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  1. Sapkota B, Pariatamby A
    Waste Manag, 2023 Aug 01;168:83-97.
    PMID: 37285639 DOI: 10.1016/j.wasman.2023.05.052
    Most households and healthcare facilities usually dispose of contaminated, unused, or expired (CUE) medicines with municipal wastes, the disposal of which usually amounts to $790/ton in the USA and £450/ton in the UK. Solid (e.g., tablets, capsules, powders) and semi-solid (e.g., ointment, creams) pharmaceuticals are managed with incineration/pyrolysis, encapsulation, and engineered landfills, whereas wastewater treatment plants (WWTPs) are recommended for liquid pharmaceutical wastes (PWs). However, to date, the sustainability and eco-friendliness profile of these techniques are only subjectively ensured, leading to controversial viewpoints in many guidelines. Each technique has relative strengths and weaknesses, and their comparative weighting to maximize these profiles is sought after. The present comprehensive review aims to fulfil knowledge gaps in this regard. Four electronic databases (e.g., PubMed/MEDLINE, Scopus, and ScienceDirect) were searched for PW management (PWM)-related qualitative and quantitative articles published till December 31, 2022. Articles without details of waste disposal techniques and their health and environmental impacts were excluded. Based on the literature review, we determine that incineration can be considered a sustainable option for solid and semi-solid PWs, and WWTPs can be eco-friendly for liquid PWs, whereas encapsulation and landfilling are less sustainable. It is high time that objectively proven sustainable and eco-friendly techniques be implemented for PWM based on their dosage forms or nature of hazards. Medicine take-back, eco-pharmacovigilance, extended producer responsibility, co-payment, and life cycle analysis of pharmaceuticals focusing on reduction, reuse/re-dispensing can be integrated to make existing models sustainable, circular, and eco-friendly.
  2. Sapkota B, Pariatamby A
    Environ Sci Pollut Res Int, 2025 Jan;32(5):2577-2591.
    PMID: 39808258 DOI: 10.1007/s11356-024-35817-y
    Wastewater treatment plant (WWTP) is a sustainable technique for making wastewater reusable for non-potable purposes. However, in developing countries, most conventional WWTPs are not equipped to trap all pharmaceutical residues (PRs) and pharmaceutically active chemicals (PhACs). This study aims to perform non-target screening of these contaminants in wastewater and explore health and environmental hazards and the removal efficiency of a WWTP in Malaysia. At Indah Water WWTP, a total of 28 wastewater samples (i.e., 2 L each of 14 influent and 14 effluent) were collected every day for a week from February to April 2023. The supernatant of the centrifuged sample was analyzed with the LCMS-QTOF system. Chromatographic profiles were analyzed, and the compounds were annotated using the METLIN database. Categorical data were statistically analyzed with SPSS 29.0 using a chi-square test and continuous variables using paired t-test and multiple regression. PRs like micronutrient (9, 2.3%) and PhACs like lipid (83, 20.8%) were more frequent. Detection frequencies of PRs and PhACs were 72 (18%) and 328 (82%), respectively. Efficiency of WWTP was 36.4 to 100% for PRs removal (mean ± SD: 65.85 ± 56.43%) and 20 to 100% for PhACs removal (mean ± SD: 49.30 ± 55.94%). A total of 943 (mean ± SD: 67.36 ± 43.28) and 400 (mean ± SD: 28.57 ± 32.44) unique PRs and PhACs were recorded. A total of 40 (10%) PRs and PhACs had the potential to irritate eyes, skin, and respiratory tract, and 46 (11.5%) chemicals needed to be avoided from being discharged into the environment. Though WWTP was 98.0% compliant with environmental standards, its efficiency should still be increased to remove the full range of PRs and PhACs. The research has implications for SDGs 6 and 14.
  3. Sapkota B, Pariatamby A
    Waste Manag, 2025 Mar;195:107-128.
    PMID: 39908624 DOI: 10.1016/j.wasman.2025.01.039
    Although healthcare waste management (HCWM) legislations prevail in Association of Southeast Asian Nations (ASEAN), there appears a prominent gap in standalone pharmaceutical waste management (PWM) legislation making harmonization of PWM challenging in the region. This review is aimed to comprehensively overview the PWM-related legislations in ASEAN, comprising of 10 economically rising countries in Southeast Asia. The relevant regulatory documents, that were promulgated till August 31, 2024 and that were in English or officially translated in English, were extracted from PubMed/Medline, Scopus, Science Direct, Google Scholar, and respective country's government websites. The documents were considered suitable based on their relevance, accessibility, and timeliness. The policy analysis revealed that all Member States in ASEAN lack specific legislations on PWM, and are managing pharmaceutical waste (PW) within the umbrella legislation of HCWM or biomedical waste management. The review discussed implications of joint ASEAN legislations, relevant guiding principles of waste management, and international guidelines relevant to PWM such as Basel Convention, Stockholm Convention, and the status of their endorsement in ASEAN. Some ASEAN countries such as Indonesia, Malaysia, Philippines, Singapore, Thailand and Vietnam have established infrastructures and regulatory setup for HCWM but still lack specific PWM legislations. ASEAN can foster harmonized legislative frameworks, facilities and technologies in PWM, raising public awareness and active participation to mitigate PW problem. The hard laws such as Acts, regulations, and ordinances are definitely aimed for PWM in ASEAN, but at least harmonized soft laws in the form of guidelines are imperative to harmonize PWM practice.
  4. Shrestha S, Sapkota B, Thapa S, K C B, Khanal S
    PLoS One, 2020;15(10):e0240488.
    PMID: 33035243 DOI: 10.1371/journal.pone.0240488
    BACKGROUND: Understanding patient satisfaction with pharmacy services can help to enhance the quality and monitoring of pharmacy services. Patient Satisfaction with Pharmacist Services Questionnaire 2.0 (PSPSQ 2.0) is a valid and reliable instrument for measuring patient satisfaction with services from the pharmacist. The availability of the PSPSQ 2.0 in Nepalese version would facilitate patient satisfaction and enhance pharmacy services in Nepal. This study aims to translate the PSPSQ 2.0 into the Nepalese version, culturally adapt it and verify its reliability and validity in the Nepalese population.

