The use of generic medicines facilitate access to treatment and reduce the overall health cost. Policies promoting generic substitution take into account many components such as quality and efficacy considering health stakeholders including physicians and pharmacists and identifying factors impacting generics prescription. The current study aimed to assess the association between the perception of physicians towards generics with their sex and age and their willingness to switch to generics after initial treatment. Furthermore, it aimed to evaluate the predictors for switching brands to generics after initial treatment and perceiving the exclusivity to perform this substitution. Prescription of generics to lower medical cost was more common among younger physicians compared to those 50 years and older. Interestingly, physicians aged 40 and above were more prone to prescribe generics to patients without medical coverage, while compared to physicians younger than 30 years of age. Age was significantly associated with switching initial treatment to generics, which was 2.46 times higher for physicians older than 50 years compared to those younger than 30 years. In addition, physicians practicing more than 20 years were about 1,5 times more accepting the substitution by pharmacists after initial treatment by brand while compared to physicians practicing for less than 10 years. Strategies to increase generic substitution and promoting its acceptance among physicians should take into consideration the different significant predictors. However, Further research is required to explore more factors, predicting prescription of generics in Lebanon, such as visits by medical representatives, regulations of the hospital that the physician is practicing, which are also proven to have high influence on the prescription practice of generics.
Introduction Migraine is common among university students and can directly affect their daily activities and learning since students with migraine have difficulties attending classes and missed more school days than other students. Objectives This study aimed to identify triggering factors of migraine along with factors that relieve headaches associated with migraine episodes among university students. Methods An observational cross-sectional study targeted students from different faculties of the public university campus in Lebanon using a survey for data collection. Results Feeling hungry (65.9%), fasting (50.7%), and coffee deprivation (22.7%) were the most commonly reported dietary factors inducing headaches among university students. In comparison, climate changes (77.1%), noise and high volumes (73.9%), and hot weather (60.2%) were the most common environmental triggers. Among the psychological factors, anxiety (53.4%) and crying (47.3%) were highly reported and were significantly higher among women. Fatigue (63.2%), studying for exams (59.5%), and neck pain (46.8%) were the most common physical activity-reported factors. Lack of sleep (72%) and changes in sleeping hours (42.7%) were the primarily reported sleeping habits that can trigger headaches, with no statistically significant differences between men and women. Sleeping (66.3%), relaxing (53.4%), avoiding migraine’s trigger factors (42.9%), and having a warm bath (38.5%) were the most reported relieving factors of headache among students. No statistically significant association was noted between any of the factors and the sex of the participants. Conclusion The triggering and relieving factors of migraine were comparable between men and women. Some triggering factors such as crying, anxiety, and fatigue were found significant among women, while driving was a higher migraine trigger among men. Lifestyle interventions may provide clues on effective relieving strategies and yield the establishment of different medical services and university programs.
BackgroundPrimary musculoskeletal pain conditions interfere greatly with the quality of life and are challenging to manage, from the patient’s and clinician’s perspectives. Susceptibility to chronic musculoskeletal pain syndromes in adulthood can be traced back to childhood when prevention might be most effective. Population-based longitudinal studies in pediatric ages allow for testing different predictors of pain trajectories to assist risk stratification. Recurrent pain experiences in non-musculoskeletal sites are common in young children and may be red flags for future musculoskeletal pain susceptibility [1].ObjectivesWe aimed to quantify the prospective association of non-musculoskeletal pain experiences at ages 7 and 10 with recurrent musculoskeletal pain at age 13 in a large population-based cohort of boys and girls.MethodsWe used data from Generation XXI, a population-based birth cohort setup in 2005-06 in the public maternities of Porto, Portugal. Participants were invited to regular follow-up visits at ages 7, 10, and 13 years. In each wave, pain history in the previous 3 months was assessed using the Luebeck Pain Screening Questionnaire, applied to caregivers (ages 7 and 10) and adolescents (age 13). We included only the main pain identified in the questionnaire, and only if it occurred more than once in the previous 3 months. Musculoskeletal pain sites comprised upper/lower limbs, back, neck, shoulders, hips, and generalized musculoskeletal. Non-musculoskeletal sites were head, abdomen/pelvis, or other. We calculated relative risks and 95% confidence intervals for the association between pain sites at ages 7 and 10 and recurrent musculoskeletal pain at age 13. The analysis was stratified by sex at birth.ResultsWe included 3833 participants (47.9% girls). Recurrent pain was reported in 28.4% of children at age 7 (25.7% of boys, and 31.3% of girls), 26.6% at age 10 (23.3% of boys, and 30.2% of girls), and 35.1% at age 13 (28.8% of boys, and 41.9% of girls).For girls, the most reported recurrent pain sites before adolescence were abdomen/pelvis (10.3% at 7, and 9.7% at 10), musculoskeletal (8.1% at 7, and 9.0% at 10), and head (7.7% at 7, and 7.3% at 10). In boys, recurrent pain was more frequent in musculoskeletal sites (9.0% at 7, and 9.6% at 10), followed by abdomen/pelvis (7.7% at 7, and 5.0% at 10), and head (5.1% at 7, and 6.0% at 10).As shown in the Figure 1, in 7-year-old girls, only abdominal/pelvic pain was predictive of future musculoskeletal pain at age 13 RR 1.43; (95%CI 1.07, 1.87). At age 10, musculoskeletal pain became predictive of musculoskeletal pain at age 13 [1.44 (1.07 - 1.84)]. In boys aged 7 years, both musculoskeletal and abdominal/pelvic pain were predictive of future musculoskeletal pain at age 13 [1.49 (1.13, 1.91) and 1.40 (1.02, 1.86), respectively]. At age 10 only musculoskeletal pain remained predictive of musculoskeletal pain at age 13 [1.45 (1.11, 1.84)].ConclusionIn this population-based cohort, musculoskeletal pain in adolescents was preceded by non-musculoskeletal pain experiences - especially abdominal/pelvic pain - during childhood in both boys and girls. Widening the scope to non-musculoskeletal sites may contribute to the early detection and risk stratification of individuals who are more susceptible to developing chronic musculoskeletal pain trajectories.Reference[1]Johnston KJA, Adams MJ, Nicholl BI, Ward J, Strawbridge RJ, et al. (2019) Genome-wide association study of multisite chronic pain in UK Biobank. PLOS Genetics 15(6): e1008164.https://doi.org/10.1371/journal.pgen.1008164Figure 1.Association between recurrent pain sites at ages 7 and 10, and recurrent musculoskeletal pain at age 13.AcknowledgementsThis work was supported by FOREUM - Foundation for Research in Rheumatology (Career Research Grant). Generation XXI cohort study is funded by EPIUnit at ISPUP, Universidade do Porto (UID/DTP/04750/2019), Fundação para a Ciência e a Tecnologia, ARS-Norte and Calouste Gulbenkian Foundation. MT was funded by the ERDF, through the North Regional Operational Program in the framework of the project HEALTH-UNORTE (NORTE-01-0145-FEDER-000039).Disclosure of InterestsNone Declared.
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