Differences In Drug Treatment Research Articles

Prevalence of Chronic Heart Failure, Associated Factors, and Therapeutic Management in Primary Care Patients in Spain, IBERICAN Study.

Background: The prevalence of chronic heart failure (CHF) in patients assisted in primary care is not well known. We investigated the prevalence of CHF, its associated factors, and its therapeutic management. Methods and findings: This was a cross-sectional, multicenter study conducted in primary care (PC) in baseline patients of the IBERICAN study (Identification of the Spanish Population at Cardiovascular and Renal Risk). CHF was defined as the presence of this condition in the medical history, classifying patients according to the type of ventricular dysfunction in CHF with preserved ejection fraction (pEF), or CHF with reduced ejection fraction (rEF). Clinical characteristics, relationship between CHF and main cardiovascular risk factors (CVRF), and drug treatments used according to ejection fraction (EF) were analyzed. Results: A total of 8066 patients were included (54.5% women), average age (SD) was 57.9 (14.8) years, of which 3.1% (95% CI: 2.3–3.7) presented CHF, without differences between men and women. CHF with pEF (61.8%; 95% CI: 55.5–67.6) was more frequent in women, and CHF with rEF (38.1%; 95% CI: 33.2–45.5) (p = 0.028) was similar in both genders (65.9%; 95% CI: 57.1–73.4 vs. 57.3%; 95% CI: 47.7–65.8) (p = 0.188). A progressive increase of the prevalence with age (15.2% in ≥80 years) and with the aggregation of CVRF was observed. The most prescribed treatments were beta-blockers (54.7%) followed by angiotensin converting enzyme inhibitors (42.8%) and angiotensin II receptor antagonists (41.3%), without differences between pEF and rEF. The variables that are most associated with the probability of suffering CHF were a personal history of left ventricular hypertrophy (OR: 5.968; p < 0.001), of atrial fibrillation (OR: 3.494; p < 0.001), and of peripheral vascular disease (OR: 2.029; p < 0.001). Conclusions: Three in every 100 patients included in the IBERICAN study presented CHF, of which two thirds had pEF. The condition increased exponentially with age and aggregation of CVRF. We did not find any differences in drug treatment according to the type of ventricular dysfunction. The treatment of HF with rEF has much room for improvement.

Differences in Drug Treatment Practices Among Younger and Older Veterans With Inflammatory Bowel Disease

Differences in Drug Treatment Practices Among Younger and Older Veterans With Inflammatory Bowel Disease

Does patient's sex influence treatment in primary care? Experiences and expressed knowledge among physicians--a qualitative study.

BackgroundBiological and sociocultural differences between men and women may play an important role in medical treatment. Little is known about the awareness of these differences among general practitioners (GPs) and if they consider such differences in their medical practice. The aim of this study was to explore GPs’ perception of sex and gender aspects in medical treatment.MethodsWe conducted five focus group discussions (FGDs) with 29 physicians (mainly GPs) in Sweden. A discussion guide with semi-structured questions was used. All FGDs were audio-recorded and transcribed word-by-word. Data were analysed through inductive thematic analysis with no predetermined categories.ResultsThree main categories emerged from the data. The first category emphasised GPs’ experiences of sex and gender differences in diagnosing and assessment of clinical findings. Medical treatment in men and women was central in the second category. The third category emphasised GPs’ knowledge of sex differences in drug therapy.ConclusionsThe GPs stated they had little knowledge of sex and gender differences in drug treatment, but gave multiple examples of how the patient’s sex affects the choice of treatment. Sex and gender aspects were considered in diagnosing and in the treatment decision. However, once the decision to treat was made the choice of drug followed recommendations by local Drug and Therapeutics Committee, which were perceived to be evidence-based. In the analysis we found a gap between perceived and expressed knowledge of sex and gender differences in drug treatment indicating a need of education about this to be included in the curriculum in medical school and in basic and specialist training for physicians. Education could also be a tool to avoid stereotypical thinking about male and female patients.

Dyslipidemia and cardiovascular disease in women.