    METHODS: The methodological and cross-sectional study design was used to translate, culturally adapt it, and validate PSPSQ 2.0 in Nepalese. The Nepalese version of PSPSQ 2.0 went through the full linguistic validation process and was evaluated in 300 patients visiting different community pharmacies in Kathmandu district, Nepal. Exploratory factor analysis was carried out using principal component analysis with varimax rotation, and Cronbach's alpha was used to evaluate the reliability.

    RESULTS: Three-hundred patients were recruited in this study. Participants ranged in age from 21 to 83 years; mean age was 53.93 years (SD: 15.21). 62% were females, and 34% educational level was above 12 and university level. Only 7% of the participants were illiterate. Kaiser-Meyer-Olkinwas found to be 0.696, and Bartlett's test of sphericity was significant with a chi-square test value of 3695.415. A principal axis factor analysis conducted on the 20 items with orthogonal rotation (varimax). PSPSQ 2.0 Nepalese version (20 items) had a good internal consistency (Cronbach's alpha = 0.758). Item-total correlations were reviewed for the items in each of the three domains of PSPSQ 2.0.

    CONCLUSION: The PSPSQ 2.0 Nepalese version demonstrated acceptable validity and reliability, which can be used in the Nepalese population for evaluating the satisfaction of patients with pharmacist services in both community pharmacy and research.

