Source of medicines and medicine information by self-reported persons living with hypertension and diabetes in rural and urban Ghana.

OBJECTIVES: This study was conducted to determine the source of medicines and medicine information of persons living with hypertension and diabetes in rural and urban Ghana and assessing if they are influenced by predisposing and enabling factors as defined by Andersen's behavioural model. METHODS: A population based cross sectional study was conducted in four (4) rural and four (4) urban districts in the Ashanti Region of Ghana. A multistage and proportional sampling method was used in enrolling participants aged 18 years and above. A pre-tested structured questionnaire was used to collect primary data from respondents. Data collected was exported to STATA for analysis. Descriptive analysis was performed. Chi-square tests/Fisher's exact test and multinomial logistic regression models were used to establish association between variables. RESULTS: A total of 336 self -reported persons with hypertension and diabetes were enrolled in the study with 199(59.23%) living in urban communities. The majority of participants with hypertension and diabetes living in the rural communities 77 (56.20%) were females contrasting with the male majority in urban communities 106 (53. 27%). In the rural communities, 49 (35.77%) of participants sourced medicines from the health centre while 45 (32.85%) and 35(25.55%) sourced medicines from the hospital and over the counter medicine shop (OTCMS) respectively. In the urban communities, 153 (76.88%) sourced medicines from the hospital while 33 (16.58%) sourced medicines from the pharmacy. The predisposing factor age (OR: 1.1, 95%CI 1.040-1.210) under OTCMS, age (OR 1.0, 95% CI: 1.002-1.066) under hospital and enabling factor socioeconomic status (OR: 0.3, 95%CI 0.085-0.855) under Hospital influenced participant's source of medicine in the urban communities. The results also revealed that majority of participants in both rural 99 (72.26%), and urban 164 (82.41%) communities sourced medicine information mainly from public healthcare facilities, pre-disposing factors; age (OR 1.1 95%CI 1.032-1.270) under family member, age (OR 1.1, 95%CI 1.022-1.167) under friend health professional, age (OR 1.1, 95%CI 1.050-1.147) under nearest health institution, marital status (OR: 0.004, 95%CI 0.003-0.441) under friend health Professional were found to influence participants' source of medicine information in the urban communities while in the rural communities the predisposing factor marital status (OR 10.6, 95%CI 1.044 -106.835), education (OR: 26.1, 95%CI 1.271-537.279) under friend health professional, age (OR 1.1, 95%CI 1.002-1.187), educational level (OR 30.6, 95%CI 1.718-546.668) under nearest health institution and enabling factor socio-economic status (OR 6.6, 95%CI 1.016 -43.510) under nearest health institution influenced one's source of medicine information. CONCLUSIONS: Majority of inhabitants with hypertension and diabetes in both rural and urban communities, sourced medicines and medicine information from public health institutions though a larger proportion was recorded in the urban communities. More participants in the rural communities than in the urban communities sourced medicines and medicine information from community pharmacies. Participants' source of medicine and medicine information was influenced by both predisposing and enabling factors.

Source of medicines and medicine information by self-reported persons living with hypertension and diabetes in rural and urban Ghana

