Anatomical Therapeutic Chemical Research Articles

Supervised chemical graph mining improves drug-induced liver injury prediction

Drug-induced liver injury (DILI) is the main cause of drug failure in clinical trials. The characterization of toxic compounds in terms of chemical structure is important because compounds can be metabolized to toxic substances in the liver. Traditional machine learning approaches have had limited success in predicting DILI, and emerging deep graph neural network (GNN) models are yet powerful enough to predict DILI. In this study, we developed a completely different approach, supervised subgraph mining (SSM), a strategy to mine explicit subgraph features by iteratively updating individual graph transitions to maximize DILI fidelity. Our method outperformed previous methods including state-of-the-art GNN tools in classifying DILI on two different datasets: DILIst and TDC-benchmark. We also combined the subgraph features by using SMARTS-based frequent structural pattern matching and associated them with drugs' ATC code.

National Trends in Statin Use in Lithuania from 2010 to 2021.

Objective: In Lithuania, no comprehensive national research on statin utilization and trends has yet been undertaken. Nonetheless, this knowledge is critical for the healthcare system to identify key areas for development. We aimed to analyze trends in statin utilization in Lithuania from the past 12 years considering changes in reimbursement policies and the publication of updated international CVD prevention guidelines. Methods: We performed a retrospective, descriptive study of statin utilization in Lithuania from 2010 to 2021. The data were obtained from PharmaZOOM LT, an independent software supplier with nationwide coverage on pharmaceutical market data. The data coverage was 95%. We used anatomical therapeutic chemical (ATC) classification for data extraction and calculated defined daily doses (DDDs) according to the ATC/DDD Toolkit of World Health Organization according to statin dose in a pill. Results: Statin use increased overall from 8.28 DDD/TID in 2010 to 96.06 DDD/TID in 2021. The annual growth rate in sales of statin DDD/TID was 22.28%. The increase was mostly due to the increase in moderate- and high-intensity statins. The increases coincided with changes in reimbursement policy or the publication of international guidelines. Polypill use in Lithuania began steadily increasing after 2016 and reached 19.37% of the total DDD/TID of statins in 2021. Conclusions: The use of statins has increased dramatically in Lithuania over the last decade. Changes in statin reimbursement regulations in the country, as well as worldwide cardiovascular preventive recommendations aiming at lower LDL-C objectives, fueled the progress.

Health Outcomes in Women Victims of Intimate Partner Violence: A 20-Year Real-World Study.

Intimate partner violence is characterized by violent actions against a person perpetrated by his or her former or current partner, regardless of cohabitation. It most frequently affects women, and one of its most relevant outcomes is the health problems associated with the experience of repeated violence. Thus, the main objective of this study is to analyse the prevalence of health problems among women for whom there was a medical suspicion of being victims of intimate partner violence. The specific objectives are to analyse the prevalence of (a) health risk behaviours; (b) traumatic injuries and intoxications; (c) mental health conditions; and (d) somatic diseases. We conducted a real-world, retrospective, observational, cross-sectional and multicentric study based on secondary data analyses of electronic health records and health care register data in patients of the Local Healthcare Unit of Matosinhos (between 2001 and 2021). The identified data were extracted from electronic health records corresponding to the Health Insurance Portability and Accountability Act Safe Harbor Standard. Information was obtained considering the International Classification of Diseases, the International Classification of Primary Care, and the Anatomical Therapeutic Chemical Classification System, as well as clinical notes (according to previously defined keywords). Considering all information sources, 1676 cases were obtained. This number means that just 2% of the women observed at this health care unit were suspected of being victims of intimate partner violence, which is far from the known statistics. However, we found much higher rates of all health risk behaviours, trauma and intoxication cases, mental health conditions, and somatic disorders we looked for, when compared to the general population. Early detection of these cases is mandatory to prevent or minimize their related health outcomes.

