Significance of organizational health features during the COVID-19 pandemic for the well-being of Lithuanian healthcare workers.

Summary: During various emergencies, especially pandemics, there is a heavy burden on healthcare workers and pharmacists. Organizational support plays a significant role in protecting their mental health. Though the study aimed analyze the subjectively perceived difficulties and challenges of healthcare workers related to organizing work in the context of a pandemic. Methods: Twenty seven subjects (20 women, 7 men) participated in the qualitative research 30-45 min. Duration semi-structured interviews were performed, and thematic data analysis was applied. Results: During the first wave of the COVD-19 pandemic, research participants experienced an avalanche of change in all significant areas of life: experienced general overall uncertainty, confusion in working order, and intense changes in work functions, responsibilities, and workload. These changes reduced the scope for control and predictability, there was a lack of structure and clarity. The avalanche of change caused by the COVID-19 pandemic provoked a strong and controversial emotional response. The contradiction was revealed between helplessness, disruption, loss of control experienced by staff and the internal and external pressure to adapt as quickly as possible to the functions of caregivers. The threats posed by the pandemic reinforced the need for active and engaged leadership and highlighted the key features of an employee supporting organization. Conclusion: Surviving the avalanche of change caused by the pandemic, healthcare workers and pharmacists emphasized the importance of management decisions about managing patient and employee health threats, clear work organization, active and inclusive leadership, change planning, and organizational concern for employee sustainability and emotional well-being. Regular, systematic, clear and understandable, timely, open and sincere, uncontroversial, and consistent communication of administration provides security for employees and can contribute to better physical and psychological well-being of employees.

Pharmacovigilance and Adverse Drug Reaction Reporting among the General Public in Lithuania: A Cross-Sectional Study.

Background: Despite the fact that for over ten years, Lithuanian consumers have been able to report adverse drug reactions (ADR) directly to the competent authority, reporting rates remain low. A comprehensive understanding of consumer perceptions and experiences regarding ADRs is needed to ascertain further factors impacting their engagement in ADR reporting. This study aimed to assess consumer knowledge of, attitude toward, and practice of reporting ADRs. Methods: A questionnaire-guided cross-sectional survey among 404 consumers between October 2021 and June 2022 was conducted. The semi-structured questionnaire comprised open-ended and closed-ended questions to explore the sociodemographic characteristics and general knowledge of ADRs and pharmacovigilance. Other question items evaluated attitudes toward ADR reporting and ADR reporting practice. The data were summarised using descriptive statistics, while the chi-square test was used to assess categorical variables at p < 0.05. The overall percent score in the knowledge and attitude domains was divided into groups of "poor", "moderate", and "good" knowledge, as well as "positive" and "negative" attitudes. Results: While having a generally poor understanding, this study demonstrates that Lithuanian consumers have a favourable attitude toward pharmacovigilance, particularly regarding issues involving the requirement for reporting. The data also revealed the justifications for reporting and not reporting ADRs. Conclusions: The current study provided the first understanding of consumer awareness and ADR reporting intentions, which can help to develop educational campaigns and interventions addressing pharmacovigilance and ADR reporting.

Psychological Aspects of Media Communication during the COVID-19 Pandemic: Insights from Healthcare and Pharmacy Specialists in Lithuania.

In the setting of disasters, people seek information as they hope that knowledge will provide security. This makes the media a critical source of crisis exposure. The aim of the study described in this article was to analyze COVID-19 pandemic-related psychological aspects of media use by healthcare and pharmacy workers in Lithuania and to reveal the subjective effects of media consumption on their psychological well-being. 967 healthcare workers and pharmacists in Lithuania completed an electronic survey, which consisted of questions about the changes in well-being experienced since the beginning of the lockdown and media use in the search for information on COVID-19. It was found that communication might have ambiguous effects on psychological well-being. Excessive, unreliable, misleading, contradictory information and "catastrophizing" were subjectively related to impaired psychological well-being. Objective and reliable, relevant, clear, timely, hopeful and supportive information had a subjective positive effect. Seeking COVID-19-related information many times a day was associated with increased fear of becoming infected with COVID-19, feeling unable to control the risk of contracting COVID-19, fear of infecting relatives with COVID-19 and feeling that other people would avoid interaction with healthcare workers and pharmacists because of their job. General browsing was not consistently associated with COVID-19-related fears.

