Pediatric Medication Noninitiation in Spain

OBJECTIVES To estimate medication noninitiation prevalence in the pediatric population and identify the explanatory factors underlying this behavior. METHODS Observational study of patients (<18 years old) receiving at least 1 new prescription (28 pharmaceutical subgroups; July 2017 to June 2018) in Catalonia, Spain. A prescription was considered new when there was no prescription for the same pharmaceutical subgroup in the previous 6 months. Noninitiation occurred when a prescription was not filled within 1 month or 6 months (sensitivity analysis). Prevalence was estimated as the proportion of total prescriptions not initiated. To identify explanatory factors, a multivariable multilevel logistic regression model was used, and adjusted odds ratios were reported. RESULTS Overall, 1 539 003 new prescriptions were issued to 715 895 children. The overall prevalence of 1-month noninitiation was 9.0% (ranging from 2.6% [oral antibiotics] to 21.5% [proton pump inhibitors]), and the prevalence of 6-month noninitiation was 8.5%. Noninitiation was higher in the youngest and oldest population groups, in children from families with a 0% copayment rate (vulnerable populations) and those with conditions from external causes. Out-of-pocket costs of drugs increased the odds of noninitiation. The odds of noninitiation were lower when the prescription was issued by a pediatrician (compared with a primary or secondary care clinician). CONCLUSIONS The prevalence of noninitiation of medical treatments in pediatrics is high and varies according to patients’ ages and medical groups. Results suggest that there are inequities in access to pharmacologic treatments in this population that must be taken into account by health care planners and providers.

Methods of using non-traditional types of physical exercises when working with pathologies that have arisen under the influence of environmental degradation

The article presents an experimental method of using game forms of classes aimed at improving the level of physical development of students with poor health and low level of physically fit. We worked with students with excessive weight gain not associated with health abnormalities. The group of students who, as a result of a medical examination, were found to have diseases of the endocrine glands, where excess weight is a concomitant sign of a serious disease did not include in the research. One of the objectives of the study was to identify changes in the students’ state of health and increase interest in classes, activating physical education classes for first-year students with various degrees of disorders of physically fit. The analysis of the impact of the proposed program on students, taking into account the specifics of the faculties and various specialties, will allow us to enrich the curriculum in physical culture. As well as, this will allow us to include in the program of classes non-traditional types of physical exercises while working with special medical groups, taking into account the pedagogical orientation of the faculties of the university.

Monitoring of the physical health state among 16–17-year-old female students

Background: The results of monitoring the physical health of 16–17-year-old girls who became first-year students of Khmelnytskyi Humanitarian-Pedagogical Academy during 2016–2019 have been analysed in the article. Material and Methods: 1670 female students participated in the research. In the course of the research, the number of people belonging to the main, preparatory and special medical group was determined, as well as those who were exempted from attending physical education classes. Results: The results of the research have found that there is a tendency for an increase in the number of female students exempted from attending physical education classes from 3.17% to 6.60%, and the increase in the number of female students assigned for health reasons to special medical groups at physical education classes from 6.57% to 11.93%. Conclusions: The analysis of changes of anthropometric indicators of girls showed that there is a growing number of overweight female students from 9.2% to 11.7%, and from 1.2% to 1.7% of those who have 1–2 degree of obesity. The analysis of functional indicators of physical condition showed that 21.8% of female students had deviations in age-related heart rate, and the indicator of vital capacity of lungs in 34.8% of female students was lower than the established norm. An analysis of the Robinson index showed that the level of energy potential of female students tends to deteriorate.

Investigating the Relationship between Ambulatory and Hospital Patient Experience Scores in a Neurosurgery Practice

Patient experience is critically important on both clinical and business levels to healthcare organizations, medical groups, and physician practices. We sought to understand whether a relationship exists between patient satisfaction scores in different settings for medical providers who practice in multiple settings (such as in the ambulatory setting and the hospital) within a system. Press Ganey (PG) ambulatory and hospital-based patient satisfaction surveys of a neurosurgery practice were retrospectively compared. Questions and sections related to the care provider, likelihood to recommend, and overall experience were examined. The ambulatory dataset included 2270 surveys, and the hospital dataset included 376. Correlation analysis of hospital survey patients who also completed an ambulatory survey (N = 120) was conducted, and weak, yet statistically significant, negative correlations between hospital “Likelihood to Recommend” and ambulatory “Care Provider Overall” (r = −0.20421, p = 0.0279), “Likelihood to Recommend” (r = −0.19622, p = 0.0356), and “Survey Overall” (r = −0.28482, p = 0.0019) were found. Our analyses found weak, yet significant, negative correlations between ambulatory and hospital PG scores. This could suggest that patient perception established in ambulatory and clinic settings could translate to a patient’s perception of their hospital experience and subsequent satisfaction scores.