The analysis of the current state of medicines for ophthalmology registered in Ukraine

Aim. To analyze the range of ophthalmic medicines registered in Ukraine as of May 2022.
 Materials and methods. The classical (traditional) method of analysis and generalization of information was used for the study. The analysis of the range of ophthalmic medicines (MD) registered in Ukraine was carried out using data from the State Register of Medicines of Ukraine and Compendium 2022 listing medicines according to the ATC classification system. The following characteristics of the study were selected: drug belonging to a certain group of the ATC classification, dosage form (DF), component by a medicinal substance (MS), manufacturing companies and their countries of origin, the container filling volume and the primary packaging material for liquid DF.
 Results. The article presents the results of the analysis of the range of drugs for the treatment of various eye diseases. As of May 2022, 293 drugs for the treatment of eye diseases were registered in the State Register of Medicines of Ukraine, of which 25 entries were duplicated due to the introduction of changes in the information about identical medicinal products and the information of them was not taken into account in the study. It has been found that there is a significant range of drugs for the treatment of various eye diseases, covering all groups of medicines according to the ATC classification. The studies have shown the overwhelming dominance of the following characteristics of ophthalmic medicines in each of the categories studied: according to the ATC – S01E anti-glaucoma and miotic agents, according to the origin of the manufacturer – foreign manufacturers, according to DF – eye drops, according to the drug composition – monocomponent, by the container filling volume – 5 ml, and by the material of the primary packaging – polymer containers.
 Conclusions. The presence of a wide assortment provides opportunities to more fully meet the needs of ophthalmological branch of medicine in ophthalmic medicines of all groups of drugs according to the ATС classification.

CONSUMPTION DETAILS OF SYSTEMICALLY ACTING ANTIVIRAL AND ANTIMICROBIAL PREPARATIONS IN PERIOD OF NOVEL CORONAVIRUS INFECTION SPREAD IN RETAIL SECTOR OF SAMARA REGION PHARMACEUTICAL MARKET

An analysis of the medicinal preparation consumption structure in the period of the COVID-19 pandemic in the pharmacy network reflects the existing outpatient practice and makes it possible to draw generalized conclusions about its compliance with the pharmacotherapy standards.The aim. Comparative analysis of population consumption of antimicrobial and antiviral medicines sold in the retail pharmacies of the Samara region in 2015–2021.Materials and methods. The study was conducted in the retail sector of the Samara region pharmaceutical market. The material of the study was the information on the list of items and dispensing volumes of antibacterial and individual antiviral drugs during the novel coronavirus infection spread (in 2020) in the network of the Samara region pharmacies. The data are compared with the indicators of the drug sales in 2015–2019. Methods of retrospective, comparative, graphical, methodological, content analyzes and statistical methods of analyses were used.Results. The authors have established a significant distortion in the consumption of systemic antimicrobial preparations in the Samara region pharmacy segment in the period of 2015–2019 with the predominance of the ATC (Anatomical Therapeutic Chemical Classification System) J01D group, primarily cephalosporins (38%), mainly by the parenteral administration route. The share of macrolides (J01F) consumption in volume terms was 14.9%, of fluoroquinolones (J01M) – 11.3%, beta-lactam antibiotics with beta-lactamase inhibitors – 10.7%, beta-lactam antibiotics penicillins (J01C) – 8.1%. Compared to 2019, in 2020, under the conditions of the COVID-19 pandemic, the total consumption of AMPs increased by 2.1 times. In the “Other beta-lactam antibiotics” group with a predominant proportion of cephalosporins, there was an increase by 3.2 times, in the “Macrolides and lincosamides” group – by 3.5 times, in “Quinolone derivatives” – by 2.6 times. The noted facts should be assessed as the phenomenon that can have a direct impact on the growth of an antibiotic resistance on a population scale. Among antivirals, the largest consumption increase was noted for oseltamivir and rimantadine. In absolute terms, the volume of antiviral preparations consumption in 2020 increased by 2.4 times, which was accompanied by an increase in the cost of one package by 55.8%.Conclusion. In the period of spreading a novel coronavirus infection, a significant increase in the consumption of antimicrobial and antiviral preparations (up to 20 times for certain pharmacotherapeutic groups and names) was notified, which may negatively affect the growth of the antibiotic resistance in the population.

