Swallowing difficulties with oral drugs among polypharmacy patients attending community pharmacies.

Background Swallowing difficulties are common and can affect patients' ability to take solid oral dosage forms, thus compromising medication adherence. Strategies developed by patients to overcome such difficulties while taking medicines have seldom been described. Objective To determine prevalence and characteristics of swallowing difficulties among primary care patients attending their community pharmacies; to explore strategies developed by patients to overcome their difficulties, and health professionals' awareness of these problems. Setting Prospective study with a semi-structured questionnaire in random community pharmacies located in two Swiss regions. Method In each pharmacy, an interviewer asked 16 questions to each consecutive patient (18 years and older) with a prescription for at least 3 different solid oral forms. Main outcome measure Quantification of number of patients with swallowing difficulties and detailed description of difficulties. Results Among 122 pharmacies, 59 (48 %) accepted to join the study and 410 patients were enrolled. Thirty-seven patients (9.0 %) reported ongoing swallowing difficulties, while 55 patients (13.4 %) reported past difficulties. For the majority of patients, difficulties occurred at each single dose (83.7 %), with a single medication (59.8 %) and lasted for less than 12 months (53.8 %). Number of tablets was not the main trigger. Swallowing difficulties impaired extremely daily life in 12 % of the patients. Intentional non adherence (23 % of patients) and altering the oral dose formulation were the most common and potentially harmful strategies used by patients to overcome their swallowing difficulties. According to the patients, pharmacists and physicians rarely inquired about their swallowing difficulties. Conclusion We report a fairly high prevalence of swallowing difficulties in polypharmacy patients attending their community pharmacies. Pharmacists have to interview patients on their swallowing difficulties in a more systematic way, support patients in finding solutions and refer them to their physician if necessary to ensure continuity in care.

Analysis of parity between protein-based electrophoretic methods for the characterization of oral Candida species

Electrophoretic studies of multilocus-enzymes (MLEE) and whole-cell protein (SDS-PAGE) were carried out in order to evaluate the parity between different methods for the characterization of five Candida species commonly isolated from oral cavity of humans by numerical taxonomy methods. The obtained data revealed that sodium dodecyl sulfate polyacrylamide gel electrophoresis is more efficient in grouping strains in their respective species while MLEE has much limited resolution in organizing all strains in their respective species-specific clusters. MLEE technique must be regarded for surveys in which just one species of Candida is involved.

Incidencia y gravedad de la enfermedad por citomegalovirus en pacientes trasplantados renales que han recibido tratamiento anticipado o profilaxis con valganciclovir oral

Antecedentes: La infección por CMV es la más frecuente que sufren los receptores de trasplante de órgano sólido (TOS) en los primeros meses del trasplante. Son abundantes las estrategias de prevención y tratamiento de la enfermedad por CMV que se han desarrollado. Métodos: El objetivo fue evaluar la incidencia y severidad de la enfermedad por CMV en 387 receptores de trasplante renal que recibieron tratamiento profiláctico (grupo de alto riesgo, n = 251) o realizaron seguimiento de PCR de CMV por ser grupo de bajo riesgo (n = 136) y recibieron tratamiento anticipado (n = 17) con valganciclovir oral (900 mg/día) cuando presentaron & 1000 copias/ml. Resultados: Presentaron enfermedad por CMV, 2 (11,76%) pacientes del grupo de riesgo estándar, descrita como enfermedad leve y 20 (7,96%) pacientes del grupo de alto riesgo, descrita como enfermedad leve en 15 casos y como enfermedad grave en 5 casos. Aquellos pacientes que desarrollaron la enfermedad, respondieron al tratamiento con ganciclovir endovenoso durante 14 días seguido de valganciclovir oral hasta completar tres meses. Conclusión: El tratamiento profiláctico con valganciclovir oral para la prevención de enfermedad o infección por CMV solamente es necesario en los receptores de TOS de alto riesgo.

Equality Impact Assessment of the Oral Health Strategy (PDF 120 KB)

The Health and Personal Social Services (Northern Ireland) Order 1972 requires the Department of Health, Social Services and Public Safety to provide or secure the provision of health services in Northern Ireland designed to promote the physical and mental health of the community through the prevention, diagnosis and treatment of illness. This includes the provision of oral health care. åÊ åÊ

An examination of male and female odds ratios by BMI, cigarette smoking, and alcohol consumption for cancers of the oral cavity, pharynx, and larynx in pooled data from 15 case-control studies.

