A 13-Year National Monitoring Study to Assess Narcotic Prescriptions and Indications (2007–2019)

Drug Safety - Analgesics are among the most widely used drugs worldwide. This study describes the population treated with narcotic analgesics, their therapeutic indications and how the data have...     

Primary health care organizational characteristics associated with better accessibility: data from the QUALICO-PC survey in Quebec

Background

First-contact accessibility remains an important problem in Canada, with this indicator staying the worst of all Organization for Economic Co-operation and Development countries. In the province of Quebec, a number of primary healthcare (PHC) organizations have adopted measures to improve access (e.g. advance access scheduling, expanded nursing role, electronic medical record, financial incentives). The impact of those changes is unknown. The goal of this study is to assess which PHC organizations’ characteristics are associated with improved first-contact accessibility.

Methods

We conducted a secondary data analysis of the Quebec survey, conducted as part of the QUALICO-PC study on primary care performance. QUALICO-PC is a cross-sectional study to assess quality, costs and equity in PHC across 35 countries and jurisdictions. Organizational characteristics were measured from the family practitioners’ questionnaire. First-contact accessibility was measured from the patient questionnaire filled by patients who received care in the participating PHC organizations. Multi-level logistic regression was used to assess the association of organizational characteristics as predictors of patient-reported accessibility.

Results

A total of 218 family practitioners participated in the study with 1798 of their patients. PHC organizations characteristics associated with increased first-contact accessibility included the possibility to have a same-day appointment or to walk in the clinic without an appointment, higher number of physicians per clinic and higher number of hours worked by the family physician. Electronic medical record and expanded nursing role were not associated with increased accessibility.

Conclusions

Same-day access and higher family physician working hours are associated with improved patient-reported accessibility. Other PHC organizations characteristics targeted by recent reforms were not associated with improved accessibility.

     

Bioimage analysis of Shigella infection reveals targeting of colonic crypts

Few studies within the pathogenic field have used advanced imaging and analytical tools to quantitatively measure pathogenicity in vivo. In this work, we present a novel approach for the investigation of host–pathogen processes based on medium-throughput 3D fluorescence imaging. The guinea pig model for Shigella flexneri invasion of the colonic mucosa was used to monitor the infectious process over time with GFP-expressing S. flexneri. A precise quantitative imaging protocol was devised to follow individual S. flexneri in a large tissue volume. An extensive dataset of confocal images was obtained and processed to extract specific quantitative information regarding the progression of S. flexneri infection in an unbiased and exhaustive manner. Specific parameters included the analysis of S. flexneri positions relative to the epithelial surface, S. flexneri density within the tissue, and volume of tissue destruction. In particular, at early time points, there was a clear association of S. flexneri with crypts, key morphological features of the colonic mucosa. Numerical simulations based on random bacterial entry confirmed the bias of experimentally measured S. flexneri for early crypt targeting. The application of a correlative light and electron microscopy technique adapted for thick tissue samples further confirmed the location of S. flexneri within colonocytes at the mouth of crypts. This quantitative imaging approach is a novel means to examine host–pathogen systems in a tailored and robust manner, inclusive of the infectious agent.The light microscope is an important tool in resolving the interactions between microbes and their hosts. With the advancement of both optical and computational techniques, quantification of biological events is not only possible, but essential in deciphering the complex interplays between host and pathogen. Acquired images are multidimensional datasets that capture complex biological phenomena, and a major task is to computationally extract statistically relevant data from those images. Such techniques have been readily applied in Cellular Microbiology, a discipline at the interface between cellular biology and microbiology (1). This field is dominated by studies focusing on microbe–host interactions at the in vitro, cellular scale, and a multitude of bioimage analysis tools have been developed and used to decipher pathogenic strategies at the cellular, as well as the molecular, level in high resolution in both space and time (2).The next imaging challenge exists on a much larger scale in the growing field of Tissue Microbiology, which places the pathogen in its native in vivo environment, the host (3). Biologically speaking, this environment is essential for the full understanding of a given pathogen’s invasive strategies and the complex host response; however, this also places additional complexity and limitations in regards to imaging, particularly in maintaining cellular and molecular resolution. Novel tools and studies addressing bacterial infection in vivo are frequently reported in the literature (4, 5). However, emphasis has been traditionally placed on qualitative observations at the expense of extensive quantitative efforts. The importance of bioimage analyses to automatically extract data from medium- to large-scale image sampling of infected tissue is often underappreciated as a method to expand our understanding of pathogens’ strategies and disease progression. In this work, we aim to bring quantitative image analysis into the realm of host–pathogen interactions, specifically examining the progression of tissue invasion by a model enteropathogenic bacterium, Shigella flexneri.S. flexneri is the causative agent of bacillary dysentery, an infectious rectocolitis, which remains a major pediatric public health concern in developing countries. This human-specific pathogen is transmitted via the fecal–oral route, and namely targets the large intestine, resulting in acute inflammation, tissue edema, and erosion of the colonic epithelium (6). The infection strategy of S. flexneri relies on (i) the transfer of bacterial proteins, termed “effectors,” into targeted host cells through the type III secretion apparatus (T3SA), which induces the uptake of the bacteria and perturbs host cellular processes, and (ii) the capacity of the intracellular bacteria to spread from cell to cell using actin microfilament-mediated cytoplasmic movement and reactivation of the T3SA (7–10).Herein, we present a straightforward approach that relies on the combination of light microscopy and computer analyses to study the mucosal invasion of a newly developed in vivo model for shigellosis, S. flexneri intrarectal inoculation of the guinea pig colon (11). Through the application of simple, open-source image analysis tools, we built up a medium-throughput analysis that allows observing and robustly measuring host–pathogen interactions. Most importantly, this approach can be adapted to other host–pathogen systems, thereby providing generic tools that bridge Cellular and Tissue Microbiology.     

