Tobacco and hazardous or harmful alcohol use in Thailand: joint prevalence and associations with socioeconomic factors

This study estimates the individual and joint prevalence of cigarette smoking and alcohol misuse, and examines the association between these risks and socioeconomic factors in Thailand. The self-reported data on cigarette and alcohol use are from a 2004 nationally representative cross-sectional survey of 39290 individuals aged 15 and over. Substantially more men than women were current smokers (45.8% vs. 2.3%; p<0.001) as well as harmful (5.4% vs. 0.9%, p<0.0001) and hazardous alcohol users (11.2% vs. 1.2%, p<0.001). The strongest predictor of alcohol misuse was smoking, and the strongest predictor of smoking was alcohol misuse in both sexes. There was an inverse relationship between education and family income with the odds of current smoking, whereas average levels of family income (not low or high) were associated with higher odds of harmful or hazardous alcohol use. Tobacco and alcohol misuse could be more effectively addressed by targeting and tailoring programs towards those who are most at risk - joint tobacco and harmful or hazardous alcohol users, and those of lower socioeconomic status.     

Glycemic control and the first use of oral antidiabetic agents among patients with type 2 diabetes mellitus

Abstract

Objective:

Examine how patients diagnosed with type 2 diabetes mellitus (T2DM) are treated with oral antidiabetic (OAD) agents and the relationship between treatment patterns and glycemic control.     

以品种为单元的药品GMP实施模式与参数放行模式的比较分析

目的通过对以品种为单元的药品GMP实施模式与参数放行模式的对比分析,探讨该模式与国际先进模式的异同,及其发展趋势。方法采用对比分析法,对两类模式的实质内涵、覆盖品种等方面的异同点进行比较分析。结果与结论以品种为单元的药品GMP实施模式是药品生产参数放行的初始阶段,随着该模式的发展完善,终将实现所有品种生产均按参数放行。     

Patterns of treatment utilization and methamphetamine use during first 10 years after methamphetamine initiation

The study examined joint trajectories of methamphetamine (MA) use and substance abuse treatment utilization and identified differences among pattern groups for a sample of 348 treated for MA use. Results from group-based trajectory modeling showed that treatment utilization during the first 10 years after initiation of MA use could be categorized into three distinctive patterns: about half the MA users have a pattern of low treatment utilization; one-fourth follow a quicker-to-treatment trajectory with higher probability of treatment during the first 5 years of MA use and less treatment in the next 5 years; and one-fourth have a slower-to-treatment trajectory with more treatment during the second half of the 10-year period. Four MA use patterns were identified: consistently low use, moderate, and high use, as well as a decreasing use pattern. Periods of greater likelihood of treatment participation were associated with periods of decreasing or lower frequency of MA use.     

Safety and treatment patterns of angiogenesis inhibitors in patients with advanced renal cell carcinoma in Spain

Objective: To examine real-world safety and treatment patterns of angiogenesis inhibitors for advanced renal cell carcinoma (aRCC) using observational data from two Spanish hospitals.

Methods: A retrospective medical record review was performed for 93 patients with a histological diagnosis of aRCC who received sunitinib, sorafenib, bevacizumab or temsirolimus as first-line angiogenesis inhibitor therapy, between January 2005 and September 2010 at two Spanish hospitals. Data were collected on adverse events (AEs), dosing to calculate relative dose intensity (RDI), treatment modifications and reasons for modifications.

Results: Sixty patients received sunitinib, 23 received sorafenib, 6 received bevacizumab, 1 received temsirolimus and 3 received a bevacizumab-temsirolimus combination. 91.7 and 100.0% of patients receiving sunitinib and sorafenib, respectively, experienced ≥ 1 AE; 40.0% and 43.5% had ≥ 1 grade 3/4 AE. Mean RDI for sunitinib and sorafenib were 0.866 (standard deviation (std) = 0.903) and 0.798 (std = 2.154), respectively. Among patients receiving sunitinib, 15.0% discontinued treatment, 43.3% had an interruption and 33.3% had a reduction due to AEs. For sorafenib, these rates were 4.3, 56.5 and 34.8%, respectively.

Conclusions: High rates of AEs were observed which resulted in high rates of treatment interruptions and dose reductions. These results suggest the need for additional treatment options for aRCC with improved tolerability.     

Comparing the treatment patterns of patients with schizophrenia treated with olanzapine and quetiapine in the Pennsylvania Medicaid population

ABSTRACT

Objective: Compare treatment patterns for patients with schizophrenia treated with olanzapine versus quetiapine in the Pennsylvania Medicaid population.

Methods: Patients (18–64 years) with a diagnosis of schizophrenia (ICD-9-CM: 295.xx) and treated with olanzapine or quetiapine were identified from the Pennsylvania Medicaid claims database (1999–2003). Patients were continuously enrolled in the 12-month pre- and 12-month post-initiation periods. To control for selection bias, propensity score method with optimal matching algorithm was used to match patients from the two treatment groups. The key study outcomes including rates of augmentation, polypharmacy, discontinuation, and switching were analyzed using Kaplan-Meier survival analysis. Medication possession ratio and use of concurrent psychotropic drugs were also compared between the two groups.

