Quality assurance in drug demand reduction in European countries: an overview

Background: The EMCDDA, through its network of National Focal Points, collects information on the quality assurance systems for drugs-related interventions across European countries. European National Drug Strategies include recommendations for systems and approaches for the assurance of the quality of interventions.

Methods: We searched National Drug Strategies for elements related to quality assurance in drug demand reduction and summarised information through questionnaires administered to the EMCDDA Network of National Focal Points.

Results: In total, 15 National Drug Strategies and 60 questionnaires were analysed. Almost all the strategies include quality-related topics. Frequently, the Ministry of Health leads quality assurance although sometimes jointly with the Ministries of Education, Labour, Family and Social Welfare. Accreditation systems are common, but implemented in different ways. Training and education are widely provided, for the vast majority of countries, consisting of short-term training to keep professionals updated. Guidelines and Standards are gathering momentum as the major tools for the implementation of evidence-based recommendations and are usually available across countries.

Conclusions: Although the evidence base for interventions in drug demand reduction is becoming available and accepted, attention needs to be given to implementation issues. The European countries are rapidly moving towards paying greater attention to the quality of interventions.     

Life expectancy and healthy life expectancy changes between 2000 and 2015: an analysis of 183 World Health Organization member states

Aim

To analyze the changes and inequalities in life expectancy (LE) and healthy life expectancy (HLE) of 183 World Health Organization (WHO) member states between 2000 and 2015, focusing on gender differences.

Subjects and methods

An exploratory study was carried out. The database containing information about male and female LE and HLE at birth and at the age of 60 years old, for the years 2000 and 2015, was gathered for each country from WHO’s global health observatory.

Results

Countries with low LE (respectively HLE) are obtaining greater gains in LE (respectively HLE), overcoming infant mortality, while countries with greater LE (respectively HLE) are improving the elderly’s survivorship. Gains in LE are expected to be followed by gains in HLE, but such gains are getting smaller over time. The female-male LE gap is strongly correlated with the female-male HLE gap. A regression towards the mean is observed regarding the gender gap.

Conclusions

Monitoring of LE and HLE indicators is important to assess the health situation in countries across time, detecting both successful and unsuccessful cases. In our analysis, we noticed that African countries are overcoming the bad results of the 1990s and that army conflicts are the main cause of losses in LE in the third millennium.

     

Cross-cultural validation of the German version of the Four-Dimensional Symptom Questionnaire (4DSQ) in multimorbid elderly people

Purpose

Psychosomatic symptoms and mental health problems are highly prevalent in multimorbid elderly people challenging general practitioners to differentiate between normal stress and psychopathological conditions. The 4DSQ is a Dutch questionnaire developed to detect anxiety, depression, somatization, and distress in primary care. This study aims to analyze measurement equivalence between a German version and the original Dutch instrument.

Methods

A Dutch and a German sample of multimorbid elderly people, matched by gender and age, were analyzed. Equivalence of scale structures was assessed by confirmatory factor analysis (CFA). To evaluate measurement equivalence across languages, differential item functioning (DIF) was analyzed using Mantel–Haenszel method and hybrid ordinal logistic regression analysis. Differential test functioning (DTF) was assessed using Rasch analysis.

Results

A total of 185 German and 185 Dutch participants completed the questionnaire. The CFA confirmed one-factor models for all scales of both 4DSQ versions. Nine items in three scales were flagged with DIF. The anxiety scale showed to be free of DIF. DTF analysis revealed negligible scale impact of DIF.

Conclusions

The German 4DSQ demonstrated measurement equivalence to the original Dutch instrument. Hence, it can be considered a valid questionnaire for the screening for mental health problems in primary care.

     

Impact of untreated dental caries severity on the quality of life of preschool children and their families: a cross-sectional study

Purpose

Untreated dental caries is a persistent oral problem among preschool children. Although there is vast evidence regarding the impact of dental caries on oral health-related quality of life (OHRQoL) in this age group, evidence on the impact of untreated caries severity is scarce. The purpose of this study was to investigate the impact of untreated caries severity on the OHRQoL of preschool children and their families.