Study of medicines for parenteral administration used in children's medical organization

Assortment of industrially manufactured solutions for parenteral use a pediatric multidisciplinary hospital - the Children's Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan (DRCH) being discussed in the article. The paper presents the distribution of drugs for parenteral administration by producing countries, anatomical-therapeutic-chemical (ATC) - classification of the assortment of injection solutions. ABC-analysis of the most expensive groups, assortment analysis according to the nomenclature of medicines were carried out. In 2021 the largest number of items used a multidisciplinary hospital was revealed among the group of drugs affecting blood and hematopoiesis, while the most financially costly group were drugs for the treatment of diseases of the musculoskeletal system. The greatest financial expenses fall on the dosage form of solutions for injections in ampoules. TOP-10 expensive medicines for parenteral use have been determined. It has been established that the most purchased drugs for parenteral administration were the drugs from the group of antibiotics, plasma-substituting agents and solvents. Pediatric dosages of these drugs are not presented in the State Register of Medicines.

The results of development in the public sector of the Russian pharmaceutical market in 2019-2021

In 2020-2021, COVID-19 pandemic made a significant impact on the pharmaceutical market in developed countries as well as developing ones. Since 2019 the Russian pharmaceutical market has been demonstrating high growth rates in value terms with the main contribution made by the public (reimbursement) sector of the market.The goal was to study the main trends in the medicines consumption in the public sector of the Russian pharmaceutical market.Materials and methods. The analysis was based on IQVIA data, including preferential medicines supply (MS) for outpatients, MS for hospitalized patients, centralized federal MS programs, and other MS. The IQVIA data did not consider the use of COVID-19 vaccines.Results. In 2019-2021, the average annual growth rate of the public sector was 125.4% in value terms, which was determined by shifts in the consumption structure in favor of more expensive drugs. The main contribution to the positive dynamics was made by the hospital segment, share of which increased over the three years by 17 percentage points up to 45%. The dynamics of preferential MS programs lagged the general growth rates. The main impact on the market had made the following pharmacotherapeutic groups (according to ATC classification): anticancer drugs (groups L01, L02), immunosuppressants (L04), antivirals (J05), antithrombotics (B01), drugs for the treatment of spinal muscular atrophy (M09). The contribution of domestic-made production to the growth in value terms consisted of 38% over three years. Its share in the consumption structure increased by 2.4 percentage points up to 35.4%.Discussion. The prerequisites for the high dynamics of the public sector in 2019 was a significant increase in government healthcare spending, including the expansion of existing MS programs. In 2020-2021, the COVID-19 epidemic had the main impact on the volume and structure of medicines consumption, as well as an increase in funding and the launch of new MS programs. During the COVID-19 epidemic, the consumption of domestic-made drugs, including new original ones, has increased.Conclusion. As in other countries, in the coming years, the factor of controlling COVID-19 epidemic will no longer make a key impact on the dynamics of the Russian pharmaceutical market, while the expansion of reimbursed MS programs will especially being actual to the expected decline in household incomes.

Statin use improves survival of patients with known or suspected lower extremity artery disease on all ankle brachial index levels.

