Are there differences in the patient-reported medication-related problems among asthma and allergy patients? A community pharmacy survey in Finland.

BACKGROUND: A medication-related problem is an event involving medication that interferes with desired health outcomes. Those are largely studied among asthma patients, but little is known about medication-related problems among allergy patients. The objective of this study was to determine the most common patient-reported medication-related problems among asthma patients compared to allergy patients during the self-management of diseases. The other objective was to identify how demographic variables and the received treatment information influence reported problems. METHODS: A nationwide survey was conducted in Finnish community pharmacies (n = 785) in September 2016. The survey targeted patients buying prescription medicines for asthma or allergy. RESULTS: Responses were received from 46% of targeted pharmacies from 956 respondents. At least one medication problem was reported by 24% of asthma patients and 12% of allergy patients. The most common problems among asthma patients were having problems taking medicines on time (16%), problems in the administration technique (7%) and in the use of the inhaler (4%). Among allergy patients, 10% reported problems remembering to take medicines on time. Severe asthma and allergy increased the risk for medication-related problems (OR 1.20, 95% CI 1.04-1.40 and OR 1.17, 95% CI 1.0-1.37). A higher age and less education were associated with fewer reported medication-related problems among both patient groups. CONCLUSIONS: Asthma patients reported more medication-related problems than allergy patients. Among both investigated patient groups, remembering to take medicines on time was the most common. Health care professionals should educate younger patients but also older and less educated asthma and allergy patients to recognize and, to solve medication-related problems. In addition, severe asthma patients still need medication counseling.

Are there differences in the treatment information received to support guided self-management between asthma and allergy patients?: A community pharmacy survey in Finland.

Background: Guided self-management of asthma supported by health care professionals is a well-established approach. For allergy patients, there is less guidelines and evidence for guided self-management than for asthma patients. Objective: The objective of this study was to find out how commonly asthma and allergy patients receive written action plans, how much and from which sources they receive treatment information to support their self-management, and to identify associated factors that may influence the support of guided self-management, and if there are any differences between these patients. Methods: A nationwide survey was conducted in Finnish community pharmacies (n = 785) in September 2016 targeting patients buying prescription medicines for asthma or allergies. Results: Responses were received from 46% of targeted pharmacies. Around 73% of the asthma patients, 61% of patients at risk of anaphylaxis, and less than 50% of the other allergy patients had received a written action plan. The most common source of treatment information for both patient groups was pharmacists. Allergy patients sought information more from written sources than asthma patients. Older males and patients with lower education received less treatment information. About 10% of both asthma and allergy patients did not report receiving any treatment information. Conclusion: The majority of asthma patients and allergy patients at risk of anaphylaxis had received a written action plan, while fewer than half of other allergy patients had received a written action plan. For both asthma and allergy patients, community pharmacists are the most common source of treatment information. Allergy patients seek more information from written sources than asthma patients. Pharmacists have a crucial role in the support of self-management for these patients.

Community pharmacists' knowledge of COPD, and practices and perceptions of medication counseling of COPD patients.

Background and purpose: COPD is one of the leading causes of morbidity and mortality worldwide. Although medication counseling interventions by pharmacists have been found to support the management of COPD, little is known about pharmacists' knowledge concerning COPD and regular practices and perceptions concerning medication counseling of COPD patients. The purpose of this study was to research these topics among Finnish community pharmacists. Materials and methods: In January 2017, an electronic survey was e-mailed to Finnish community pharmacies (n=741) via the Association of the Finnish Pharmacies. One pharmacist from each pharmacy, preferably a specialist in asthma, was invited to answer the survey. Results: Completed responses were received from 263 pharmacists (response rate =35%), of whom 196 pharmacists were specialists in asthma. Response rate among asthma pharmacists was 42%. Pharmacists were positive about their role in medication counseling and in support of the self-management of COPD patients. COPD-related knowledge was self-assessed as being good and was on a good level in respect of basic facts. However, almost half (46%) of the pharmacists did not know that COPD is considered a national public health issue, and ~50% of the pharmacists were not familiar with the current care guideline on COPD. Medication counseling was found to be more medicinal product-driven and less advisory concerning lifestyle changes such as smoking cessation and physical exercise. Conclusion: Although the pharmacists' knowledge of COPD was good on general topics, there were some gaps in their knowledge on the current care guideline and status of the disease. Pharmacists should more systematically individually target medication counseling according to patients' needs. In addition, lifestyle treatments, including smoking cessation and physical exercise, should be part of the medication counseling.

