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Objectives:

Residues of pharmaceuticals, originating from production, distribution or consumption, reach the environment where they have negative consequences on ecosystems. Educating future physicians and pharmacists could promote more environmentally friendly decisions throughout the life-cycle of pharmaceuticals. The aim of this cross-sectional study was to describe how pharmaceuticals in the environment was integrated into Swedish universities' medicine and pharmacy educations.

Methods:

The study was conducted November-December 2022 and consisted of two parts; i) a review of program curricula for medicine and pharmacy programs in Sweden and ii) a questionnaire distributed to course managers at pharmacy programs, and to program managers at medicine programs. Multiple-choice questions were analysed with descriptive statistics. Openended questions and program curricula were assessed qualitatively with content analysis.

Results:

Pharmaceuticals in the environment was mentioned in the general learning objectives aligned with the Higher Education Ordinance, but content related to environment was only included in curricula for some courses, mainly regarding sustainable development. A total of 47/ 100 pharmacy course managers and 6/7 medicine program managers responded to the questionnaire. 19/47 pharmacy course managers and 6/6 medicine program managers indicated that their courses include aspects of pharmaceuticals in the environment. The most common areas in pharmacy courses were sustainable drug use, and sustainable drug manufacturing/development.

Conclusions:

Sweden's medicine and pharmacy programs contain some education about environmental impacts of pharmaceuticals but the curricula could be developed further. There is room for improvement in integrating environmental themes throughout the programs, potentially as an interprofessional education with a life-cycle perspective of pharmaceuticals.

Background

During the initial phase of the COVID-19 pandemic, there was an intensive debate on which strategies would be most effective to minimize the negative societal impact of the pandemic. This study aimed to provide an overview of key epidemiological outcome measures of the disease in the Nordic countries and the subsequent policy implementation that were undertaken to curb the outbreak.

Methods

Time trends in test-positive infections, hospitalizations, and intensive care unit (ICU) admissions due to COVID-19 as well as COVID-19 mortality and excess mortality were compared between Denmark, Finland, Iceland, Norway, and Sweden. The epidemiological patterns were presented in relation to 13 different policies implemented to a different degree in the countries, eight of which were related to containment and five to health systems policy. A stringency index summarized the intensity of the policies. Data were collected from Our World in Data, the Oxford COVID-19 Government Response Tracker and Eurostat. The investigated time period was 1 January 2020 to 30 April 2022.

Results

Overall, Sweden had more infections, deaths, hospitalizations, and ICU admissions than the other Nordic countries during the first three waves of the pandemic. However, in the fourth wave, Denmark exceeded Sweden in all outcomes. The overall stringency among the Nordic countries varied broadly. The lowest average stringency index was observed in Iceland and the highest in Sweden. Excess mortality over the whole study period was lowest in Iceland while Norway had very few ICU admissions.

Conclusions

The Nordic countries took vastly different approaches to contain the spread of the pandemic, but the long-term impact on excess mortality was similar. The variety in policy responses and epidemiological measures bring many opportunities for learning across the countries.

Introduction: Polypharmacy is increasing among older individuals worldwide. Deprescribing has been suggested as a strategy to reduce polypharmacy, but it has had a limited impact.

Objective: This study investigated the facilitators and barriers to deprescribing in older adults, as perceived by primary care general practitioners, focusing particularly on factors influencing deprescribing in frail individuals.

Methods: A qualitative approach was employed and semistructured interviews were conducted between 9 April and 29 May 2024 with a sample of 30 general practitioners working in primary care facilities in Crete, Greece. The interviews were recorded and transcribed verbatim. Thematic analysis was performed on the basis of the Theoretical Domains Framework.

