Drug Dispensing Research Articles

Efficacy and safety of oral sirolimus for high-flow vascular malformations in real clinical practice.

Vascular malformations are a complex pathology with few treatment options. In previously published studies, oral sirolimus (rapamycin) has shown promising results in the treatment of low-flow vascular malformations, but its usefulness in high-flow vascular malformations is controversial. To evaluate the efficacy and safety of sirolimus for the treatment of high-flow vascular malformations in real-life practice. In a unit specializing in vascular anomalies, patients treated with oral sirolimus for high-flow vascular malformations were located by consulting the drug dispensations. Reviewing the electronic medical records, data on patient demographics, vascular malformation characteristics, treatments, toxicity and clinical course were collected and statistically analysed. Nine patients with vascular malformations were included: eight had arteriovenous malformation and one had arteriovenous fistula. Six of these malformations were isolated while three were part of a syndrome. Sirolimus was initiated at a dosage of 1-4 mg/day to be taken as a single dose. Partial response was observed in eight of the nine patients (88.9%) with high-flow vascular malformation, while worsening was observed in the remaining patient. The treatment was well tolerated and at the most recent follow-up, five patients remained on treatment with oral sirolimus. Our results show that oral sirolimus is a well-tolerated therapeutic option, with an excellent safety profile, which can be useful in the long-term stabilization of patients with high-flow vascular malformations. Single-daily dosage may improve long-term adherence to treatment without worsening its effectiveness.

Determinants of dispensing antibiotics without prescription in Eritrea: a mixed-method qualitative study on pharmacy professionals’ perspective

ObjectiveAntimicrobial resistance is a global public health challenge. Dispensing of antibiotics without prescription (DAWP), a major contributor to antibiotic resistance, is extensive in Eritrea. This study was, therefore, aimed at...

Continued 5ASA use after initiation of anti-TNF or immunomodulator confers no benefit in IBD: a population-based study.

With the advent of biological therapy in IBD, it is uncertain to what extent 5aminosalicylates (5ASA) are used. To explore whether or not 5ASA is continued once biological or immunomodulator therapy is initiated, and the outcomes in those who continued the 5ASAs. We conducted a retrospective cohort study using the population-based University of Manitoba IBD Epidemiologic Database which includes prescription drug dispensation from 1996 through 2018. We assessed outcomes among 5ASA users who continued versus discontinued 5ASA after initiation of anti-TNF therapy or immunomodulators. In all, 8379 (77%) of persons with IBD received at least one 5ASA dispensation (85% of ulcerative colitis, UC and 68% of Crohn's disease, CD). There was a reduction in later years, particularly for CD. The most common pattern of 5ASA use was intermittent at 65.1% (stopping and restarting use) versus one-time (4.1%), previous continuous (13.8%) and persistent (17%). Among the total IBD population use was 59% oral, 3% rectal and 14% combination. Of all 5ASA starts, only 25% were continued longer than 20 months. After immunomodulator or anti-TNF initiation, there was no difference in either UC or CD for negative outcomes (hospitalisation, surgery, corticosteroid starts, colorectal cancers or drug-related adverse events) between those who continued 5ASA versus those who discontinued. 5ASA remains commonly prescribed in UC and CD. Rates of persistent use in UC are low. Once an anti-TNF or immunomodulator is initiated, continuation of 5ASA seems to add no benefit.

Anticholinergic burden: First comprehensive analysis using claims data shows large variation by age and sex.