Background: Statin medication improves the prognosis of patients with lower extremity artery disease (LEAD). Research has previously focused on patients with a lowered ankle brachial index (ABI) excluding patients with a normal or elevated ankle brachial index. The aim of this study was to analyze the impact of statin use on survival and cardiovascular mortality in patients with LEAD of different severity depicted by the ABI level. Patients and methods: 4128 ABI measurements by trained and experienced nurses between 2000 and 2009 were combined with medication data from the Social Insurance Institution and causes of death data from the national causes of death registry. End of follow-up was set at the end of 2014. The data of statin use included all statin medication with the Anatomical Therapeutic Chemical (ATC) classification codes between C10AA01 and C10AA08. Results: 1956 (47.4%) patients had statin medication. Statin use was associated with improved overall survival and amputation free survival (AFS) on all ABI levels. When adjusted for age, sex and diabetes the greatest overall survival benefit from statin use was for the patients with ABI>1.3 (hazard ratio, HR: 0.67, 95% CI: 0.48-0.94, p=0.020, reference group statin non-users) and ABI 0.9-1.3 (HR: 0.78, 95% CI: 0.65-0.94, p=0.008). In propensity score matched pairs statin treatment was associated with significantly lower all-cause mortality (p<0.0001), cardiovascular mortality (p=0.034), cerebrovascular mortality (p=0.003) and embolic stroke related mortality (p=0.001) in patients with ABI >1.3 or <0.9. Overall survival benefit was significant in females with ABI<0.5 and in males across several ABI levels. Conclusions: According to our study, statins seem to improve overall and amputation free survival regardless of ABI level. Statin use was associated with lower mortality from cerebrovascular disease, overall mortality and in the propensity score matched patients with ABI<0.9 or >1.3 with cardiovascular mortality.

OP97 Stakeholders’ Involvement In Brazilian Health Technology Assessment Incorporation In 2021: A Statistical Description Of Demands To The Brazilian National Committee For Health Technology Incorporation

IntroductionThe demands for incorporating or excluding health technologies within the Brazilian Public Health System (SUS) can be requested by different stakeholders, including public administration, pharmaceutical companies, specialists’ and patients’ organizations/associations. The Brazilian National Committee for Health Technology Incorporation (CONITEC), part of the Ministry of Health, is the responsible organ to evaluate these demands and emit recommendations. The aim of this study is to show an overview of stakeholders according to the type of technology under request.MethodsOn 26 November 2021, a search was performed at CONITEC website. Health Technology Assessment (HTA) incorporation reports from 1 January to 26 November 2021 were extracted. From these reports, data regarding the demanded technology (e.g., medications, diagnostic tests, etc.), demand (technology incorporation, exclusion, or alteration), pharmacological classification according with the Anatomical Therapeutic Chemical (ATC), and requester’ categorization (e.g., pharmaceutical companies, official administration organs, etc.).ResultsPreliminary results showed a total of 77 health technologies, in 63 HTA incorporation submissions, of which 87 percent (n = 67) were medications, and 9 percent (n = 6) were new medical procedures. Only one medical device, one vaccine and two diagnostic tests were requested. Technology incorporation accounted for 94.8 percent of the demands (73), and 4 demands of exclusion. Seventy-one percent of the requested medications were classified, according to first ATC coding level, within groups L (Antineoplastic and immunomodulating agents), N group (Nervous system), A group (Alimentary tract and metabolism), and R group (Respiratory system), accounting 28.3, 17.9, 8.9 and 8.9 percent, respectively. Regarding stakeholders, the Brazilian Ministry of Health and its associated departments were responsible for 57.1 percent of the demands, while pharmaceutical companies requested 37.6 percent of incorporations. Other requesters included the Federal Justice Department, patients’, and specialists’ organizations, summing up with only four demands.ConclusionsThese results present the numerical weight of stakeholders in the Brazilian HTA incorporation system, with special attention to Brazilian bureaucracy and pharmaceutical companies. Further analysis regarding association between demand and other variables such as budgetary impact, costs, and ICD-10, shall deepen our understanding of different stakeholders’ role in Brazilian HTAi.

HPR49 Are Countries Using ATC Classification and Defined Daily Dose for Pricing and Reimbursement Decisions of Pharmaceuticals?

HPR49 Are Countries Using ATC Classification and Defined Daily Dose for Pricing and Reimbursement Decisions of Pharmaceuticals?

Antibiotic use in elderly patients in ambulatory care: A comparison between Hungary and Sweden.