  5. Sapkota B, Bokati P, Dangal S, Aryal P, Shrestha S
    Medicine (Baltimore), 2022 Apr 22;101(16):e29192.
    PMID: 35482989 DOI: 10.1097/MD.0000000000029192
    The medication therapy management (MTM) pharmacists follow the philosophy of pharmaceutical care to address individualistic medication therapy requirements in their practice settings.The present study aimed to introduce the pharmacist-delivered MTM services among type 2 diabetes mellitus patients at a tertiary care hospital in Nepal.Cross-sectional study was conducted at Patan Hospital, Lalitpur, Nepal, among 200 patients with type 2 diabetes mellitus from July to December 2019. The intervention included maintenance of medication profile for individual patients, and then MTM service was proposed based on 5 core elements of MTM services proposed by the American Pharmacists Association. Both antidiabetic and non-antidiabetic medicines were coded as per the anatomic, therapeutic, and chemical classification and defined daily dose assignment 2020 for documentation. The Charlson Comorbidity Index was used to index comorbidities. The drug interaction profile was checked with the Medscape Drug Interaction Checker.Both fasting and postprandial blood sugar levels were significantly associated with age (P-values
  6. Ranabhat R, Giri A, Sapkota B, Shrestha R, Shrestha S
    SAGE Open Med, 2023;11:20503121231215237.
    PMID: 38078204 DOI: 10.1177/20503121231215237
    INTRODUCTION: Burnout is a significant concern among healthcare professionals, including pharmacists, as it can lead to adverse effects on their well-being, job satisfaction, and patient care delivery. However, no previous study was conducted among pharmacy professionals in Nepal to assess their burnout cases. This study aimed to evaluate burnout presence and explore its associated factors among pharmacy professionals in Nepal.

    METHODS: A cross-sectional study was conducted among pharmacy professionals of Kathmandu Valley, Nepal. The validated Burnout Assessment Tool measured burnout across multiple domains. Data on demographic and work-related characteristics were also collected. Descriptive statistics and Chi-square tests were used to analyze the data and identify significant associations among the variables.

    RESULTS: Most participants were in the age group of 21-30 (64.7%), had a graduate degree (47.3%), and worked in hospital pharmacy settings (49.1%). Exhaustion was the most common (39.7%) burnout experienced, while mental distance and emotional and cognitive impairment were reported in one-fourth of the participants. Alternatively, only one in five participants showed secondary symptoms of burnout. Gender, working hours, exercise frequency, and substance abuse were significantly associated with burnout domains.

    CONCLUSION: This study provides valuable insights into the prevalence and factors associated with burnout among pharmacy professionals in Nepal. The findings highlight the significance of addressing burnout in this crucial healthcare sector, with gender, exercise frequency, and substance use emerging as notable contributors. These results underscore the need for targeted interventions and support systems to promote the well-being of pharmacy professionals and ensure the continued delivery of high-quality healthcare services in Nepal.

  7. Sapkota B, Palaian S, Shrestha S, Ibrahim MIM
    Ther Innov Regul Sci, 2023 Jul;57(4):886-898.
    PMID: 37106236 DOI: 10.1007/s43441-023-00514-4
    Materiovigilance (Mv) has the same purpose and approach in ensuring patient safety as pharmacovigilance but deals with medical devices associated with adverse events (MDAEs) and their monitoring. Mv has been instrumental in recalling many defective or malfunctioning devices based on their safety data. All MDAEs, such as critical or non-critical, known, or unknown, those with inadequate or incomplete specifications, and frequent or rare events should be reported and evaluated. Mv helps to improve medical devices' design and efficiency profile and avoid device-related complications and associated failures. It alerts consumers and health professionals regarding counterfeit or substandard devices. Common events reported through Mv are device breakage and malfunction, entry- and exit-site infections, organ perforations or injuries, need for surgery and even death, and life cycle assessment of devices. Health authorities globally have developed reporting frameworks with timeframes for MDAEs, such as MedWatch in the USA, MedSafe in New Zealand, and others. Health professionals and consumers need to be made aware of the significance of Mv in ensuring the safe use of medical devices and getting familiar with the reporting procedures and action plans in case of a device-induced adverse event.
  8. Shrestha R, Sapkota B, Khatiwada AP, Shrestha S, Khanal S, Kc B, et al.
    Patient Prefer Adherence, 2021;15:1873-1885.
    PMID: 34475753 DOI: 10.2147/PPA.S320866
    Background: The General Medication Adherence Scale (GMAS) evaluates intentional and unintentional behaviour of patients, disease and medication burden and cost-related burden associated with non-adherence. GMAS was developed and validated among Urdu-speaking patients with chronic diseases. However, validated tool in Nepalese language to measure medication adherence among chronic illness patients currently does not exist.

