Use Of Medications For Treatment Research Articles

702-P: Prescription Medication Use for Treatment of Mental Health Conditions among Adults With and Without Diabetes, 1999–2020

702-P: Prescription Medication Use for Treatment of Mental Health Conditions among Adults With and Without Diabetes, 1999–2020

FRI528 Trends And Components Of Thyroid Status Evaluation In Commercially Insured Adults In The US, 2006-2020

Abstract Disclosure: E.J. Morris: None. N.M. Singh Ospina: None. S. Maraka: None. S.M. Vouri: Employee; Self; Pfizer, Inc. Background. In clinical practice, evaluation of thyroid function can be used to monitor patients with thyroid dysfunction, to clarify the etiology of a patient’s symptom, or as screening. Although studies suggest variability and possibly overuse of TSH testing, no contemporary assessment of TSH testing trends and components of thyroid testing are available. Methods. We conducted a longitudinal assessment of commercially insured adults to characterize thyroid function testing among patients without pre-existing thyroid disease. We identified all adults 18-64 years old with at least 365 days of continuous enrollment between January 1, 2006 to July 31, 2020 using IBM MarketScan Commercial Claims Databases. This nationwide administrative claims database contains beneficiary-level clinical information related to diagnoses, procedures, and prescriptions. To identify patients without or at high risk for thyroid disease we excluded those with evidence of medication use for treatment of thyroid dysfunction or interfering with thyroid function, diagnosis of thyroid disease, or pregnancy. Descriptive statistics were used to summarize relevant characteristics of patients undergoing TSH testing, TSH tests per 1,000 eligible person-months, and composition of thyroid function testing. Results. Among 67,353,280 patients meeting eligibility criteria, we identified 25,606,518 TSH tests and 15,138,211 patients with ≥ 1 TSH test. Patients contributing an episode of TSH testing were most commonly 45-54 years old (29.8%) and female (63.6%). Dyslipidemia (34.2%) and fatigue (21.4%) were the most common associated comorbidities. TSH testing rates remained relatively consistent throughout the study period with 11.4 and 11.7 TSH tests per 1,000 person-months in the first and last study months, respectively. Among all study months, we observed a mean of 12.2 TSH tests per 1,000 person-months. TSH testing rates dropped sharply in the spring of 2020 (4.2 TSH tests per 1,000 person-months). Females showed a nearly twofold higher rate of TSH testing compared to males (16.1 TSH tests per 1,000 person-months vs. 8.6 TSH tests). TSH testing rates increased consistently with age (8.2 TSH tests per 1,000 person-months among individuals 18-34 years old vs. 15.4 TSH tests among individuals 55-64 years old). The evaluation of thyroid function was completed only with TSH in most episodes (70.8%), followed by combination of TSH and FT4 testing (14.8%). Evaluation of thyroid autoimmunity was included in 2.7% of testing episodes. Panels including RT3, THBR or Tg represented 4.5% of the episodes. Conclusion. TSH testing frequency among commercially insured individuals without thyroid disease appears stable, with higher frequency found in females and with increasing age. Testing most commonly includes only TSH. The appropriateness of thyroid function evaluation will require further investigation. Presentation: Friday, June 16, 2023

Patterns in Medication Use for Treatment of Depression in Autistic Spectrum Disorder.

Depression impacts many individuals with autism spectrum disorder (ASD), carrying increased risk of functional impairment, hospitalization, and suicide. Prescribing medication to target depression in patients with ASD occurs despite limited available systematic data describing medication management of depression in this population. The purpose of this study is to discover prescribing patterns for individuals with MDD and ASD during this time period (2004-2012) to inform current and future prescribing practices with historical data. Drawing from a large clinical database describing the prescribing practices in patients with ASD, we identified 166 individuals with ASD (mean age 14.5 ± 8.3 years old) who received medication targeting symptoms of depression. We report prescribing rates for specific drugs, drug treatment duration, and reasons for drug discontinuation when applicable. Sertraline, mirtazapine, and fluoxetine were the three most commonly prescribed medications to treat comorbid depression for this patient population. Among 241 drug starts, 123 (49%) drug treatments were continued at the final reviewed follow-up visit (average treatment duration of ± 0.72 years). The most common reason for discontinuation across all medications prescribed was loss of or lack of effectiveness. This study raises concern that standard of care pharmacological treatments for depression in individuals with ASD may be less effective than in neurotypical populations. There remains a need to develop effective interventions for depression specifically tailored to the needs of individuals with ASD.