How Does the Assessment of Work Organization during the COVID-19 Pandemic Relate to Changes in the Well-Being of Health System Workers?

In the case of various emergencies, especially pandemics, healthcare workers are faced with disproportionate pressures. Organizational support plays a significant role in protecting the psychological and physical health of healthcare workers. This interdisciplinary research aims to determine how changes in the physical and psychological well-being of healthcare and pharmacy workers during the first wave of the COVID-19 lockdown are related to work organization factors that support safety and stability. A quantitative research strategy was applied in the research. Data from an electronic survey assessed the changes in the physical and psychological well-being of healthcare and pharmacy workers during the lockdown period and the organizational factors supporting safety and stability. The sample of the quantitative research consisted of 967 employees of healthcare institutions and pharmacies in Lithuania. This research broadens the concept of organizational factors and provides data on their interaction with the changes of employee well-being indicators in a pandemic situation. It was found that positive changes in the evaluation of physical as well as psychological well-being during the COVID-19 lockdown could be consistently predicted by all the analyzed safety and stability supporting organizational factors that were found to be associated with subjective physical well-being and psychological well-being even when adjusting for the effect of socio-demographic factors (gender, age, work field, and specialty). The identification and proper management of organizational factors was significant for the psychological and physical well-being of healthcare workers during the lockdown period. It was found that all estimates of safety and stability supporting organizational factors during the first wave of the COVID-19 pandemic lockdown were positively related and could act as protective factors to the subjective physical and psychological well-being of healthcare and pharmacy workers.

Qualitative Study of Community Pharmacists' and General Practitioners' Views toward Pharmacovigilance in Lithuania.

Lithuania is the leader in pharmacovigilance among the three Baltic countries. However, comparisons with other European countries are difficult because the reported number of adverse drug reactions (ADRs) in Lithuania is too low to rely on in terms of the annual use of medicines by the population over the year. The aim of this study was to explore challenges related to the understanding and practices of general practitioners and community pharmacists in reporting ADRs in Lithuania. The qualitative study approach of face-to-face interviews was used. All interviews were recorded, transcribed verbatim, and thematically analyzed. Twelve interviews with general practitioners and community pharmacists were conducted from March 2020 through December 2020. All participants had a basic knowledge of pharmacovigilance, but only four participants reported ADRs to the interviewer. Six main barriers regarding ADR reporting were identified, and appropriate interventions were suggested. The importance of collaboration between physicians and pharmacists was highlighted, and the need for guidelines supporting collaboration was expressed. Medications are becoming more complex, and comprehensive medication management is key for the optimization of patient outcomes. Our results reveal the need to improve and innovate the current pharmacovigilance system at all levels, starting from education for pharmacy and healthcare students and continuing through the development of ADR procedures.

Comparison of Ethanolic and Aqueous-Polyethylenglycolic Propolis Extracts: Chemical Composition and Antioxidant Properties.

In recent years, particular attention has been paid to the natural antioxidants. Bee products, especially propolis, are characterized by multifunctional (antioxidant, anti-inflammatory, antibacterial, antiviral, and food preservative) effects and can be used for the development of functional food or food preservatives. Propolis extracts that are commonly produced are ethanolic; therefore, to certain groups of consumers, for example, children and alcohol sensitive group, their applicability is limited. The aim of this study was to develop alternative propolis from aqueous-polyethylenglycolic propolis extract (AQUA-PEG) and compare the chemical composition as well as antioxidant (radical-scavenging and reduction properties) activities to those of ethanolic propolis extract (EEP). Polyethylene glycol is quite a good solvent, which can be successfully used for the preparation of NEP. The total quantity of phenolic compounds identified in AQUA-PEG (400.36 µg/mL), prepared according to our technology, is very similar to that of EEP (433.53 µg/mL), whereas the amount of phenolic acids was greater by 1.31-fold in AQUA-PEG and of flavonoids was greater by 2.38-fold in EEP. The antioxidant activity depends on the method used: by applying the ABTS and CUPRAC methods, both extracts demonstrate similar antioxidant (antiradical and reducing) activity, whereas in the case of the DPPH and FRAP method, significantly higher antioxidant activity was detected in EEP. This should be taken by researchers into account especially when interpreting the results and drawing conclusions about the antioxidant activity of propolis extracts. On the basis of the results, AQUA-PEG, prepared by the developed technology, can be used as an alternative form to ethanolic propolis extract, since it contains a large quantity of antioxidants, namely, flavonoids and phenolic acids. We believe that nonethanolic propolis extract has the prospect of being applied for the development of functional foods in order to alleviate certain symptoms of oxidative stress or for the prevention of some oxidative-stress-related diseases.

