Between 1981 and 1982 the Banjarmasin Quadrangle in South-East Kalimantan was mapped by the Geological Research and Development Centre, Bandung at the scale of 1 : 250,000. This thesis reports the results of a follow-up study to the mapping programme, which was directed towards determining the age, origin and tectonic evolution of the Pre-Tertiary rocks which form the Meratus Mountains in the eastern part of the Banjarmasin Sheet. The study consists of detailed field-mapping of Pre-Tertiary rocks in well exposed river sections at the scale of 1:10,000. Measured sections of sedimentary units were made and all structural features were recorded. A comprehensive collection of rock samples was made for laboratory studies. Thin sections were used to determine the composition and origin of sedimentary and igneous rocks. Macro-and microfossils have been examined to determine the depositional environments and the ages of the sedimentary units. From these studies the Pre-Tertiary rocks are divided into a number of tectonostratigraphic units, whose age, origin, structural and tectonic evolution has been determined as far as possible. This information has been used to compile a synthesis of the tectonic development of the Meratus Mountains in the context of plate tectonics and the development of the western Indonesian region. Isotopic and palaeontological dating has shown that the units exposed in the Meratus Mountains range in age from Early Cretaceous to Early Palaeocene. The oldest unit is the Paniungan Formation of Berriasian to Barremian age. It grades upward into the Upper Barremian to Lower Aptian Batununggal Formation. These formations are interpreted as shelf to slope sediments. It is suggested that shortly after deposition, most parts of the shelf to slope sediments were juxtaposed by strike-slip faulting with oceanic crust now represented by the Meratus Ophiolite Complex. Subduction generated a calcalkaline volcanic arc which then collided with the Sunda continent in the Cenomanian time. This collision zone was disrupted and sliced by strike-slip faults, forming a pull-apart basin within it. The absence of Palaeocene to Lower Eocene deposits reflects uplift, subsequently followed by rifting, regional subsidence and deposition of an Eocene-Miocene transgressive sequence. The present configuration of the Meratus Mountains resulted from late Middle Miocene and Plio-Pleistocene tectonic events.

Archaean rocks of the area make up three depositional series which are separated in time one from another by periods of folding. The oldest rocks, exposed in the southern areas, consist of marine-laid basic lavas overlain by felsic volcanics and clastic sediments, all sheared and folded in a northwesterly direction. During the folding, regional metamorphism to the greenschist and amphibolite facies and intrusion of gabbro and ultrabasic rock, took place. The medium-aged rocks were deposited in a broad geosyncline which deepened to the north. In the central parts of the area, shelf facies deposits consist of basic lavas overlain by felsic agglomerate and coarse clastic sediments, but northward these rocks give way to uniformly banded fine clastic sediments deposited in a deeper sea environment. During the later stages of volcanism and sedimentation the rocks were folded synchronously along north-south and approximately east-west lines and metamorphism to greenschist and amphibolite facies took place. Domal structures controlled the locations of volcanic centres, igneous intrusion, and orebodies. The youngest group of rocks, which occurs in the northwestern area, was folded along dominantly east-west lines. Metamorphism of the original sedimentary rocks to gneisses of the high amphibolite facies may have taken place at this time. Faulting and the related intrusion of diabase dykes along north-south, northeasterly and northwesterly lines took place as uplift occurred in the northern areas during Proterozoic time. Widespread, severe retrograde metamorphism accompanied the faulting. Glacial, glacial-lacustrian, and fluvio-glacial deposits of pleistocene age now cover most of the bedrock to depths which range up to 400 feet.

Aim: The aims of the study were to compare the effects on depressive symptoms and insomnia between agomelatine and SSRIs/SNRIs in adult patients with major depression disorder. Method: Materials were collected from the database Pubmed and selected through the aims of the study and certain selection criterias. It was required that the studies fulfilled at least one of the study´s aims to be eligible for inclusion. Eight randomised clinical trials were included in the study. The results from the studies were compared according to statistical and clinical significance. Results: Depressive symtoms were reduced both with agomelatin and SSRIs/SNRIs. Generally the rates of respone and remission were similar of agomelatine and SSRIs/SNRIs. There were advantages for agomelatine in the individual studies concerning rates of respone and remission. Six of the included studies investigated the effect on insomnia. In a majority of these studies agomelatine caused a statistically significant improvement compared to SSRIs/SNRIs. Clinically, both agomelatine och SSRIs/SNRIs improved most of the variables related to insomnia that were examinated according to patient-reported outcome results. Conclusion: Statistically both SSRIs/SNRIs and agomelatine achieved similiar effects on depressive symptoms. In the majority of the included studies that examinated effect on insomnia agomelatine showed a statistically significant improvement compared to SSRIs/SNRIs. Clinically, agomelatine is viewed as a viable option for adult patients with major depressive disorder with unsuccessful response or remission from SSRIs/SNRIs. A similiar clinical relevance were shown for agomelatine and SSRIs/SNRIs concerning improvement of insomnia according to patient-reported outcome results.

