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Aim: To investigate how oral health in adults is affected by asthma and asthma medication treatment.  Method: The study design was a general literature review. A search for scientific articles was performed in the databases DOSS, CINAHL, and MEDLINE. A total of 17 scientific articles were selected for the result of the literature review based on relevant inclusion and exclusion criteria, keywords, and the quality of the review. Results: Asthma and asthma medication had an impact on oral health in adults. Studies showed a higher prevalence of dental caries and pathology of periodontal tissues, dry mouth, erosion damage, and poorer oral hygiene among adults with asthma compared to those without asthma. It was also found that adults with asthma who were undergoing medication treatment had an increased presence of Candida albicans in saliva. Other oral health-related conditions such as certain dermatological diseases and benign tumors were also found to be associated with asthma in adults. Conclusion: Adult individuals with asthma showed a higher prevalence of oral diseases compared to adults without asthma. Side effects as a result of medication treatment were an influencing factor in the occurrence of oral diseases in adult asthmatics.

Background: Multi-medication and potentially inappropriate medications are a problem among the elderly who live in retirement homes. Drug-related problems are a common cause of hospitalization among the elderly, but most of these problems can be prevented with the help of medication reviews. Aim: The aim of this study is to investigate how the execution of medication reviews takes place in retirement homes in four counties in southern Sweden.  Methods: A survey has been developed and sent to operations managers/head of units at 114 different retirement homes with a somatic focus in four counties in southern Sweden in two occasions: on 7 November and 20 November 2023. Descriptive statistics have been used to analyze data. Results: A total of 35 responses have been received which corresponds to a 31% response rate. Most of the retirement homes in these counties have stated that medication reviews are performed at least once a year. Regarding the participation of pharmacists, more than half of the retirement homes in two counties indicated that pharmacists participate in the performance of medication reviews, while in the other two counties none of the retirement homes stated that pharmacists participate.  In this study, the large retirement homes performed medication reviews to a greater extent than the small retirement homes.  Conclusion: Medication reviews are used in retirement homes. Larger retirement homes perform medication reviews to a greater extent than small retirement homes. Continued studies are needed to observe the effect of medication reviews and explain the differences between counties.

Bakgrund: Det har visat sig under de senaste 20 åren att användning av aripiprazol ökar risken för spel- och impulskontrollstörningar. Aripiprazol är ett första generationens antipsykotiska läkemedel och fungerar som en partiell serotonin 5-HT1A-receptoragonist, en 5-HT2A-receptorantagonist och en specifik partiell dopamin D2/D3-agonist.  Syfte: Syftet är att studera hur förekomsten av spel- och impulskontrollstörningar skiljer sig mellan neurologiska patienter som får Aripiprazol respektive andra antipsykotiska läkemedel som komplement till behandling med Parkinsons sjukdom eller Restless Legs Syndrome.  Metoder: Detta är en retrospektiv registerstudie som analyserar läkemedelsdata som täcker åren 2005 till 2022 och patientdata som innehåller diagnoser för Parkinsons sjukdom och Restless Legs Syndrome samt spel- och impulskontrollstörningar. Data analyserades genom att mäta frekvensen av recept för att analysera antalet händelser av spelstörningar, impulskontrollstörningar och kontrollgrupper hos personer med Parkinsons sjukdom och Restless Legs Syndrome.  Resultat: Det finns en tydlig skillnad mellan de antipsykotiska läkemedlen. Första och andra generationens antipsykotika, inklusive litium, olanzapin, levomepromazin och aripiprazol, har visats vara associerade med störningar i spel och impulskontroll hos patienter med Parkinsons sjukdom och Restless Legs Syndrome. Aripiprazol visade sig ha det starkaste sambandet med störningar i impulskontroll och litium hade det starkaste sambandet med spelstörningar hos personer med Restless Legs Syndrome. Dessutom hade Levomepromazin det starkaste sambandet med störningar i impulskontroll och Olanzapin hade det starkaste sambandet med spelstörningar hos personer med Parkinsons sjukdom.  Slutsatser: Denna studie har konsekvenser för framtiden då den hjälper till att veta om det finns risk för spel- och impulskontrollstörningar vid användning av antipsykotiska läkemedel. Så det hjälper till att skapa maximal säkerhet för antipsykotiska läkemedel och hantera risken för spel- och impulskontrollstörningar på bästa möjliga sätt.

