Medication Use Research Articles

Pain Medication Frequency and Fall Risk Among Community-Dwelling Older Adults With Arthritis.

Pain medication is commonly used among older adults with arthritis, elevating the risk of falling. We examined fall risks related to the frequency of taking pain medication among community-dwelling older adults with arthritis by analyzing a nationally representative sample of community-dwelling Medicare beneficiaries aged >65 with self-reported arthritis (n = 4,225) in the 2015 National Health and Aging Trends Study. The survey-weighted logistic regression revealed that after controlling for confounding factors, recent falls were associated with taking pain medication daily compared to never (OR = 1.45, 95% CI: 1.06, 1.96). The other categories of medication frequency, compared to never, were not associated with fall risk. Findings suggest that more prudent use of pain medication should be stressed by health care providers for older adults with arthritis to help reduce the risk of falls and fall injuries. Nonpharmacological pain management is encouraged to support active living among older adults with arthritis.

Supporting General Practitioners and people with hypertension to maximise medication use to control blood pressure: the contribution of Collective Intelligence to the development of the ‘Maximising Adherence, Minimising Inertia’ (MIAMI) intervention

ABSTRACT Background: Hypertension remains one of the most important modifiable risk factors for stroke and heart disease. Anti-hypertensive medications are effective, but are often not used to maximum benefit. Sub-optimal dosing by prescribers and challenges with medication-taking for patients remain barriers to effective blood pressure control. Objectives: We aimed to systematically develop a theory-based complex intervention to support General Practitioners (GPs) and people with hypertension to maximise medication use to control blood pressure. Methods: We used the three-phase Behaviour Change Wheel (BCW) as the overarching intervention development framework. Collective Intelligence methodology was used to operationalise the stakeholder input to Phases 2 and 3 of the BCW. This took the form of a Collective Intelligence workshop with 19 stakeholders from diverse backgrounds including lived experience, general practice, nursing, pharmacy and health psychology. Techniques such as barrier identification, idea-writing and scenario-based design were used to generate possible intervention options. Intervention options were then selected and refined using the Acceptability, Practicability, Effectiveness, Affordability, Side-effects and Equity (APEASE) criteria and guidance from the MIAMI Public and Patient Involvement Panel. Results: The finalised MIAMI intervention consists of both GP and patient supports. GP supports include a 30-minute online training, information booklet and consultation guide (drop-down menu) embedded within the patient electronic health system. Patient supports include a pre-consultation plan, website, and a structured GP consultation with results from an Ambulatory Blood Pressure Monitor and urine chemical adherence test. The intervention components have been mapped to the intervention functions of the BCW and Behaviour Change Technique Ontology. Conclusion: Collective Intelligence offered a novel method to operationalise stakeholder input to Phases 2 and 3 of the BCW. The MIAMI intervention is now at pilot evaluation stage.

CAN CHATGPT IDENTIFY POTENTIALLY INAPPROPRIATE MEDICATIONS (PIM) IN OLDER ADULTS?

Abstract Reducing prevalent polypharmacy in older adults is critically important in daily practice, but it takes time to do it. Pharmacy care and other practice models can be helpful but costly. ChatGPT passed the USMLE exam and could be used to identify PIM in older adults in daily practice. Based on a case from a published curriculum by the author, ChatGPT was prompted to answer multiple clinical questions with two approaches. First, ChatGPT was prompted to answer four general questions on appropriate use of medications 1) Which of the commonly used 8 drug (s) is (are) PIM and should be avoided in older adults? 2) What is PIM in older adults? 3) How to identify PIM in older adults? 4) What to do with PIM? Second, ChatGPT was prompted to answer additional four specific questions related to the case 1) any drug-drug interactions for this patient? 2) any drug is ineffective for this patient? 3) this patient was taking so many medications. Any way to reduce the number of her medications? 4) Any drug-disease interaction for this patient? The author was the only person to determine the correctness of output from ChatGPT. Overall, ChatGPT can provide the principles of prescribing and de-prescribing for older adults. ChatGPT identified harmful medications and drug-drug interactions, but not drug-disease interactions. This indicated ChatGPT can be helpful in identifying certain PIM, but not drug-disease interactions in older adults. ChatGPT needs to be trained before providers use it to identify all PIM at daily practice.