Этические вопросы off-label применения препаратов для лечения COVID-19

The article discusses the issues related to the ethical aspects of the off-label use of medications for treatment of coronavirus infection, including in terms of conducting clinical trials of these medications. Furthermore, the article raises the issue of using drugs for treatment of coronavirus infection at the moment and discusses the related ethical principles. The major issue of this review is the ethical aspect of the search for benefits of using drugs not according to instructions in patients with emergencies and life-threatening conditions, such as COVID-19. The ethical role of the informed consent in both clinical trials and off-label prescription of drugs in general is also clarified. Several options provided in this review are proposed to address this issue.

Parental Perceptions of Medication Use for the Treatment of Obesity in Youth.

Background: This survey-based study identified views on antiobesity medications in youth referred to a weight management program. Methods: One parent completed a 14-item Research Electronic Data Capture (REDcap) survey regarding openness to medication use in youth with obesity at their first visit in a weight management program. Medical data were extracted from the medical records of all responders. Results: Ninety-four percent (116/125) of parents approached completed the survey (youths' demographic: mean age = 14.1 years old, 46.8% female, 68.8% Hispanic). Results indicate that 75% of parents surveyed were open to medication use. There was no difference in sex, age, insurance, severity of obesity, or family history between parents who were and were not open to medication (all p > 0.05). Hispanic ethnicity was associated with greater openness to medication use (odds ratio: 3.4, 95% confidence interval: 1.4-8.5, p = 0.007). Conclusions: These results highlight the importance of parental perceptions of medication use for obesity treatment and suggest a need for improved education about the role of medication in the management of pediatric obesity.

Geriatric Depression and Inappropriate Medication: Benefits of Interprofessional Team Cooperation in Nursing Homes.

An investigation of inappropriate medication use in treatment of depressivity in institutionalized older adults, based on a nurse-led evaluation of functional status and depressive symptoms in nursing home residents. Methods: A cross-sectional multicenter study was performed using records from 1087 residents cared for in fifteen nursing homes (NHs) in the Czech Republic. Inclusion criteria were being a permanent resident of one of the facilities, being 60 years of age or older, having a Geriatric Depression Scale score of 6 or more, and having a Mini Mental State examination score 10 or more. The final sample for analysis included 317 depressed NH residents. Results: 52 percent of NH residents with depressivity had no antidepressant treatment. Benzodiazepines were the only medication in 16 percent of depressed residents, and were added to antidepressant treatment in 18 percent of residents. Benzodiazepine users had significantly higher GDS scores compared to non-users (p = 0.007). Conclusion: More than half of depressed NH residents remained without antidepressant treatment. Residents inappropriately treated with benzodiazepines were more depressed than residents treated with antidepressants only, or even not treated at all. Cooperation of the interprofessional team in the screening of depressive symptoms has the potential to improve the quality of care.

Use of Medications for Treatment of Opioid Use Disorder Among US Medicaid Enrollees in 11 States, 2014-2018