The cumulative effect of medication inhibiting acetylcholine activity-also known as anticholinergic burden (AB)-can lead to functional and cognitive decline, falls, and death. Given that studies on the population prevalence of AB are rare, we aimed to describe it in a large and unselected population sample. Using the German Pharmacoepidemiological Research Database (GePaRD) with claims data from ~20% of the German population we analyzed outpatient drug dispensations in 2016. Based on the Anticholinergic Cognitive Burden (ACB) scale, we classified persons into four categories and determined the cumulative AB as continuous variable. Among 16,470,946 persons (54% female), the prevalence of clinically relevant AB (ACB≥3) was 10% (women) and 7% (men). Below age 40 it was highest in persons ≤18 years (6% both sexes). At older ages (50-59 vs. 90-99 years), prevalence of ACB≥3 increased from 7% to 26% (men) and from 10% to 32% (women). Medication classes contributing to the cumulative AB differed by age: antihistamines, antibiotics, glucocorticoids (≤19 years), antidepressants (20-49 years), antidepressants, cardiovascular medication, antidiabetics (50-64 years), and additionally medication for urinary incontinence/overactive bladder (≥65 years). Medication dispensed by general physicians contributed most to the cumulative AB. Although a clinically relevant AB is particularly common in older persons, prevalence in younger age groups was up to 7%. Given the risks associated with AB in older persons, targeted interventions at the prescriber level are needed. Furthermore, risks associated with AB in younger persons should be explored.

Диуретики: возможен ли безрецептурный отпуск?

Relevance. Diuretics currently play an important role in modern clinical practice. However, at present, diuretics are increasingly used and not “for medical purposes”: to reduce excess weight for cosmetic purposes or by people involved in sports, in those forms where weight categories are provided, or to reduce the concentration of a prohibited substance in urine. In this case, diuretic therapy is associated with the development of a large number of undesirable drug reactions, the likelihood of which increases with the “over-the-counter” dispensing of drugs and, accordingly, with their uncontrolled consumption. Aim. Using an anonymous questionnaire to reveal the demand for diuretics among the visitors of Tyumen pharmacies and the readiness of pharmacists for their over-the-counter dispensing. Materials and methods: analysis of the results of an anonymous survey, visitors and employees of the pharmacy chain (n = 70) in Tyumen. Results. In 42.9% of cases, respondents applied for “over-the-counter” purchase of diuretics (no hard copy). All non-prescription consumers were of working age: 70% were between the ages of 30 and 60, and 30% were under 30. In 20% of cases, over-the-counter dispensing of diuretic drugs was denied by pharmacy staff. 12.5% of non-prescription consumers reported adverse drug reactions to diuretics. An anonymous survey of “non-prescription respondents” under 30 revealed that in 50% of cases, diuretics were used to eliminate edema, in 25% of cases – for weight loss for cosmetic purposes, and in 25% – for weight loss by people involved in sports. In 37.5% of cases, respondents noted the development of unwanted drug reactions in the form of arterial hypotension, seizures, and decreased performance. Conclusion. Non-prescription leave dispensing of diuretics is noted in 42.9% of cases. The main consumers of non-prescription leave diuretics are people of working age. There is a low awareness of consumers about adverse drug reactions of diuretics, which requires not only to limit the over-the-counter dispensing of this group of drugs, but also to educate the population about the dangers of self-medication.

Trend of Intravitreal Bevacizumab Dispensing Technique in Nepal.

The main purpose of this survey was to find out what technique for bevacizumab injection is practiced by ophthalmologists in Nepal and to evaluate which is the best technique of drug dispensing and what possible hindrances are there in following it. This was an online survey using google forms. There were a total of 34 participants in the survey. Most of the participants (58.8%) followed the same vial, multiple prick, multiple days method for giving intravitreal bevacizumab.. Majority of participants said they thought that aliquoting the drug and using it same day would be the best technique to prevent post injection endophthalmitis. Cost and unsuitability for small hospitals were the main factor preventing surgeons from practicing the best method. Risk of endophthalmitis can be reduced by following proper drug dispensing techniques. Aliquoting bevacizumab in smaller syringes under aseptic conditions can reduce the risk of endophthalmitis.

Pharmacogenetics of Bleeding and Thromboembolic Events in Direct Oral Anticoagulant Users.