IMPACT OF COMMUNITY TYPE ON SLEEP HEALTH DISPARITIES IN GRANDPARENTS RAISING GRANDCHILDREN

Abstract Grandparents raising grandchildren (GRG) report greater sleep problems than non-caregiving peers. Individuals living in low-income urban areas also report difficulty sleeping due to increased noise, light, and unsafe neighborhoods. However, no studies have examined urbanity’s impact on sleep among GRG and this study fills that gap. Grandparents living in rural (N=50, Mage=56.80), urban (N=59, Mage=53.07), and suburban areas (N=74, Mage=56.03) caring for their grandchild (>17 years old) completed the Pittsburg Sleep Quality Index (PSQI-sleep latency, sleep duration, sleep efficiency, sleep medication, sleep disturbances, and global sleep scales) and indicated their community type (rural, urban, suburban). Two-way ANOVAs evaluated interactions (sleep x community) and main effects. Pairwise comparisons clarified significant differences. Interactions were not significant. There was a significant main effect (p=.047) of community on sleep medication use, sleep disturbances (p=.009), and global sleep problems (p=.012). Urban grandparents reported more sleep medication (M=1.58+\-1.20) than rural (M=1.06+\-1.27; p=.046) or suburban grandparents (M=1.07+\-1.26; p=.026). Urban grandparents reported more sleep disturbance (M=1.63+\-.64) than rural (M=1.25+\-.55; p<.001) or suburban grandparents (M=1.44+\-.53; p=.080). Urban grandparents reported more global sleep problems (M=10.61+\-3.17) than rural (M=8.28+\-3.43; p=.010) or suburban grandparents (M=8.61+\-2.87; p=.010). Results suggest that level of urbanity impacts sleep health disparities among GRG and urban GRG may be at greater risk for sleep problems. More research (e.g., longitudinal) should examine what contributes to increased sleep problems among urban GRG, but these results suggest that behavioral sleep treatment programs should potentially target environmental and socioeconomic factors unique to urban GRG (e.g., increased noise, decreased safety and security, etc.).

PRIORITIES ALIGNED DEPRESCRIBING FOR PERSONS LIVING WITH DEMENTIA AND THEIR CARE PARTNERS

Abstract PlwD average 8 daily medications compared to 3 for persons without dementia. PlwD have high polypharmacy burden from anticholinergic and psychotropic medications. PlwD, their care partners and clinicians endure the workload of managing multiple medications, and want to decrease this burden. Thus, a shift that reduces polypharmacy, and focuses medication use on what matters most is needed. Deprescribing is an approach to reduce polypharmacy for PlwD. However, deprescribing studies for PlwD have a narrow scope. Few studies place deprescribing within ambulatory care contexts for patients with mild to moderate dementia. Appropriate deprescribing in dementia requires identifying health priorities. Deprescribing is most appropriate when guided by priorities of patients and care partners. Patient Priorities Care (PPC) is an evidence-based approach to health priorities aligned decision making. We found evidence that PPC facilitates deprescribing by identifying health priorities that are misaligned with current medications. When used in the care of PlwD and their care partners, PPC could facilitate deprescribing. Less is known about how PPC works in the triadic context of clinician, care partner, and PlwD. Care partners may have concerns about stopping medications considered inappropriate such meds help manage symptoms. Clinicians may focus on cognitive and functional harms of medications without considering tradeoffs of stopping medications. Without eliciting priorities, families and care partners of PlwD may make decisions to stop medication without communication with their clinicians. We recently completed a study using PPC to deprescribe unnecessary medications among PlwD. We will discuss our findings and the implications for future work.

A Pharmacovigilance Study on Anti-Asthmatic Agent

Pharmacovigilance plays a critical role in ensuring the safety and efficacy of anti-asthmatic agents, including inhaled corticosteroids (ICS), long-acting beta-agonists (LABAs), and leukotriene receptor antagonists (LTRAs). This study evaluates adverse drug reactions (ADRs) associated with these medications, emphasizing their clinical impact, risk factors, and patient outcomes. A systematic approach, including spontaneous ADR reporting, database reviews, and post-marketing surveillance, was utilized to identify patterns of drug-related complications, such as dysphonia, oral candidiasis, and cardiovascular risks. Findings highlight the importance of monitoring combination therapies, optimizing medication use, and enhancing patient education to improve asthma management while minimizing risks. Future directions include integrating pharmacogenomic data into safety assessments to personalize asthma treatment

