The Impact of the Socio-Demographic Characteristics of Complementary and Alternative Medicine Users in Serbia on OTC Drug Consumption.

The Aim of this research is to analyze how the socio-demographic characteristics of users of Complementary and Alternative Medicine (CAM) in Serbia influence and impact their consumption of OTC drugs. Respondents and methods: The study employed the third edition of the National Health Survey of the Republic of Serbia, published in 2013, as a data source covering the Serbian population. The sample comprised of 550 interviewed individuals who had been applying a variety of CAM treatments over the previous 12 months. Their socio-demographic characteristics were used as independent variables impacting the consumption of OTC drugs over the previous 2-week period, representing the dependent variable. Results: Two thirds (65.3%) of the CAM users consumed OTC drugs at their own discretion, without recommendation by a physician or a relevant prescription. Users of OTC drugs were most often females whose ages ranged within the average interval of 49.16 ± 16.02, whose education level was to secondary school diploma, who were married and employed, lived in urban areas, mostly Belgrade, belonged to the middle-income group, and followed relevant headlines via public information channels (TV, the internet, radio, and print). Comparison of the results revealed, on the one hand, that 2/3 of respondents who had used and 1/3 of those who did not consume OTC drugs had undergone fecal occult blood tests over the past year (p < 0.05) and, on the other hand, that those respondents had been less frequently hospitalized in the previous year (p = 0.05). In addition, the same responders were found to access available health care services more frequently than did others (p < 0.05). Conclusion: Since, according to the statistics, it is highly likely that respondents who were CAM- and OTC drug-users would be less frequently hospitalized and not use medical leave, these results provide a strong indication that this phenomenon should be investigated in more depth. Moreover, the areas to be considered when defining strategies for determining patient treatments should also include the influence of socio-demographic factors on the patient's consciousness that would enable easier understanding of the proper usage of OTC drugs.

Design, synthesis, and local anti-inflammatory activity of 17ß-carboxamide derivatives of glucocorticoids.

Molecular docking studies were performed on 18 17ß-carboxamide steroids in order to select compounds with potential local anti-inflammatory activity. These derivatives are amides of cortienic acids (obtained from hydrocortisone, prednisolone, and methylprednisolone) with methyl or ethyl esters of six amino acids. Interactions with the glucocorticoid receptor (GR), binding energies and ligand efficiency values of these compounds were compared with dexamethasone and cortienic acid obtained from prednisolone (inactive metabolite). On the basis of molecular docking studies, seven compounds were selected and their binding affinities for the GR were predicted by use of the exponential model created in this study. Subsequently, selected compounds were synthesized in good yields by use of modified N,N'-dicyclohexylcarbodiimide (DCC)/1-hydroxybenzotriazole (HOBt) coupling procedure. Finally, the local anti-inflammatory activity of the synthesized compounds was examined by use of the croton oil-induced ear edema test. In vivo evaluation of systemic side effects as well as in silico prediction of metabolism were performed on the derivative with the best local anti-inflammatory activity. The combination of molecular docking studies and the exponential model for the GR binding affinity prediction could be used as an in silico tool for the rational design of novel 17ß-carboxamide steroids with potentially better biological profile than dexamethasone.

Cross-sectional survey on complementary and alternative medicine awareness among health care professionals and students using CHBQ questionnaire in a Balkan country.

OBJECTIVE: To conduct a study on attitudes, knowledge, and use of complementary and alternative medicine (CAM) therapies in Serbia. Available data about CAM therapies in the region are scarce, opinions lacking from health sector. Balkan region countries had a delay in issuing national policies on CAM therapies. METHODS: The questionnaire used was based on previously validated CAM Health Belief Questionnaire (CHBQ), formulated as 5-item Likert type scale, adjusted for local environment. Health care students and professionals were evaluated. The questionnaire comprehended 10 closed questions on attitudes, knowledge and use of CAM therapies. This survey was conducted in eight cities of Serbia, January 2010-July 2011. A total of 797 participants was included. The second group of participants was 145 healthcare professionals (50 academic staff, 64 clinical staff, 19 pharmacists, 6 other clinical branch specialists and 6 nurses). Data were collected by an interview. Examinees could acquire maximum of 70 points, 35 representing neutral attitude. RESULTS: Students of dentistry (54.65±6.07) were better informed on CAM therapies than medicine students (50.26±7.92). Pharmacy students (51.16±7.10) accepted low-scientific CAM. Pharmacists scored better than university professors (55.12±6.55 vs. 50.29±9.50). Primary health care professionals had better awareness than pharmacists in dispensing pharmacies. Both groups of participants preferred use of vitamins over any other CAM therapy. CONCLUSION: These pioneering efforts in the region exposed weaknesses in CAM attitudes of current and future health care professionals. Nevertheless, awareness on alternative medicine treatment choices is growing among Balkan prescribers. Supportive legal framework would facilitate dissemination of CAM medical practices.

Complex regional pain syndrome type I in the upper extremity - how efficient physical therapy and rehabilitation are.

AIM: To evaluate the effects of early started combined therapy in Complex Regional Pain Syndrome-1 (CRPS-1) on the upper extremities. METHODS: The study included 36 patients in the first stadium of CRPS-1 on the upper extremities The mean age of patients was 42.6±14.6, the majority of them (26 of 36) were females. The right side of the upper extremity was affected much more then the left side. They were treated by combined therapy including analgetics, electrotherapy, magneto therapy and kinesitherapy. The average length of observation was 172.1 days (from 90 to 250 days). The average length of treatment was 91.5±42.16 days. Intensity of pain, swelling of the extremity, the change in skin coloration and cutaneous manifestations were assessed three times, at the beginning of the treatment, after 6 weeks and at the end of the treatment. RESULTS: The pain was registered in all patients at visit 1 (average pain intensity was 5.70 ±1.44 on 100 mm visual analogue scale), and it was progressively decreased during the treatment from 3.60±1.22 at the second visit to 0.34±0.68 at the third visit. Vasodilatation was registered in 30 (83.33%) patients and skin temperature asymmetries was found in 21 (58.33%) patients. The difference of size was detected in 30 (83.33%) patients at the first visit compared to four (11.11%) patients at the end of the treatment. There were six (16.66%) patients without swelling at the beginning compared to 26 (72.22%) at the end of the treatment (p less than 0.000). Complete healing was achieved in 32 patients (88.88%). CONCLUSION: The carefully chosen physical agents in combination with analgesic and non-steroidal anti-inflammatory drugs may benefit in patients with CRPS-1 on the upper extremity if the treatment starts as soon as possible.