Adverse Drug Reaction Reporting by Patients in 12 European Countries.

Patients who report suspected adverse drug reactions (ADRs) help minimize drug safety risks and bolster the pharmacovigilance system. The aim of this study was to examine the contribution of patients to pharmacovigilance and compare the tools used to promote patient reporting in European countries that implemented this reporting type in 2012-2013. A web-based questionnaire was sent to the national competent authorities (NCAs) of the European countries. The received answers were systematized and compared using statistical analysis. The performed statistical analysis demonstrated that changes in the number of received ADR reports increased significantly in each country during the analyzed period. These changes were significantly different in Ireland and Finland from those in the other reviewed countries. The common source of information on direct patient reporting was the country's NCA website. Other sources used were social media pages, leaflets, and posters. This is the first study on patient reporting schemes implemented after the significant reform of the European regulatory system for pharmacovigilance. However, some countries did not actively promote their patient reporting schemes. Our findings indicate that countries with minimal experience in pharmacovigilance systems that include direct patient reporting should organize comprehensive campaigns on ADR reporting.

In vitro antiviral activity of fifteen plant extracts against avian infectious bronchitis virus.

BACKGROUND: Avian infectious bronchitis (IB) is a disease that can result in huge economic losses in the poultry industry. The high level of mutations of the IB virus (IBV) leads to the emergence of new serotypes and genotypes, and limits the efficacy of routine prevention. Medicinal plants, or substances derived from them, are being tested as options in the prevention of infectious diseases such as IB in many countries. The objective of this study was to investigate extracts of 15 selected medicinal plants for anti-IBV activity. RESULTS: Extracts of S. montana, O. vulgare, M. piperita, M. officinalis, T. vulgaris, H. officinalis, S. officinalis and D. canadense showed anti-IBV activity prior to and during infection, while S. montana showed activity prior to and after infection. M. piperita, O. vulgare and T. vulgaris extracts had > 60 SI. In further studies no virus plaques (plaque reduction rate 100%) or cytopathogenic effect (decrease of TCID50 from 2.0 to 5.0 log10) were detected after IBV treatment with extracts of M. piperita, D. canadense and T. vulgaris at concentrations of extracts ≥0.25 cytotoxic concentration (CC50) (P < 0.05). Both PFU number and TCID50 increased after the use of M. piperita, D. canadense, T. vulgaris and M. officinalis extracts, the concentrations of which were 0.125 CC50 and 0.25 CC50 (P < 0.05). Real-time PCR detected IBV RNA after treatment with all plant extracts using concentrations of 1:2 CC50, 1:4 CC50 and 1:8 CC50. Delta cycle threshold (Ct) values decreased significantly comparing Ct values of 1:2 CC50 and 1:8 CC50 dilutions (P < 0.05). CONCLUSIONS: Many extracts of plants acted against IBV prior to and during infection, but the most effective were those of M. piperita, T. vulgaris and D. canadense .

Comparison of aqueous, polyethylene glycol-aqueous and ethanolic propolis extracts: antioxidant and mitochondria modulating properties.