A New Method of Positioning at Delivery Compared With the Dorsal Recumbent Position: An Exploratory Retrospective Study of Obstetric Outcomes

BackgroundIn the last 30 years, several initiatives have aimed to reintroduce a certain freedom in positioning during labour. The objective of this study was to compare an alternative method of positioning at delivery (APOR B method) with the dorsal recumbent (supine) position.MethodsWe undertook a comparative, retrospective study of 276 singleton deliveries at ≥ 36 weeks The APOR B method used by two general practitioners (GPs) was compared with the dorsal recumbent position used by two other GPs with similar years of experience. We assessed obstetric outcomes with logistic regression analyses.ResultsThe study populations were similar except for more cases of induced labour (40% vs. 27%, P = 0.030) and earlier gestational age at delivery (mean ± SD 39.1 ± 1.4 vs. 39.4 ± 1. 0 weeks of amenorrhea, P = 0.032) in the APOR B group (adjustment provided). Mode of delivery and perineal outcomes were similar, with 74% and 72% (P = 0.816) of spontaneous vaginal deliveries and 38% and 44% (P = 0 368) of intact perineums for APOR B and dorsal recumbent positions, respectively. Women in the APOR B group were less likely to have vaginal tears (15% vs 28%, aOR 0.45, 95% CI 0.23 to 0.89). No differences were observed in the frequency of abnormal fetal heart rate, Apgar score < 7 at five minutes, dystocia, and blood loss. However, umbilical cord arterial pH < 7.20 was more frequent in the APOR B group (32% vs. 20%, aOR 2.0, 95% CI 1. 1 to 3.8).ConclusionThe outcomes of the two methods of positioning at delivery were mostly equivalent, except for fewer vaginal tears and lower umbilical cord arterial pH in the APOR B group. These findings will need to be further assessed in randomized controlled trials.     

Trends of atropinic (anticholinergic) exposure in the elderly: a 10‐year analysis in the French EGB database

Atropinic drugs are known to potentially induce physical and/or mental impairments in the elderly. The aim of this study was to investigate trends of atropinic exposure in patients ≥65 years in France between 2006 and 2015. A repeated cross‐sectional study was performed quarterly from January 1, 2006 to December 31, 2015, in the ‘Echantillon Généraliste des Bénéficiaires (EGB)’, a representative sample of the French population. Exposed patients were identified using the Anticholinergic Durán's list. Outcomes were rate of patients exposed to at least one atropinic drug (atropinic prevalence rate) and atropinic burden per patient (sum of atropinic burden scores). Interrupted time series were used to analyze the impact of market withdrawal of some drugs with atropinic properties during the period of the study. The number of patients ≥65 years registered in the EGB ranged from 75 611 in 2006 to 95 389 in 2015. Atropinic prevalence rate decreased significantly from 45.6% in 2006 to 33.2% in 2015 (?12.4%, slope significance P < 0.05). Subjects aged ≥85 years were the most exposed. Total atropinic burden decreased significantly between 2006 and 2015 (2.2 ± 1.7 in 2006; 2.0 ± 1.5 in 2015; slope significance P < 0.05), especially in patients ≥85 years. Market withdrawals for safety reasons of some atropinic drugs were significantly associated with a decrease in the atropinic prevalence rate (P < 0.05) and atropinic burden per patient (P < 0.05). In conclusion, atropinic drug exposure in the elderly significantly decreased in France between 2006 and 2015. This decrease can be partly explained by regulatory measures against some atropinic drugs.     

No differences between men and women in adverse drug reactions related to psychotropic drugs: a survey from France,Italy and Spain

A large number of studies have suggested that being a woman represents a potential risk factor for the development of adverse drug reactions (ADRs). The aim of this study is to further explore the differences between men and women with regard to reported ADRs, particularly those associated with psychotropic drugs. We used spontaneous reports of suspected ADRs collected by Midi‐Pyrénées (France), Veneto (Italy) and Castilla y León (Spain) Regional Pharmacovigilance Centres (January 2007–December 2009). All the reports including a psychotropic medication were selected in a first step; age distribution, seriousness and type of ADRs were compared between men and women. Reports of nonpsychotropic drugs were similarly identified and treated. The absolute number of reports and the proportion, considering population, were higher in women than in men. This was observed for all reports, but was particularly higher for psychotropic drugs (592 vs. 375; P < 0.001) than for nonpsychotropics drugs (5193 vs. 4035; P < 0.001). Antidepressants were the most reported (women, 303; men, 141; P < 0.001); the reporting rates (number of reports divided by exposed patients in the same period, estimated through sales data) for these drugs, however, were not significantly different between women (0.87 cases per 10 000 treated persons per year) and men (0.81 cases per 10 000 treated persons per year). Although there was a higher number of reports of ADRs in women, ADR reporting rates might be similar as highlighted by the case of antidepressants. Antidepressant ADRs in fact were similarly reported in men and in women. Gender differences are sometimes subtle and difficult to explore. International networks, as the one established for this study, do contribute to better analyse problems associated with medications.