There is limited information about trends in the treatment of opioid use disorder (OUD) among Medicaid enrollees. To examine the use of medications for OUD and potential indicators of quality of care in multiple states. Exploratory serial cross-sectional study of 1 024 301 Medicaid enrollees in 11 states aged 12 through 64 years (not eligible for Medicare) with International Classification of Diseases, Ninth Revision (ICD-9 or ICD-10) codes for OUD from 2014 through 2018. Each state used generalized estimating equations to estimate associations between enrollee characteristics and outcome measure prevalence, subsequently pooled to generate global estimates using random effects meta-analyses. Calendar year, demographic characteristics, eligibility groups, and comorbidities. Use of medications for OUD (buprenorphine, methadone, or naltrexone); potential indicators of good quality (OUD medication continuity for 180 days, behavioral health counseling, urine drug tests); potential indicators of poor quality (prescribing of opioid analgesics and benzodiazepines). In 2018, 41.7% of Medicaid enrollees with OUD were aged 21 through 34 years, 51.2% were female, 76.1% were non-Hispanic White, 50.7% were eligible through Medicaid expansion, and 50.6% had other substance use disorders. Prevalence of OUD increased in these 11 states from 3.3% (290 628 of 8 737 082) in 2014 to 5.0% (527 983 of 10 585 790) in 2018. The pooled prevalence of enrollees with OUD receiving medication treatment increased from 47.8% in 2014 (range across states, 35.3% to 74.5%) to 57.1% in 2018 (range, 45.7% to 71.7%). The overall prevalence of enrollees receiving 180 days of continuous medications for OUD did not significantly change from the 2014-2015 to 2017-2018 periods (-0.01 prevalence difference, 95% CI, -0.03 to 0.02) with state variability in trend (90% prediction interval, -0.08 to 0.06). Non-Hispanic Black enrollees had lower OUD medication use than White enrollees (prevalence ratio [PR], 0.72; 95% CI, 0.64 to 0.81; P < .001; 90% prediction interval, 0.52 to 1.00). Pregnant women had higher use of OUD medications (PR, 1.18; 95% CI, 1.11-1.25; P < .001; 90% prediction interval, 1.01-1.38) and medication continuity (PR, 1.14; 95% CI, 1.10-1.17, P < .001; 90% prediction interval, 1.06-1.22) than did other eligibility groups. Among US Medicaid enrollees in 11 states, the prevalence of medication use for treatment of opioid use disorder increased from 2014 through 2018. The pattern in other states requires further research.

Posttreatment Anxiety, Depression, Sleep Disorders, and Associated Factors in Women Who Survive Breast Cancer

Objective:Breast Cancer Survivors (BCSs) experience negative effects on their physical and mental health, including sleep disorders, after the completion of treatment and over the whole spectrum of survival. The aim of this study was to investigate the levels of posttreatment anxiety, depression, and sleep disorders exhibited by women who have survived breast cancer.Methods:A descriptive, cross-sectional study was conducted with a population of 170 BCSs, who were monitored as outpatients by two surgical departments of a central Athens hospital for between one and five–5 years after completing their therapy. The data were collected between November 2019 and March 2020 and included demographic and clinical characteristics, as well as the Athens Insomnia Scale to measure sleep disorders and the Hospital Anxiety and Depression Scale to assess the incidence of mental disorders.Results:The majority of the patients were aged 61–70 years (41.4%), married (56.9%), with two children (56.3%), and graduates of higher education (41.8%). Of the total population, 53.5% had sleep disorders, 29.4% anxiety, and 18.2% depression. Insomnia had a moderately positive correlation with both anxiety and depression (r = 0.598, P < 0.001 and r = 0.584, P < 0.001, respectively), while a strongly positive correlation was found between depression and anxiety (r = 0.683, P < 0.001). Sleep disorders were associated with factors such as profession (P < 0.001), income (P = 0.01), the number of minor children (P = 0.021), and the number of pathological problems (P = 0.003); anxiety was related to the number of minor children (P = 0.008) and the use of drug therapy to treat mental disorders (P = 0.038); while for depression, the relevant factors were the duration of treatment (P = 0.029), the number of minor children (P < 0.001), the use of medication for treatment of mental disorders (P = 0.008), and sleep disorders (P = 0.003).Conclusions:Women who have survived breast cancer in Greece show a high rate of anxiety and depression related to the disease, as well as sleep problems that are partly associated with their psychological status, but are also affected by parameters such as income, type of profession, and the presence of minor children in the household.