Läkemedels miljöpåverkan har uppmärksammats allt mer de senaste åren. För att minska läkemedels miljöpåverkan har det införts ett miljöklassificeringssystem för läkemedel i Sverige. Vi har i denna uppsats studerat hur, och i vilken utsträckning, miljöklassificeringen av läkemedel används för att kunna minska läkemedels påverkan på miljön. Detta har gjorts genom att vi har behandlat miljöklassificeringen som en form av styrmedel och försökt identifiera miljöklassificeringens ansvarsroller. Eftersom miljöklassificeringens ansvarsroller kan beskrivas som något otydliga och någon utvärdering inte är gjord är det svårt att bedöma miljöklassificeringens effektivitet. Däremot medverkar miljöklassificeringen till att uppmärksamma problemet med läkemedel i miljön. De aktörer som utformat miljöklassificeringen hoppas på en spridning av systemet för att fler samhällssektorer ska vidta miljöåtgärder. Om detta sker kan miljöklassificeringen som ett informativt styrmedel, antagligen bidra till ett förändrat beteende som leder till minskad miljöpåverkan av läkemedel. / Pharmaceutical environmental impacts have been increasing in recent years. To reduce the environmental impact of pharmaceuticals, an environmental rating system for pharmaceuticals has been introduced in Sweden. We have in this case, studied how, and to what extent, environmental classification of drugs is used to reduce the drugs impact on the environment. This has been done by considering the environmental classification as a form of political instrument and trying to identify the responsibility roles within the environmental classification. Since the responsibility roles within the environmental classification can be described as slightly unclear and no evaluation is made, it is difficult to estimate the efficiency of the environmental classification. By contrast, the environmental classification may enlighten the problem of pharmaceuticals in the environment. The creators of the environmental classification is hoping for an expansion of the system to more sectors of the society. If this leads to more environmental actions, the environmental classification as an informative tool, probably can bring changes in behavior that lead to reduced environmental impact of pharmaceuticals.

Sex Differences in the Use of Pain Medication in Sweden and Denmark Abstract Background: Pain is a multifaceted experience and understanding its mechanisms and effective treatment methods being of paramount interest. Sex differences in pain perception, treatment, and response are increasingly recognized as pivotal areas of investigation. Aim: This study aims to compare the usage patterns of analgesic medications between Sweden and Denmark, focusing on sex and gender differences. Method: A quantitative cross-sectional study utilizing aggregated individual-level data from national registries in Sweden and Denmark was conducted. The study focused on prescribed analgesic medications, including NSAIDs (M01A), paracetamol including combinations (N02BE), salicylic acid and derivatives (N02BA), and opioids (N02A), identified by their respective ATC- code. The analysis encompassed adult individuals aged 25 and above, in total and divided into three age groups. The studied measure was period prevalence, defined as the number of individuals per 1000 inhabitants that purchased at least one prescription during the year. Differences between men and women were calculated as risk ratios (RRs). Data were collected for the years 2022 and 2010 to provide a comparative analysis over time. Results: Clear disparities in analgesic medication usage between men and women were observed in both countries in 2022, with women generally exhibiting higher utilization rates compared to men. In Sweden, risk ratios (men/women) for NSAIDs, opioids, salicylic acid derivatives, and paracetamol including combinations were 0.76, 0.75, 0.50, and 0.63, respectively. In Denmark, similar trends were observed. The risk ratios for NSAIDs, opioids, salicylic acid derivatives, and paracetamol including combinations were 0.83, 0.78, 0.76, and 0.70, respectively. Analysis of trends from 2010 to 2022 showed change in sex differences in drug use. Furthermore, variations in usage patterns were noted between age groups. Conclusion: This study underscores the presence of sex disparities in analgesic medication usage in Sweden and Denmark in 2022. These disparities persist across different age groups and between the two countries.

