|
| ||
|
|
||
Chronic Users (chronic + user)
Selected AbstractsCOX-2 inhibitors: complex association with lower risk of hospitalization for gastrointestinal events compared to traditional NSAIDs plus proton pump inhibitors,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 10 2009Michiel W. van der Linden MDPhD Abstract Purpose To compare hospitalization rates for serious upper and lower gastrointestinal (GI) events between chronic and acute users of a traditional non-steroidal anti-inflammatory drugs (tNSAID),+,proton pump inhibitor (PPI) and users of a COX-2 selective inhibitor (Coxib). Methods The PHARMO Record Linkage System, including linked drug-dispensing and hospital records of approximately 3 million individuals in the Netherlands was used. We selected new Coxib or tNSAID users (01/01/2000,31/12/2004) with ,1,year history before the first NSAID dispensing and ,1,year follow-up ending at the first hospitalization for GI event (the outcome), last dispensing, or end of the study period. Chronic users were patients who used any NSAIDs for ,60,days during the first year (n,=,58,770); others were acute users (n,=,538,420). Multivariate analysis was performed by Poisson regression adjusted for gender, age, and duration of follow-up, tNSAID and Coxib dose, NSAID/PPI adherence, use of other gastroprotective agents, anticoagulants, acetaminophen, corticosteroids, and cardiovascular disease. Results The cohort included 23,999 new tNSAIDs,+,PPI users and 25,977 new Coxib users, with main characteristics: mean,±,SD age 58.1,±,15.5 vs. 56.7,±,17.5; female 55.3% vs. 62.2%; duration of treatment (days): 137,±,217 vs. 138,±,179, respectively. Among acute users, adjusted hazard ratios (95% Confidence Interval) were 0.21 (0.14,0.32) for upper and 0.26 (0.16,0.42) for lower GI events, for Coxib versus tNSAIDs,+,PPI users. Among chronic users, these were 0.35 (0.22,0.55) for upper GI and 0.43 (0.25,0.75) for lower GI events. Conclusions Coxib users had significantly lower rates of GI events. Further research should elucidate the possible impact of selection bias. Copyright © 2009 John Wiley & Sons, Ltd. [source] Do ,9 -tetrahydrocannabinol concentrations indicate recent use in chronic cannabis users?ADDICTION, Issue 12 2009Erin L. Karschner ABSTRACT Aims To quantify blood ,9 -tetrahydrocannabinol (THC) concentrations in chronic cannabis users over 7 days of continuous monitored abstinence. Participants Twenty-five frequent, long-term cannabis users resided on a secure clinical research unit at the US National Institute on Drug Abuse under continuous medical surveillance to prevent cannabis self-administration. Measurements Whole blood cannabinoid concentrations were determined by two-dimensional gas chromatography-mass spectrometry. Findings Nine chronic users (36%) had no measurable THC during 7 days of cannabis abstinence; 16 had at least one positive THC ,0.25 ng/ml, but not necessarily on the first day. On day 7, 6 full days after entering the unit, six participants still displayed detectable THC concentrations [mean ± standard deviation (SD), 0.3 ± 0.7 ng/ml] and all 25 had measurable carboxy-metabolite (6.2 ± 8.8 ng/ml). The highest observed THC concentrations on admission (day 1) and day 7 were 7.0 and 3.0 ng/ml, respectively. Interestingly, five participants, all female, had THC-positive whole blood specimens over all 7 days. Body mass index did not correlate with time until the last THC-positive specimen (n = 16; r = ,0.2; P = 0.445). Conclusions Substantial whole blood THC concentrations persist multiple days after drug discontinuation in heavy chronic cannabis users. It is currently unknown whether neurocognitive impairment occurs with low blood THC concentrations, and whether return to normal performance, as documented previously following extended cannabis abstinence, is accompanied by the removal of residual THC in brain. These findings also may impact on the implementation of per se limits in driving under the influence of drugs legislation. [source] Antidepressant drug prescribing among elderly subjects: a population-based studyINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 2 2005Mauro Percudani Abstract Background The patterns of antidepressant drug prescribing have rarely been studied in large and geographically defined populations of elderly subjects. In the present study we examined the prevalence