Medical arguments for and against the liberalization of doping

The use of doping has been banned for almost a century due to the risk involved to the athlete's health. Since then, the crite-rion of prohibiting substances has been reinforced to improve performance, becoming a rarely controversial issue nowadays. However, opinions defending the liberalization of doping has been sometimes given based on various arguments. One of the most common is the impossibility of completely eradicating doping and that this can be safe, from the point of view of health, if it is done by qualified doctors.This paper presents the arguments against the liberalization of doping from a medical point of view, contemplating various aspects.Those related to the use of substances such as: lack of clear criteria for inclusion in the list of prohibited substances and the unclear margin between the use of medication for treatment and for doping. Arguments related to health protection such as: the risk of sport for the athlete, the healthy sport, doping substances have few health risks, the use of medications, allow genetic doping because it is inevitable, risks of self-medication or use of me-dication without a prescription.Arguments related to sports performance such as: Doping products do not improve performance, doping is comparable to other performance improvement techniques, match genetic differences among athletes.And other arguments such as: prohibition favours doping, the control of doping increases the risks of doping itself, the high cost of anti-doping fight or the few anti-doping resources.The proposal for liberalization of doping under medical control is analyzed and discussed as well as the effects of liberalization on children and adolescents. At the end the medical ethical aspects related to doping are presented to conclude with the opposition of the medical profession against doping and its liberalization.

Non-antibiotic medication use in an Indonesian community cohort 0-18 months of age.

Rational medication use for treatment is mandatory, particularly in children as they are vulnerable to possible hazards of drugs. Understanding the medication use pattern is of importance to identify the problems of drug therapy and to improve the appropriate use of medication among this population. A post-hoc study of the RV3-BB Phase IIb trial to children aged 0-18 months which was conducted in Indonesia during January 2013 to July 2016. Any concomitant medication use and health events among 1621 trial participants during the 18 months of follow-up were documented. Information on medication use included the frequency, formulation, indication, duration of usage, number of regimens, medication types, and therapeutic classes. The majority of participants (N = 1333/1621; 82.2%) used at least one non-antibiotic medication for treatment during the 18-month observation period. A total of 7586 medication uses were recorded, mostly in oral formulation (90.5%). Of all illnesses recorded, 24.7% were treated with a single drug regimen of non-antibiotic medication. The most common therapeutic classes used were analgesics/antipyretics (30.1%), antihistamines for systemic use (17.4%), cough and cold preparations (13.5%), vitamins (8.6%), and antidiarrheals (6.6%). The main medication types used were paracetamol (29.9%), chlorpheniramine (16.8%), guaifenesin (8.9%), zinc (4.6%), and ambroxol (4.1%). Respiratory system disorder was the most common reason for medication use (51.9%), followed by gastrointestinal disorders (19.2%), pyrexia (16.9%), and skin disorders (7.0%). A large number of children were exposed to at least one medication during their early life, including those where evidence of efficacy and safety in a pediatric population is lacking. This supports the need for further research on pediatric drug therapy to improve the appropriate use of medication in this population.

Epidemiological, Clinical and Paraclinical Evaluation of Recorded Cases with Brucellosis in Kermanshah Province Health Center 2012 - 2016

Background: Brucellosis is a major problem in many parts of the world, including Iran, where livestock are an important source of income and employment. Methods: This cross-sectional (descriptive-correlational) study enrolled individuals diagnosed with brucellosis from 2012 to 2016 and their information was available in the health center of Kermanshah province. Data were analyzed in SPSS software (version 21). Results: From all the patients with brucellosis (2714), 55.3% were male and 44.7% were female. Most of them were living in Kermanshah province, their mean age was 35.05 ± 17.35 years and the most common age group was 21 - 30 years. The most common route of transmission was consumption of contaminated dairy products (99.1%) and contact with livestock (99.71%). Musculoskeletal and back pain were the most commonly observed clinical signs (89.8%). There was a statistically significant difference between years of incidence and livestock vaccination history (P < 0.001). The highest number of patients wright test was in titer 1:160 (33.1%) and 2 ME test 1:80 (36.8%). Regarding the use of medication for treatment, most patients were prescribed combination of rifampin and co-trimoxazole (12.97%). Conclusions: Timely diagnosis, livestock vaccination, training and refraining from unpasteurized dairy products can be effective in preventing outbreaks of brucellosis.