    Aim: To translate, culturally adapt, and validate the English version of GMAS into the Nepalese language to measure medication adherence among chronic illness patients.

    Methods: The study was conducted among patients with chronic diseases in both hospital and community pharmacies of Nepal. The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Good Practice Guideline for linguistic translation and cultural adaptation was used to translate and culturally adapt the English version of GMAS into the Nepalese version. The translated version was validated amongst patients with chronic diseases in Nepal. Exploratory factor analysis was carried out using principal component analysis with varimax rotation. Test-retest reliability and internal consistency were analysed.

    Results: A total of 220 (53.6% females, and 51.4% of 51 to 70 aged patients) patients with chronic diseases participated in the study. The majority of patients took two medications (27.3%) from six months to five and half years (68.2%). Kaiser Meyer Olkin was found to be 0.83. A principal axis factor analysis was conducted on the 3 items of GMAS without and with orthogonal rotation (varimax). The scree plot showed an inflexion on the third item that meant three components were present. The overall Cronbach's alpha value of the full-phase study was 0.82.

    Conclusion: The General Medication Adherence Scale was successfully translated into the Nepalese language, culturally adapted, and validated amongst chronic diseases patients of Nepal. Therefore, the GMAS-Nepalese version can be used to evaluate medication adherence among Nepalese-speaking patients with chronic disease.

  9. Shrestha S, Poudel RS, Kc B, Poudel BK, Sapkota B, Sharma S, et al.
    PMID: 32266073 DOI: 10.1186/s40545-020-0203-0
    Objective: To assess the variation in price among different brands of anticancer medicines available in hospital pharmacies at Nepalese cancer hospitals.

    Methods: The price of different brands of the same anticancer medicines available in the hospital pharmacies of two cancer hospitals was assessed. Prices of different dosage forms such as a single tablet, capsule and vial were calculated. The difference in the maximum and minimum price of the same drug manufactured by different pharmaceutical industries was determined, and the percentage variation in price was calculated. The prices of medicines (brands) were also compared with the price determined by the government where available.

    Results: Price variation was assessed for 31 anticancer medicines belonging to six broad categories. Prices were found to vary maximally among the following medicines, each belonging to separate categories: among alkylating agents, the price of temozolomide 100 mg capsule varied 308%; among antimetabolite agents, the price of pemetrexed 500 mg injection varied 134%; among hormonal drugs, the price of letrozole 2.5 mg tablet varied 200%; among antibody class, the price of trastuzumab 440 mg injection varied 73%; among natural products, the price of irinotecan 100 mg injection varied 590%; and among miscellaneous agents, the price of bortezomib 2 mg injection varied 241%. There was a significant difference in the mean MRP of the alkylating agents with the antimetabolites (p-value 0.006) and the monoclonal antibody (p-value

  10. Shrestha S, Shrestha S, Kc B, Sapkota B, Khadka A, Khanal S, et al.
    J Patient Rep Outcomes, 2020 Jun 17;4(1):46.
    PMID: 32556701 DOI: 10.1186/s41687-020-00205-w
    BACKGROUND: The quality of life (QoL) of patients with lung cancer (LC) may be affected by disease-related limitations such as patients' functioning, the severity of symptoms, financial problems resulting along with the side effects of the treatment. The objective of this study was to translate LC-specific QoL questionnaire EORTC QLQ-LC29 into Nepalese language for Nepalese LC patients.

    METHODS: In the process of translation, the European Organization for Research and Treatment of Cancer (EORTC) translations guidelines were followed. The translated questionnaire was pilot-tested in a sample of 15 patients with LC. Descriptive statistics were calculated with SPSS version 21.0.