Effects of fresh lubricant oils on particle emissions emitted by a modern gasoline direct injection passenger car.

Particle emissions from a modern turbocharged gasoline direct injection passenger car equipped with a three-way catalyst and an exhaust gas recirculation system were studied while the vehicle was running on low-sulfur gasoline and, consecutively, with five different lubrication oils. Exhaust particle number concentration, size distribution, and volatility were determined both at laboratory and on-road conditions. The results indicated that the choice of lubricant affected particle emissions both during the cold start and warm driving cycles. However, the contribution of engine oil depended on driving conditions being higher during acceleration and steady state driving than during deceleration. The highest emission factors were found with two oils that had the highest metal content. The results indicate that a 10% decrease in the Zn content of engine oils is linked with an 11-13% decrease to the nonvolatile particle number emissions in steady driving conditions and a 5% decrease over the New European Driving Cycle. The effect of lubricant on volatile particles was even higher, on the order of 20%.

Vehicle engines produce exhaust nanoparticles even when not fueled.

Vehicle engines produce submicrometer exhaust particles affecting air quality, especially in urban environments. In on-road exhaust studies with a heavy duty diesel vehicle and in laboratory studies with two gasoline-fueled passenger cars, we found that as much as 20-30% of the number of exhaust particles larger than 3 nm may be formed during engine braking conditions-that is, during decelerations and downhill driving while the engine is not fueled. Particles appeared at size ranges extending even below 7 nm and at high number concentrations. Their small size and nonvolatility, coupled with the observation that these particles contain lube-oil-derived metals zinc, phosphorus, and calcium, are suggestive of health risks at least similar to those of exhaust particles observed before. The particles' characteristics indicate that their emissions can be reduced using exhaust after-treatment devices, although these devices have not been mandated for all relevant vehicle types. Altogether, our findings enhance the understanding of the formation vehicle emissions and allow for improved protection of human health in proximity to traffic.

Sulfur driven nucleation mode formation in diesel exhaust under transient driving conditions.

Sulfur driven diesel exhaust nucleation particle formation processes were studied in an aerosol laboratory, on engine dynamometers, and on the road. All test engines were equipped with a combination of a diesel oxidation catalyst (DOC) and a partial diesel particulate filter (pDPF). At steady operating conditions, the formation of semivolatile nucleation particles directly depended on SO2 conversion in the catalyst. The nucleation particle emission was most significant after a rapid increase in engine load and exhaust gas temperature. Results indicate that the nucleation particle formation at transient driving conditions does not require compounds such as hydrocarbons or sulfated hydrocarbons, however, it cannot be explained only by the nucleation of sulfuric acid. A real-world exhaust study with a heavy duty diesel truck showed that the nucleation particle formation occurs even with ultralow sulfur diesel fuel, even at downhill driving conditions, and that nucleation particles can contribute 60% of total particle number emissions. In general, due to sulfur storage and release within the exhaust aftertreatment systems and transients in driving, emissions of nucleation particles can even be the dominant part of modern diesel vehicle exhaust particulate number emissions.

Effects of gaseous sulphuric acid on diesel exhaust nanoparticle formation and characteristics.