Validation of the Use of Electronic Medical Records for Identification of Post-gastric Bypass Hypoglycemia Cases.

We sought to validate an algorithm designed to identify patients with post-gastric bypass hypoglycemia (PGBH) using clinician chart review. We conducted a chart review study of non-diabetic patients who underwent Roux-en-Y gastric bypass (RYGB) at our institution from 2004 to 2013. The electronic medical record (EMR) algorithm was based on any post-operative glucose <60mg/dl, diagnosis of hypoglycemia, or medication use for treatment of PGBH and identified 158 charts as PGBH and 1048 charts without PGBH. Two clinicians independently reviewed a random selection of 80 cases and 80 control charts and determined the presence or absence of PGBH by searching the chart using keywords and reviewing laboratory results, medications, and clinic notes. Of the 160 charts reviewed, the EMR algorithm agreed with the chart review for 130 (accuracy = 80%, 95% CI = 75-87%) with sensitivity of 89% (95% CI = 83-96%) and specificity of 86% (95% CI = 78-93%). We improved the algorithm's accuracy to 90% by limiting the search to data obtained 3months or more following RYGB. The EMR algorithm has high sensitivity, specificity, and accuracy to identify post-gastric bypass hypoglycemia within our patient cohort. The use EMR-based algorithms may be a useful tool for future research to improve our understanding of epidemiology and risk factors for post-bariatric surgery hypoglycemia.

Abstract P372: The Effect of Periodic Fasting on Patients With Hypertension and Metabolic Syndrome

Periodic fasting may serve as therapeutic strategy for the management of hypertension and metabolic syndrome. We hypothesize that fasting affects the gut microbiome and promotes immune cell homeostasis resulting in lower blood pressure. Patients suffering from metabolic syndrome and hypertension were randomized either to 7-day periodic fasting combined with lifestyle change or Dietary Approaches to Stop Hypertension (DASH) intervention. Data derived from clinical parameters, 16S sequencing of the gut microbiome and immunophenotyping were collected at baseline, at day 7 and 3 months post intervention. At baseline, 21 out 30 patients in the fasting and 23 out of 31 in the DASH group had elevated systolic office blood pressure (SBP &gt;130 mmHg), which dropped significantly by 10 mmHg after fasting, and remained lower 3 months post intervention (7 mmHg). In the DASH group, SBP significantly decreased by 12 mmHg after 1 week and 8 mmHg after 3 months. At 3 months post intervention, 24-h ABPM confirmed the decrease in fasting, but not in DASH. Fasting, but not DASH significantly reduced body weight and BMI after 7 days compared to baseline, and this effect persisted for 3 months post-intervention. Furthermore, 50 % (15/30) of patients in fasting and 23 % (7/31) in DASH were able to decrease their use of medications for treatment of metabolic syndrome. Spearman correlation tests showed that fasting, but not DASH, altered the gut microbiome. After fasting Bacteroides , Lachnoclostridium , Coprococcus , and Ruminococcus Operational Taxonomic Units (OTUs) decreased, while the Eubacterium rectale OTU increased. In contrast to DASH, fasting significantly reduced the frequency of CD4+ Th17 cells, active CD69+ mucosa-associated invariant T cells (MAIT) and IFNg+IL-2+ or TNFa+ MAITs indicating the anti-inflammatory effect of fasting. While some of these changes reverted to baseline after 3 months, several persisted. Despite a similar decrease in office SBP in both study arms, the periodic fasting intervention is more beneficial in reducing body weight and BMI compared to baseline. Fasting altered the prevalence of certain gut microbes and influenced immune cell signatures whereas DASH did not, suggesting a distinct role of fasting for improving cardiometabolic health.