Drugs are an essential part of health care today. They improve and extend the lives of many people. If drugs are wrongfully combined or given in inaccurate dose, it may lead to poorer quality of life, hospital admissions and even deaths. Drug-related problems cost society a large amount of money each year. To minimize these problems, there are now electronic decision supports that doctors and pharmacists can use. At all pharmacies in Sweden, the electronic expert support system available. The EES analyzes electronic prescriptions and doses prescribed and indicates if it detects any potential drug-related problems. Such risks may be that the customer has several drugs with the same effect, drug interactions or that the drug is inappropriate due to age. For children, there are special warnings that may be that the doctor on the prescription has prescribed a higher dose of the drug against what is commonly given to a child. The purpose of the study was to investigate pharmacy customers view of and knowledge about pharmacist use of EES. Data were collected via surveys for 100 hours at several different pharmacies in Sweden. The vast majority of pharmacy customers did not know of EES, only one fifth of the survey respondents knew what EES meant. Consent from the customer is required for the pharmacist to use EES when dispensing drugs and one third of the customers did not know if they agreed to this or not. Half of the customers did not know if the pharmacist used EES when the drugs were dispensed. Most of the customers also did not know whether their drug dispensing would be safer, if they would get better advice if the EES was used or if they wanted the pharmacist to use EES as a tool in the prescription expedition. The study shows that pharmacy customers' views and knowledge about the use of  EES by pharmacists are limited. The reason for this may be that it takes extra time for pharmacists to inform customers about what EES means and ask them for consent that the expert support should be used in the prescription expedition. Many times the pharmacist is experiencing a shortage of time to do this. The reason why EES is not used may be because the pharmacist does not feel adequately educated in how the decision support works and therefore chooses not to use it. It may also be due to communication difficulties such as language problems, hearing impairment or the customer's reduced cognitive ability. There is a need for communicative improvements between the customer and the pharmacist so that the pharmacists will increase the use of EES when dispensing drugs. There is also a need for pharmacists to get education in how EES works and how to use the decision support. If this is done, it will provide the customer with a better drug use with reduced risk of side effects and drug-related problems.

Abstract Pharmacists have for many years been an important part of health care. They have rescued many people from diseases and poisoning. It´s important that they ensure the right drug, dosage and administration in right time for each customer. Elderly people usually have more prescribes than younger which increases the risk of interactions. Poor compliance may result in increased morbidity or premature death. There are several reasons why treatment is not followed. Lack of information about the treatment of disease or information about the medications for both indication and side effects are some of them At all pharmacies in Sweden, EES, Electronic Expert Support, is available. The introduction of e-prescription in the 21st century has enabled an additional safety check for the pharmacist, using Electronic Expert Support (EES) for dispatching prescriptions. The current recipe is compared with other prescriptions where there are withdrawals and the prescriptions where there should be pharmaceuticals left to consume. If there is a risk of incorrect dose, double prescription, age warning, interactions, gender specific or if drug affecting disease, a signal is given at EES control showing strength and action that may, should be done. The purpose of the study was to investigate customers perception of advice at the pharmacy and if the use and knowledge of the EES (Elektroniskt Expertstöd) differed between different age groups. The survey was conducted using data collection from seven pharmacies located in five locations spread across Sweden. The collection was conducted for about 100 hours and generated in 277 participants. All participation was voluntary and anonymous. The participants were divided into three age groups: 40 years or younger, 41-60 and over 60 years. The collected data was analyzed by using IBM SPSS and a chi2 test was performed to see if there were any significant differences between the age-groups. The result was compiled and demonstrated in excel diagrams. There was no significant difference between the groups in terms of safety and information they received about their drugs. Most people received information about their medicines by the doctor, pharmacist or by reading the package leaflet. However, there was some difference regarding the use of the Internet in a search for information retrieval among those over 60 years. This may be due to lack of internet knowledge or physical impairment. There was also a significant difference when it came to the question of calling 1177 for information on medicines, where people 40 years or younger, called more often than other groups. This may be because they usually have younger children and may need advice regarding illness or injuries. There was a significant difference between the age-groups in consent to use EES were elderly people had consented more often. Elderly people usually have more drug prescribes than younger and therefore is it more useful for people over 60 years. The risk of interactions increases with the number of drugs.