BACKGROUND: Propolis is multicomponent substance collected by honeybees from various plants. It is known for numerous biological effects and is commonly used as ethanolic extract because most of active substances of propolis are ethanol-soluble. However, water-based propolis extracts could be applied more safely, as this solvent is more biocompatible. On the other hand, water extracts has significantly smaller range and quantity of active compounds. The extraction power of water could be enhanced by adding co-solvent which increases both solubility and penetration of propolis compounds. However, variation of solvents results in different composition of active substances that might have distinct effects. The majority of biological effects of propolis are attributed to the antioxidant properties of its active compounds. Antioxidant effect might be a result of either direct scavenging of ROS or modulation of ROS producing organelle activity. Therefore, the aim of this study was to investigate and compare chemical composition, antioxidant properties and effects on mitochondrial respiration of aqueous (AqEP), polyethylene glycol-aqueous (Pg-AqEP) and ethanolic (EEP) propolis extracts. METHODS: Chemical composition of propolis extracts was determined using HPLC and Folin-Ciocalteu method. Ability to neutralize H2O2 and intracellular ROS concentration in C6 glioma cells were determined fluorometrically by using 10-acetyl-3,7-dihydroxyphenoxazine and 2',7'-dichlorofluorescein diacetate, respectively. Mitochondrial superoxide generation was assessed under fluorescent microscope by using MitoSOX Red. Oxygen uptake rates of mitochondria were recorded by high-resolution respirometer Oxygraph-2 k. RESULTS: Our data revealed that phenolic acids and aldehydes make up 40-42% of all extracted and identified compounds in AqEP and Pg-AqEP and only 16% in EEP. All preparations revealed similar antioxidant activity in cell culture medium but Pg-AqEP and EEP demonstrated better mitochondrial superoxide and total intracellular ROS decreasing properties. At higher concentrations, AqEP and EEP inhibited mitochondrial respiration, but Pg-AqEP had concentration-dependent mitochondria-uncoupling effect. CONCLUSIONS: Aqueous and non-aqueous propolis extracts differ by composition, but all of them possess antioxidant properties and neutralize H2O2 in solution at similar efficiency. However, both Pg-AqEP and EEP were more effective in decreasing intracellular and intramitochondrial ROS compared to AqEP. At higher concentrations, these preparations affect mitochondrial functions and change energy production in C6 cells.

Provision of pharmaceutical care by community pharmacists across Europe: Is it developing and spreading?

RATIONALE, AIMS, AND OBJECTIVES: Pharmaceutical care involves patient-centred pharmacist activity to improve medicines management by patients. The implementation of this service in a comprehensive manner, however, requires considerable organisation and effort, and indeed, it is often not fully implemented in care settings. The main objective was to assess how pharmaceutical care provision within community pharmacy has evolved over time in Europe. METHOD: A cross-sectional questionnaire-based survey of community pharmacies, using a modified version of the Behavioural Pharmaceutical Care Scale (BPCS) was conducted in late 2012/early 2013 within 16 European countries and compared with an earlier assessment conducted in 2006. RESULTS: The provision of comprehensive pharmaceutical care has slightly improved in all European countries that participated in both editions of this survey (n = 8) with progress being made particularly in Denmark and Switzerland. Moreover, there was a wider country uptake, indicating spread of the concept. However, due to a number of limitations, the results should be interpreted with caution. Using combined data from participating countries, the provision of pharmaceutical care was positively correlated with the participation of the community pharmacists in patient-centred activities, routine use of pharmacy software with access to clinical data, participation in multidisciplinary team meetings, and having specialized education. CONCLUSIONS: The present study demonstrated a slight evolution in self-reported provision of pharmaceutical care by community pharmacists across Europe, as measured by the BPCS. The slow progress suggests a range of barriers, which are preventing pharmacists moving beyond traditional roles. Support from professional bodies and more patient-centred community pharmacy contracts, including remuneration for pharmaceutical care services, are likely to be required if quicker progress is to be made in the future.

Evaluation of Beeswax Influence on Physical Properties of Lipstick Using Instrumental and Sensory Methods.

The aim of this study was to optimize the lipsticks formulation according to the physical properties and sensory attributes and investigate the relationship between instrumental and sensory analyses and evaluate the influence of the main ingredients, beeswax and oil, with analysis of lipsticks properties. Central composite design was used to optimize the mixture of oils and beeswax and cocoa butter for formulation of lipsticks. Antioxidant activity was evaluated by DPPH free radical scavenging method spectrophotometrically. Physical properties of lipsticks melting point were determined in a glass tube; the hardness was investigated with texture analyzer. Sensory analysis was performed with untrained volunteers. The optimized mixture of sea buckthorn oil and grapeseed oil mixture ratio 13.96 : 6.18 showed the highest antioxidative activity (70 ± 0.84%) and was chosen for lipstick formulation. According to the sensory and instrumental analysis results, optimal ingredients amounts for the lipstick were calculated: 57.67% mixture of oils, 19.58% beeswax, and 22.75% cocoa butter. Experimentally designed and optimized lipstick formulation had good physical properties and high scored sensory evaluation. Correlation analysis showed a significant relationship between sensory and instrumental evaluations.

