Development of an immediate release excipient composition for 3D printing via direct powder extrusion in a hospital.

3D printing offers the possibility to prepare personalized tablets on demand, making it an intriguing technology for hospital pharmacies. For the implementation of 3D-printed tablets into the digital Closed Loop Medication Management system, the required tablet formulation and development of the manufacturing process as well as the pharmaceutical validation were conducted. The goal of the formulation development was to enable an optimal printing process and rapid dissolution of the printed tablets for the selected model drugs Levodopa/Carbidopa. The 3D printed tablets were prepared by direct powder extrusion. Printability, thermal properties, disintegration, dissolution, physical properties and storage stability were investigated by employing analytical methods such as HPLC-UV, DSC and TGA. The developed formulation shows a high dose accuracy and an immediate drug release for Levodopa. In addition, the tablets exhibit high crushing strength and very low friability. Unfortunately, Carbidopa did not tolerate the printing process. This is the first study to develop an immediate release excipient composition via direct powder extrusion in a hospital pharmacy setting. The developed process is suitable for the implementation in Closed-Loop Medication Management systems in hospital pharmacies and could therefore contribute to medication safety.

Country of birth and hospitalization for pelvic inflammatory disease, ectopic pregnancy, endometriosis, and infertility: a nationwide study of 2 million women in Sweden.

OBJECTIVE: To examine the association between country of birth and hospitalization for pelvic inflammatory disease (PID), ectopic pregnancy (EP), endometriosis, and infertility. DESIGN: Follow-up study. SETTING: Sweden. PARTICIPANT(S): A total of 2,170,177 women living in Sweden at some point between 1990 and 2004, categorized into 10 different groups according to country of birth. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Hospitalization for PID, EP, endometriosis, and infertility. RESULTS: For PID and infertility, all groups of foreign-born women exhibited significantly increased risks compared with Swedish-born women. The highest risks of PID were found among women from southern Europe, Eritrea/Ethiopia/Somalia, and other African countries, whereas the highest risks of infertility were found among women from Middle Eastern countries, other Asian countries, and other African countries. Compared with PID and infertility, country of birth was less associated with endometriosis and EP, although some differences were found. All relative risks were adjusted for age, time period, and the women's socioeconomic status. CONCLUSION(S): Even in a country like Sweden, which offers publicly financed treatment for infertility, differences based on country of birth exist. Although data on partners' income were not available to us, it is possible that other factors besides socioeconomic factors are present in the etiology of female health problems related to infertility.

The clinical diagnosis of pelvic inflammatory disease--reuse of electronic medical record data from 189 patients visiting a Swedish university hospital emergency department.

BACKGROUND: The pelvic inflammatory disease (PID) diagnosis is mostly based on clinical findings. However, few studies have examined the clinical basis for the diagnostics of PID, which was the aim of this study. METHODS: A retrospective study was performed of 189 out-patients diagnosed as having PID at the obstetric and gynecological emergency department of a Swedish university hospital. Data on symptoms, signs, pelvic examination and laboratory tests were extracted from the electronic medical records in comparison with the diagnostic criteria of the PID Guideline of the US Center of Disease Control from 2002 (CDC 2002 Guidelines). RESULTS: Eight symptoms in varying combinations were associated with the PID diagnosis. Most of them are mentioned in the CDC 2002 Guidelines. Detected rates of C. Trachomatis (CT) and N. Gonorrhoeae (NG) were 5% and 0%, respectively, among the tested patients (CT = 52% and NG = 12%). The C-reactive protein was normal in the majority of tested patients. CONCLUSION: The clinical basis for the diagnostics of PID was largely in accordance with the criteria in the CDC 2002 Guidelines. The limited number of CT tests performed is somewhat disappointing, considering the fact that effective disease prevention includes widespread CT screening. Further studies in different settings are needed in order to analyze how the testing rate for CT can be improved in clinical praxis.

Socioeconomic factors, country of birth, and years in Sweden are associated with first birth fertility trends during the 1990s: a national cohort study.

AIMS: Decreasing fertility rates and postponement of first birth are of considerable public health concern in many industrialized countries. Previous studies suggest that this will increase involuntary childlessness in the population. The general aim was to examine the association between sociodemographic factors and first birth fertility trends in Sweden during the 1990s. METHODS: This Swedish national study examined changes in first birth rates and mean age at first birth between 1991 and 1992 (n = 452,000) and 1997-98 (n = 495,756). The impact of socioeconomic factors and years in Sweden on first birth fertility was examined among Swedish-born and 19 subgroups of foreign-born women aged 20-41 years. Poisson regression was used in the analysis. RESULTS: First birth rates decreased and mean age at first birth increased between the two periods among the Swedish-born and most foreign-born women. Non-employment and low income were associated with decreased first birth fertility, and low educational status was associated with slightly increased first birth fertility. Interaction tests revealed that, in contrast to Swedish-born women, several groups of foreign-born women increased their first birth fertility even if they were non-employed or had a low income. Among foreign-born women fewer years in Sweden was significantly associated with increased first birth fertility. CONCLUSION: Public health information should emphasize that postponement of first birth could lead to involuntary childlessness. Health care workers need to consider the woman's socioeconomic characteristics, country of birth, and years in Sweden when such information is given.

Effects of alcohol consumption on female fertility during an 18-year period.

OBJECTIVE: To investigate the long-term effects of alcohol consumption on female fertility. DESIGN: Prospective study of a random sample of 7,393 women, selected from the 445,000 inhabitants of Stockholm County, Sweden, in 1969. Self-estimated alcohol consumption was obtained from postal questionnaires. Data on hospitalizations for pregnancy outcomes including infertility examinations were analyzed until 1987. SETTING: Healthy women in Stockholm County, Sweden. PATIENT(S): Seven thousand three hundred ninety-three women in the age range 18-28 years. MAIN OUTCOME MEASURE(S): Rates of hospitalization for deliveries, miscarriages, legal abortions, extrauterine pregnancies, pelvic inflammatory disease, endometriosis, and infertility examinations were analyzed in relation to the intake of alcohol. RESULT(S): Two hundred fifty-two women underwent infertility examinations. High consumers had an increased risk for such examinations, as compared with moderate consumers: relative risk ratio (RR) = 1.59 (95% confidence interval [CI]: 1.09-2.31); and low consumers had a decreased risk (RR = 0.64; CI: 0.46-0.90). Moreover, for both high and low consumers we observed a significantly lower number of first and second partus. Rates of miscarriage, extrauterine pregnancy, and pelvic inflammatory disease did not differ between high and low consumers of alcohol. CONCLUSION(S): High alcohol consumption was associated with increased risk of infertility examinations at hospitals and with lower numbers of first and second partus. It may be important for the female partner in an infertile couple to limit alcohol intake or to not drink at all.