This study aimed to analyze associations between genetic variants and the occurrence of clinical outcomes in dabigatran, apixaban, and rivaroxaban users. This was a retrospective real-world study linking genotype data of three Finnish biobanks with national register data on drug dispensations and healthcare encounters. We investigated several single-nucleotide variants (SNVs) in the ABCG2, ABCB1, CES1, and CYP3A5 genes potentially associated with bleeding or thromboembolic events in direct oral anticoagulant (DOAC) users based on earlier research. We used Cox regression models to compare the incidence of clinical outcomes between carriers and noncarriers of the SNVs or haplotypes. In total, 1,806 patients on apixaban, dabigatran, or rivaroxaban were studied. The ABCB1 c.3435C>T (p.Ile1145=, rs1045642) SNV (hazard ratio (HR) 0.42, 95% confidence interval (CI), 0.18-0.98, P=0.044) and 1236T-2677T-3435T (rs1128503-rs2032582-rs1045642) haplotype (HR 0.44, 95% CI, 0.20-0.95, P=0.036) were associated with a reduced risk for thromboembolic outcomes, and the 1236C-2677G-3435C (HR 2.55, 95% CI, 1.03-6.36, P=0.044) and 1236T-2677G-3435C (HR 5.88, 95% CI, 2.35-14.72, P<0.001) haplotypes with an increased risk for thromboembolic outcomes in rivaroxaban users. The ABCB1 c.2482-2236G>A (rs4148738) SNV associated with a lower risk for bleeding events (HR 0.37, 95% CI, 0.16-0.89, P=0.025) in apixaban users. ABCB1 variants are potential factors affecting thromboembolic events in rivaroxaban users and bleeding events in apixaban users. Studies with larger numbers of patients are warranted for comprehensive assessment of the pharmacogenetic associations of DOACs and their relevance for clinical practice.

Professional status and role of a pharmaceutical specialist: expert opinion

Self-assessment of the status and role of a pharmaceutical specialist is an important element of professionalization. To evaluate the opinion of the professional pharmaceutical community on the status and role of pharmaceutical specialist in the society, an expert interview of the heads of pharmaceutical organizations (N=32) was conducted. Experts revealed that the prestige of the profession of a pharmaceutical specialist has decreased and that the social significance of the profession was underestimated, affecting the professional status. The role of pharmacists is expandingin addition to drug dispensing and manufacturing; thus, it becomes important to form a high level of satisfaction of the population as pharmaceutical care consumers and to participate in public health and health process together with the doctor. Actual conditions of the pharmaceutical specialist activity affect the status held in the society, and the proper performance of the functions of providing pharmaceutical assistance determines the further development of the profession.

Non-employment and low educational level as risk factors for inequitable treatment and mortality in heart failure: a population-based cohort study of register data

BackgroundThe risk of heart failure is disproportionately high among the socioeconomically disadvantaged. Furthermore, socioeconomically deprived patients are at risk of inequitable access to heart failure treatment and poor outcomes. Non-employment as a risk factor in this respect has not previously been studied at the level of the individual. The aim of this register-based cohort study was to analyse equity in access to renin-angiotensin system blockers and mortality, by employment status and educational level.MethodsThe study population consisted of Swedish patients aged 20–64 years hospitalised for heart failure in July 2006–December 2010, without a heart failure hospitalisation within one year or more before index hospitalisation and without renin-angiotensin system blocker dispensation in the 6 months preceding index hospitalisation. Non-access to renin-angiotensin system blockers, measured as drug dispensations, was investigated by employment status and educational level through logistic regression. Cox regression models were used to obtain hazard ratios for all-cause death by educational level and employment status. Interaction analysis was used to test whether associations between access to treatment and mortality differed by employment status.ResultsAmong the 3874 patients, 1239 (32%) were women. The median age was 57 years. Fifty-three percent were employed. The non-employed patients had more comorbidity and lower access (68%) to renin-angiotensin system blockers compared with the employed (82%). The adjusted odds ratio for non-access to renin-angiotensin system blockers among the non-employed was 1.76. Non-employment was associated with an adjusted hazard ratio of 1.76 for death. Low educational level was associated with a higher death risk. Mortality was highest among the non-employed without access to renin-angiotensin system blockers and the association between access to renin-angiotensin system blockers and survival was slightly weaker in this group.ConclusionsNon-employment and low educational level were associated with elevated mortality in heart failure. Non-employment was a risk factor for lower access to evidence-based treatment, and among the non-employed access to treatment was associated with a slightly smaller risk reduction than among the employed. The results underscore that clinicians need to be aware of the importance of socioeconomic factors in heart failure care.

