Репозиторий Университета

Background: There is currently a wide therapeutic arsenal for migraine patients, without a single first-line preventive drug and we choose the different available alternatives taking into account comorbidities, national guidelines, previous treatments and personal experiences. Our objective was to evaluate the differences in the use of migraine treatments between neurologists from different countries. Methods: This is a multi-centre observational study carried out by neurologists from specialized headache units in seven countries, retrospective with consecutive inclusion of all patients presenting with a migraine diagnosis, over a period of three months. Results: A total of 734 patients were recruited but only 600 were considered in the analysis in order to homogenize the patient cohorts from countries: 200 Spain (ES), 100 Italy (IT), 85 Russia (RUS), 80 Germany (DE), 60 Portugal (PT), 45 Poland (PL) and 30 Australia (AU). 85.4 % of patients were women with a mean age of 42.6 ± 11.8 years. Considering previous and current preventive treatment, the order of use was: antidepressants (69.3 %), antiepileptic drugs (54.7 %), beta-blockers and antihypertensive drugs (49.7 %), OnabotulinumtoxinA (44.0 %) and others (36.2 %). Statistically significant differences were found between all pharmacological classes: antidepressants were commonly used in all countries, with the exception of Poland (AU: 76.7 %, IT: 71.0 %, DE: 60.0 %, PL: 31.1 %, PT: 71.7 %, RUS: 70.6 %, ES: 78.5 %; p < 0.0001); antiepileptic drugs were more frequently prescribed in Portugal, Australia and Spain (AU: 73.3 %, IT: 40.0 %, DE: 37.5 %, PL: 48.9 %, PT: 85.0 %, RUS: 29.4 % and ES: 69.0 %; p < 0.0001); beta-blockers and antihypertensive drugs were frequently used in all countries except Italy (AU: 60.0 %, IT: 14.0 %, DE: 53.8 %, PL: 48.9 %, PT: 68.3 %, RUS: 49.4 % and ES: 59.0 %; p < 0.0001); BTX-A were predominately used in Spain, Italy and Australia (AU:56.7 %, IT:58.0 %, DE:20.0 %, PL: 42.2 %, PT: 26.7 %, RUS: 24.7 % and ES: 58.5 %; p < 0.0001) and others were most frequently used in Poland (AU: 0.0 %, IT: 19.0 %, DE: 42.5 %, PL: 95.6 %, PT: 31.7 %, RUS: 3.5 % and ES: 49.5 %; p < 0.0001). If only patients without comorbidities are considered (200/600), statistically differences between countries persist in all preventive treatments. Conclusions: There is heterogeneity in the choice of preventive treatment between different countries. Prospective comparative studies of the different oral and subcutaneous alternatives would help to create a global therapeutic algorithm that would guarantee the best option for our patients.

© Pushkareva M.V., Shevyreva M.P., Goncharuk N.N., May I.V., Andrishunas A.M., 2018. The article contains information on hazardous chemical wastes, reasons that cause their occurrence and accumulation in the environment as well as issues related to accumulation of persistent organic pollutants (POPs) in the environmental objects. The authors outline specific features of POPs and their possible influence on the environment and a human body; they also dwell on priority activities accomplished in the RF in relation to POPs after Stockholm Convention on Persistent Organic Pollution was ratified. Provisions of international law in the sphere of providing chemical safety are being consolidated now and operating bodies of Basel, Rotterdam, and Stockholm Conventions interact with each other in order to fix concentrations for chemicals which are persistent organic pollutants and to determine their low contents in wastes. The European Union countries and Canada have submitted their proposals on concentrations of 21 various chemicals in wastes for consideration by all the concerned parties. Scientific validity of the proposed concentrations has been analyzed; the analysis results are given in the article. Given the hazards caused by chemicals wastes that contain POPs for people and the environment, the authors suppose that additional research should be performed on substantiation of POPs safe concentrations in wastes. Taking into account national security and common provisions of international laws related to solving global, national, and regional tasks, the authors note that it is necessary to update legislation on state regulation in the sphere of providing chemical safety; they also give grounds and outline conceptual approaches to creation of the Federal Law "On chemical safety". The article gives a basic idea of this law; its purpose; an object of its regulation; people or economic entities whose activities are subject to its force; a place this law, when passed, is going to have in the RF federal legislation and a system of international agreements that are ratified by the RF. It should be noted that when the Federal Law "On chemical safety" is adopted, it will allow to reduce negative effects produced by hazardous chemical wastes on population and the environment and will have both medical and social-economic outcomes.