BACKGROUND: Greater tobacco smoking and alcohol consumption and lower body mass index (BMI) increase odds ratios (OR) for oral cavity, oropharyngeal, hypopharyngeal, and laryngeal cancers; however, there are no comprehensive sex-specific comparisons of ORs for these factors. METHODS: We analyzed 2,441 oral cavity (925 women and 1,516 men), 2,297 oropharynx (564 women and 1,733 men), 508 hypopharynx (96 women and 412 men), and 1,740 larynx (237 women and 1,503 men) cases from the INHANCE consortium of 15 head and neck cancer case-control studies. Controls numbered from 7,604 to 13,829 subjects, depending on analysis. Analyses fitted linear-exponential excess ORs models. RESULTS: ORs were increased in underweight (<18.5 BMI) relative to normal weight (18.5-24.9) and reduced in overweight and obese categories (>/=25 BMI) for all sites and were homogeneous by sex. ORs by smoking and drinking in women compared with men were significantly greater for oropharyngeal cancer (p < 0.01 for both factors), suggestive for hypopharyngeal cancer (p = 0.05 and p = 0.06, respectively), but homogeneous for oral cavity (p = 0.56 and p = 0.64) and laryngeal (p = 0.18 and p = 0.72) cancers. CONCLUSIONS: The extent that OR modifications of smoking and drinking by sex for oropharyngeal and, possibly, hypopharyngeal cancers represent true associations, or derive from unmeasured confounders or unobserved sex-related disease subtypes (e.g., human papillomavirus-positive oropharyngeal cancer) remains to be clarified.

An Oral Health Strategy for NI - Questionnaire (PDF 187 KB)

A Consultation Document September 2004

An Oral Health Strategy for NI (PDF 893 KB)

A Consultation Document September 2004

Improvement of chronic congestive heart-failure by oral captopril

Catopril, an inhibitor of angiotensin converting enzyme, was given orally during cardiac catheterisation to 6 normotensive patients with refractory congestive heart-failure. 60--180 minutes after administration of 25 mg captopril, arterial pressure fell by 25%, cardiac index rose by 38%, and left-ventricular pressure and right-atrial pressure fell by 25% and 40% respectively. Plasma-renin activity rose while plasma noradrenaline and aldosterone fell. These data suggest that, in the short term, captopril can reduce both preload and afterload, and improve cardiac function, in refractory congestive heart-failure.

Oral Health Strategy - General Dental Services (PDF 397KB)

Equality Impact Assessments

Oral Health Strategy - General Dental Services (PDF 121 KB)

Equality Impact Assessments

Oral Health Strategy - General Dental Services - Preliminary Consultation Report (PDF 144 KB)

Equality Impact Assessments

Equality Impact Assessments - Oral Health Strategy - General Dental Services - May 2001 (PDF 72KB)

In 1998, a new law came into force in Northern Ireland – the Northern Ireland Act 1998. Section 75 of the Act places a legal obligation on each public authority to have due regard to the need to promote equality of opportunity: • between persons of different religious belief, political opinion, racial group, age, marital status or sexual orientation; • between men and women generally; • between persons with a disability and persons without; and • between persons with dependants and persons without. åÊ

Multicenter Brazilian Study of Oral Candida Species Isolated from Aids Patients

Oropharyngeal candidiasis continues to be considered the most common opportunistic disease in Aids patients. This study was designed to investigate species distribution, serotype and antifungal susceptibility profile among Candida spp. isolated from the oral cavity of Aids patients recruited from six Brazilian university centers. Oral swabs from 130 Aids patients were plated onto CHROMagar Candida medium and 142 isolates were recovered. Yeast isolates were identified by classical methods and serotyped using the Candida Check® system-Iatron. Antifungal susceptibility testing was performed according to the NCCLS microbroth assay. C. albicans was the most frequently isolated species (91%), and 70% of the isolates belonged to serotype A. We detected 12 episodes of co-infection (9%), including co-infection with both serotypes of C. albicans. Non-albicans species were isolated from 12 episodes, 50% of them exhibited DDS or resistance to azoles. Otherwise, only 8 out 130 isolates of C. albicans exhibited DDS or resistance to azoles. Brazilian Aids patients are infected mainly by C. albicans serotype A, most of them susceptible to all antifungal drugs.