Use of antimicrobials and antimicrobial resistance in Nepal: a nationwide survey

Nepal suffers from high burden of antimicrobial resistance (AMR) due to inappropriate use of antibiotics. The main objective of this study was to explore knowledge, attitude and practices of antibiotics uses among patients, healthcare workers, laboratories, drug sellers and farmers in eight districts of Nepal. A cross-sectional survey was conducted between April and July 2017. A total of 516 individuals participated in a face-to-face interview that included clinicians, private drug dispensers, patients, laboratories, public health centers/hospitals and, livestock and poultry farmers. Out of 516 respondents, 62.8% (324/516) were patients, 16.9% (87/516) were clinicians, 6.4% (33/516) were private drug dispensers. A significant proportion of patients (42.9%; 139/324) thought that fever could be treated with antibiotics. Majority (79%; 256/324) of the patients purchased antibiotics over the counter. The knowledge of antibiotics used among patients increased proportionately with the level of education: literate only [AOR = 1.4 (95% Cl = 0.6–4.4)], versus secondary education (8–10 grade) [AOR = 1.8 (95% Cl = 1.0–3.4)]. Adult patients were more aware of antibiotic resistance. Use of antibiotics over the counter was found high in this study. Knowledge, attitude and practice related to antibiotic among respondents showed significant gaps and need an urgent effort to mitigate such practice.

Can Pharmacy Be Futureproof?

Emerging from a year-long crisis offers us a fresh stimulus to reflect on the pharmacy profession and the challenges that lie ahead. Industry observers have long noted the limited value of the dispensing function, and some have predicted that it will ultimately succumb to automation. Pharmacists have been jealous guardians of the professional role of pharmacists in overseeing the dispensing of prescription drugs, but the economics may eventually dictate that the process can safely be turned over to machines.

P651 Diagnostic delay, effectiveness and safety outcomes in a real-world cohort of patients with Crohn’s disease: data from administrative databases in Tuscany, Italy

Abstract Background Diagnostic delay (DD) of Crohn’s disease (CD) is poorly investigated in the real-world setting, and could affect significantly the outcome of CD. The aim of the present study was to quantify the possible DD of CD in CD patients in Tuscany region of Italy, evaluating effectiveness and safety outcomes in CD patients with DD. Methods We conducted a retrospective cohort study on data extracted from administrative databases of Tuscany. We included patients &amp;gt;18 years old (yo) with a record of ICD-9 diagnosis for CD or disease exemption or a dispensation of oral budesonide from 6/1/2011 to 6/30/2016 (index date, ID) whichever came first. Patients with a look-back period (time before ID) &amp;lt; 5 y and follow-up (FUP) &amp;lt; 3 y were excluded. Patients with at least one Emergency Department (ED) access or hospitalisation for gastrointestinal causes in the lookback period (excluding 6 months before ID) could have a possible DD. DD was classified in short (up to 18 months) and long (up to 60 months). We performed survival analyses (Kaplan-Meier curves) for effectiveness (time free from the first: dispensation of azathioprine, biologic drug and ileocecal resection surgery) and safety outcomes (time free from first: ED access and/or hospitalization for any cause). Hazard ratio (HR) was calculated by using Cox models adjusted for age, gender and number of concomitant drugs in the month before ID. Both outcomes were evaluated for dichotomous (No DD and DD) and categorical variables of DD (No DD, short DD and long DD). Results Among 3342 CD patients, 584 (17,5%) had a suspected DD: 212 and 372 patients had short and long DD, respectively, p&amp;lt;0.001. The effectiveness analysis revealed that about the 20% of patients with long DD were treated with a biologic within 3 years, as compared with those with short DD or no DD (10%), p=0.0007. The adjusted (a)HR for biologic drug was 1.30 (Confidence Interval, CI 95%: 1.12–1.56) for patients with long DD and 1.02 (CI 95%:0.82–1.30) for those with short DD. No significant aHRs were found for the other effectiveness outcomes. The safety analysis showed that 75% of patients with DD had first ED access or hospitalization for any causes with the FUP, as compared with those without (about 60%), p&amp;lt;0.001. The aHR showed an increased risk for safety outcomes in patients with DD: 1.71 (CI 95%:1.61–1.91) for the ED accesses, 1.31 (CI 95%:1.19–1.49) for hospitalization, and 1.54 (CI 95%:1.41–1.71) for the composite outcome. Conclusion More than 17% of patients had a putative DD (mostly long DD). A risk of treatment with biologic drug, ED accesses and hospitalizations for any cause was found for patients with DD compared with those timely diagnosed.