Cardiovascular disease is the major cause of death in women in developed countries. Dyslipidemia is highly prevalent in women, particularly after the menopause. Elevated low-density lipoprotein cholesterol (LDL-C) has been identified as the key lipid parameter in both genders whereas HDL-cholesterol and triglycerides have been more closely associated, in some studies, with cardiovascular risk in women. Menopause has been shown to be associated with an increase in total and LDL-cholesterol and a decrease in HDL-cholesterol (predominantly in the HDL2 subfraction). Despite its beneficial effects on the lipid profile, hormone replacement therapy is not recommended for primary or secondary prevention of cardiovascular disease in women. The latest meta-analysis of statin trials with gender-specific outcomes showed a similar benefit in women and men. The addition of ezetimibe to simvastatin in patients with acute coronary syndromes showed a further reduction of the primary endpoint in both genders. While there are no gender-related differences in drug treatment of dyslipidemia, current guidelines, to avoid overtreatment, strongly suggest risk estimation before initiating lipid-lowering treatment in women without manifest cardiovascular disease.

Coccidioidal Meningitis

Despite the advent of new antifungal agents, coccidioidal meningitis (CM) remains a difficult-to-treat condition with significant morbidity and mortality. In this study we directly compare the clinical presentation and management of patients with Coccidioides immitis meningitis in the azole era (after 1980) to that of a cohort of patients from the pre-azole era. We reviewed 30 CM cases seen at 3 Los Angeles hospitals between the years 1993 to 2008 ("2008 cohort") and compared them to 31 patients ("1980 cohort") described by Bouza et al in a previous study. The demographics and clinical presentation of patients in the 2008 cohort were similar to those of the 1980 cohort except for a higher incidence of Hispanic patients (2008: 53% vs. 1980: 6%) and a greater percentage of patients with underlying, predisposing clinical conditions (2008: 66% vs. 1980: 32%). Ten patients in the 2008 cohort had human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), a condition not reported in the earlier study. Laboratory findings were similar between the 2 groups except for a lower incidence of peripheral leukocytosis and eosinophilia in the 2008 group.There were marked differences in drug treatment between the 2 eras. In the 2008 cohort, 29 patients received fluconazole therapy: 13 were treated with fluconazole monotherapy, and 16 received a combination of fluconazole and intravenous amphotericin B. Although almost all patients (29/31) in the 1980 cohort received intrathecal amphotericin B, only 3 patients in the 2008 study received amphotericin B via this route. With respect to complications of CM, a similar percentage of patients in each cohort developed complications such as stroke and hydrocephalus. The 2008 cohort (40%) had similar mortality compared to patients in the 1980 study (39%); survivors in both groups experienced significant impairment of activities of daily living. Although recommended as first-line therapy for CM, azole-based therapies are not curative and do not necessarily prevent complications associated with the disease.CM remains a serious illness with a high rate of morbidity and mortality. Immunocompromised individuals, especially those with HIV/AIDS, are at special risk for CM and represent a greater share of the overall population with this condition. Despite the clear advantages of azole treatment in CM, new therapeutic approaches are needed to provide definitive cure and to reduce the need for long-term suppressive therapy.

Prescribing patterns of antiparkinsonian agents in Europe

In the 1990 s, previous knowledge and randomized controlled trials supported the establishment of today's therapeutic recommendations in Parkinson's disease (PD). Scientific evidence allows different options for the treatment of PD. Patterns of use of antiparkinsonian agents (APA) across European countries may thus reflect these options. We wanted to describe patterns of use of APA in Europe and characterize the changes in prescription habits between 2003 and 2007. We investigated APA outpatient sales in 26 European countries where all commercially available APA were studied. Data for molecules and brand names were collected through IMS Health. Treatment per 1000 inhabitants daily (DID) was obtained from the WHO defined daily dose. Prescription pattern changes were evaluated by market share. Prescription patterns varied widely. In most countries, levodopa/dopamine agonists accounted for half of the drug use; whereas in others, anticholinergics, MAO inhibitors and amantadine prevailed. The greatest increase occurred with monoamine oxidase inhibitors and levodopa. There was an increase in dopamine agonists and a decrease in anticholinergics. For a 6.8% dose consume increase, there was a 41.1% sales increase (in euro). We showed an increase in the consumption of APA over 5 years. There was significant heterogeneity in the use of APA in Europe, suggesting differences in drug treatment. Costs of medication increased more than did dose consume, implying an increase in the cost of individual patient treatment. Published evidence does not explain the observed differences in the prescribing of APA.