    RESULTS: All steps of the EORTC translation guideline were followed successfully. Fifteen lung cancer patients were included in the pilot study. Sixty percent were male and the mean age was 49.87 (range 21-76 years). For all items not related to thoracic surgery, patients used the entire range of the response options from 1 to 4 and no missing responses were observed. The highest mean (indicating a high symptom burden) was observed for the item number. 35 (shortness of breath; Mean = 3.33, SD = 1.11) and the lowest mean for an item number. 45 (dizzy; Mean = 1.73, SD = 0.96).

    CONCLUSION: The Nepalese version of EORTC QLQ-LC29 is a result of a successfully conducted rigorous translation procedure, and is highly comprehensible as well as acceptable to Nepalese LC patients. Thus, the Nepalese version of EORTC QLQ-LC29 is ready to be used in international clinical studies as well as in Nepalese clinical practice.

  11. Shrestha R, Palaian S, Sapkota B, Shrestha S, Khatiwada AP, Shankar PR
    Sci Rep, 2022 Oct 05;12(1):16590.
    PMID: 36198682 DOI: 10.1038/s41598-022-16653-x
    Pharmaceutical care (PC) services reduce medication errors, improve the use of medicines, and optimize the cost of treatment. It can detect medication-related problems and improve patient medication adherence. However, PC services are not commonly provided in hospital pharmacies in Nepal. Therefore, the present study was done to determine the situation of PC in hospital pharmacies and explore the perception, practice, and barriers (and their determinants) encountered by hospital pharmacists while providing PC. A descriptive online cross-sectional study was conducted from 25th March to 25th October 2021 among pharmacists with a bachelor's degree and above working in hospital pharmacies using non-probability quota sampling. The questionnaire in English addressed perception and practice regarding PC, and barriers encountered and were validated by experts and pre-tested among 23 pharmacists. Descriptive statistics were used to describe the data. Kendall's correlation was used to explore the correlations among various perception and practice constructs. The scores were also compared among subgroups of respondents using the Mann-Whitney test for subgroups with two categories and Kruskal-Wallis test for greater than two categories. A total of 144 pharmacists participated in the study. Majority of the participants were male, between 22 and 31 years of age, and had work experience between 10 and 20 years. Over 50% had received no training in PC. The perception scores were higher among those with more work experience and the practice scores among those who had received PC training. Participants agreed that there were significant barriers to providing PC, including lack of support from other professionals, lack of demand from patients, absence of guidelines, inadequate training, lack of skills in communication, lack of compensation, problems with access to the patient medical record, lack of remuneration, and problems with accessing objective medicine information sources. A correlation was noted between certain perceptions and practice-related constructs. Hospital pharmacists who participated had a positive perception and practice providing PC. However, PC was not commonly practised in hospital pharmacies. Significant barriers were identified in providing PC. Further studies, especially in the eastern and western provinces, are required. Similar studies may be considered in community pharmacies.
  12. Kc B, Alrasheedy AA, Leggat PA, Mohamed Ibrahim MI, Christopher CM, Sapkota B, et al.
    Travel Med Infect Dis, 2023;51:102494.
    PMID: 36400319 DOI: 10.1016/j.tmaid.2022.102494
    BACKGROUND AND AIM: Pharmacists have an important role in providing travel health services and medications to travelers. However, given the limited literature on this topic, the aim of this study is to systematically review the types and outcomes of pharmacist-managed travel health services.

    METHODS: A comprehensive literature search was performed in four electronic databases, namely Scopus, Web of Science, PubMed and ProQuest to identify studies published in English from 1999 to July 2022. The inclusion criteria included the studies that reported an experience of providing dedicated travel health services by pharmacists and reported the outcomes and/or evaluation of these travel health services.

    RESULTS: Nine studies were identified from the literature and included in the review. The pharmacists have provided a wide range of general and specialized travel health services including pre-travel risk assessment, routine and travel-related vaccination service, prescribing or recommending medications for travel-related illnesses, counseling and travel health advice. Overall, 94-100% of the patients were satisfied or very satisfied with pharmacist-managed travel health services. In addition, a good acceptance rate of pharmacist recommendations for vaccines and travel-related mediations was reported with most studies reporting an overall acceptance rate of ≥75% (acceptance rate range: 48%-94.2%). In addition, high rates of acceptance of other nonpharmacological advices were noted.

