Background: Diclofenac is an analgesic, antipyretic and anti-inflammatory drug that may have harmful effects on the environment, It has contributed to the death of fish exposed to the substance through discharges into lakes and seas. Even birds, especially vultures, have died after exposure to diclofenac by consuming carcasses that were treated before they died. Aim: The purpose of this study was to assess the sales of diclofenac around Lake Mälaren. Method: Data were obtained from the Swedish eHealth Agencys statistics database Concise, for the time period 2018–2021. The counties studied were Uppsala, Västmanland, Södermanland and Örebro, which have waste water treatment plants with Lake Mälaren as the recipient. The amount sold in kg was calculated using DDD, number of packages and package size and analyzed by season, time, sales method and region. Results: Uppsala accounted for the highest sales of diclofenac of the counties studied and over-the-counter sales at pharmacies sold most of the various sales methods. During the winter there was an increase of sold diclofenac while no other seasonal variations were observed. Following the prescription in June 2020, sales of tablets and capsules decreased, while other forms of preparation were not affected. For each year studied, the number of kg of diclofenac sold has decreased. Conclusion: Sales of diclofenac have declined during the period of 2018-2021, which is positive from an environmental point of view as reduced use means reduced emissions to nature.  This data can be used to investigate farmacies and citys on a lower level.

Background: The increased use of medicines in recent decades has affected the environmentand led to negative consequences. Environmental risk for a drug can be classified by using PBTindex and PEC / PNEC-ratio. Environmental risk information can be found on the knowledgesupport websites "medicines and the environment" at Janusinfo.se and in environmentalinformation at Fass.se. The Drug- and Therapeutics Committees (DTCs) ensure that medicinesare used in a correct and cost-effective manner and recommend medicines in annually updatedguidelines. Method: A survey was created and pilot-tested by 10 persons experienced from DTCs. Thequestionnaire consisted of four parts, general questions, questions about the use of theknowledge support "medicines and the environment" on janusinfo, questions about the use ofenvironmental information from Fass.se and other questions about environmental aspects. Result: In total, 9 out of 10 people who were included in the pilot study answered. Threerespondents had only positive feedback on the questionnaires. Some respondents thought thatthere were some questions and answers’ options that were not easy to understand and that somequestions could be answered only by people familiar with the subject.Conclusions: The conclusion is that the pilot study has led to many improvements in surveyquestions and approaches. In the future, further research is needed for knowledge about drugeffects in the environment.

Background:  Generic substitution has resulted in large economical savings for prescription drugs, but there is concern about potential negative consequences such as double medication, altered effect and poor compliance. Such problems would be worst among the elderly since they use many drugs, some have impaired cognitive function and a higher risk of serious consequences. Objective: The purpose of this study is to assess if there are any negative consequences of genetic changes in the elderly. Method: The study was a systematic review where data from scientific articles were collected from the PubMed database. A search strategy was developed using MeSH terms and keywords. The work was carried out according to the PRISMA guidelines for systematic review. A total of 232 papers were screened and 5 papers remained fulfilling inclusion and exclusion critera. Results: Two studies show that generic substitution has no effect on patient compliance. One study on antiepiletics showdes that patients experienced different effects and new side effects after switching to generic drugs. However there was no association between switching and seizure related hospital visits. In another study, the results showed no association between hospitalization and generic substitution Conclusion: There are few studies on the consequences of generic substitution in elderly. Current studies indicate that generic substitution has no effect on the patient's compliance, it may  cause some confusion and anxiety in certain groups, but no increase in hospital admissions been found.

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Background and objective: An adequate communication of medicine information to the patient along with a correct medication list form the basis for a safe use of medicines. The aim was to study patients’ experiences of the information and communication about newly initiated drug treatment along with if and how the information was given during discharge.  Study design: A qualitative observational and semistructured interview. Observational data were collected using an observational form. Interview data was recorded with tape recorder and transcribed in verbatim in Microsoft Word. Analysis was performed using content analysis.  Setting: The cardiac ward at Länssjukhuset hospital in Kalmar and telephone interviews within one week after discharge. Six patientes were included. Main outcome measures: Primarily patient experiences of the drug information and communication about newly initiated drug treatment and secondarily which kind of information is given to the patient at discharge.  Results: Six patientes were included. Analysis of patient observations and interviews showed a great variation in experiences of the given information about newly introduced drugs. Eight main categories; clear drug information, sufficient drug information, insufficient drug information, positive experience of communication, obstacles for good communication, feeling of participation, barriers for participation and independently searching for information. All patients recieved a printed medication list at discharge but none recieved a written medication report.  Conclusion: Patients describe varying experiences of the drug information at discharge. Patients are prone to seek information about their medication in different sources following discharge. The information provided should be more individualized so that the patient is given the opportunity to feel involved in the drug treatment.