The value of physical culture and health-improving activity in the physical training of students with weakened health

The article examines the key features of the organisation of physical culture and health-improving activities in the framework of physical training of students with impaired health. The considered research problem lies in the contradiction between the need to improve physical culture and health-improving activity in higher training and the lack in the modern training system of effective practices for organising physical training of students with impaired health. The study examines the main changes in recent years in the practice of organising physical culture and health-improving activities for students with impaired health, we reveal the mechanism for the formation of special medical groups, as well as their differentiation depending on the type of students' diseases. The importance of increasing the effectiveness of physical culture and health-improving activity in universities is noted, in view of the continuing growth in the number of students with impaired health. Based on the analysis of the current state of the system of physical training of university students, the main problems inherent in this area are highlighted, namely – the diversity of competences in the field of physical culture, the lack of balance between the acquisition of theoretical knowledge and the physical activity of students with impaired health, the lack of a motivational aspect in the system of physical training. The need for a qualitative modernisation of the practice of applying the competency approach to physical training of students and the introduction of a motivational component in the curriculum for physical culture is emphasised. For the further development of this direction, it is necessary to find and maintain a balance between theoretical work and obtaining practical skills in the process of physical culture and health-improving activities, as well as the ability to apply them in subsequent life.

INFLUENCE OF INCLUSIVE AND SEGREGATIVE PHYSICAL EDUCATION FOR SCHOOLCHILDREN OF DIFFERENT MEDICAL GROUPS

The study aimed to compare the effectiveness of inclusive and segregative physical education classes for students of various medical groups, taking into account sociopsychological indicators and indicators of psychoemotional state. The study involved 1,414 schoolchildren aged 10–16 years (M=12.7, SD=1.6). Through the survey, pupils’ wellbeing, needs, motivations, and motor preferences at their leisure and physical education classes, level of situational and personal anxiety, degree of integration of the group, and motivation for success were ascertained. Data comparisons were made between schoolchildren who studied in segregated and inclusive ways of organizing physical education in schools. Attitudes towards schoolchildren’s physical education and leisure patterns make it possible to assert that an inclusive model is effective. Integrative physical education classes are less mentally traumatic, more convenient, and psychologically comfortable than segregative ones. The way physical education is organized does not affect the level of anxiety and the class’s degree of motivation in achieving success in schoolchildren’s activities. Positive changes in the integrative conditions in the mental state come with all schoolchildren, but they are most noticeable among schoolchildren with low functional reserve capabilities.

Stress Cardiomyopathy Due to Exogenous Thyrotoxicosis From T3 Supplementation

Background: Wilson’s Temperature Syndrome (WTS) refers to a constellation of nonspecific symptoms, some of which include a low-normal body temperature, headaches, and fatigue. WTS was rejected by the American Thyroid Association as a valid medical diagnosis in 2005. Originally proposed in 1990 by Dr. E Denis Wilson, the etiology was theorized to be an impaired ability to convert T4 to T3, although this was not corroborated in thyroid lab abnormalities. Despite being publicly rebuffed as a true medical diagnosis, WTS has continued to gain traction amongst certain alternative medical groups and is treated with T3 supplementation. The development of a stress cardiomyopathy due to T3 supplementation is rare. Extrapolating from endogenous thyroid mediated stress cardiomyopathy and T4 supplementation induced stress cardiomyopathy, the pathophysiologic mechanism is likely excessive sympathetic activation. Clinical Case: A 58-year old female with no prior cardiac history presented to the emergency department with chest pain. Physical exam revealed a euvolemic appearing women, with intact and symmetric distal pulses, and a normal cardiac exam without murmurs or other abnormal heart sounds. There were no abnormal lung sounds. Her O2 sats were normal on room air. EKG and CXR were unremarkable. Her troponin was elevated (3.7 ng/mL, n< 0.034 ng/mL) and her BNP was elevated (4,568 pg/mL, n< 150 pg/mL). The patient was given aspirin and started on therapeutic heparin given concern for NSTEMI. Echocardiogram revealed an ejection fraction of 30% with hypokinesis of the entire apex and mid ventricle, raising concern for a stress cardiomyopathy. Coronary angiogram was performed which demonstrated no coronary artery disease. The patient underwent a cardiac MRI which confirmed a stress cardiomyopathy. Meanwhile, her laboratory workup was completed which revealed an undetectable TSH, a low T4 (0.53 ng/dL, n 0.7-1.8 ng/dL), and an elevated T3 (6.37 pg/mL, n 1.71-3.71 pg/mL). Patient endorsed taking oral liothyronine (T3) at doses of 5-40 mcg BID over the past 6 weeks per her alternative medicine provider for treatment of WTS. Her stress cardiomyopathy was presumed to be due to her exogenous thyrotoxicosis from T3 supplementation. She was counseled on the importance of cessation of T3 supplementation, and was started on heart failure medications. On hospital day 3, her T3 normalized to 2.73 pg/mL, and T4 remained low (0.4 pg/mL). Follow-up echocardiogram four months later demonstrated an ejection fraction that had improved to 45%. Conclusion: This case highlights the importance of physician awareness of alternative medicine diagnoses and treatment regimens that affect thyroid hormones and may cause harm to patients. This case is an important reminder of the effect thyroid hormones have on coronary vasculature, myocytes and myocardial function.