Diesel exhaust gaseous sulphuric acid (GSA) concentrations and particle size distributions, concentrations, and volatility were studied at four driving conditions with a heavy duty diesel engine equipped with oxidative exhaust after-treatment. Low sulfur fuel and lubricant oil were used in the study. The concentration of the exhaust GSA was observed to vary depending on the engine driving history and load. The GSA affected the volatile particle fraction at high engine loads; higher GSA mole fraction was followed by an increase in volatile nucleation particle concentration and size as well as increase of size of particles possessing nonvolatile core. The GSA did not affect the number of nonvolatile particles. At low and medium loads, the exhaust GSA concentration was low and any GSA driven changes in particle population were not observed. Results show that during the exhaust cooling and dilution processes, besides critical in volatile nucleation particle formation, GSA can change the characteristics of all nucleation mode particles. Results show the dual nature of the nucleation mode particles so that the nucleation mode can include simultaneously volatile and nonvolatile particles, and fulfill the previous results for the nucleation mode formation, especially related to the role of GSA in formation processes.

Study of Miller timing on exhaust emissions of a hydrotreated vegetable oil (HVO)-fueled diesel engine.

The effect of intake valve closure (IVC) timing by utilizing Miller cycle and start of injection (SOI) on particulate matter (PM), particle number and nitrogen oxide (NOx) emissions was studied with a hydrotreated vegetable oil (HVO)-fueled nonroad diesel engine. HVO-fueled engine emissions, including aldehyde and polyaromatic hydrocarbon (PAH) emissions, were also compared with those emitted with fossil EN590 diesel fuel. At the engine standard settings, particle number and NOx emissions decreased at all the studied load points (50%, 75%, and 100%) when the fuel was changed from EN590 to HVO. Adjusting IVC timing enabled a substantial decrease in NOx emission and combined with SOI timing adjustment somewhat smaller decrease in both NOx and particle emissions at IVC -50 and -70 degrees CA points. The HVO fuel decreased PAH emissions mainly due to the absence of aromatics. Aldehyde emissions were lower with the HVO fuel with medium (50%) load. At higher loads (75% and 100%), aldehyde emissions were slightly higher with the HVO fuel. However, the aldehyde emission levels were quite low, so no clear conclusions on the effect of fuel can be made. Overall, the study indicates that paraffinic HVO fuels are suitable for emission reduction with valve and injection timing adjustment and thus provide possibilities for engine manufacturers to meet the strictening emission limits.

Reductions in particulate and NO(x) emissions by diesel engine parameter adjustments with HVO fuel.

Hydrotreated vegetable oil (HVO) diesel fuel is a promising biofuel candidate that can complement or substitute traditional diesel fuel in engines. It has been already reported that by changing the fuel from conventional EN590 diesel to HVO decreases exhaust emissions. However, as the fuels have certain chemical and physical differences, it is clear that the full advantage of HVO cannot be realized unless the engine is optimized for the new fuel. In this article, we studied how much exhaust emissions can be reduced by adjusting engine parameters for HVO. The results indicate that, with all the studied loads (50%, 75%, and 100%), particulate mass and NO(x) can both be reduced over 25% by engine parameter adjustments. Further, the emission reduction was even higher when the target for adjusting engine parameters was to exclusively reduce either particulates or NO(x). In addition to particulate mass, different indicators of particulate emissions were also compared. These indicators included filter smoke number (FSN), total particle number, total particle surface area, and geometric mean diameter of the emitted particle size distribution. As a result of this comparison, a linear correlation between FSN and total particulate surface area at low FSN region was found.

Human cell-based micro electrode array platform for studying neurotoxicity.