Results: Several barriers to deprescribing were revealed, including a lack of expertise and motivation, inadequate communication skills, time constraints, and negative beliefs toward deprescribing held by physicians and patients. The lack of an established role for general practitioners in primary care, the absence of a national initiative targeting polypharmacy, and the influence of pharmacists and pharmaceutical representatives were highlighted as challenges. The identified facilitators included the incorporation of deprescribing recommendations and considerations for frail patients into guidelines, fostering a strong doctor-patient relationship, promoting shared decision-making, facilitating effective collaboration with caregivers, and utilizing nonpharmacological therapy.

Conclusions: General practitioners encounter both barriers and facilitators when making deprescribing decisions for older adults, particularly those with frailty syndrome. Researchers and policymakers can use the findings of this research to guide future interventions and promote successful deprescribing practices.

Purpose

Studies on antihypertensive treatment are important, as hypertension remains the major risk factor for cardiovascular morbidity and premature death. However, antihypertensive medicines are also used for other conditions, and the use of these medicines as a proxy for a diagnosis of hypertension might lead to misclassification in pharmacoepidemiological studies. This study aimed to investigate to what extent people dispensed antihypertensive medicines have been diagnosed with hypertension.

Methods

Cross-sectional study with data covering all healthcare and all dispensed prescriptions of antihypertensive medicines 2019 and diagnoses recorded 2015–2019 from the Stockholm Region, Sweden. Multinomial logistic regressions were used to assess the probability of having hypertension concerning age, sex, and antihypertensive drug class.

Results

A total of 386 860 individuals were included, 49% men, 12% incident users, and 80% of all had a recorded diagnosis of hypertension. In 73% of incident users, only one antihypertensive drug class was dispensed, as compared to 36% of prevalent users. A total of 38% of incident users and 9% of prevalent users had none of the diagnoses selected for the study recorded in any health record during 5 years. Prevalent and older users over the age of 65 from high (50%–79%) to very high (80% and more) probability of a recorded diagnosis of hypertension. Patients on antiadrenergic agents, high-ceiling diuretics, aldosterone antagonists, or beta receptor blockers had a lower probability of having a recorded diagnosis of hypertension than patients dispensed angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or calcium channel blockers.

Conclusion

Most patients dispensed antihypertensive medicines have a diagnosis of hypertension. However, caution is needed using data on dispensed medicines to classify incident antihypertensive users and younger patients as having a diagnosis of hypertension.

Background: Poor adherence to secondary preventive medication after myocardial infarction (MI) negatively affects long-term prognosis, but knowledge is lacking regarding the impact of poor adherence on prognosis for patients with myocardial infarction with non-obstructive coronary arteries (MINOCA). We therefore investigated the effect of persistence to secondary preventive medication on prognosis in patients with MINOCA compared with patients with myocardial infarction with obstructive coronary arteries (MI-CAD).

Methods: In this nationwide observational study of 116,143 patients with MI recorded in the SWEDEHEART registry between 2006 & horbar;2017, MINOCA were identified in 9,124 patients and MI-CAD in 107,019 patients. Persistence to treatment with aspirin, statins, beta blockers and angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs) was investigated for 5 years post discharge and patients were followed for a composite endpoint of major adverse cardiovascular events (MACE), including all-cause death, MI, ischemic stroke and heart failure.

Results: Persistent use of secondary preventive medications was associated with a decrease in the risk of MACE during follow-up in both MINOCA and MI-CAD patients; aspirin HR 0.70 (CI 0.60-0.82) vs. HR 0.60 (CI 0.57-0.64), statins HR 0.80 (CI 0.68-0.95) vs. HR 0.66 (CI 0.63-0.69), beta blockers HR 0.77 (CI 0.65-0.92) vs. HR 0.76 (CI 0.73-0.80) and ACEIs/ARBs HR 0.62 (CI 0.50-0.77) vs. 0.67 (CI 0.63-0.71).

Conclusion: Persistence to secondary preventive medications after MI is associated with a reduction in the risk for MACE in both patients with MINOCA and MI-CAD. Continuous efforts to improve adherence to evidence-based medications in general to all patients with MI should be a priority.