and distribution of antidepressant prescribing in Lombardy, a northern Italy region with more than one and a half million elderly inhabitants. Methods We used the Regional Administrative Database of Lombardy. This database includes all prescriptions reimbursed by the National Health System in the population living in this region. All antidepressant prescriptions dispensed to subjects aged 65 years or above during 2001 were extracted and prevalence data calculated by dividing antidepressant users by the total number of male and female residents in each age group. Results During the 12 months surveyed 153,706 subjects were dispensed one or more prescriptions of antidepressants, yielding a prevalence of use of 9.49 subjects per 100 inhabitants (95% confidence interval 9.44, 9.53). Although the proportion of chronic users slightly decreased with age, more than 35% of those older that 85 years were moderate or chronic antidepressant users. General practitioners issued the majority of antidepressant prescriptions, and most antidepressant users were also dispensed agents for medical disorders. Conclusions The very high rates of antidepressant drug prescribing detected in late life suggest the need of characterising these subjects in terms of medical and psychiatric characteristics, needs and quality of life. It also suggests the need for pragmatic clinical trials, carried out in the general practice, with the aim of assessing whether antidepressants are effective in these conditions. Copyright © 2005 John Wiley & Sons, Ltd. [source] Improving geriatric mental health nursing care: Making a case for going beyond psychotropic medicationsINTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 1 2003Philippe Voyer ABSTRACT Providing high-quality mental health nursing care should be an important and continuous preoccupation in the gerontological nursing field. As the proportion of elderly people in our society is growing, the emphasis on high-quality care will receive increasing attention from administrators, politicians, organized groups, researchers and clinical nurses. Recent findings illustrate unequivocally the important contribution of nurses to achieving the goal of high-quality geriatric care. However, the quality of care for the elderly with psychological difficulties has not been addressed. The objective of this article is to illustrate that while nurses can accomplish much to improve the well-being and mental health of the elderly, their skills are often underutilized. Psychotropic drugs are often the first-line interventions used by health-care professionals to treat mental health concerns of elderly persons. Alternative therapies that could be implemented and evaluated, such as psychological counselling, supportive counselling, education and life review, are infrequently used. Nevertheless, current scientific data suggest that it would be very advantageous if nurses were to play a dominant role in the care of elderly people who are depressed or experiencing sleep pattern disturbances. The same can be said about elderly chronic users of benzodiazepines, as well as those with cognitive impairment. Evidence for the use of psychotropic medications as a viable treatment option for the elderly both in the community and in the long-term care setting who are experiencing mental health challenges is examined. Alternative non-pharmacological approaches that nurses can use to augment care are also briefly discussed. [source] Socio-demographic factors influence chronic proton pump inhibitor use by a large population in the NetherlandsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 5 2009O. S. Van BOXEL Summary Background, Chronic proton pump inhibitor (PPI) use is common in the Western world. Socio-economic status and socio-demographic factors have been shown to influence decisions related to prescribing of various drugs, but the influence of these factors on chronic PPI use is uncertain. Aim, To study the influence of SES and socio-demographic factors on chronic PPI use. Methods, Data were collected from a database of a Dutch health insurance company. Subjects having had at least one prescription for a PPI were identified and followed up for 6 months. Patients were then subdivided into chronic PPI users. Socio-demographic status was based on neighbourhood level of residence. Logistic regression was performed to