Objectives: This study was conducted to determine the source of medicines and medicine information of persons living with hypertension and diabetes in rural and urban Ghana and assessing if they are influenced by predisposing and enabling factors as defined by Andersen's behavioural model. Methods: A population based cross sectional study was conducted in four (4) rural and four (4) urban districts in the Ashanti Region of Ghana. A multistage and proportional sampling method was used in enrolling participants aged 18 years and above. A pre-tested structured questionnaire was used to collect primary data from respondents. Data collected was exported to STATA for analysis. Descriptive analysis was performed. Chi-square tests/Fisher's exact test and multinomial logistic regression models were used to establish association between variables. Results: A total of 336 self -reported persons with hypertension and diabetes were enrolled in the study with 199(59.23%) living in urban communities. The majority of participants with hypertension and diabetes living in the rural communities 77 (56.20%) were females contrasting with the male majority in urban communities 106 (53. 27%). In the rural communities, 49 (35.77%) of participants sourced medicines from the health centre while 45 (32.85%) and 35(25.55%) sourced medicines from the hospital and over the counter medicine shop (OTCMS) respectively. In the urban communities, 153 (76.88%) sourced medicines from the hospital while 33 (16.58%) sourced medicines from the pharmacy. The predisposing factor age (OR: 1.1, 95%CI 1.040-1.210) under OTCMS, age (OR 1.0, 95%CI: 1.002-1.066) under hospital and enabling factor socioeconomic status (OR: 0.3, 95%CI 0.085-0.855) under Hospital influenced participant's source of medicine in the urban communities. The results also revealed that majority of participants in both rural 99 (72.26%), and urban 164 (82.41%) communities sourced medicine information mainly from public healthcare facilities, pre-disposing factors; age (OR 1.1 95%CI 1.032-1.270) under family member, age (OR 1.1, 95%CI 1.022-1.167) under friend health professional, age (OR 1.1, 95%CI 1.050-1.147) under nearest health institution, marital status (OR: 0.004, 95%CI 0.003-0.441) under friend health Professional were found to influence participants' source of medicine information in the urban communities while in the rural communities the predisposing factor marital status (OR 10.6, 95%CI 1.044 -106.835), education (OR: 26.1, 95%CI 1.271-537.279) under friend health professional, age (OR 1.1, 95%CI 1.002-1.187), educational level (OR 30.6, 95%CI 1.718-546.668) under nearest health institution and enabling factor socio-economic status (OR 6.6, 95%CI 1.016 -43.510) under nearest health institution influenced one's source of medicine information. Conclusions: Majority of inhabitants with hypertension and diabetes in both rural and urban communities, sourced medicines and medicine information from public health institutions though a larger proportion was recorded in the urban communities. More participants in the rural communities than in the urban communities sourced medicines and medicine information from community pharmacies. Participants' source of medicine and medicine information was influenced by both predisposing and enabling factors

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Structured pharmaceutical care improves the health-related quality of life of patients with asthma.

BACKGROUND: Asthma as a chronic health condition can be controlled when in addition to clinical care, adequate education and support is provided to enhance self-management. Like many other chronic health conditions improved self-management positively impacts the health-related quality of life (HRQoL). It can therefore be said that a well-structured pharmaceutical care delivery that addresses the issues related to patient education and support towards self-management stands a good chance of positively impacting asthma control. This study evaluated the impact of a structured pharmaceutical care delivery on asthma control. METHODS: A prospective pre-/post- intervention study of a single cohort of 77 adult out-patients visiting specialist asthma clinics in Ghana were assessed for HRQoL and peak expiratory flow rates (PEFR) one month after pharmaceutical care intervention. Pharmaceutical care intervention covered education on the health condition, pharmacotherapy and self-management issues as well as correction of inhaler-use technique, where necessary and when to urgently seek medical care. The mean difference of the HRQoL and PEFR values were subjected to paired samples t-test analysis. RESULTS: Delivery of a structured pharmaceutical care led to a significant improvement in asthma specific quality of life and PEFR. The mean paired difference of the HRQoL for a cohort of patients with asthma post- pharmaceutical care intervention was 0.697(95% CI: 0.490 - 0.900) at t = 6.85 (p < 0.05). The mean paired difference for PEFR post intervention was 17.533 (95% CI: 2.876 - 32.190) at t = 2.384 (p = 0.02). CONCLUSION: This study identified important challenges with both the pharmacologic and the non-pharmacologic management of adult asthma patients. Inadequate inhaler-use skills, widespread occurrence of preventable adverse events and irregular use of preventer medicines were prevalent among patients. At one month after pharmaceutical care intervention, patients with asthma in a cohort follow-up study showed significant improvements with regard to asthma-specific quality of life, peak flow rates and knowledge. TRIAL REGISTRATION: GHS-ERC: 08/9/11 of October 19, 2011.

[Acute effect of maternal smoking on fetal blood circulation]. / Az anyai dohányzás akut hatása az anyai és magzati vérkeringésre.

The authors examined the acute effects of cigarette smoking on maternal and fetal cardiovascular system in 22 healthy voluntary pregnant smoker women. All examined patients were chronic cigarette smokers who smoked more than 5 cigarettes per day before and during pregnancy. All of the pregnancies subsequently had normal outcomes. Maternal heart rate, and blood pressure, fetal heart rate, resistance indices of fetal descending aorta, those of umbilical artery, middle cerebral artery and uterine artery were measured immediately before and after cigarette smoking. It was found that smoking was associated with increase in maternal and fetal heart rate and an increase in umbilical artery resistance indices was also observed. These changes might be considered as a reaction improving fetal oxygen supply.

[Practical questions about organizing a gynecologic outpatient clinic for climacteric-osteoporosis patients]. / Nögyógyászati klimax-osteoporosis ambulancia szervezésének kérdései.