Cross-sectional associations between patterns of cultural engagement and indicators of biological dysregulation

Background Research has shown that cultural activities may bring about improved health. However, large-scale quantitative analyses on cultural engagement and biomarkers are lacking to date. As a result, the mechanisms through which cultural activities may be associated with health are unclear. Aim Test quantitative associations between cultural engagement pattern (including active and passive engagement in arts, sports, and heritage activities) and indicators of biological dysregulation in a large dataset. Subjects and methods Understanding Society data were used to conduct cross-sectional linear regression analyses between a data-driven latent class model of cultural engagement and indicators of anthropometric, cardiovascular, metabolic, immune, and neuroendocrine function. Analyses were adjusted for age, gender, ethnicity, childcare responsibility, urbanicity, leisure time satisfaction, capacity-related factors, socioeconomic position, social and economic capital indicators, physical activity, and medication use. Results More culturally participants had better indicators of biological health, such as lower waist circumference and fibrinogen blood concentration. Specific associations between cultural engagement pattern and the different biological outcomes were also observed. The associations were explained in part by correlated factors (accounting for around half of the association). Conclusions Cultural engagement is cross-sectionally associated with biomarkers, although the characteristics of people who engage with culture are an important consideration when interpreting these findings.

SEX DIFFERENCES IN FACTORS ASSOCIATED WITH FALLS AMONG COMMUNITY-DWELLING OLDER ADULTS WITH OSTEOARTHRITIS

Abstract Osteoarthritis elevates the risk of falling among older adults due to joint pain and stiffness. Research suggests that sleep problems, depression, and fatigue may also relate to falls among those with osteoarthritis, yet sex influences in these associations remain understudied. This study investigated factors associated with falls by sex (male vs. female). A sample of 3,895 community-dwelling older adults with osteoarthritis in the 2016 Health and Retirement Study (2,624 females; 1,271 males) were analyzed using survey-weighted logistic regression. All analyses were controlled for sociodemographic characteristics, including geographic residence, and health-related issues (e.g., balance problems, chronic diseases, and medication use). Most participants were female (64.5%), in their 70s (M = 73.74, SD = 6.4), White (89.0%), had a high school or higher education (89.3%), and non-rural residents (70.9%). For both men and women, balance problems, functional limitations, and cancer increased the risk of falling, while pain, sleep problems, depression, or fatigue were not associated with falls. Among women, being White (OR = 3.87, 95% CI; 1.86, 8.05 compared to Black), rural residence (OR = 1.59, 95% CI: 1.01–2.50 compared to urban residence), and opioid use (OR = 1.60, 95% CI: 1.00, 2.54) increased the risk of falling. Among men, having heart problems (OR = 1.84, 95% CI: 1.24, 2.72) increased the risk of falling. Sex-tailored fall prevention strategies, such as providing rural programs and opioid education for women and increasing awareness and fall education for men with heart problems, are encouraged to support active living among older adults with osteoarthritis.

OLDER ADULTS’ PERCEPTION TOWARD DEPRESCRIBING INAPPROPRIATE MEDICATIONS

Abstract Introduction Inappropriate prescription of medications is a problem of growing interest in geriatrics. Initiatives have been ongoing to evaluate interventions targeting the hazards of inappropriate prescription of medications; Deprescribing is one of these initiatives. However, no current study has examined medicine-related perceptions toward deprescribing inappropriate medications among older adults. Methods A convenience sample of older adults who regularly visited the outpatient clinics during July 2023 for regular checkups were recruited. Data were collected by a graduate nursing student from one pharmacy located in a public hospital, five days per week, via in-person interviews using the Patient’s Perceptions of Deprescribing survey. Results The study found that older adults’ perceived interest in stopping medications, belief about medicine overuse, the unimportance of medicines, and medication concerns are significantly associated with a variety of sociodemographic (e.g., age), clinical (e.g., comorbidities), and PCP-related factors (e.g., knowledge of medications). Conclusion Inappropriate prescription of medication is one of the most common polypharmacy-related issues among older adults. The current study reported its findings on medicine-related perception toward deprescribing inappropriate medications among older adults. Care providers should discuss the benefits of deprescribing inappropriate medications with their patients to prevent the side effects associated with long-term unnecessary use. The long-term use of inappropriate medications by older adults should be carefully evaluated. Future studies on the effectiveness of an evidence-based deprescribing protocol on minimizing the clinical side effects associated with inappropriate prescription of medications among older adults are recommended.