At present, most of the neurotoxicological analyses are based on in vitro and in vivo models utilizing animal cells or animal models. In addition, the used in vitro models are mostly based on molecular biological end-point analyses. Thus, for neurotoxicological screening, human cell-based analysis platforms in which the functional neuronal networks responses for various neurotoxicants can be also detected real-time are highly needed. Microelectrode array (MEA) is a method which enables the measurement of functional activity of neuronal cell networks in vitro for long periods of time. Here, we utilize MEA to study the neurotoxicity of methyl mercury chloride (MeHgCl, concentrations 0.5-500 nM) to human embryonic stem cell (hESC)-derived neuronal cell networks exhibiting spontaneous electrical activity. The neuronal cell cultures were matured on MEAs into networks expressing spontaneous spike train-like activity before exposing the cells to MeHgCl for 72 h. MEA measurements were performed acutely and 24, 48, and 72 h after the onset of the exposure. Finally, exposed cells were analyzed with traditional molecular biological methods for cell proliferation, cell survival, and gene and protein expression. Our results show that 500 nM MeHgCl decreases the electrical signaling and alters the pharmacologic response of hESC-derived neuronal networks in delayed manner whereas effects can not be detected with qRT-PCR, immunostainings, or proliferation measurements. Thus, we conclude that human cell-based MEA platform is a sensitive online method for neurotoxicological screening.

Nanoparticle emissions from a heavy-duty engine running on alternative diesel fuels.

We have studied the effect of three different fuels (fossil diesel fuel (EN590); rapeseed methyl ester (RME); and synthetic gas-to-liquid (GTL)) on heavy-duty diesel engine emissions. Our main focus was on nanoparticle emissions of the engine. Our results show that the particle emissions from a modern diesel engine run with EN590, GTL, or RME consisted of two partly nonvolatile modes that were clearly separated in particle size. The concentration and geometric mean diameter of nonvolatile nucleation mode cores measured with RME were substantially greater than with the other fuels. The soot particle concentration and soot particle size were lowest with RME. With EN590 and GTL, a similar engine load dependence of the nonvolatile nucleation mode particle size and concentration imply a similar formation mechanism of the particles. For RME, the nonvolatile core particle size was larger and the concentration dependence on engine load was clearly different from that of EN590 and GTL. This indicates that the formation mechanism of the core particles is different for RME. This can be explained by differences in the fuel characteristics.

Effect of open channel filter on particle emissions of modern diesel engine.

Particle emissions of modern diesel engines are of a particular interest because of their negative health effects. The special interest is in nanosized solid particles. The effect of an open channel filter on particle emissions of a modern heavy-duty diesel engine (MAN D2066 LF31, model year 2006) was studied. Here, the authors show that the open channel filter made from metal screen efficiently reduced the number of the smallest particles and, notably, the number and mass concentration of soot particles. The filter used in this study reached 78% particle mass reduction over the European Steady Cycle. Considering the size-segregated number concentration reduction, the collection efficiency was over 95% for particles smaller than 10 nm. The diffusion is the dominant collection mechanism in small particle sizes, thus the collection efficiency decreased as particle size increased, attaining 50% at 100 nm. The overall particle number reduction was 66-99%, and for accumulation-mode particles the number concentration reduction was 62-69%, both depending on the engine load.

Immersion coating of pellets with calcium pectinate and chitosan.

This study has investigated the potential of immersion coating calcium containing pellet cores first with pectin, and then with two different cross-linkers, calcium or chitosan. The interaction between pectin and calcium, and between pectin and chitosan, are believed to slow down the drug release, and thereby, the coated pellets might possibly be used for colon specific drug delivery. Both the calcium coated pellets and the chitosan coated pellets had a reduced drug release compared to uncoated pellets in 0.1M HCl (1 h) and phosphate buffer pH 6.8 (4 h). The most successful combination had a drug release of only 17% during the entire test period in comparison to the uncoated pellets that had a drug release of 80%. When chitosan was used as a cross-linker, a higher reduction in drug release was obtained than by using calcium as the cross-linker. For the pellets coated with pectin in combination with chitosan, the type of pectin with a degree of methoxylation (DM) of 35 was superior to the pectin type with DM 17. The drug release was further slowed down by choosing a type of chitosan with a high degree of deacetylation (Dda) 89% and by coating at low concentrations (0.1%) in the immersion solution.