    CONCLUSION: Pharmacists with training in travel medicine have successfully provided a wide range of general and specialized travel health services. Most travelers were highly satisfied with the pharmacy-based travel health services and accepted the pharmacist recommendations.

  13. Sapkota B, Saud B, Shrestha R, Al-Fahad D, Sah R, Shrestha S, et al.
    J Travel Med, 2022 May 31;29(3).
    PMID: 34918097 DOI: 10.1093/jtm/taab191
    BACKGROUND/OBJECTIVE: Heterologous prime-boost doses of COVID-19 vaccines ('mix-and-match' approach) are being studied to test for the effectiveness of Oxford (AZD1222), Pfizer (BNT162b2), Moderna (mRNA-1273) and Novavax (NVX-CoV2373) vaccines for COVID in 'Com-Cov2 trial' in UK, and that of Oxford and Pfizer vaccines in 'CombivacS trial' in Spain. Later, other heterologous combinations of CoronaVac (DB15806), Janssen (JNJ-78436735), CanSino (AD5-nCOV) and other were also being trialled to explore their effectiveness. Previously, such a strategy was deployed for HIV, Ebola virus, malaria, tuberculosis, influenza and hepatitis B to develop the artificial acquired active immunity. The present review explores the science behind such an approach for candidate COVID-19 vaccines developed using 11 different platforms approved by the World Health Organization.

    METHODS: The candidate vaccines' pharmaceutical parameters (e.g. platforms, number needed to vaccinate and intervals, adjuvanted status, excipients and preservatives added, efficacy and effectiveness, vaccine adverse events, and boosters), and clinical aspects must be analysed for the mix-and-match approach. Results prime-boost trials showed safety, effectiveness, higher systemic reactogenicity, well tolerability with improved immunogenicity, and flexibility profiles for future vaccinations, especially during acute and global shortages, compared to the homologous counterparts.

    CONCLUSION: Still, large controlled trials are warranted to address challenging variants of concerns including Omicron and other, and to generalize the effectiveness of the approach in regular as well as emergency use during vaccine scarcity.

  14. Shrestha S, Khatiwada AP, Sapkota B, Sapkota S, Poudel P, Kc B, et al.
    J Pain Res, 2023;16:383-394.
    PMID: 36798077 DOI: 10.2147/JPR.S389358
    INTRODUCTION: Opioid stewardship has been widely used to promote rational use, monitoring and discontinuation of opioid therapy; however, its definition and scope of practice remain unclear.

    OBJECTIVE: To synthesize definitions of opioid stewardship proposed by clinical practice guidelines and professional societies, and to offer a proposal for a universally acceptable definition.

    METHODS: Systematic literature searches were performed (earliest records to May 2022) in six databases (MEDLINE, EMBASE, APA PsycINFO, Scopus, and CENTRAL) and grey sources guidelines development bodies and professional societies through Google. The conventional but widely applied content analysis and word frequencies were used to analyze the definitions and scope of practice.

    RESULTS: After removing duplicates, 449 articles were retrieved (439 databases and registers and 11 from other sources), 19 of which included a definition of "opioids stewardship". A total of 12 themes was identified in the definitions, including 1) improvement or appropriateness of prescribing opioids use, 2) mitigation of risk from opioids, 3) monitoring opioid use, 4) evaluation of opioid use, 5) judicious opioid use, 6) appropriateness of opioid disposal, 7) identification and treatment of opioid use disorder, 8) reduction in mortality associated with opioid overdoses, 9) appropriate procurement practices, 10) appropriate storage, 11) promoting better communications between patients and prescribers including education provision and 12) patient-centered decision-making.

    CONCLUSION: Opioid stewardship is inconsistently defined across professional and research literature. While there is a greater focus on appropriateness and need for improvement of prescribing and monitoring of opioid use, the importance of communications between patients and prescribers, and patient involvement in both prescribing and deprescribing decision-making remains sparse. A comprehensive definition has been proposed as part of the work. There is a need to develop and validate the proposed definition and scope of practice to promote rationale for opioid prescribing, use and attainment of favourable outcomes through international consensus involving practitioners, researchers, and patients.