determine socio-demographic factors associated with PPI use. Results, A total of 2 001 787 insured individuals were included, 85 253 subjects were chronic users. Both low income (OR 1.55; CI 1.52,1.58) and low educational level (OR 1.33; CI 1.31,1.36) were associated with chronic PPI use. Other independent predictive variables included use of 10 or more concomitant medications (OR 5.33; CI 4.96,5.72) and the use of prokinetic drugs (OR 10.01; CI 9.22,10.88). Conclusions, Patients of a lower socio-demographic status are more likely to use PPIs on a chronic basis. The observed gradient in PPIs use may reflect differences in health, healthcare use or healthcare supply. [source] Patient-directed strategy to reduce prescribing for patients with dyspepsia in general practice: a randomized trialALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 8 2004N. Krol Summary Background :,The percentage of patients receiving long-term treatment with acid suppressive drugs, mainly proton pump inhibitors, is higher than the prevalence of diseases that are commonly accepted as the proper indication for long-term proton pump inhibitor use. Aim :,To evaluate whether a patient-directed intervention (direct mail) reduced the prescription of antisecretory medication for dyspepsia in general practice. Methods :,A cluster-randomized trial was performed. One hundred and thirteen chronic users of proton pump inhibitors were recruited by 20 general practitioners. An unsolicited information leaflet was sent to patients that suggested stopping or reducing the use of proton pump inhibitors. The number of patients who stopped or reduced proton pump inhibitor use was measured at 12 and 20 weeks after the intervention. Secondary outcome measures were dyspepsia symptom severity and perceived quality of life measured at 12 weeks after the intervention. Results :,Fourteen of the 59 (24%) intervention group patients stopped or reduced their use of proton pump inhibitors, compared with three of the 45 (7%) control group patients (relative risk ratio 3.56; CI 95%: 1.088,11.642). Dyspepsia symptom severity and quality of life did not change. Conclusions :,A simple patient-directed intervention reduced the volume of long-term prescriptions of proton pump inhibitors in patients with dyspepsia. [source] COX-2 inhibitors: complex association with lower risk of hospitalization for gastrointestinal events compared to traditional NSAIDs plus proton pump inhibitors,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 10 2009Michiel W. van der Linden MDPhD Abstract Purpose To compare hospitalization rates for serious upper and lower gastrointestinal (GI) events between chronic and acute users of a traditional non-steroidal anti-inflammatory drugs (tNSAID),+,proton pump inhibitor (PPI) and users of a COX-2 selective inhibitor (Coxib). Methods The PHARMO Record Linkage System, including linked drug-dispensing and hospital records of approximately 3 million individuals in the Netherlands was used. We selected new Coxib or tNSAID users (01/01/2000,31/12/2004) with ,1,year history before the first NSAID dispensing and ,1,year follow-up ending at the first hospitalization for GI event (the outcome), last dispensing, or end of the study period. Chronic users were patients who used any NSAIDs for ,60,days during the first year (n,=,58,770); others were acute users (n,=,538,420). Multivariate analysis was performed by Poisson regression adjusted for gender, age, and duration of follow-up, tNSAID and Coxib dose, NSAID/PPI adherence, use of other gastroprotective agents, anticoagulants, acetaminophen, corticosteroids, and cardiovascular disease. Results The cohort included 23,999 new tNSAIDs,+,PPI users and 25,977 new Coxib users, with main characteristics: mean,±,SD age 58.1,±,15.5 vs. 56.7,±,17.5; female 55.3% vs. 62.2%; duration of treatment (days): 137,±,217 vs. 138,±,179, respectively. Among acute users, adjusted hazard ratios (95% Confidence Interval) were 0.21 (0.14,0.32) for upper and 0.26 (0.16,0.42) for lower GI events, for Coxib versus tNSAIDs,+,PPI users. Among chronic users, these were 0.35 (0.22,0.55) for upper GI and 0.43 (0.25,0.75) for lower GI events. Conclusions Coxib users had significantly lower rates of GI events. Further research should elucidate the possible impact of selection bias. Copyright © 2009 John Wiley & Sons, Ltd. [source] | ||||||||||