Pharmacotherapeutic disparities: Racial, ethnic, and sex variations in medication treatment

Variations in the medication treatment received by racial and ethnic minorities and women and the negative health outcomes associated with these differences were examined. Studies published between January 1990 and June 2008 were identified via electronic searches of MEDLINE, PsychINFO, International Pharmaceutical Abstracts, PubMed, and CINAHL using search terms related to race, ethnicity, sex, drug treatment, and disparity or variation. Articles were excluded if they addressed only medical or surgical care or did not include a statistical analysis of differences in drug treatment based on race, ethnicity, or sex. Data regarding the frequency of reported race, ethnic, and sex differences in medication treatment, the types of treatment differences observed, and associated health outcomes were extracted. A total of 311 research articles were identified that investigated whether race, ethnicity, or sex was associated with disparities in medication treatment. Seventy- seven percent (n = 240) of included articles revealed significant disparities in drug treatment across race, ethnicity, and sex (p < 0.05). The most frequent disparity, found in 73% of the articles studied, was differences in the receipt of prescription drugs; however, documented disparities occurred related to differences in the drugs prescribed, drug dosing or administration, and wait time to receipt of a drug. Documented outcomes associated with pharmacotherapeutic disparities included increased rates of hospitalization, decreased rates of therapeutic goal attainment (e.g., low- density-lipoprotein cholesterol, blood pressure goals), and decreased rates of survival. A literature review revealed significant disparities in the medication treatment received by racial and ethnic minorities and women.

Service Utilization Differences for Axis I Psychiatric and Substance Use Disorders Between White and Black Adults

Service Utilization Differences for Axis I Psychiatric and Substance Use Disorders Between White and Black Adults

Low-dose digoxin in heart failure

With interest we read the study by Ahmed et al [ [1] Ahmed A. Pitt B. Rahimtoola S. et al. Effects of digoxin at low serum concentrations on mortality and hospitalization in heart failure: a propensity-matched study of the DIG-trial. Int J Cardiol. 2008; 123: 138-146 Abstract Full Text Full Text PDF PubMed Scopus (97) Google Scholar ] in which the authors showed that morbidity and mortality in patients with chronic heart failure (CHF) was significantly reduced by digoxin at low serum digoxin concentrations (SDC) in the DIG study, and that these low SDCs were strongly related to low-dose use of the drug. Clearly, digoxin still has an important place in the management of patients with CHF [ [2] Gheorghiade M. Van Veldhuisen D.J. Colucci W. Contemporary use of digoxin in the management of cardiovascular disorders. Circulation. 2006; 113: 2556-2564 Crossref PubMed Scopus (164) Google Scholar ] as the authors point out, but its role has been declining in recent years. In a large CHF trial that was conducted between 1992 and 1995 (PRIME-II) [ [3] Hampton J.R. Van Veldhuisen D.J. Kleber F.X. et al. Randomised study of effect of ibopamine on survival in patients with advanced severe heart failure. Lancet. 1997; 349: 971-977 Abstract Full Text Full Text PDF PubMed Scopus (323) Google Scholar ], as many as 64% of the population was using digoxin at the time, although there were large differences between European countries, with digoxin use ranging from 39% in the UK to 87% in Germany [ [4] Van Veldhuisen D.J. Charlesworth A. Crijns H.J.G.M. Lie K.I. Hampton J.R. Differences in drug treatment of chronic heart failure between European countries. Eur Heart J. 1999; 20: 666-672 Crossref PubMed Scopus (54) Google Scholar ]. In a recent large CHF survival study (CORONA), which enrolled patients between 2003 and 2005, only 33% was still using digoxin [ [5] Kjekshus J. Apetrei E. Barrios V. et al. Rosuvastatin in older patients with heart failure. N Engl J Med. 2007; 357: 2248-2261 Crossref PubMed Scopus (1244) Google Scholar ]. Although the populations were largely comparable in terms of baseline demographics, there was a significant difference in age (mean age in PRIME-II vs CORONA, 65±9 years vs 73±9 years). Furthermore, in contrast to the decrease in digoxin use was the increase in the use of beta-blockers, going from only 6% in 1992–1995 [ 3 Hampton J.R. Van Veldhuisen D.J. Kleber F.X. et al. Randomised study of effect of ibopamine on survival in patients with advanced severe heart failure. Lancet. 1997; 349: 971-977 Abstract Full Text Full Text PDF PubMed Scopus (323) Google Scholar , 4 Van Veldhuisen D.J. Charlesworth A. Crijns H.J.G.M. Lie K.I. Hampton J.R. Differences in drug treatment of chronic heart failure between European countries. Eur Heart J. 1999; 20: 666-672 Crossref PubMed Scopus (54) Google Scholar ] to 75% in 2003–2005 [ [5] Kjekshus J. Apetrei E. Barrios V. et al. Rosuvastatin in older patients with heart failure. N Engl J Med. 2007; 357: 2248-2261 Crossref PubMed Scopus (1244) Google Scholar ].