Methods

A cross-sectional study was conducted with 563 individuals in the city of Goiania, Brazil. Data were collected through interviews with parents/caregivers and clinical examinations of their children. The OHRQoL was measured by the Brazilian version of the Early Childhood Oral Health Impact Scale. Untreated dental caries severity was assessed using validated indices. Other independent variables were socioeconomic, toothache prevalence, and the questionnaire respondent. Statistical analysis involved bivariate comparisons and Poisson regression analyses.

Results

A higher prevalence of impact on OHRQoL was found among preschool children with untreated dental caries with clinical consequences (PR 1.31; 95% CI 1.01–1.70) compared to those without caries; those aged 5 years (PR 1.47; 95% CI 1.18–1.82), compared to those aged two; and those with a toothache (PR 1.54; 95% CI 1.34–1.76), compared to those without toothache. Moreover, fathers (PR 0.71; 95% CI 0.55–0.92) and other respondents (PR 0.70; 95% CI 0.52–0.96) perceived less impact on the OHRQoL in comparison to mothers.

Conclusions

Severe untreated dental caries with clinical consequences had a negative impact on the children’s OHRQoL, regardless of toothache and socioeconomic factors.

     

PVA-PEG physically cross-linked hydrogel film as a wound dressing: experimental design and optimization

The development of hydrogel films as wound healing dressings is of a great interest owing to their biological tissue-like nature. Polyvinyl alcohol/polyethylene glycol (PVA/PEG) hydrogels loaded with asiaticoside, a standardized rich fraction of Centella asiatica, were successfully developed using the freeze–thaw method. Response surface methodology with Box–Behnken experimental design was employed to optimize the hydrogels. The hydrogels were characterized and optimized by gel fraction, swelling behavior, water vapor transmission rate and mechanical strength. The formulation with 8% PVA, 5% PEG 400 and five consecutive freeze–thaw cycles was selected as the optimized formulation and was further characterized by its drug release, rheological study, morphology, cytotoxicity and microbial studies. The optimized formulation showed more than 90% drug release at 12?hours. The rheological properties exhibited that the formulation has viscoelastic behavior and remains stable upon storage. Cell culture studies confirmed the biocompatible nature of the optimized hydrogel formulation. In the microbial limit tests, the optimized hydrogel showed no microbial growth. The developed optimized PVA/PEG hydrogel using freeze–thaw method was swellable, elastic, safe, and it can be considered as a promising new wound dressing formulation.     

Bauhinia forficata in the treatment of diabetes mellitus: a patent review

Introduction: Diabetes Mellitus has been considered an epidemic by the World Health Organization, with a high risk of morbidity and mortality. The treatment of this pathology consists in glycemic control, which can be done by oral hypoglycemic agents, insulin therapy, dietary guidance, regular physical activity, and psychosocial support. In addition, other adjuvant treatments are employed, such as phytotherapic, and one of the most used plants is Bauhinia forficata.

Areas covered: In the current review, patents using Bauhinia forficata for the Diabetes Mellitus treatment have been analyzed. There were 03 patents in WIPO, 01 in Espacenet, 01 in USPTO, and 02 in INPI.

Expert opinion: Patents on the adjuvant treatment of Diabetes Mellitus by Bauhinia forficata are discussed. Although there are some phytotherapy products containing this medicinal plant which has hypoglycemic effect here is still a need for the development of more products based on natural resources, for the treatment of this pathology, without side effects and with other benefits, to assist in the glycemia control in diabetic patients, and to improve their quality of life.     

Patents related to the treatment and diagnosis of bruxism

Introduction: Bruxism is among the most chronic dental problems worldwide, and its perception may increase indicatively the condition of people’s health, avoiding future health problems. Technologic solutions have improved considerably owing to new diagnostic and treatment technologies and their automation. This review aims to assess therapeutic methods for bruxism through analysis of patent applications spanning recent decades.

Areas covered: Patent families of bruxism, and products available on the market. Data were obtained through Questel Orbit from the European Patent Office on a worldwide basis using Cooperative Patent Classification (CPC), analyzing 134 patent families. The products on the market were mapped and classified as used for diagnosis, treatment, or both.

Expert opinion: This technological prospect has shown that the technological field of bruxism is growing toward smaller, automated devices; there is still no predominant owner of the technologies. Products are expected to provide home use with a high degree of reliability and specificity, using the Internet of Things (telemedicine associated with industry 4.0) and enabling real-time diagnosis.