Background: The elderly use antibiotics frequently due to their increasing infection susceptibility. Given the high and increasing proportion of elderly in the population, their antibiotic use is substantial. Objective: This study aimed to compare antibiotic use in the elderly in the ambulatory care sector between Hungary and Sweden. Methods: This retrospective, descriptive, cross-national, comparative study included antibacterial use data from the Hungarian National Health Insurance Fund and the Swedish eHealth Agency. Antibiotic use (anatomical therapeutical chemical: J01) was expressed as the number of prescriptions/1000 inhabitants/year or month and was further stratified by age and sex. Results: Antibiotic exposure was higher in the Hungarian elderly population (649.8 prescriptions/1000 inhabitants/year) compared to its Swedish counterparts (545.0 prescriptions/1000 inhabitants/year). Hungary had a similar scale of antibacterial exposure across all elderly age subgroups, with different trends in males and females, while Sweden had a stepwise increase in antibiotic exposure by age in both sexes. The seasonal fluctuation was high in Hungary and reached a peak of 80.7 prescriptions/1000 inhabitants/month in January 2017, while even antibiotic use was detected throughout the year in Sweden. The pattern of antibiotic use in the elderly considerably differed between the two countries. Penicillin and beta-lactamase combinations, such as co-amoxiclav, were more frequently used in Hungary than in Sweden (19.08% vs 1.83% of corresponding total ambulatory antibiotic use). Likewise, quinolones were more commonly used in Hungary than in Sweden (34.53% vs. 9.98). The elderly in Sweden were mostly prescribed narrow spectra penicillins (26.71% vs. 0.29% in Hungary). Conclusion: This cross-national comparison revealed important differences in all aspects of antibiotic use in the elderly between the two countries. The identical scale and pattern of antibiotic use cannot be anticipated due to the poorer health status of the Hungarian elderly population. However, the substantial differences indicate some room for improvement in the antibiotic prescription for the Hungarian elderly.

Medication errors in cancer therapy: Reports from German hospital pharmacists between 2008 and 2019.

Since medication errors can have severe consequences, the development of methods to improve patient safety is becoming increasingly important. The aim of this evaluation was to identify frequent medication errors in oncology as well as characteristic correlations in the various error patterns. In addition, the implementation rate of the proposed pharmaceutical intervention was determined in order to assess the benefit of a clinical pharmacist in the field of oncology. The evaluation was based on a data-set from a national documentation system for medication errors and interventions (DokuPIK) used by hospital pharmacists in the field of oncology from 2008 to 2019, namely 6684 reported cases in oncology, representing about 5% of all reports in DokuPIK. The most frequently reported errors were incorrect doses (22% of reported errors), followed by interactions (14%); in 10% of errors the prescription/documentation was incomplete/incorrect. The intervention suggested by the pharmacist was implemented in 97% of the cases. Based on the respective Anatomical Therapeutical Chemical Classification (ATC codes), drugs (or groups of drugs) were identified that were reported frequently in connection with medication errors, namely carboplatin and cyclophosphamide as anticancer drugs pantoprazole as non-anticancer drug. Frequently occurring medication errors in the field of oncology were identified, facilitating the development of specific recommendations for action and prevention strategies. The implementation of an electronic prescription software is particularly recommended for the avoidance of dosage errors in chemotherapy.

Abstract 13522: Gender Disparities in Low Density Lipoprotein Cholesterol Management Across the Spectrum of Atherosclerotic Cardiovascular Diseases: Insights From the Houston Methodist Cardiovascular Disease Learning Health System Registry