Sleep patterns among Aboriginal and Torres Strait Islander Peoples and non-Indigenous Australians: A South Australian descriptive exploratory study.

Irregularities with sleep patterns and behaviours are commonly observed in Australia, but there is lack of information regarding sleep patterns among Aboriginal or Torres Strait Islander adults. This study explores sleep patterns in Aboriginal or Torres Strait Islander adults, comparing it with non-Indigenous Australian adults in addition to investigating any potential effects on daytime behaviour. A total of 730 Aboriginal and Torres Strait Islander Peoples aged 18 years and above were included in the study. The participants completed a self-reported questionnaire on various aspects of sleep, such as difficulty falling asleep, waking up during the night, feeling well-rested upon waking, snoring loudly, gasping/choking during sleep, use of prescription medication and experiencing fatigue or sleepiness during the day. Additionally, the participants were interviewed using the 'Top End Sleepiness Scale' to report increased sleepiness during daily activities. The responses were compared with those of non-Indigenous Australians in the 2016 Sleep Health Foundation national survey, using questions that measures similar variables. Aboriginal and Torres Strait Islander Peoples experienced higher rates of sleep disturbances, including difficulty in falling asleep and waking in the night. Snoring and breathing pauses during sleep were more common in middle-aged men, and sleeping difficulties and daytime symptoms related to insufficient or unrefreshing sleep were more common in women. Sleep issues increased with age among adult Australians but were more common in the age group of 25-34 years for Aboriginal and Torres Strait Islander Peoples. The data suggest that Aboriginal and Torres Strait Islander adults report irregularities in sleep patterns. Early interventions and management of sleep habits could potentially have benefits for overall physical and mental health.

A Case Report of Lurasidone-Induced Tardive Dyskinesia: Therapeutic Role of Valbenazine

Background: Tardive dyskinesia (TD) is a complex, potentially irreversible movement disorder primarily associated with the long-term use of antipsychotic medications, particularly typical neuroleptic drugs. TD can develop during treatment and persist long after the discontinuation of the culprit medication. The etiology of this condition involves dysregulation of dopaminergic signalling, especially within the striatum, leading to activation of D2 dopamine receptors. This imbalance affects the homeostasis of neurotransmitters, including GABA and Glu. Chronic dopamine receptor antagonism incites neuroadaptive alterations that may linger post-therapy, resulting in abnormal involuntary movements affecting the orofacial regions, limbs, and trunk, which profoundly diminish patient quality of life. Case: A 29-year-old female with a known history of schizophrenia presented with sudden-onset neurological symptoms, notably persistent orofacial dyskinesias such as lip smacking and grimacing, which had developed over a 24-hour period. A thorough review of her medications indicated that lurasidone, classified as an atypical antipsychotic, was likely responsible for the onset of these dyskinetic movement features. Consequently, the physician opted to discontinue lurasidone and initiate valbenazine at 40 mg once daily with the intent of managing the dyskinetic symptoms while considering the overall psychiatric and medical treatment plan for the patient. Conclusion: The emergence of orofacial dyskinesias in this patient suggests a possible adverse reaction to lurasidone, necessitating re-evaluation of her psychopharmacological regimen. Valbenazine, a selective vesicular monoamine transporter 2 inhibitor, may provide a tailored approach to mitigate dyskinetic movements, while maintaining therapeutic efficacy in psychiatric care.

Factors Affecting Knowledge and Practice of Hypertension and Medication Use in Hypertensive Pregnant Women