RELATIONSHIP BETWEEN THE FUNCTIONAL RESERVE OF THE HEART AND THE PHYSICAL FACILITY OF ADOLESCENTS OF THE SPECIAL MEDICAL GROUP

Relevance. The most common indicators for assessing the effectiveness of health technologies are the cardiovascular performance of adolescents. At present, there is insufficient information on the quantitative substantiation of informativeness, prognostic and diagnostic significance of such indicators in the process of correction of functional and reserve capabilities of the cardiovascular system of adolescents. Purpose: To determine the levels of functional reserve of the heart according to the Rufier index and to study the physical performance of students aged 12-14 years of different medical groups. Materials and methods. 178 seventh-eighth-graders aged 12-14 (85 boys and 93 girls) were examined. All students voluntarily participated in this experiment, and the written consent of their parents was obtained. Physical performance was studied according to the parameters of the bicycle ergometric test PWC170. The division of students into medical groups was carried out according to the indicators of the level of functional and reserve capabilities of the cardiovascular system, conducted according to the Rufier index. Statistical analysis of the results was performed using the application package Statistica-V.10.0. The normality of the distribution was checked by the Kolmogorov-Smirnov test. The studied indicators are described by the median (Me) and 25, 75 percentiles. The relationships of the studied indicators were analyzed according to Spearman's rank correlation coefficients. To determine the reliability of differences in indicators used the criterion of Kraskel Wallis. Results. The main group included 13.5% of adolescents, the preparatory group – 35.4%, the special medical group – 51.1% of students. Among student-athletes, 25.9% of boys and 45.4% of girls belong to a special medical group. In school athletes, the correlations between the Rufier index and the PWC170 test are low and statistically insignificant. Indicators of physical performance in the range of 25-75 percentiles do not differ in different medical groups. This indicates that in a special medical group there are students with medium and high levels of physical fitness. Conclusions. The established age and gender differences in the functional reserve of the heart of schoolchildren determine the need to develop differentiated approaches to the assessment of the Rufier index. Physical performance in different medical groups varies in a fairly wide range. The division of students into medical groups according to the Rufier index does not reflect the level of physical performance of students and, accordingly, their real adaptive capabilities. Further studies are needed on the informativeness of using the Rufier test to divide students into medical groups.

Corrective influence on the state of psychophysiological functions of students in physical education by by technologies of distance learning

The article substantiates the organizational and methodological support of physical education classes for students of higher education institutions by means of distance technologies aimed at the development of their physical activity in the school day. The article determines the didactic potential of such technologies in creating an experimental program of physical education of students. The purpose of the study is to analyze the state of psychophysiological functions of attention of students of the main medical groups under the influence of the experimental program of physical education by means of remote technologies. Research methods: general scientific methods of theoretical level: analysis and synthesis, and methods of obtaining empirical data: pedagogical experiment, pedagogical testing, methods of mathematical statistics. The state of psychophysiological functions of attention of students of the basic medical groups in the course of practical introduction of the experimental program is empirically analyzed. Distinctive features of such a program are the gradual development of motor activity and differentiation on each means, methods of teaching; direction of physical activity; dosing of loads for each lesson; types and content of control, self-control. The program provided for the introduction of traditional and non-traditional forms of physical education and innovative modern means of physical activity. The use of the developed experimental program of physical education of students by means of remote technologies provided significantly (p from <0.05 to <0.001) higher result than obtained after using the traditional approach to the organization of physical education. Experimental verification showed the high efficiency of the proposed program for its implementation. at the end of the experimental verification of the proposed innovations, the students of the experimental group achieve significantly higher values in all studied indicators, compared with the students of the control group. Thus, the dynamics of mental capacity and cognitive functions during the course of classes in general demonstrated the advantage of students of the experimental group over the control in the development of psychophysiological functions. It is proved that rationally organized classes according to the experimental program of physical education in the conditions of distance learning allow to realize the educational process without negative consequences for the state of psychophysiological functions of students, but also contribute to the improvement of their condition.