Results: A total of 2321 quetiapine and 6929 olanzapine patients were identified. In all, 2321 pairs of patients were matched between the two groups and they had similar baseline characteristics. Over the 12-month study period, olanzapine patients had a better medication adherence (0.47 vs. 0.43; p?<?0.0001), and were less likely to use other psychotropic medications concomitantly (all p?<?0.05). Olanzapine patients had a significantly lower risk of augmentation and polypharmacy with other antipsychotics. The 6-month augmentation rates with antipsychotics were 12.9% and 16.7% for olanzapine and quetiapine, respectively (p?<?0.05); the polypharmacy rates with any antipsychotics were 12.5% and 18.6% for olanzapine and quetiapine, respectively (p?<?0.001). No significant differences were observed for discontinuation and switching between the two treatment groups. Sensitivity analysis with a 60-day minimum monotherapy requirement showed similar results.

Limitations: This study's limitations include the analysis of a single Medicaid state, which may limit the generalizability to the entire Medicaid population with schizophrenia or to all patients with schizophrenia.

Conclusion: This large Medicaid claims database analysis showed that olanzapine patients were significantly more compliant to treatment and less likely to augment or have polypharmacy with antipsychotics during the course of treatment compared to quetiapine patients.     

The ARGA study with Italian general practitioners: prescriptions for allergic rhinitis and adherence to ARIA guidelines

Abstract

Background:

General practitioners (GPs) are the healthcare professionals to whom patients with rhinitis firstly refer for their symptoms.     

Recreational drug use concurrent with abuse or dependence on other psychoactive substances

In an effort to identify instances of the non-problematic use of a drug concurrent with the problematic use of one or more other drugs, we used structured interviews to obtain comprehensive drug use histories from 48 clients admitted to an intensive outpatient program. We classified clients on the basis of whether they demonstrated evidence of concurrent problematic and non-problematic drug use (Index and Probable Index cases) or only problematic drug use patterns (Non-Index cases). Both Index and Non-Index drug use patterns were about equally common in our sample. Both Index and Probable Index cases used a variety of drugs in a non-problematic manner and were generally congruent in their self-labelling of their drug use relative to their DSM-IV status for each drug used. We discuss several limitations of the study, including our reliance on retrospective, self-report data; potential problems with generalization to other populations; and possible changes in drug use patterns over time.     

Time-related effects of intoxication with cadmium and mercury in the red wood ant

Biochemical and physiological effects of prolonged feeding of the ant Formica aquilonia, in natural conditions with excess of cadmium or mercury, were studied. In all developmental stages metals caused the time-dependent increase of AMP, parallel with a decrease of ATP and the pool size of adenylates. This was reflected by a low adenylate energy charge (AEC) index and accompanied by an inhibition of ATPases. Despite the fall in the adenylate pool of workers, the levels of adenylate energy charge confirmed their ability to maintain energetic balance. Prolonged access to food highly contaminated with Cd, or Cd with Hg, diminished these adaptive abilities, but pre-adaptive reactions (not correlated with the metal load) were induced. Activity patterns of enzymes involved in energy metabolism showed metal dependent inhibitory effects, but repeated contamination evoked some compensatory mechanisms, both in workers and in the pupal stage from the next generations. Cadmium (indirectly) stimulated the esterases and free radical scavengers. Compensatory mechanisms were insufficient in insects contaminated with both Hg and Cd, even causing family disappearance, through increased mortality and migration to other colonies. Compensatory mechanisms expressed by the adult workers appeared to be of a phenotypic origin     

Baseline characteristics and treatment patterns of patients with schizophrenia initiated on once-every-three-months paliperidone palmitate in a real-world setting

Objectives: Since May 2015, adult patients with schizophrenia adequately treated with once monthly paliperidone palmitate (PP1M) may be transitioned to once-every-three-months paliperidone palmitate (PP3M). This study aims to describe baseline characteristics and treatment patterns of patients with schizophrenia initiated on PP3M in a real-world setting.

Methods: Pharmacy and medical claims from May 2014 to September 2016 for adult patients with schizophrenia initiated on PP3M (index date) in the Symphony Health Solutions database were analyzed. The cohort consisting of all patients and the one restricted to those transitioning from PP1M as per prescribing guideline recommendations were considered. Baseline characteristics were assessed during the 12 month baseline period. PP1M treatment patterns, proportion of days covered (PDC) by mental-health-related medications, and healthcare resource utilization (HRU) patterns were evaluated for each baseline quarter. PP3M treatment patterns were assessed post-index.

Results: Among the 1545 adult patients initiated on PP3M who formed the first cohort, 68.8% transitioned from PP1M based on prescribing guidelines and on an adaptation of the strict clinical trial protocol for PP1M to PP3M transition, forming the second cohort. In both cohorts, the proportion of patients with a PDC ≥80% for antipsychotics, antidepressants, anxiolytics, and mood stabilizers increased while the proportion of patients with ≥1 emergency room, inpatient, or outpatient visit decreased in baseline quarters closer to PP3M initiation. Among patients with ≥4 months of follow-up after the first dose, 85–88% had a second dose. Similarly, among those with ≥4 months of follow-up after the second dose, 87–90% received a third dose.

Conclusions: Patients initiated on PP3M demonstrated decreased HRU and increased adherence in quarters closer to PP3M initiation, and were persistent on their PP3M treatment.