Background: Pain is one of the most prominent and disturbing symptoms reported by cancer patients. Appropriate pain relief is obtainable in more than 75 % of the patients with optimized analgesic treatment. Opioids and non-opioids are being utilized in cancer pain treatment and analgesics are used to improve the effectiveness of opioids. Gabapentin is primarily used as an anti-epileptic drug that is also recommended as the first-choice drug in treatment of neuropathic pain. Research is being conducted to evaluate cannabinoids as adjuvans analgesics. Sativex is the extract of cannabis sativa plant and is used to treat and ease moderate to severe symptoms of spasticity caused by multiple sclerosis (MS) in Sweden. Several scientific studies have recently studied sativex with positive results and the drug is currently being used in some countries in treatment of resistant cancer-related neuropathic pain. Purpose: The purpose of this paper was to conduct a scientific study and examine whether sativex is as efficient and secure as gabapentin and thus an option as addendum in cancer-related neuropathic pain when the treatment with only opioids is not sufficient for pain relief. Method: This literature study is based on examination of six clinical scientific studies. The articles are searched in PubMed database, the articles are about examination of effectiveness and security of gabapentin and sativex compared to placebo or other equivalent drugs in cancer patients suffering from neuropathic pain. Results: Two of the studies that compared gabapentin with placebo and one that compared Gabapentin with Amitriptylin (an anti depressive drug) showed that gabapentin was an efficient adjuvans analgesic that led to statistically significant pain relief in patients suffering from cancer. The side effects were mild to moderate in all three studies, and overdose of the study-drug was tolerated well. One of three studies evaluating efficacy and safety of sativex showed that the change in daily average pain score during two weeks of treatment was statistically significant in patients in the sativex-group compared to the group of patients receiving THC-extract and placebo-group. In the second study, sativex was compared within three different dosage groups (low, middle and high) as well as placebo and the result showed that sativex had significant pain relief only in patients receiving low dose of sativex. The third study showed that sativex led to pain relief in patients receiving sativex compared to those receiving placebo however the effect was not statistically significant. Dizziness, nausea and vomiting were the most common side effects in all three studies. The side-effects were mild to moderate and no serious safety issues were observed in the first and third studies. In the second study on the other hand, the patients were encouraged to maintain a stable opioid-dose which resulted in more side-effects. Conclusion: All three studies that examined the effectivness of sativex showed improvement on sleeping quality as well as pain relief, where two of the studies showed statistically significant pain relief in patients suffering from neuropathic cancer-pain. Studies on cannabinoids are quite controversial and there are not many global studies available that have studied its safety and efficacy in the treatment of neuropathic cancer-related pain. It is however a growing and upcoming area that is also expected to grow multiply in turnover which should enable more studies being conducted. These results show that sativex has the potential of being a good alternative in the treatment of neuropathic cancer-related pain. Sativex is also effective in low doses without the need for increases over time, furthermore side effects are mild to moderate and possible overdose is well managed by patients. Gabapentin been used in pain management in neuropathic cancer-pain for a long time with minimal side effects. Sativex, on the other hand, is quite new and there are not many studies performed on the medicine. Furthermore, there are no studies comparing sativex and gabapentin which makes it very difficult to conclude whether it holds the same safety and may act as a good alternative to gabapentin. In future studies, sativex should be compared to medicines used today such as gabapentin in order to prove its ability of being an alternative.