This thesis consists of four essays in economics related to the pharmaceutical market. The first essay, Pharmaceutical Pricing in a Regulated Market, compares the pricing of new pharmaceuticals in the Swedish market where prices are regulated, with the results of Lu and Comanor who studied the pricing of new pharmaceuticals in the US market. The results indicate that price regulation discourages the use of penetration strategies and decreases price competition between brand name drugs. The second essay, Innovativeness and Market Shares in the Pharmaceutical Industry, analyzes the pharmaceutical market in a model of horizontal and vertical product differentiation. The implications from the model are tested on data from the Swedish pharmaceutical market. Vertically differentiated drugs are found to gain larger market shares, command higher prices, and be less sensitive to substitutes than drugs that are only horizontally differentiated. The third essay, Generic entry before and after reference prices, examines the effect of the reference pricing system on generic entry in markets where brand name pharmaceuticals lose patent protection. The main result is that savings due to increased competition in markets affected by the reference pricing system may have been outbalanced by higher prices due to less competition in markets where the reference pricing system led to deterred entry. The fourth essay, Innovative Drugs and the Increase in Pharmaceutical Expenditures, seeks to establish the most important factors behind the growth in pharmaceutical expenditures. One important conjecture is that the change in the drug price index has little impact on the rate at which pharmaceutical expenditures grow. Instead, the introduction of new innovative drugs seems to be the most important driving force of the growth in pharmaceutical expenditures. / Diss. (sammanfattning) Stockholm : Handelshögsk., 2001

During and after medical treatment, pharmaceutical compounds as well as their metabolites and conjugates are excreted from the users through urine and feces. The pharmaceuticals end up in wastewater treatment plants, which are not designed to deal with this kind of organic micro-pollutant. Eventually the pharmaceuticals end up in the environment where they can have adverse physiological and behavioral effects on aquatic life and could contribute to the spread of antibiotic resistance among microorganisms. Adsorption to activated carbon is an established method for removal of pharmaceuticals from wastewater. It is however quite expensive and it is of interest to identify cost-effective alternatives. One possible alternative is bark, which is a common by-product from forest industry and has a complex microstructure and high porosity compared to many other naturally occurring materials. In order to investigate the potential of using bark to remove pharmaceuticals from municipal wastewater four column filters were built, two with activated carbon and two with bark. They were used in an experiment conducted at Kungsängsverket, the largest wastewater treatment plant in Uppsala municipality. The objectives were to assess pharmaceutical concentrations in treated wastewater at Kungsängsverket and to compare the performance of bark and activated carbon filters under different loading rates. During this time the filters were run at different loading rates and two different types of bark was used. 24 common pharmaceuticals from different therapeutic groups were targeted. The pharmaceutical concentrations measured at Kungsängsverket were generally low, but mean concentrations of five pharmaceuticals (atenolol, metoprolol, furosemide, hydrochlorothizide and diclofenac) exceeded 250 ng/l. Out of these, four have been shown to have adverse effects on aquatic life and it would be preferable if they were not released into the recipient. Bark was not as good at removing pharmaceuticals from wastewater as activated carbon was, but decent removal rates were achieved for several compounds. The removal rates of either filter type did not seem to be significantly impacted by variations in loading rate or bark size. The concentrations of a few compounds increased after treatment with the bark filters and the reason for this is not clear. One possibility is interference from other organic substances in the wastewater or the bark, but determining the reason for this increase should be a priority for any further research on the subject. Another problem encountered during the project that is likely to pose a problem for future implementation is that the bark filters were very sensitive to clogging. Running the filters at full scale would require frequent back-washing which would be a disadvantage from both economical and practical reasons.

