comprised an age-matched sample from the population-based study collected by the National Public Health Institute. Any prescribed medication was used by 34.5 % of the athletes and 24.9 % of the controls during the past seven days. The most frequently reported physician-prescribed medications among athletes during the previous seven days were anti-allergic medicines (12.6 % of the respondents), non-steroidal anti-inflammatory drugs (NSAIDs; 8.1 %), anti-asthmatic medicines (7.0 %), and oral antibiotics (2.7 %). The adjusted odds ratios (95 % CI) for the physician-prescribed medications used during the previous seven days was 2.42 (1.69 - 3.46), 3.63 (2.25 - 5.84), 3.42 (2.05 - 5.70), and 2.15 (1.03 - 4.45) for use of anti-allergic medication, NSAIDs, anti-asthmatic medication, and oral antibiotics, respectively, in the athletes compared with controls. Every fifth athlete reported some NSAID-related adverse effect. In conclusion, the athletes used NSAIDs, antibiotics, anti-asthmatic and anti-allergic medication significantly more often than a representative sample of age-matched controls. All these medicines have potential adverse effects that may have a deleterious impact on the maximum exercise performance of elite athletes. Adverse effects were commonly reported in connection with NSAID use.
To study physicians' opinions on community pharmacists' involvement in counselling patients on use of psychotropic medication.
A postal questionnaire with open-ended questions completed by physicians.
A six per cent random sample (n = 759) of the members of the Finnish Medical Association representing physicians working in hospitals, community health centres, private practices and occupational health services (response rate 64%, n = 487).
Physicians' opinions concerning community pharmacists' involvement in counselling patients about purpose of the medication and adverse effects of benzodiazepines and neuroleptics.
When classifying opinions into five categories, majority (72%) of the physicians regarded community pharmacists as a provider of comprehensive or at least general information about adverse effects of benzodiazepines, but only 43% about the purpose of the medication. Correspondingly, 60% of the physicians regarded community pharmacists as a provider of comprehensive or general information about adverse effects of neuroleptics, but only 35% about the purpose of the medication. There was a strong correlation between physicians' opinions concerning pharmacists' involvement in counselling patients about the purpose of the medication of benzodiazepines and neuroleptics (Spearman's coefficient 0.667), and about adverse effects of both type of medication (0.668). Male physicians had more fixed opinions, both positive and negative, than female physicians.
Finnish physicians are still quite critical about community pharmacists involvement in counselling patients on psychotropic medication. Especially with neuroleptics, physicians feel that pharmacists should be cautious when discussing the purpose of the medication if it is excluded from the prescription.
The aim of this study was to assess to what extent the principles of asthma monitoring are implemented among Finnish asthma patients and if the patients have received sufficient information to adjust their medication according to asthma symptoms.
All Finnish asthma patients receiving asthma medication from Finnish community pharmacies during two days in June 1998.
The proportions of asthma patients who monitor their asthma status according to the national guidelines and have received specific instructions on how and when to adjust their asthma medication.
Eighty-six per cent of the respondents (86%) monitored their asthma status on a method recommended by the national guidelines. They made Peak Expiratory Flow (PEF) measurements (39% of the respondents), they monitored their symptoms (34%) or both (13%). A smaller proportion of the respondents (58%) were instructed on adjusting their medication according to symptoms. The lowest rates for monitoring the asthma status was found among the elderly (65 years or more) and among those who reported that they had been on medication for longer than 5 years (17% and 13% of the subgroup populations, respectively). The lowest rates for having received specific instructions on adjusting their asthma medication according to symptoms were found among the elderly (36%), among those who reported that they had been on asthma medication less than one year (44%), and among males (54%).
Pharmacists and other health care professionals need to enhance their education activities and their co-operation in training asthma patients to monitor their disease, especially principles of adjusting medication according to symptoms. In this process, especially the training needs of the elderly patients and those who have been using asthma medicines for a long time need to be taken into account.
The effects of a pharmacy-based intervention on the knowledge and attitudes of asthma patients was studied with a small convenience sample in four Finnish community pharmacies. The intervention consisted of patient education, counselling and outcomes monitoring according to Therapeutic Outcomes Monitoring (TOM) concept. Twenty-eight patients aged 20-64 years suffering from asthma and having problems in asthma management were involved. Measurements were done at baseline, immediately after the intervention (12 months) and 1 year after the intervention (24 months) using a pre/post-test design, with the patients being their own controls. Both knowledge about and attitudes towards asthma as a disease improved significantly during the intervention. Also knowledge about medication improved significantly during the intervention, though the patients' attitudes towards the medication remained unchanged. The negative correlation between knowledge about and attitudes towards asthma (-0.35) at baseline disappeared after the intervention (0.21). There was a positive correlation between knowledge about and attitudes towards medication at 12 months (0.40, P=0.04) which was still significant 1 year after the intervention (0.40, P=0.04).
Drug-drug interactions (DDIs) are a significant cause for adverse drug events (ADEs). DDIs are often predictable and preventable, but their prevention and management require systematic service development. Most DDI studies focus on interaction rates in hospitalized patients. Less is known of DDIs in outpatients, particularly how community pharmacists could contribute to DDI management by applying their surveillance systems for identifying high-risk medications.
The study was related to the implementation of the first online DDI surveillance system in Finnish community pharmacies. The goal was to demonstrate how community pharmacies can utilize their prospective surveillance system 1) for identifying high risk medications causing potential DDIs in outpatients, 2) for collaborative service development with local physicians, and 3) for academic risk management research purposes.