Commentary: A Historical Review of Centers for Disease Control and Prevention Antiviral Treatment and Postexposure Chemoprophylaxis Guidance for Human Infections With Novel Influenza A Viruses Associated With Severe Human Disease.

Human infections with novel influenza A viruses are of global public health concern, and antiviral medications have a potentially important role in treatment and prevention of human illness. Initial guidance was developed by the U.S. Centers for Disease Control and Prevention after the emergence of human infections with avian influenza A(H5N1) and has evolved over time, with identification of influenza A(H7N9) virus infections in humans, as well as detection of avian influenza viruses in birds in the United States. This commentary describes the historical context and current guidance for the use of influenza antiviral medications for treatment and post-exposure chemoprophylaxis of human infections with novel influenza A viruses associated with severe human illness, or with the potential to cause severe human disease, and provides the scientific rationale behind current recommendations.

Risk of post-gastric bypass surgery hypoglycemia in nondiabetic individuals: A single center experience.

The epidemiology of post-gastric bypass surgery hypoglycemia (PGBH) is incompletely understood. This study aimed to evaluate the risk of PGBH among nondiabetic patients and associated factors. A cohort study of nondiabetic patients who underwent Roux-en-Y gastric bypass (RYGB) was conducted. PGBH was defined by any postoperative record of glucose < 60 mg/dL, diagnosis of hypoglycemia, or any medication use for treatment of PGBH. Kaplan-Meier analysis was used to describe PGBH occurrence, log-rank tests, and Cox regression to examine associated factors. Of the 1,206 eligible patients, 86% were female with mean age of 43.7 years, mean preoperative BMI of 48.7 kg/m(2) , and a mean follow-up of 4.8 years. The cumulative incidence of hypoglycemia at 1 and 5 years post-RYGB was 2.7% and 13.3%, respectively. Incidence of PGBH was identified in 158 patients and was associated with lower preoperative BMI (P = 0.048), lower preoperative HbA1c (P = 0.012), and higher 6-month percent of excess body weight loss (%EWL) (P = 0.001). A lower preoperative HbA1c (HR = 1.73, P = 0.0034) and higher 6-month %EWL (HR = 1.96, P = 0.0074) remained independently correlated with increased risk for PGBH in multi-regression analysis. The 5-year incidence of PGBH among nondiabetic individuals was 13.3% and was associated with a lower preoperative HbA1c and greater weight loss at 6 months following surgery.

Prevalence of Hypertension, Diabetes, Obesity and Smoking in Patients with Hemophilia Followed at a Single Treatment Center