The Pioneer Neuropharmacologist Alfred Fröhlich (1871–1953) and the Origins of Neuroendocrinology: A Sesquicentennial Remembrance

The birth of neuroendocrinology as a scientific discipline is traced back to 1900–1901, when Joseph Babinski, Alfred Fröhlich, and Harvey Cushing independently identified adiposogenital dystrophy (Fröhlich syndrome), and related gonadal underdevelopment and obesity to a tumor near the pituitary gland. This discovery prompted decades of research into the brain mechanisms responsible for the control of peripheral metabolism and endocrine functions. On the occasion of the 150th anniversary of Fröhlich’s birth, this study traces the origins of his intellectual formation and his association with renowned contemporaries in Austria, England, Italy, and finally Cincinnati, Ohio, where he sought refuge after Austria’s annexation by Nazi Germany. Fröhlich interacted with seminal figures in biomedicine, including Lothar von Frankl-Hochwart, Hans Horst Meyer, Ernst Peter Pick, Harvey Cushing, John Newport Langley, and the Nobel laureates Charles Scott Sherrington and Otto Loewi. Alfred Fröhlich, one of the 20th century’s most emblematic physicians, left his mark on neurophysiology and neuropharmacology with important works, and published authoritative manuals of drug dispensing and clinical therapy. He confronted the calamities of two World Wars with remarkable resilience like many of his Viennese colleagues who, overcoming the constraints of National Socialism, settled overseas to fulfil their calling as physicians, researchers, and teachers.

Older adult health and primary care: autonomy, vulnerabilities and challenges of care.

ABSTRACTOBJECTIVE:To understand the relations between autonomy and health-disease-care processes of older adults in the daily life of primary health care.METHODS:Qualitative research developed in 2019, in a primary health unit in the central region of the city of São Paulo, using participant observation and in-depth interviews with 16 health professionals and 8 older adults. The construction and interpretation of the narratives produced in the study were guided by the perspective of Gadamer’s philosophical hermeneutics and Ricoeur’s theory of interpretation. The theoretical framework of vulnerability/Careᵃ, as proposed by Ayres, guided the definition of the study and interpretative categories.RESULTS:Closely related to the difficulties, facilities and strategies to cope with the daily challenges in the health care of older adults, autonomy was an important marker of vulnerability (interpersonal, social and programmatic), indicating areas that require special attention, such as drug dispensing, urban mobility, social isolation, financial frailties and adequacy of service routines.CONCLUSION:Distinctly from an individual attribute, autonomy has proved to be the expression of relational characteristics, requiring plural and flexible practical-moral strategies, techniques and horizons, although always guided by the same ethical commitment to respect the singular needs of individuals.