Abstract Restless legs syndrome (RLS) är ett kroniskt neurologiskt tillstånd som karakteriseras av en intensiv oro och obehagliga krypningar djupt inne i benen som förekommer i vila. Besvären upplevs som svårast på kvällen och natten och lindras av att man rör på sig. Hos majoriteten av de som lider av RLS förekommer även ofrivilliga periodiska benrörelser i sömn (PLMS) vilket medför täta mikrouppvaknanden. Detta försvårar övergång i djupare sömn vilket kan i sin tur leda till allvarliga sömnstörningar. Man kan dela in RLS i en primär form och en sekundär form beroende på om syndromet kan klarläggas till någon bakomliggande orsak. Eftersom syndromets patofysiologi fortfarande är oklar finns inte någon botande behandling men det finns bra möjligheter att lindra symtomen. Dopaminagonister har visat ha god effekt på både RLS-symtomen och PLMS vid behandling av primär RLS. Effekterna brukar man känna av redan vid låga doser. Vid behandling med dopaminagonister kan biverkningar förekomma så som illamående, huvudvärk, sömnighet etc. Dopaminagonister kan användas som monoterapi vid behandling av RLS-symtom eller i kombination med andra läkemedel. Syftet med denna litteraturstudie var att undersöka vad de två ”icke-ergolina” dopaminagonisterna pramipexol och ropinirol har för olika effekter vid behandling av RLS. Metoden som använts i detta arbete har varit en litteraturstudie. Fem artiklar valdes ut från databasen PubMed samt att befintlig litteratur söktes på Kalmars Högskolebibliotek och Örebros sjukhusbibliotek. Samtliga studier visade signifikant förbättring på RLS-symtomen med pramipexol- och ropinirolbehandling jämfört med placebo. Däremot krävs fler randomiserade kontrollerade studier av hög kvalitet som bland annat undersöker den långsiktiga behandlingseffekten av dessa preparat och att man koncentrerar sig på de kvarstående problemen kring negativa effekter som kan uppstå vid behandling. 2008:F25

Adherence to medical ordination is low and for long-time medication it is estimated to be as low as 50 percent. Depending on the prescribed drug this could lead to adverse effects and/or loss of effect of the drug. Information about why a drug is prescribed is important patient information and is thought to help increase compliance with the physician’s prescription. According to results from a recent study of visits to the emergency room at Karolinska Universitetssjukhuset in Solna, Stockholm, medically related problems were the cause in about 30 percent of the cases. According to the same study 11 percent of these visits were due to problems with patient adherence. Specifying indications on prescriptions could be a way to enhance drug compliance. Furthermore clinical indications on prescriptions ensure that the correct drug is administered for the correct condition. The purpose of this study was to examine how often indications were found on prescription labels on anti-parkinson drugs, ATC-code N04. Prescription data were collected from the Swedish Prescribed Drug Register. A total of 22 994 prescriptions of anti-parkinson drugs dispensed in October 2007 were transferred from the register in Excel-files. Information about the patient’s year of birth and gender was included as well as the name of the drug, ATC-code, amount of drug dispensed, strength and information about the prescribed drug. Prescriptions lacking information about the patient’s year of birth or gender was excluded as well as prescriptions for animals. On prescriptions for anti-parkinson drugs, with a total of 22 939 prescriptions after exclusion, half of them were provided with indication labelling. Indication labelling was more common on prescriptions for women. As regards patients older than 85 years, 63 % of the prescriptions were labelled with indication. / Abstract Patienters bristande följsamhet till förskriven ordination är ett av de stora läkemedelsproblemen av idag. Att förse varje recept med användningsområde i doseringstexten är ett sätt att försöka förbättra patientföljsamheten. Sådan information är även av vikt för expedierande farmaceut för att kunna göra en professionell bedömning om huruvida valt läkemedel, dos och styrka passar ihop med sjukdomsbilden. Tidigare studier har visat att det är långt ifrån på alla recept som användningsområde finns angivet. Syftet med arbetet har varit att undersöka på hur stor andel av recept inom ATC-grupp N04 (medel mot parkinsonism), det finns angivet användningsområde i doseringstexten. En jämförelse mellan dopaminerga och antikolinerga medel inom gruppen gjordes även. Data från Apotekets transaktionsdatabas tillhandahölls i form av excel-filer. Dessa innehöll information från recept utskrivna på ATC-grupp N04, som expedierats på apotek i Sverige oktober 2007. Information om patientens födelseår, kön, läkemedlets ATC-kod, benämning, förpackningsstorlek, styrka och doseringstext erhölls. De recept som saknade uppgift om kön eller födelseår exkluderades, likaså recept till djur. Exkluderade från undersökningen var även dosdispenserade läkemedel. Av de 22 939 expedierade recepten inom ATC-grupp N04 som uppfyllde inklusionskriterierna innehöll hälften av dessa användningsområde i doseringstexten. Användningsområde på recept var något vanligare hos kvinnor än hos män. Högst frekvens av informationen sågs på recept till personer 85 år och äldre. Resultatet för recept på dopaminerga medel var i stort jämförbart med huvudgruppens resultat, dvs. hälften av recepten innehöll användningsområde, det var vanligast på recept till personer över 85 år och informationen var mer frekvent förekommande på recept till kvinnor. De antikolinerga medlen hade användningsområde angivet på 38 % av recepten, det var ungefär lika vanligt förekommande på recept till kvinnor som män, och en minskning av förekomsten av användningsområde sågs på recept till personer över 74 år. Sammanfattningsvis kan konstateras att förskrivare alltför ofta underlåter att skriva ut användningsområde i doseringstexten trots nyttan det skulle innebära för både patient och farmaceut. 2008:F16