Assessing the relationship between pharmacists' job satisfaction and over-the-counter counselling at community pharmacies.

BACKGROUND: Community pharmacies have an increasing role in self-medication and community health is dependent on the quality of counselling services provided to patients. Some studies show that pharmacists' job satisfaction affects their work quality; other studies found that higher involvement in clinical services increases pharmacists' job satisfaction. OBJECTIVE: To test the relationship between job satisfaction and over-the-counter counselling practice at community pharmacies. SETTING: Community pharmacies in Lithuania. METHOD: A convenience sample (n = 305) of community pharmacists participated in the cross-sectional survey where they expressed satisfaction with job and reported on their over-the-counter counselling behaviour on self-report scales. The Partial Least Squares Structural Equation Modelling approach was employed for data analysis. MAIN OUTCOME MEASURE: The strength of the relationship between job satisfaction and over-the-counter counselling service. RESULTS: A bidirectional relationship between job satisfaction and over-the-counter counselling service was found. In addition, job satisfaction and over-the-counter counselling quality depended on pharmacists' age. CONCLUSION: Organizations were recommended to create a counselling friendly environment that would increase pharmacists' job satisfaction and, in return, counselling quality. Also, additional motivation of the retired pharmacists, as well as development of counselling skills of the younger pharmacy workforce, were seen as a means to improve both organizational climate and counselling quality over the counter.

Alternative preparation of propolis extracts: comparison of their composition and biological activities.

BACKGROUND: Propolis is the bee product noted for multiple biological effects, and therefore it is widely used for the prevention and treatment of a variety of diseases. The active substances of propolis are easily soluble in ethanol. However ethanolic extracts cannot be used in treatment of certain diseases encountered in ophthalmology, pediatrics, etc. Unfortunately, the main biologically active substances of propolis are scarcely soluble in water, oil and other solvents usually used in pharmaceutical industry. The aim of this study was to investigate chemical composition, radical scavenging and antimicrobial activity of propolis extracts differently made in nonethanolic solvents. METHODS: Total content of phenolic compounds in extracts was determined using Folin-Ciocalteu method. Chemical composition and radical scavenging activity of extracts were determined using HPLC system with free radical reaction detector. Antimicrobial activity of examined preparations was evaluated using the agar-well diffusion assay. RESULTS: Total amount of phenolic compounds in extracts made in polyethylene glycol 400 (PEG) and water mixture or in PEG, olive oil and water mixture at 70 °C was comparable to that of ethanolic extract. Predominantly identified compounds were phenolic acids, which contribute ca. 40 % of total radical scavenging activity. Investigated nonethanolic extracts inhibited the growth and reproduction of all tested microrganisms. Antimicrobial activity of some extracts was equal or exceeded the antimicrobial effect of ethanolic extract. Extracts made in pure water or oil only at room temperature, contained more than 5 - 10-fold lower amount of phenolic compounds, and demonstrated no antimicrobial activity. CONCLUSIONS: Nonethanolic solvent complex and the effect of higher temperature allows more effective extraction of active compounds from propolis. Concentration of total phenolic compounds in these extracts does not differ significantly from the concentration found in ethanolic extract. Propolis nonethanolic extracts have radical scavenging and antimicrobial activity.

Experiences of community pharmacists advising pregnant women.