The author established a climacteric-osteoporosis outpatient clinic at his department of obstetrics and gynecology among the first ones in Hungary. On the basis obtained with the care of 3000 patients the author outlines the most important duties connected with such a clinic. In his opinion it is of special importance to screen women with several risk factors for postmenopausal osteoporosis,--supply these women at risk with hormone replacement therapy (HRT) and to care them,--include diseases which contraindicate HRT before starting it, --work out rational cooperation between the interested specialties and to delimit the duties,--make the rules of direction of patients clear,--supply osteoporotic women treated by rheumatologists with HRT, --use uniformed diagnostic and therapeutical protocol, --inform the women population and to prepare the specialists and family doctors and to take part in their further education. According to experiences of the author HRT is especially effective to stop climacteric complaints and to prevent and treat osteoporosis.

[Incidence of intrauterine growth retardation and its significance in perinatology in Hungary]. / Az intrauterin növekedési retardáció elöfordulása és perinatológiai jelentösége Magyarországon.

The authors have examined the incidence of intrauterine growth retardation at a country level for the first time both in local and international aspect. Using the nomenclature of NDN-system they have found the frequency of WL-(proportional) retardation 7.95% and that of N-(disproportional) retardation 5.99%. They show incidence of retardation from county to county, as well. Examining the correlation between retardation and perinatal mortality they've stated that while the frequency of still-birth among the average developed and proportionally nutrified fetus is 0.34% and the frequency of perinatal mortality among them is 1.23%, that of the N-retardated newborns is 0.88% and 2.08%, respectively, and that of the WL-retarded is higher than the latter: 2.03% and 3.90% respectively. Regarding the incidence and mortality ratio among the two types of retardation the difference is significant.

[Clinical significance of intrauterine growth retardation]. / Az intrauterin növekedési retardáció klinikai jelentösége.

The authors have examined the measure of the influence of the proportional and disproportional retardation on the results of the pre- and subnatal observation of the fetus and on the frequency of perinatal mortality and newborns' morbidity, premature birth and newborns born with low birth weight. The authors have stated the two types of retardation leads to a higher global perinatal mortality mainly by causing a more frequent intrauterine mortality. Comparing the results of the retarded newborns to those of the somatically normally developed neonates they prove it from several aspects that the proportional retardation means a much higher risk for the newborn than the disproportional retardation which is also a risk factor. The new NDN classification system elaborated and used by the authors is suitable for differing the two types of retarded newborns.

[A new method for the classification of neonates based on maturity and somatic development]. / Az újszülöttek érettség és fejlettség szerinti új osztályozási rendszere.

The author points out the sad fact that the methods of estimating classifying, comparative examining of the maturity, somatic development of newborns and the methods of marking off the retarded newborns used up to now are essentially centering round the birth-weight. He exposes the errors, deficiencies of these methods and confronts them with the possibilities of the NDN-system (newborn's somatic development and nutritional state) worked out earlier by him. He thinks the NDF-system to be able to express simultaneously and exactly the gestational age, weight- and length-development, state of being fed of the newborns and the relation to the populational average, the fact and type of retardation, as well. The informational means of NDF-system in NDF-index. The NDF-system makes it possible to break down the birth-weight centric view as it offers a more suitable and qualified method than used before to describe the maturity and somatic development and the classifying of the newborns on the basis of these.

[Representation of the increase of fetal biparietal and thoracic diameter on a new (14-zone) ultrasonic diagnostic table]. / A magzati biparietális- és thorax-átmérö növekedésének ábrázolása újszerü (14 zónás) ultrahang diagnosztikai táblázaton.

From the somatic development of the fetus one may conclude to its functional maturity and if birth is near to its life prospects too. Thus the ultrasonographic examination of the biparietal and thorax transversal diameter reflecting the somatic development is of prognostic significance too. The authors composed a new table to increase the information value of the ultrasonographic finding, for the uniform designation of the given BPD and THD (biparietal and thorax diameter) sizes and for the better recognition of the tendencies of BPD and THD changes. A new system of symbols and representation method were elaborated for the description of standard positions. According to the gestation weeks 14-14 BPD and THD size-ranges were separated. The so called "UFD" Ultrasonographic index of the Fetal Development gives information besides the gestation time also on the BPD and THD standard position of the fetus and demonstrates illustratively the direction and rate of deviation of the standard positions from the average. The system provides the possibility of a better information to the obstetrician or consulting physician who evaluates the US finding, a uniform interpretation of the findings and serves better the clinical diagnostics.