Irritable bowel syndrome (IBS) är en komplex sjukdom som yttrar sig på många sätt och i olika svårighetsgrad. Nuvarande behandling riktar sig mot att behandla varje symtom var för sig. Hos patienter med svåra symtom är detta inte alltid tillräckligt. Efterupptäckten att tricykliska antidepressiva (TCA) kan lindra IBS hos diarrédominanta patienter ökade intresset för andra antidepressiva läkemedel. Detta ledde till att selektiva serotoninåterupptagshämmare (SSRI) blev intressanta. SSRI preparat har visats ha en smärtlindrande effekt hos patienter med IBS och en parallell har dragits till signalsubstansen serotonin som finns i både hjärnan och tarmen. Därför har forskare nu funnit det intressant att undersöka SSRI-läkemedel. Syftet med denna litteraturstudie var att undersöka om SSRI-läkemedlet citalopram kan ha en lindrande effekt vid IBS olika symtom, såsom förstoppning, diarré, uppsvälldhet, gaser och framförallt smärta i buken. Artiklarna för studien var hämtade från databasen PubMed och Kalmar Högskolas egen databas Elin. Fem artiklar ingick i arbetet och alla är undersökningar där citalopram administrerats till människor och råttor. Två av artiklarna visade på symtomlindring hos patienter med IBS medan de i tre av artiklarna inte kunde visade någon signifikant (p>0.05) skillnad mellan citalopram och placebo. På grund av stora placeboeffekter vid IBS i de olika studierna är det svårt att avgöra om citalopram har en symtomlindrande effekt hos patienter med IBS. De olika studiedesignerna gjorde det också svårt att dra några egentliga slutsatser. Det finns dock en viss indikation att citalopram skulle kunna fungera symtomlindrande hos patienter med IBS. Dock behövs mer studier inom området med fler patienter för att kunna befästa om citalopram har en symtomlindrande effekt vid IBS. 2008:F27

There are many factors that play a role in the response of a drug. An interesting factor that is often discussed in the academia is the role of ethnicity. Differences in the expression of CYP enzyme, protein transporters and receptors between different ethnic groups believed to affect the outcome of many drugs relevant to cardiovascular disease. Polymorphism is believed to play an important role in this regard. Genetic alleles that differ through ethnicity-based polymorphism causes CYP enzymes and protein transporters to respond differently to different drugs. It is nevertheless not always fully explored if these ethnic differences are always due to genetic or non-genetic causes. There are however important changes toward the notion of recognizing ethnicity as a key role in pharmaceutical development. The Food and Drug Administration in the US have for example released guidance on how to define and work towards categorizing ethnicity in clinical research. There are also several western countries creating guidelines for drug therapy specific to ethnic groups. The purpose of this literary work was to study the differences between ethnic groups in terms of dosing, efficacy and pharmacokinetics of drugs used in cardiovascular disease. Five studies were used in the literary work. The first study examined the differences in dosing for warfarin therapy between different ethnicities. The second trial studied the plasma exposure of rosuvastatin between Caucasian and Asian people. The third study examined the effect of the ACE inhibitor enalapril in black and white patients with left ventricular dysfunction. The fourth study investigated the effect of beta blocker atenolol in white and black participants. The last study was done to compare the effect of the thiazide diuretic chlorthalidone against calcium channel inhibitors and ACE inhibitors in black and non-black patients.   The results showed that warfarin dosage differs between ethnicities. Plasma exposure of rosuvastatin is different between Caucasian and Asian people. ACE inhibitors work better with white patients, atenolol is more effective for white patients and chlorthalidone works better in black patients with certain cardiovascular diseases.   The studies presented indicate that there are differences in drug response in various ethnicities and these distinctions are different in extent and significance. It can be argued for genetic and non-genetic causes of differences depending on the drug being studied.