BACKGROUND: Recent studies have shown that pharmacists provide healthcare advice to pregnant women, and that they can play an important role in maternal care. However, pharmacists have faced challenges in advising mothers and coordinating with physicians. OBJECTIVE: To explore the experiences of community pharmacists in advising pregnant women at Lithuanian community pharmacies. SETTING: Community pharmacies in Lithuania. METHODS: Community pharmacists (n = 27) were recruited for semistructured face-to-face interviews from June 2012 to March 2013. A qualitative and descriptive study based on the content analysis approach was used for data collection and analysis. MAIN OUTCOME MEASURE: Thematic coding of Lithuanian community pharmacist interview content. RESULTS: Three main areas emerged: topics of advice-giving, provision of information, and barriers to advice-giving. The question of whether to interact with the physician connected to all of these areas. Pharmacists described different practices about the advice they gave and how they gave it. Lack of knowledge and skills, both about pregnancy and about patient-physician-pharmacist interaction, were a clear barrier to care for pregnant women in community pharmacies. CONCLUSION: Respondents were comfortable giving advice in clear situations, and found it challenging to do so otherwise. Improving the physician-pharmacist-patient communication environment and providing education and training programmes for pharmacists is necessary to reduce stress and to overcome barriers in advising pregnant women.

Assessing the effects of pharmacists' perceived organizational support, organizational commitment and turnover intention on provision of medication information at community pharmacies in Lithuania: a structural equation modeling approach.

BACKGROUND: As a member of a pharmacy organization, a pharmacist is not only bound to fulfill his/her professional obligations but is also affected by different personal and organizational factors that may influence his/her behavior and, consequently, the quality of the services he/she provides to patients. The main purpose of the research was to test a hypothesized model of the relationships among several organizational variables, and to investigate whether any of these variables affects the service of provision of medication information at community pharmacies. METHODS: During the survey, pharmacists working at community pharmacies in Lithuania were asked to express their opinions on the community pharmacies at which they worked and to reflect on their actions when providing information on medicines to their patients. The statistical data were analyzed by applying a structural equation modeling technique to test the hypothesized model of the relationships among the variables of Perceived Organizational Support, Organizational Commitment, Turnover Intention, and Provision of Medication Information. RESULTS: The final model revealed that Organizational Commitment had a positive direct effect on Provision of Medication Information (standardized estimate = 0.27) and a negative direct effect (standardized estimate = -0.66) on Turnover Intention. Organizational Commitment mediated the indirect effects of Perceived Organizational Support on Turnover Intention (standardized estimate = -0.48) and on Provision of Medication Information (standardized estimate = 0.20). Pharmacists' Turnover Intention had no significant effect on Provision of Medication Information. CONCLUSIONS: Community pharmacies may be viewed as encouraging, to some extent, the service of provision of medication information. Pharmacists who felt higher levels of support from their organizations also expressed, to a certain extent, higher commitment to their organizations by providing more consistent medication information to patients. However, the effect of organizational variables on the variable of Provision of Medication Information appeared to be limited.

The impact of complex cardiac rehabilitation on manifestation of risk factors in patients with coronary heart disease.

BACKGROUND: Each year more than 4.3 million people in Europe will die of cardiovascular disease. Therefore, the implementation of simple interventions such as smoking cessation, weight loss, improved diets, and increased exercise is the top priority in prevention and rehabilitation programs. The aim of this study was to evaluate the impact of complex rehabilitation on the manifestation of risk factors and cardiac events in patients with coronary heart disease. MATERIAL AND METHODS: A total of 140 patients with coronary heart disease and NYHA functional class II-IV ischemic heart failure were recruited to the study. The patients were divided into 2 groups: 70 patients who underwent a 6-month complex rehabilitation course (rehabilitation group) and 70 patients who received drug treatment only (control group). Smoking, dietary, and physical activity habits were documented using the questionnaires. Blood pressure (BP), body weight and height, and total serum cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglyceride (Tg), and blood glucose levels were measured. Measurements were repeated after 3 and 6 months. RESULTS: After 6 months, significantly reduced systolic BP was observed in both the groups as compared with the baseline values (P<0.05). A significant decrease in the diastolic BP; total cholesterol, LDL-cholesterol, triglyceride and blood glucose levels; body mass index, and percentage of patients with the metabolic syndrome as compared with the baseline data was documented only in the rehabilitation group (P<0.05). All the patients quitted smoking as well as all the patients in the rehabilitation group changed their dietary habits (P<0.05). Fewer patients were excluded from the rehabilitation group because of cardiac events as compared with the control group (7.1% vs. 11.4%, P<0.05). CONCLUSIONS: Complex long-term rehabilitation of cardiovascular patients significantly reduced the manifestation of major cardiovascular risk factors and the rate of cardiac events. Aerobic exercise must be the most important part of training but well-done resistance training must also be encouraged.