Introduction: Statin utilization for LDL-C lowering remains the cornerstone management strategy to reduce the risk of ASCVD. While lower statin utilization has been reported among women compared to men, contemporary studies evaluating sex disparities in LDL-C management across the spectrum of ASCVD are lacking, particularly across age and racial/ethnic subgroups. We aimed to provide detailed insights into this using data from a large US healthcare system. Methods: Cross-sectional study using data from ∼1.1 million patients aged 18+ years in the Houston Methodist Learning Health System Registry (2016-2022). Prevalent ASCVD including CAD, PAD, and stroke were identified using ICD 10-CM codes. Statin use and dose were identified in the database using ATC codes, and this information was recorded based on medication reconciliation reviews with patients at each clinical encounter. Individuals (n=973,720) without established ASCVD were excluded. Results: The study population consisted of 97,819 patients with prevalent ASCVD (55% men; 45% women, mean age: 69 years, 19% NHB, 12% Hispanic). Women with ASCVD reported lower statin use (64.3% vs 72.6%) and lower high-intensity statin use (29.8% vs 42.5%) compared with men. Women were also less likely to have on-treatment LDL-C &lt;70, and this was true for total ASCVD (21.8% vs 30.6%), CAD (24.9% vs 32.9%), PAD (23.2% vs 32.6%), and stroke (20.9% vs 30.1%). These disparities persisted across age (&lt;45, 45-64, &gt;65 years) and racial/ethnic (NHW, Hispanics, NHB, Asian/Other) strata. Conclusion: Significant gender disparities exist in contemporary LDL-C management among US patients with ASCVD, with women being less likely to receive any and high-intensity statin therapy, and reach the guideline defined goal of LDL-C &lt;70 mg/dL than men across age and racial/ethnic subgroups. These disparities underscore the need for further research to understand their drivers, and targeted systemwide programs to overcome care gaps.

Association between air pollution levels and drug sales for asthma and allergy in 63 million people in metropolitan France

Introduction Air pollution is known to have an impact on respiratory health. However, the assessment of this relationship is far from complete and is rarely extended to the country level. We used drug sales data, both Over-The-Counter (OTC) and prescription drugs, to assess exhaustively the impact of air pollution on asthma and allergy at the national level in France. Methods The WHO Anatomical Therapeutic Chemical (ATC) classification system was used to describe the distribution of sales of drugs of class R03 (Drugs for obstructive airways diseases, overall for asthma) and R06 (Antihistamines for systemic use). We performed a Quasi-Poisson regression model with a generalized additive model (GAM) to estimate the relationship (Relative Risks and 95% Confidence Interval) between drug sales and air pollutants, that is Particulate Matter with a diameter less than 2.5 micrometers (PM2.5) and less than 10 micrometers (PM10) and Nitrogen dioxide (NO2), as assessed using the high-resolution CHIMERE dispersion model. We designed unadjusted and adjusted single-pollutant models as well as two-pollutant models. Results PM2.5, PM10, and NO2 were significantly and positively associated with sales of R03 and R06 class drugs, after adjustment for potential confounders. Results were confirmed in the two-pollutant model for PM10 and NO2 but not for PM2.5. Conclusions Our study confirms the presence of an association between major air pollutants and the sales of drugs against asthma and allergies. Further studies on larger databases and over several years are necessary to confirm and better understand these results.

Trends in Adverse Drug Reactions Among Children: Evidence from Jiangsu Province of China, 2010-2019.

Medication safety among children represents an underrecognized public health concern worldwide, yet little evidence was found in China. This study aimed to examine trends in rates of pediatric adverse drug reaction (ADR) reports in Jiangsu Province of China with a catchment population of more than 11 million children. Data for children aged under 15 years were extracted from the spontaneous reporting system of ADR surveillance in Jiangsu Province. Suspected therapeutic agents for ADRs were coded using the Anatomical Therapeutic Chemical classification system. We used the Chinese modification of the International Classification of Diseases, Tenth Revision, to group primary diseases, and the Medical Dictionary for Regulatory Activities to classify the manifestation of ADRs. We used Joinpoint to estimate age-adjusted ADR rates stratified by sex from July 2010 to June 2019, and further by specific features, including patient characteristics, main suspected therapeutic medications, primary diseases, and ADRs. We used the percentage change annualized estimator to evaluate trends over time. A total of 79,903 ADR reports were identified among children aged under 15 years, which accounted for 11.4% of all ADRs reported in Jiangsu Province during the same period. The age-adjusted ADR report rates increased significantly from 66.20 to 96.76 per 100,000 children during the period July 2010-June 2019, with an annual increase of 4.9% (95% confidence interval 1.3-8.5%; p value 0.014). Of all ADR reports, there were 47,774 (59.8%) boys and 32,129 (40.2%) girls. Children aged 0-4 years accounted for more than half of the ADR reports (n=47,680, 59.7%). Skin and subcutaneous tissue disorders were the most frequently reported ADRs (45,773, 57.3%). Respiratory diseases were the most commonly observed medical conditions in relation to pediatric ADRs, accounting for 68.8% (n=54,940) of all ADR reports, and anti-infectives for systemic use consistently represented over time the most common medication group, contributing to 69.8% of all reports. A reduction in ADR report rates was observed for vaccines, with an annual decrease of 19% in children. ADRs remain a public health challenge among the vulnerable pediatric populations. Findings from the present study call for continuing efforts in ADR prevention and medication safety improvement in children.