Bakgrund: I Sverige avlider, varje dag, cirka tre äldre människor till följd av en fallolycka. Cirka 17 000 äldre människor drabbas per år av höftfrakturer till följd av fallolyckor. Uppgifter från 2014 visar att fallolyckor hos äldre kostar samhället cirka 14 miljarder kronor per år. Syfte: Syftet med denna studie var att hitta fysiologiska och farmakologiska faktorer som predisponerar för falltendens och fallskador hos människor, ≥75 år. Metod: Denna studie baserades på journaldata som extraherats från den pågående studien: ”Betydelsen av bra D-vitaminstatus för äldres hälsa” och omfattar tre patientgrupper: 100 patienter som ramlat och fått fraktur, 96 strokepatienter, 148 friska kontroller med avseende på följande parametrar: andel patienter med: hypoglykemi, hypotoni, D-vitaminbrist, sänkt njurfunktion och antal läkemedel på ordination. Resultat: Denna studie visar att gruppen patienter med fraktur som har ramlat har högst andel med hypotoni, hypoglykemi, D-vitaminbrist och försämrad njurfunktion. I genomsnitt fick frakturpatienter 5,6 läkemedel/dag, strokepatienter 5,5 läkemedel/dag och kontrollgruppen 2,3 läkemedel/dag. Flertalet läkemedel hade biverkningar som kan kopplas till fall och fallskador. Slutsats: Studien visar att det var vanligare bland de som drabbats av färsk lågenergifraktur att ha predisponerande riskfaktorer för fall och därmed fallskador jämfört med strokegruppen och kontrollgruppen. Studier på läkemedel och dess biverkningar visade att flertalet läkemedel i denna studie kan kopplas till falltendens och fallskador. Flera av de läkemedel som studerades kan även påverka de olika parametrarna som undersökts i de olika studiegrupperna.

Bakgrund: Bristande följsamhet är ett vanligt problem bland personer med schizofreni eller schizofreniliknande tillstånd. Oönskade biverkningar, bristande sjukdomsinsikt och stigmatisering är faktorer som påverkar följsamheten. Bristande följsamhet kan leda till återfall, försämrad livskvalitet och ökad risk för missbruk och suicid. Syfte: Syftet med studien är att belysa omvårdnadsmetoder som sjuksköterskor kan använda för att förbättra följsamheten till läkemedelsbehandling hos patienter med schizofreni och schizofreniliknande tillstånd. Metod: En litteraturöversikt baserad på elva kvantitativa studier som undersöker metoder för förbättrad följsamhet vid schizofreni. Resultat: Tre olika kategorier av metoder identifierades: individcentrerade, familjefokuserade och läkemedelsfokuserade metoder. Individcentrerade metoder såsom motiverande samtal och adherence therapy fungerade bäst i kombination med varandra. Familjefokuserade metoder var effektiva, särskilt när de skräddarsyddes efter den kulturella kontexten. Läkemedelsfokuserade metoder var påminnelser, belöningar och möjligheten för patienten att själv påverka läkemedelsvalet. Slutsatser: Individcentrerade, familjefokuserade och läkemedelsfokuserade metoder kan alla vara effektiva hjälpmedel för sjuksköterskor i mötet med patienter med schizofreni eller schizofreniliknande tillstånd och bristande följsamhet till läkemedelsbehandling. Klinisk betydelse: Resultatet har visat att flera av metoderna är effektiva. De skulle, enskilt eller i kombination med varandra, kunna vara till nytta för sjuksköterskor i klinisk praxis. / Background: Poor compliance to medication is a common problem among patients with schizophrenia or schizophrenia spectrum disorders. Medication side effects, poor insight into illness and stigma are factors that affect compliance. Poor compliance can lead to relapse, decreased quality of life, and an increased risk of substance abuse and suicide. Aim: The aim of this study is to shed light on methods that nurses can apply in order to increase compliance to medication in patients with schizophrenia and schizophrenia spectrum disorders. Method: A literature review of eleven quantitative articles that examine methods for increased compliance in patients with schizophrenia. Results: Three different categories were identified: individualized, family focused and medicine focused methods. Individualized methods like motivational interviewing and adherence therapy worked best combined. Family focused methods were effective, especially when they were tailored according to the cultural context of the family. Medicine focused methods were reminders, rewards and the opportunity to choose your own medication. Conclusions: Individualized methods, family focused methods and medicine focused methods can be effective methods that nurses can use in the treatment of patients with schizophrenia or schizophrenia spectrum disorders, who are nonadherent to medication. Clinical significance: Several of these methods have proven to be effective. When used separately, or in combination with each other, they could be of use for nurses in clinical practice.