  15. Alshammari F, Ansari M, Khan KU, Neupane D, Hussain A, Anwar S, et al.
    PLoS One, 2024;19(5):e0299995.
    PMID: 38713663 DOI: 10.1371/journal.pone.0299995
    BACKGROUND: Diabetes Mellitus is a serious and expanding health problem, together with the issues of health- related quality of life (HRQoL). This further puts pressure on the government to allocate more funds for public healthcare.

    OBJECTIVES: This study was devised to evaluate the health-related quality of life of people living with diabetes in Hail region of Saudi Arabia.

    METHODS: This cross-sectional research was carried out at eight locations in the Hail region of Saudi Arabia between 21st March-20th May 2022 using the adapted version of the Euro QoL-5 dimension (EQ-5D-3L) questionnaire. A multistage random sample approach was used to choose the diabetes clinics, and data collectors approached the participants in the waiting areas to collect the information. The data were analyzed using logistic regression analysis, Mann-Whitney test, and Kruskal-Wallis tests in IBM SPSS statistics 21.0.

    RESULTS: The mean HRQoL score was 0.71±0.21 with a visual analog score of 68.4±16.2. Despite having much higher levels of quality of life in terms of self-care (85.8%), regular activity (73.8%) and anxiety (71.8%), nearly one half of the people reported moderate pain or discomfort, and more than one third reported having moderate mobility issues. In general, the quality of life for women was poorer than for men. Individuals with diabetes who were unmarried, young, educated, financially secure, and taking only oral medication had much improved HRQoL. The Euro QoL of people with diabetes patients were significantly influenced by gender, marital status, age, education, employment and treatment modality (p-values < 0.05), whereas only treatment modality had a significant impact on the patients' visual analogue measures (p-values < 0.05).

    CONCLUSIONS: The HRQoL of people with diabetes in Hail region was moderate in general, with pain and mobility issues being particularly prevalent. Gender, marital status, age, education, employment and type of medication therapy are significant predictors of HRQoL of patients with diabetes. Hence, planning and programs to enhance the HRQoL of people with diabetes, especially women is recommended.

  16. Murayama A, Hoshi M, Saito H, Kamamoto S, Tanaka M, Kawashima M, et al.
    Respiration, 2022;101(12):1088-1098.
    PMID: 36353778 DOI: 10.1159/000526576
    BACKGROUND: Financial relationships between healthcare professionals and pharmaceutical companies have historically caused conflicts of interest and unduly influenced patient care. However, little was known about such relationship and its effect in clinical practice among specialists in respiratory medicine.

    METHODS: Based on the retrospective analysis of payment data made available by all 92 pharmaceutical companies in Japan, this study evaluated the magnitude and trend of financial relationships between all board-certified Japanese respiratory specialists and pharmaceutical companies between 2016 and 2019. Magnitude and prevalence of payments for specialists were analyzed descriptively. The payment trends were assessed using the generalized estimating equations for the payment per specialist and the number of specialists with payments.

    RESULTS: Among all 7,114 respiratory specialists certified as of August 2021, 4,413 (62.0%) received a total of USD 53,547,391 and 74,195 counts from 72 (78.3%) pharmaceutical companies between 2016 and 2019. The median (interquartile range) 4-year combined payment values per specialist were USD 2,210 (USD 715-8,178). At maximum, one specialist received USD 495,332 personal payments over the 4 years. Both payments per specialist and number of specialists with payments significantly increased during the 4-year period, with 7.8% (95% CI: 5.5-9.8; p < 0.001) in payments and 1.5% (95% CI: 0.61-2.4; p = 0.001) in number of specialists with payments, respectively.

    CONCLUSION: The majority of respiratory specialists had increasingly received more personal payments from pharmaceutical companies for the reimbursement of lecturing, consulting, and writing between 2016 and 2019. These increasing financial relationships with pharmaceutical companies might cause conflicts of interest among respiratory physicians.

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