Factors associated with formal and informal resource utilization in nursing home patients with and without dementia: cross-sectional analyses from the COSMOS trial

ObjectivesTo investigate the association between clinical, demographic, and organizational factors and formal (health professionals) and informal (relatives) resource utilization in nursing home patients with and without dementia.MethodsBaseline data from the multicomponent cluster randomized control COSMOS trial including 33 Norwegian nursing homes and 723 residents with and without dementia. Nursing home staff (n = 117) participated as proxy raters to approximate formal and informal resource use in daily care.MeasurementsThe primary outcome was the Resource Utilization in Dementia - Formal Care scale to assess formal and informal care time in hours/month regarding basic activities of daily living (ADL), instrumental ADL, and supervision. Secondary outcomes were hours/week spent on formal and informal leisure activities. Behavioral and psychological symptoms in dementia (BPSD) were assessed by the Neuropsychiatric Inventory-Nursing Home version, physical function by the Physical Self-Maintenance Scale, and psychotropic drug use by the Anatomical Therapeutic Chemical classification system. Organizational factors were ward size and staff ratio.ResultsGeneralized linear mixed-effect models and two-part modelling revealed an association between increased formal care time and poorer physical function, higher agitation and psychotropic drug use and lower cognitive function (all p < .05). Enhanced formal leisure time was related to better ADL function (p < .05) and smaller wards (p < .05). The family related leisure time was associated with agitation, decline in ADL function, smaller wards, and better staffing ratio (all p < .05). Married patients received more informal direct care (p < .05) and leisure time (p < .05) compared to unmarried/widowed.ConclusionFor nursing home staff, higher agitation and psychotropic drug use, and lower cognitive function, is associated with more direct care time, whereas leisure time activities are less prioritized in people with lower physical function. Informal caregivers’ engagement is encouraged by smaller nursing homes and better staff ratio. Therefore, we recommend stakeholders and healthcare professionals to consider these clinical and organizational factors to optimize treatment and leisure time activities in nursing home patients with various needs.Trial registrationClinicalTrials.gov; NCT02238652.

Association of Hormone Therapy With Depression During Menopause in a Cohort of Danish Women