Hypertension in pregnant women is one of the public health concerns globally and its management requires a consideration of benefits outweighing the risk of treatment. Patients’ knowledge and practices regards to the disease and medication is crucial in ensuring the reduction in morbidity and mortality rate in the mother and foetus. This study aimed to assess the level of knowledge and practice of hypertension and its management, the medication use and factors associated with a good level of knowledge and practice in pregnant women with hypertension. This study was a cross-sectional, observational study, using a self-administered questionnaire, involving a total of 70 pregnant women who were attending antenatal checkup in Hospital Al-Sultan Abdullah (HASA), UiTM Puncak Alam, Selangor, Malaysia. Majority of the participants had poor knowledge regarding hypertension during pregnancy (55.71%) but adopted good practice (74.29%) on the disease management. Majority of participants showed a good level of knowledge (68.6%) and practice (82.86%) on the medication use during pregnancy. Pharmacists were the major (35.7%) source of information in seeking information on the medication followed by doctors and online resources. Factors such as higher age, higher education, and having more children are linked to a high level of knowledge on medication use. Good practices in medication use are associated with high education, employment, and having one to three children. Factors related to good knowledge of the disease and its management include being over 30 years old and living in an urban area. In contrast, paticipants who is over 30 years old is associated with good practices in disease management. It is evident that most participants exhibited good knowledge and practice regarding medication use during pregnancy, despite significant knowledge gaps related to hypertension. This research may project a refine guideline for a comprehensive and targeted patient education aiming good maternal health outcomes.

Increased medication utilization precedes incidentally diagnosed inflammatory bowel disease: a multicenter, case-control study.

This study investigates whether subclinical inflammation in asymptomatic inflammatory bowel disease (IBD) patients leads to increased medication use. In a multicenter, retrospective analysis of patients diagnosed with incidental ulcerative colitis or Crohn's disease during colorectal cancer screening (2010-2021), medication use was compared with symptomatic patients and healthy non-IBD controls. Asymptomatic patients showed a higher use of cardiovascular, antiparasitic, musculoskeletal, respiratory, and sensory organ medications up to five years before diagnosis. This trend suggests that a systemic inflammatory process occurs years before clinical onset of IBD, suggesting the potential for earlier diagnosis and intervention.

A <b>Case Series Analysis of Trans-Arterial Embolization for Osteoarthritis-Related Hand Pain</b>

Osteoarthritis (OA) is a widespread disorder which commonly impacts a significant portion of the population. Although most cases involve the knee joint, it can also affect the carpometacarpal joint and cause significant pain in the hand and thumb. Traditional treatments often provide short-term pain relief and need continual treatment prompting the need for exploring alternative therapies to prolong the duration of pain relief. This case series assesses the clinical success of trans-arterial embolization (TAE) of the joints in the hand as a minimally invasive treatment for chronic pain associated with hand joint OA, defined as a 50% (or greater) decrease in Visual Analog Scale (VAS) score overall, as well as a decrease in prescribed pain medication use. We present a case report of four patients who underwent this intervention for hand joint osteoarthritis. Preliminary results show an average decrease in VAS exceeding the 50% threshold, with a notable reduction in pain medication usage and improvements in daily activities. These findings suggest that TAE shows promise as a minimally invasive therapy for hand joint OA, warranting further investigation into its long-term efficacy and safety.

Evaluation of Turkish women’s attitudes and perceptions regarding medication use in pregnancy: A pilot study

Evaluation of Turkish women’s attitudes and perceptions regarding medication use in pregnancy: A pilot study

Substance use prediction using artificial intelligence techniques

Substance use poses a significant public health challenge worldwide, including in Finland. This study seeks to predict patterns of substance use, aiming to identify the driving factors behind these trends using artificial intelligence techniques. This research utilizes data from the 2022 Finnish National Drug Survey, comprising 3,857 participants, to develop predictive models targeting the use of cannabis, ecstasy, amphetamine, cocaine, and non-prescribed medications. Analysis of 23 questionnaire items yielded 76 features across four substance use dimensions: demographic attributes, experience and preferences of drug use, health-related aspects of drug use, and social attributes of drug use. In addition to traditional machine learning (ML) approaches previously applied in this field, three sophisticated deep learning models—standard LSTM, BiLSTM, and Recursive LSTM—were employed to evaluate their predictive performance. These LSTM models were further augmented with SHAP analysis to identify the primary influences on substance use patterns. While all these artificial intelligence models demonstrated superior predictive performance, our focus was specifically on the outcomes of the LSTM models due to their novel application in this field. The results underscore the exceptional performance of both LSTM and ML models in unraveling complex substance use behaviors, underlining their applicability in diverse public health contexts. This study not only sheds light on the predictors of substance uses but also furthers methodological innovation in drug research, charting new directions for crafting targeted intervention strategies and policies. The observed variability in predictor significance across different substances indicates the necessity for tailored prevention programs catering to particular user groups. Integrating machine learning with social science and public health policy, our research deepens the understanding of the factors influencing substance use and promotes effective strategies for its mitigation. Despite some limitations, this investigation establishes a foundation for future studies and accentuates the critical role of advanced computational techniques in addressing intricate social issues.