IntroductionHemophilia A and B are hereditary genetic disorders caused by clotting factor deficiency, factors VIII and IX respectively. In the era of effective therapy with factor concentrates life expectancy of patients with hemophilia has significantly increased. With increasing age, these patients face the same medical problems as other aging groups, especially atherosclerosis and cardiovascular disease. Medications which affect the clotting process, like aspirin, clopidogrel or warfarin are usually central to the treatment of these conditions. Obviously, antiplatelet therapy and anticoagulants could be potentially dangerous for patients with baseline increased risk of bleeding. This is why emphasis on prevention of cardiovascular disease is that much more important in this patient group. Data about prevalence of atherosclerotic cardiovascular risk factors in this group of patients are still suboptimal. The aim of our study was to assess prevalence of modifiable cardiovascular risk factors like hypertension, diabetes, obesity and smoking in patients with hemophilia A and B at out treatment center.MethodsWe performed retrospective chart review of patients followed at a single hemophilia treatment center in the United States. We included 59 patients with factor VIII or IX deficiency, age 30 and older, followed in clinic between 2005 and 2014. Patients with acquired hemophilia were excluded from the study. Hypertension was defined as blood pressure over 140/90 mmHg and/or the use of antihypertensive medications; diabetes mellitus as HbA1c at least 6.5% and/or use of medications for treatment of diabetes; overweight as body mass index between 25 kg/m2 and 29.9 kg/m2 and obesity as body mass index (BMI) of 30 kg/m2 or more. Patient was considered a smoker if he smoked tobacco during the month preceding last clinic visit. We chose to address the other significant risk factor namely hyperlipidemia, in more detail in a separate abstract as the newest 2013 ACC/AHA Guideline have proposed a stepwise approach to hyperlipidemia treatment.Results34 (57.6%) patients had hypertension [95% CI 0.44-0.70], 6 (10.2%) patients had diabetes treated with oral medications only [95% CI 0.04-0.21] , 3 (5.1%) patients had diabetes treated with insulin [95% CI 0.01-0.14], 20 (33.9%) patients were overweight [95% CI 0.22-0.47], 24 (40.7%) patients had obesity [95% CI 0.28-0.54], 23 (39%) patients were smokers [95% CI 0.27-0.53]. 3 (5.1%) patients experienced myocardial infarction and 1 (1.7%) of them died due to intracerebral hemorrhage during treatment with antiplatelet therapy.ConclusionsCardiovascular disease is the leading cause of death in developed countries. With increasing life expectancy of patients with hemophilia greater emphasis is needed on modifiable risk factors for prevention as treatment of cardiovascular events carries greater risk of adverse outcomes due to bleeding in these patients. Our study indicated that the prevalence of cardiovascular risk factors in hemophilia patients is high. There are only few existing publications about prevalence of hypertension, diabetes, obesity and smoking in hemophilia patients. This is an area that warrants more systematic study and a cooperative effort to generate such data at a national and even international level that in turn would assist with strategic planning and mitigation. DisclosuresNo relevant conflicts of interest to declare.

Diabetes and Prediabetes are Significantly Higher in Morbidly Obese Children Compared With Obese Children

The objective of this study was to examine the prevalence and characteristics of comorbidities in obese and morbidly obese children with a comparison between the 2 sets of children. This was a retrospective electronic chart review of obese and morbidly obese children and adolescents as defined by body mass index. We evaluated medical history of comorbid conditions, medication use, and cardiovascular risk markers, including blood pressure, lipid profile, and glycosylated hemoglobin. There were 1,111 subjects (African American = 635; non-Hispanic white = 364; Hispanic = 36; others = 86), of which 274 were obese and 837 were morbidly obese children with a mean age of 12.7 ± 3.37 years. Morbidly obese children had a higher prevalence of prediabetes (19.5% of obese versus 27.3% of morbidly obese; P<.0001) and type 2 diabetes (39.8% of obese versus 52.4% of morbidly obese; P<.0001). Use of medications for treatment of asthma was significantly higher in the morbidly obese group compared with the obese group (21% versus 14%; P = .01). Morbidly obese children have a higher prevalence of diabetes, prediabetes, and use of asthma medications compared with obese children.

Off-Label Use of Medications for Treatment of Benzodiazepine Use Disorder

There is a high rate of benzodiazepine use in the population. Benzodiazepines are used for multiple indications (anxiety, seizures, alcohol withdrawal, muscular relaxation and anesthesia). Benzodiazepines are also addictive substances and a non-negligible fraction of regular users will develop dependence. There is currently no approved pharmacotherapy for benzodiazepine use disorder treatment and optimal strategies for treatment are unclear. In this review, we aimed to summarize the findings on off-label pharmacologic therapy that have been used for BZD dependence. One classical approach is to provide a slow taper associated with counseling. Anti-epileptic drugs appear also to alleviate symptoms of withdrawal. The long-term strategies of maintenance therapy (with benzodiazepine) or of blocking therapy (with a GABA antagonist such as flumazenil) could provide some clinical benefit but have not yet been tested appropriately. Pregabalin appears promising and deserves further investigation. There is a clear need for more clinical trials in this area to improve care.

The efficacy and safety of the Timothy grass allergy sublingual immunotherapy tablet in Canadian adults and children.