During menopause, the levels of estrogen and progesterone decrease and 60% to 70% of women experience menopausal symptoms, including mood disturbances. The latter might be prevented by hormone therapy (HT), yet some studies have suggested that use of HT might be associated with increased risk of depression. To examine whether use of HT during menopause was associated with a subsequent diagnosis of depression. This nationwide register-based cohort and self-controlled case series study included all women in Denmark aged 45 years between January 1, 1995, through December 31, 2017 (n = 825 238), without prior oophorectomy, breast cancer, or cancer in reproductive organs. Follow-up was completed on December 31, 2018. The statistical analysis was performed from September 1, 2021, through May 31, 2022. Redeemed prescriptions of different types of HT identified by the Anatomical Therapeutic Chemical classification system codes (G03C [estrogen] and G03F [estrogen combined with progestin]) in the Danish National Prescription Registry between 1995 and 2017. Type of administration was divided into systemic (oral or transdermal) and local (intravaginal or intrauterine). A hospital diagnosis of depression (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, codes F32-F33 and International Classification of Diseases, Eighth Revision, codes 296.09, 296.29, 298.0, and 300.49) between 1995 through 2018. Associations were examined in cohort and self-controlled case series analysis using Cox proportional hazards and fixed-effects Poisson regression models. During follow-up from 45 years of age to a mean of 56.0 (range, 45.1-67.7) years, 189 821 women (23.0%) initiated systemically or locally administered HT and 13 069 (1.6%) were diagnosed with depression. Systemically administered HT was mainly initiated before 50 years of age and was associated with a higher risk of a subsequent depression diagnosis (hazard ratio [HR] for 48-50 years of age, 1.50 [95% CI, 1.24-1.81]). The risk was especially elevated the year after initiation of both treatment with estrogen alone (HR, 2.03 [95% CI, 1.21-3.41]) and estrogen combined with progestin (HR, 2.01 [95% CI,1.26-3.21]). Locally administered HT was initiated across all ages and was not associated with depression risk (HR, 1.15 [95% CI, 0.70-1.87]). It was, however, associated with a lower risk of depression when initiated after 54 years of age (HR for 54-60 years of age, 0.80 [95% CI, 0.70-0.91]). In self-controlled analysis, which efficiently accounts for time-invariant confounding, users of systemically administered HT had higher rates of depression in the years after initiation compared with the years before treatment (incidence rate ratio for 0-1 year after initiation, 1.66 [95% CI, 1.30-2.14]). These findings suggest that systemically administered HT before and during menopause is associated with higher risk of depression, especially in the years immediately after initiation, whereas locally administered HT is associated with lower risk of depression for women 54 years or older.

Use of chronic medications and risk of death due to COVID-19 in hospitalised patients

ObjectivesTo evaluate the potential association between chronic exposure to medication and death related to COVID-19.MethodsThis is a retrospective cross-sectional study that included all patients hospitalised due to COVID-19 from 11...

Random Forest-Based Compound ATC Classification Using Structural and Physiochemical Information

Random Forest-Based Compound ATC Classification Using Structural and Physiochemical Information

Antibiotic consumption in the public sector of the Limpopo province, South Africa, 2014-2018.

Antibiotic consumption (ABC) surveillance is a critical component of the strategic priority response to the increasing antibiotic resistance threat. Levels of ABC at the national and provincial levels in South Africa are unknown because of inadequate ABC surveillance systems and literature. Antibiotic consumption in the public sector of Limpopo province, South Africa, 2014-2018. This retrospective study used sales data retrieved from a pharmaceutical warehouse distribution database to quantify ABC. Antibiotic consumption was measured by the defined daily dose (DDD) per 1000 inhabitants per day (DID) and 75% drug utilisation index (DU75%). Change in consumption was measured by the compound annual growth rate (CAGR). Between 2014 and 2018, the mean ABC was 4.6 ± 1.0 DID, with an overall decrease of 1.6% in the CAGR. Penicillins (2.3 ± 0.8; 50.0%), sulphonamide and trimethoprim combinations (1.4 ± 0.3 DID; 30.4%) were the most consumed antibiotics. Macrolides had the highest relative increase in consumption during the study period, with a CAGR of 18.5%. In contrast, tetracyclines had the highest relative decrease in consumption, with a CAGR of 100.0%. The CAGR ratio for broad- to narrow-spectrum increased by 39.3%, from 0.4 in 2014 to 2.1 in 2018. The DU75% comprised amoxicillin (28.4%), sulphamethoxazole and trimethoprim (SMX-TMP) (27.2%), doxycycline (12.3%) and azithromycin (9.2%). While ABC remained relatively stable throughout the study, there was an increase in broad-spectrum ABC that requires further investigation. This study contributes ABC surveillance data in Southern Africa, described by ATC classification, which is essential for monitoring and evaluating antibiotic stewardship programmes.