Uncontrolled hypertension among adult hypertensive patients in Addis Ababa public hospitals: A cross-sectional study of prevalence and associated factors.

In 2019, 77% of women and 82% of men with hypertension had uncontrolled hypertension worldwide. Uncontrolled hypertension can cause stroke, myocardial infarction, heart failure, renal failure, dementia, blindness, and death. However, most of the studies used the previous seventh joint national committee classification to classify hypertensive patients as either controlled or uncontrolled. This study aimed to assess the prevalence and associated factors of uncontrolled hypertension among adult hypertensive patients at public hospitals in Addis Ababa, Ethiopia. From April 12 to May 12, 2024, three public hospitals in Addis Ababa employed a hospital-based cross-sectional study design with 408 hypertensive patients. Systematic random sampling was used to select the study participants. We used a structured interview questionnaire and chart review and took physical measurements. Data were entered into Epidata and analyzed using the statistical package for social science version 25. A logistic regression model was used to identify factors associated with uncontrolled hypertension at a P-value < 0.05 with a 95% confidence interval. The prevalence of uncontrolled hypertension among hypertensive patients at public hospitals in Addis Ababa was 66.2% (95% CI: 61.6%, 70.8%). After adjusted analysis, age ≥ 60 years (AOR = 2.88, 95% CI: 1.37, 6.04), the presence of comorbidities (AOR = 2.21, 95% CI: 1.23, 3.96), being overweight (AOR = 2.25, 95% CI: 1.20, 4.24), non-adherence to antihypertensive medication (AOR = 5.21, 95% CI: 2.76, 9.83), non-adherence to a low-salt diet and dietary approaches to stop hypertension (AOR = 2.74, 95% CI: 1.35, 5.53), taking three or more antihypertensive medications (AOR = 3.10, 95% CI: 1.16, 8.25), and non-adherence to physical exercise (AOR = 2.84, 95% CI 1.49, 5.39) were factors associated with uncontrolled hypertension. Uncontrolled hypertension was very high in public hospitals in Addis Ababa, Ethiopia. Key factors for uncontrolled hypertension are non-adherence to antihypertensive medications, use of multiple medications, lack of physical exercise, and low adherence to low salt and dietary approaches to stop hypertension. To address these, enhancing patient education on medication adherence, promoting lifestyle changes, and leveraging digital health tools, like mobile apps, for real-time support and adherence tracking are recommended.

Central Sleep Apnea and Cardiovascular Disease State-of-the-Art.

Central sleep apnea (CSA), a rare polysomnographic finding in the general population, is prevalent in certain cardiovascular conditions including systolic and diastolic left ventricular dysfunction, atrial fibrillation, coronary artery disease, carotid artery stenosis, stroke and use of certain cardiac-related medications. Polysomnographic findings of CSA with adverse cardiovascular impacts include nocturnal hypoxemia and arousals, which can lead to increased sympathetic activity both at night and in the daytime. Among cardiovascular diseases, CSA is most prevalent in patients with left ventricular systolic dysfunction; a large study of more than 900 treated patients has shown a dose dependent relationship between nocturnal desaturation and mortality. Multiple small randomized controlled trials have shown mitigation of sympathetic activity when CSA is treated with nocturnal oxygen, continuous positive airway pressure and adaptive servoventilation. However, two early randomized controlled trials with positive airway pressure devices have shown either neutral effect on survival or excess premature mortality in the active treatment arm, compared to untreated CSA. In contrast, the results of the most recent trial using an advanced adaptive servoventilation device showed improved quality of life and no signal for mortality suggesting that treatment of CSA was at least safe. In addition to positive airway pressure devices, multiple medications have been shown to improve CSA, but no long-term trials of pharmacologic therapy have been published. Currently, phrenic nerve stimulation is approved for treatment of CSA, and the results of a randomized controlled trial showed significant improvement in sleep metrics and quality of life.