Large Differences in Drug Treatment of Chronic Heart Failure Between the European Countries

Large Differences in Drug Treatment of Chronic Heart Failure Between the European Countries

Large differences in drug treatment of chronic heart failure between the European countries

Large differences in drug treatment of chronic heart failure between the European countries

Psychotherapy in irritable bowel syndrome. A controlled outcome study.

ABSTRACTPsychotherapy in the treatment of irritable bowel syndrome. A controlled outcome study. By Jan Svedlund, Department of Psychiatry, Sahlgren's Hospital, University of Göteborg, Sweden. Thesis defended 20th May, 1983.Problem: The irritable bowel syndrome (IBS) often becomes a chronic relapsing condition despite medical treatment. The influence of psychological factors on the course of the disorder has been recognized, but has had little influence on treatment. The aims of the study were to compare the effectiveness of routine medical treatment with combined medical treatment and psychotherapy, to elucidate mechanisms of therapeutic action and to find prognostic factors.Method: 101 IBS‐outpatients with at least one year of complaints were randomly aallocated to two treatment groups. All patients received the same medical treatment. The patients in one group (n=50) were given dynamically oriented short term psychotherapy in addition. The psychotherapy was administered in one‐hour‐sessions weekly during three months and limited to ten sessions. Assessments were made by independent raters, and by self‐ratings on three occasions, at intake before assignment to treatment group, three months later after the psychotherapy course and after a one year follow up. Changes in the severity of symptoms, social adjustment and coping ability with problems focused in the therapy were the main criteria of outcome.Results: The patients in both groups improved during treatment but after three months there was a significantly greater improvement in favour of the psychotherapy group. The difference became still more pronounced one year later as the psychotherapy group showed further improvement while the control group showed some deterioration. Global ratings of severity by independent raters showed that almost half of the patients in the psychotherapy group had improved at follow up versus ten per cent in the control group. According to patients' self‐ratings two thirds had improved in the psychotherapy group versus 40 percent in the control group. The self‐confidence and coping ability had also improved significantly more among patients receiving the combined treatment. Confounding factors such as differences in drug treatment, extra‐therapeutic life events, treatments not included in the study, changes in smoking and drinking habits and drop‐out rate did not contribute to the different outcomes. The combined treatment approach was applicable to a large proportion of the IBS‐patients. Patients with a periodic course were more suitable for psychotherapy and patients with a need for achievement were more suitable for medical treatment only. Patients displaying reactivity during therapy were more successful in the handling of focused problems. Suitability for insight‐oriented psychotherapy was more related to coping ability than to symptomatic improvement.Conclusions: Medical treatment gives a short term symptomatic improvement in IBS. By combining medical treatment with psychotherapy the outcome can be essentially improved, not only in short term but also in the long run. The major mechanism of action is probably the acquisition of more effective ways of coping with emotional problems. The result is in agreement with a psychosomatic approach, from which can be stated that treatment is more effective and rational if it considers both somatic and psychological aspects of a disorder, and lends added support to the concept of a psycho‐physiological basis for IBS.