All DDI alerts given by the online surveillance system were collected during a one-month period in 16 out of 17 University Pharmacy outlets in Finland, covering approximately 10% of the national outpatient prescription volume. The surveillance system was based on the FASS database, which categorizes DDIs into four classes (A-D) according to their clinical significance.
Potential drug-drug DDIs were analyzed for 276,891 dispensed community pharmacy prescriptions. Potential DDIs were associated with 10.8%, or 31,110 of these prescriptions. Clinically significant interaction alerts categorized as FASS classes D (most severe, should be avoided) and C (clinically significant but controllable) were associated with 0.5% and 7.0% of the prescriptions, respectively. Methotrexate and warfarin had the highest risk of causing potentially serious (class D) interactions. These interaction alerts were most frequently between methotrexate and NSAIDs and warfarin and NSAIDs. In general, NSAIDs were the most commonly interacting drugs in this study.
This study demonstrates that community pharmacies can actively contribute to DDI risk management and systematically use their surveillance systems for identifying patients having clinically significant DDIs. The findings also indicate that the majority of potentially serious interactions in outpatients involve a limited number of drugs, particularly NSAIDs, warfarin and methotrexate. Further research should focus on community pharmacists' involvement in DDI risk management in collaboration with local health care providers.
Mechanical exhaust ventilation system is typical in apartment buildings in Finland. In most buildings the base floor between the first floor apartments and crawl space is not air tight. As the apartments have lower pressure than the crawl space due to ventilation, contaminated air may flow from the crawl space to the apartments. The object of this study was to find out whether a potential air flow from crawl space has an influence on the indoor air quality. The results show that in most cases the concentration of fungal spores was clearly higher in the crawl space than inside the building. The size distribution of fungal spores depended on the fungal species. Correlation between the fungal spores in the crawl space and indoors varied with microbial species. Some species have sources inside the building, which confounds the possible relation between crawl pace and indoor concentrations. Some species, such as Acremonium, do not normally have a source indoors, but its concentration in the crawl space was elevated; our measurements showed also elevated concentrations of Acremonium in the air of the apartments. This consistent finding shows a clear linkage between fungal spores in the indoor air and crawl space. We conclude that a building with a crawl space and pressure difference over the base floor could be a potential risk for indoor air quality in the first floor apartments.
This study presents data on cumulative risk of seizures, cause, comorbidity, and remission of epilepsy among mentally retarded (MR) children followed until the age of 22 years.
A total of 151 MR children were identified at the age of 8 or 9 years by screening four birth cohorts of 12,882 children born from 1969 to 1972 in the Finnish province of Kuopio. Information about epilepsy was gathered longitudinally when children were 9 to 10, 17, and 22 years old. The guidelines for epidemiological studies on epilepsy proposed by the International League Against Epilepsy were followed.
By the age of 10 years, 29 of the 151 MR children (19%) had epilepsy. The cumulative risk for epilepsy at 22 years was 21%. The probability of developing epilepsy was increased fivefold in severely MR children compared with mildly MR children, i.e., in 27 of the 77 severely MR children (35%) versus 5 of the 74 mildly MR children (7%). Postnatal causes of mental retardation or association with cerebral palsy increased the risk for epilepsy, especially in the mildly MR children. When these risk factors were not present, the mildly MR children exhibited only a 3% risk for epilepsy, whereas the respective risk was about 10-fold in severe mental retardation. The cumulative probability of epilepsy being in remission for 5 years by the age of 22 was 32%.
The cumulative risk of epilepsy varies according to the severity and the cause of the retardation as well as the presence of additional disabilities. The cumulative probability of epilepsy remission tended to increase with age.
The purpose of this study was to assess the impact of the WHO/EuroPharm Forum "Questions to Ask About Your Medicines" campaign on patient counseling in Finnish community pharmacies.
The impact of the campaign was assessed by comparing the baseline findings with those at 3 months and 12 months after the implementation. The research methods involved observation of pharmacist-customer interactions, followed by personal interview of the customer.
The main positive outcome was the manner in which information was provided, as the counseling became more customized, more empathy was shown toward the customer, and haste was less obvious. The campaign did not increase the number of customers asking questions, with 6% asking at least one pharmacotherapeutic question throughout the campaign. Information was given mostly on the pharmacists' initiative, with approximately 40% receiving at least some oral counseling, mostly regarding how to use the medicine. Approximately 10% of the customers were provided with written information. No change was observed in the pharmacists' spontaneous provision of oral or written information.
The campaign was an attempt to set national and local standards for patient counseling in Finnish pharmacies. Further efforts are needed to change the content and availability of counseling.
Iceland lichen (Cetraria islandica) is sold in health food stores to prevent various disorders. In olden times it and sometimes also reindeer lichen (Cladonia sp.) have been used as emergency food. Lichen contains bitter and potentially toxic lichen acids and it also concentrates heavy metals. Therefore lichen toxicity was studied with traditional pretreatment methods (boiling, ash-soaking or both). Untreated and only shortly boiled lichens were lethally toxic to mice in 50 and 25% w/w mixtures in food, but when ash-soaking was added mice tolerated Cetraria (but not Cladonia) reasonably well for 3 weeks. In a 3 month test in rats 25% mixture of Cladonia was tolerated well and blood tests were normal at the end. However, urinary protein was increased, the autopsies revealed kidney changes corresponding to a mild heavy metal poisoning, as the lead concentrations in kidney and lichen were high.