Determination of Factors Associated with Glycemic Control in Women with Type 2 Diabetes: Nutrition and Physical Activity Level

Aim: Effective diabetes management is achieved with adequate glycemic control. Nutrition and physical activity have an important role in glycemic control. This study was conducted to determine the relationship between glycemic control and nutrition attitude, Mediterranean diet adherence and physical activity levels of women with Type 2 diabetes aged 20-64 years who applied to a state hospital in Konya province. Material and Methods: This correlational study was conducted with 246 women aged 20-64 years with Type 2 diabetes who applied to the Internal Medicine and Endocrinology outpatient clinics of a hospital in Konya. Individuals were selected by random sampling method. Data were collected using a questionnaire form, Attitudes Toward Healthy Eating Scale, Mediterranean Diet Adherence Scale and International Physical Activity Questionnaire Short Form (IPAQ-SF). Descriptive statistics, Chi-Square, Fisher's exact test, Kruskal Wallis test, Spearman correlation analysis and logistic regression analysis were used to analyze the data collected by face-to-face interviews. Results: In the study, glycated hemoglobin A1c (HbA1c) and fasting blood glucose (FBG) were used to assess glycemic control. 55.3% and 56.9% of the individuals had poor glycemic control in terms of HbA1c and FBG, respectively. According to logistic regression analysis, for HbA1c; having diabetes for more than 10 years (OR=0.291, 95% Cl=0.095-0.894), high triglycerides (OR=0.440, 95% Cl=0.190-1.017) and low high density lipoprotein (HDL) (OR=0.293, 95% Cl=0.114-0.753); For FBG, increased frequency of skipping medication and insulin use (OR=2.431, 95% Cl=1.090-5.424) and low HDL level (OR=0.269, 95% Cl=0.110-0.653) were significant risk factors. Among the individuals, 73.2% had a moderate attitude towards healthy eating, 46.3% had a moderate adherence to the Mediterranean diet and 60.6% were physically inactive. In addition, there was a very weak negative significant correlation (p

The Use of Melatoninergic Antidepressants for Stabilization of Remission in Depression Comorbid with Alcohol Abuse, Anxiety or Neuropsychiatric Disorders: A Systematic Review

BACKGROUND: Depression is one of the most common mental disorders and is associated with a significant increase in the risk of mental and somatic comorbidities. The chronobiological theory of the pathogenesis of depression explains the relationship between the symptoms of depression and disturbance of circadian rhythm regulation. Disrupted circadian rhythms are also observed in other disorders such as alcohol use disorder, anxiety disorders, epilepsy, and Parkinson’s disease. Therefore, there is a growing interest in the use of medications with a melatoninergic mechanism of action in the treatment of depression comorbid with the aforementioned disorders. AIM: This review aims to systematically examine the evidence for the use of melatoninergic antidepressants (agomelatine and fluvoxamine) in the treatment of depression comorbid with alcohol abuse, anxiety disorders (including phobic anxiety, panic, and generalized anxiety disorders), or neuropsychiatric disorders (such as epilepsy and Parkinson’s disease). METHODS: This systematic review included experimental studies, systematic reviews, and meta-analyses published in English and Russian, which examined the use of fluvoxamine and agomelatine in adult patients with recurrent depressive disorder (ICD-10) or major depressive disorder (DSM-5) comorbid with alcohol abuse, anxiety or neuropsychiatric disorders. The search was conducted in the PubMed, Cochrane Library and eLIBRARY scientific databases. The quality of the selected studies was assessed using the Cochrane Risk of Bias tool, which is used to evaluate the risk of systematic errors in clinical studies. The results were presented as a narrative synthesis and grouped by the comorbidities evaluated. RESULTS: A total of 20 articles were reviewed (with a pooled sample size of n=1,833 participants). The results suggest that melatoninergic antidepressants might help in reducing depressive and anxiety symptoms, improve sleep, decrease alcohol cravings, and alleviate the severity of motor symptoms in Parkinson’s disease. Moreover, the use of pharmacogenetic testing to select the medication and dosage may enhance its therapeutic effectiveness. CONCLUSION: The review demonstrates a significant lack of clinical data and guidelines on the use of melatoninergic medications for the treatment of depression comorbid with other disorders. In this regard, it is currently difficult to draw a definitive conclusion regarding the efficacy and safety of agomelatine and fluvoxamine in the treatment of these comorbidities. Available studies suggest an improvement in the clinical manifestations of the comorbidities. Future research directions might include the development and implementation of double-blind, randomized clinical trials to study the use of melatoninergic medications in patients with depression comorbid with other disorders.