[The effectiveness of long-term rehabilitation in patients with cardiovascular diseases]. / Serganciuju sirdies ir kraujagysliu ligomis ilgalaikes reabilitacijos efektyvumas.

BACKGROUND: Screening results of EuroAspire III study have revealed the failure of effective correction of cardiovascular risk factors in all 22 participating EU countries. How long should cardiac rehabilitation programs last to impact motivation for lifestyle change? AIM AND OBJECTIVES: To compare the impact of long-term (6 months) rehabilitation versus short-term (4 weeks) rehabilitation on the reduction of risk factors and cardiac events, as well as on the use of cardioprotective drugs. METHODS: Study contingent of 150 patients, suffering from functional class III-IV (NYHA) chronic heart failure caused by ischemic and hypertensive cardiomyopathy, was subjected to complex rehabilitation: exercise training, dietary corrections, and smoking cessation. The patients were divided into two groups: long-term rehabilitation group (n=80) and short-term rehabilitation group (n=70). Blood pressure, body mass index, dietary habits, dyslipidemia, sedentary lifestyle, smoking, chronic fatigue, and use of cardioprotective drugs were evaluated in all patients at the onset of study, after 4 weeks, and 6 months. Cardiovascular events were estimated throughout the whole 6-month period. RESULTS: In the long-term rehabilitation group, there was a significant reduction (P<0.05) in systolic blood pressure (151+/-9.2 vs. 135+/-9.7 mm Hg), diastolic blood pressure (92.3+/-6.5 vs. 75.4+/-3.8 mm Hg,) body mass index (35.4+/-3.5 vs. 27.2+/-4.8 kg/m(2)), dyslipidemia (56.3 vs. 23.4%), sedentary lifestyle (31.3 vs. 4.7%), and smoking (10.0 vs. 0%). The impact of a short-term rehabilitation was not significant. Because of cardiac events, 13 patients (16.3%) in the long-term rehabilitation group and 26 (16.3%) in the short-term rehabilitation group failed to complete the 6-month study (P<0.05). The following change in drug use pattern was noted in the long-term rehabilitation group: nitrates, 74 vs. 65%; digitalis, 42 vs. 32%; antiarrhythmic agents, 15 vs. 10%; statins, 36 vs. 20% (P<0.05). During 6 months, in both groups, because of better physician monitoring, there was no decrease in the use of major cardioprotective drugs, such as antiaggregants, beta-blockers, and ACE inhibitors. CONCLUSIONS: Long-term (6 months) versus short-term (4 weeks) rehabilitation of cardiovascular patients significantly reduces manifestation of major cardiovascular risk factors, the rate of cardiac events, chronic fatigue and improves the use of cardioprotective drugs.

[Survey on drug-related problems in Lithuania's pharmacies]. / Vaistu vartojimo problemu tyrimas Lietuvos vaistinese.

OBJECTIVE: to survey the most common and the most important drug-related problems in Lithuania, to explore their solution and factors influencing it, to formulate recommendations for solving drug-related problems. MATERIAL AND METHODS: Pharmacists from community pharmacies participated in a random survey. They filled in questionnaires about drug-related problems and their solutions. It was the first survey on drug-related problems ever carried out in Lithuania. RESULTS: For the first time, it was found out that in Lithuania pharmacists most commonly encountered drug-related problem--additional drug therapy (52.03% of respondents)--and most rarely encountered drug-related problem--dosage too high (3% of respondents). Pharmacists stated that all categories of drug-related problems were of equal importance. It was established that pharmacists commonly solved drug-related problems associated with noncompliance with instructions (72.5% of respondents) and rarely met the problem when improper drug was selected (39.56% of respondents). CONCLUSION: Patients taking prescription medicines commonly encounter additional drug therapy problem, and patients taking nonprescription medications commonly encounter problems related to noncompliance with instructions.