BackgroundThe effect of sublingual Timothy grass immunotherapy tablet 2800 BAU (grass SLIT-T) has been evaluated in three North American trials in adults and children who have allergic rhinitis with or without conjunctivitis (AR/C). This paper examines the effects of grass SLIT-T in Canadians.MethodsData for grass-allergic Canadians in three randomized, placebo-controlled, double-blind trials were analyzed post hoc: 1) adults ≥18 y, grass-pollen season [GPS] 2009; 2) children 5– <18 y, 2009; and 3) adults 18–65 y and children 5– <18 y, GPS 2012. Data from the GPS 2009 trials were pooled to provide a more precise estimate of treatment effects than the individual studies would provide. In every trial, participants received once-daily grass SLIT-T or placebo approximately 12 weeks before and continuing throughout the GPS. Participants used daily electronic diaries to record AR/C symptoms and medication use for treatment of symptoms. The therapeutic effect of grass SLIT-T was measured as a total combined score (TCS = daily symptom score + daily medication score) averaged over the entire GPS. Safety was assessed by monitoring adverse events (AEs).ResultsIn the three trials, 386 Canadian participants were randomized; the overall population had 2284 participants. Canadian participants treated with grass SLIT-T in the pooled adult-pediatric 2009 trials showed a 38% mean TCS reduction relative to placebo (-2.06 difference [95% CI: -3.72, -0.39]; 3.32 vs. 5.37). Participants treated with grass SLIT-T in the adult-pediatric 2012 trial showed a 37% median TCS reduction relative to placebo (-1.53 difference [95% CI: -2.1, -0.3]; 2.58 vs. 4.11). Similar efficacy findings were observed over the peak GPS. Approximately 90% of treatment-related AEs were mild or moderate in severity. Two Canadian participants had moderate systemic allergic reactions (skin, respiratory, abdominal symptoms) to grass SLIT-T; symptoms resolved within 1 hour without medical intervention or treatment. No serious or life-threatening treatment-related AEs occurred.ConclusionThe 2800 BAU Timothy grass SLIT-T significantly improved AR/C induced by Timothy grass pollen in adults and children ≥5 y in Canadians, which was consistent with the robust efficacy observed in the overall trial population. The treatment was generally well tolerated.Trial registrationClinicaltrials.gov identifiers NCT00562159, NCT00550550, NCT01385371.

Influenza antiviral treatment in spinal cord injury patients, 2007–2010

ObjectiveThis study assessed antiviral medication use for treatment of influenza-like illness (ILI) in Veterans with spinal cord injury or disorder (SCI/D) and examined whether antiviral prescribing improved over time.DesignRetrospective cohort study of Department of Veterans Affairs (VA) facilities.ParticipantsVeterans with SCI/D and matched non-SCI/D controls (matched by facility and date of visit/admission) who were diagnosed by a clinician with ILI during the period 1 October 2007 to 31 May 2010.Main outcome measuresAntiviral receipt and appropriateness were examined. Appropriate antiviral prescribing was defined as patients who received an antiviral medication within 2 days of collection of a sample for diagnostic testing or within 2 days of symptom onset.ResultsWe identified 101 influenza visits/admissions for veterans with SCI/D and 123 for controls. Antiviral prescribing for Veterans with SCI/D increased from 37.1% in 2007/2008 to 67.6% in 2009/2010 (P = 0.01) and appropriate antiviral prescribing increased from 20.0 to 41.2% (P = 0.05). Predictors of antiviral prescribing included being treated in the 2009/2010 influenza season (vs. 2007/2008) and having a cough. Fever, aches/myalgia, or a positive influenza test was associated with appropriate antiviral treatment. SCI/D was an independent predictor of receiving antiviral treatment (adjusted odds ratio = 1.16, 95% confidence interval 1.04–1.29), but having SCI/D was not associated with receiving appropriate treatment.ConclusionsInfluenza antiviral prescribing increased over time and in a larger proportion in veterans with SCI/D (vs. controls). This suggests that providers treating patients with SCI/D recognize treatment guidelines and their importance in a high-risk population. Continued efforts are needed to improve appropriate influenza antiviral prescribing.