STUDY OF PHARMACEUTICAL SPECIALISTS’ INFORMATION AWARENESS ON THE MATTERS OF DRUG ABUSE

Prevention of non-medical use of drugs is the most important task of the state anti-drug policy of the Russian Federation, the effectiveness of which can largely be due to the professional awareness of pharmaceutical specialists, their compliance with the established regulations for the dispensing of drugs, and proper pharmaceutical advice.The aim. The research of pharmaceutical specialists’ information awareness on the matters of drug abuse.Material and methods. The study was based on the analysis of the regulatory legal acts of the Russian Federation governing the procedure for prescribing and dispensing drugs, instructions for the medical use of the drugs used for the purpose of abuse. In the course of the study, a systematic approach has been applied. It includes methods of structural-logical, cluster and content analyses, methods of generalization and grouping. The study of pharmaceutical specialists’ information awareness on the matters of drug abuse was carried out using a random sample survey using a specially developed questionnaire: 396 employees of pharmacy organizations of various forms of property from the Perm Territory, the Chelyabinsk and Kirov regions, the Udmurt and Chuvash Republics, the Komi Republic, were questioned in the period from 2017 to 2019. The questionnaire included 35 questions, structured in 4 blocks. The first block included questions on education, position, work experience of the respondents, the second - questions on identifying knowledge on the range of drugs used for abuse, and categories of consumers of such drugs. The third block contained questions on the regulation and compliance with the procedure for dispensing drugs. The fourth block of the questionnaire was intended to establish the methods and sources of obtaining information on the abuse of the drugs sold by specialists of pharmacy organizations.Results. On the basis of the analysis carried out, an insufficient level of knowledge by specialists of the regulatory legal acts governing the trade of drugs, the range of drugs used for the purpose of abuse, and the categories of their consumers have been established. The violation of the rules for dispensing drugs has been revealed, as well as the lack of systematic sources of information on drug abuse.Conclusion. The need to develop a training program for pharmaceutical specialists on the prophylaxis and prevention of drug abuse has been established. In order to work out additional competencies in the prevention of non-medical use of drugs and improve the quality of pharmaceutical consulting, it is necessary to conduct appropriate educational activities.

Intra-database validation of case-identifying algorithms using reconstituted electronic health records from healthcare claims data

BackgroundDiagnosis performances of case-identifying algorithms developed in healthcare database are usually assessed by comparing identified cases with an external data source. When this is not feasible, intra-database validation can present an appropriate alternative.ObjectivesTo illustrate through two practical examples how to perform intra-database validations of case-identifying algorithms using reconstituted Electronic Health Records (rEHRs).MethodsPatients with 1) multiple sclerosis (MS) relapses and 2) metastatic castration-resistant prostate cancer (mCRPC) were identified in the French nationwide healthcare database (SNDS) using two case-identifying algorithms. A validation study was then conducted to estimate diagnostic performances of these algorithms through the calculation of their positive predictive value (PPV) and negative predictive value (NPV). To that end, anonymized rEHRs were generated based on the overall information captured in the SNDS over time (e.g. procedure, hospital stays, drug dispensing, medical visits) for a random selection of patients identified as cases or non-cases according to the predefined algorithms. For each disease, an independent validation committee reviewed the rEHRs of 100 cases and 100 non-cases in order to adjudicate on the status of the selected patients (true case/ true non-case), blinded with respect to the result of the corresponding algorithm.ResultsAlgorithm for relapses identification in MS showed a 95% PPV and 100% NPV. Algorithm for mCRPC identification showed a 97% PPV and 99% NPV.ConclusionThe use of rEHRs to conduct an intra-database validation appears to be a valuable tool to estimate the performances of a case-identifying algorithm and assess its validity, in the absence of alternative.

Incidence of diabetes mellitus among people living with and without HIV in British Columbia, Canada between 2001 and 2013: a longitudinal population-based cohort study

IntroductionPeople living with HIV (PLHIV) are increasingly at risk of age-related comorbidities such as diabetes mellitus (DM). While DM is associated with elevated mortality and morbidity, understanding of DM among...

Optimization for medical logistics robot based on model of traveling salesman problems and vehicle routing problems

Fast medicine dispensing system (FMDS) as a kind of medical logistic robot can dispense many drugs for one prescription at the same time. To guarantee the sustainability of drug dispensation, it is required that FMDS replenish drugs rapidly. The traditional order picking model (OPM) is difficult to meet the demand of prompt replenishment. To solve the problems of prolonged refilling route and inefficiency of drugs replenishment, a mixed refilling model based on multiple steps traveling salesman problem model (MTSPM) and vehicle routing problem model (VRPM) is proposed, and it is deployed in two circumstances of FMDS, including temporary replenishment mode (TRM) and concentrate replenishment mode (CRM). It not only meted the demand under different circumstances of drug replenishment but also shortened the refilling route significantly. First, the new pick sets were generated. Then, the orders of pick sets were optimized and the new paths were achieved. When the number of pickings is varied no more than 20, experiment results declared that the refilling route is the shortest by utilizing MTSPM when working under the TRM condition. Comparing MTSPM with OPM, the rate of refilling route length decreased up to 32.18%. Under the CRM condition, the refilling route is the shortest by utilizing VRPM. Comparing VRPM with OPM, the rate of refilling route length decreased up to 58.32%. Comparing VRPM with MTSPM, the rate of refilling route length has dropped more than 43.26%.

Association Between Parental Type 1 and Type 2 Diabetes Diagnosis and Major Osteoporotic Fracture Risk in Adult Offspring: A Population-Based Cohort Study

ObjectivesPrevious research suggests an intergenerational influence of diabetes on bone health. We examined the association between parental diabetes and major osteoporotic fracture (MOF) risk in offspring. MethodsThis population-based cohort study used de-identified administrative health data from Manitoba, Canada, which capture population-level records of hospitalizations, physician visits and drug dispensations. The cohort included individuals ≥40 years of age with at least 1 parent identified in the data between 1997 and 2015. The exposure was parental diagnosis of diabetes since 1970; the outcome was offspring incident MOF diagnosis of the hip, forearm, spine or humerus. Both measures were identified from hospital and physician visit records using validated case definitions. Multivariable Cox proportional hazards regression models tested the association of parental diabetes and offspring MOF risk. ResultsThe cohort included 279,085 offspring; 48.5% were females and 86.8% were ≤44 years of age. Both parents were identified for 89.4% of the cohort; 36.7% had a parental diabetes diagnosis. During a median follow up of 12.0 (interquartile range, 6.0 to 18.0) years, 8,762 offspring had an MOF diagnosis. After adjusting for fracture risk factors, parental diabetes diagnosis was not associated with MOF risk, whether diagnosed in fathers (adjusted hazard ratio [aHR], 1.02; 95% confidence interval [CI], 0.97 to 1.08), mothers (aHR, 1.02; 95% CI, 0.97 to 1.07) or both parents (aHR, 1.01; 95% CI, 0.93 to 1.11). The results remained consistent in a stratified analysis by offspring sex, secondary analysis based on MOF site and sensitivity analyses. ConclusionsThe results indicate parental diabetes is not associated with offspring MOF risk.

Changes in Multimorbidity and Polypharmacy Patterns in Young and Adult Population over a 4-Year Period: A 2011-2015 Comparison Using Real-World Data.

The pressing problem of multimorbidity and polypharmacy is aggravated by the lack of specific care models for this population. We aimed to investigate the evolution of multimorbidity and polypharmacy patterns in a given population over a 4-year period (2011–2015). A cross-sectional, observational study among the EpiChron Cohort, including anonymized demographic, clinical and drug dispensation information of all users of the public health system ≥65 years in Aragon (Spain), was performed. An exploratory factor analysis, stratified by age and sex, using an open cohort was carried out based on the tetra-choric correlations among chronic diseases and dispensed drugs during 2011 and compared with 2015. Seven baseline patterns were identified during 2011 named as: mental health, respiratory, allergic, mechanical pain, cardiometabolic, osteometabolic, and allergic/derma. Of the epidemiological patterns identified in 2015, six were already present in 2011 but a new allergic/derma one appeared. Patterns identified in 2011 were more complex in terms of both disease and drugs. Results confirmed the existing association between age and clinical complexity. The systematic associations between diseases and drugs remain similar regarding their clinical nature over time, helping in early identification of potential interactions in multimorbid patients with a high risk of negative health outcomes due to polypharmacy.