Prescription Medications Research Articles

Reference Values for Water-Specific T1, Intermuscular and Intramuscular Fat Content in Skeletal Muscle at 2.89 T.

MRI offers quantification of proton density fat fraction (PDFF) and tissue characteristics with T1 mapping. The influence of age, sex, and the potential confounding effects of fat on T1 values in skeletal muscle in healthy adults are insufficiently known. To determine the accuracy and repeatability of a saturation-recovery chemical-shift encoded multiparametric approach (SR-CSE) for quantification of T1Water and muscle fat content, and establish normative values (age, sex) from a healthy cohort. Prospective observational; phantoms (NiCL2-agarose T1 phantoms with no fat content; gadolinium T1 phantoms with mixed fat-water content). A total of 130 healthy community-dwelling adults (63 male, 18-76 years) free of chronic health conditions that require regular prescription medication, and with no contraindications to MRI. 2.89 T; gradient echo sequences including saturation-recovery chemical-shift encoded T1 mapping (SR-CSE); MOLLI; SASHA; CSE; and single voxel spectroscopy. SR-CSE provided T1Water and PDFF maps for assessment of intramuscular (MFIntra), intermuscular (MFInter), and subcutaneous fat and muscle volumes (thigh, paraspinal muscles). Comparison with MOLLI/SASHA T1 mapping. Univariable and multivariable linear regression, general linear models, Bland and Altman, coefficient of variation (CV). P-value <0.05 was considered statistically significant. Phantom and in vivo validation studies showed excellent accuracy of SR-CSE T1Water and PDFF vs. values from reference standards and repeatability CVs between 0.2% and 2.6% for T1Water, R2*, MFInter, MFIntra, subcutaneous fat and muscle volumes. Mean T1Water was 36 msec significantly higher in females (1445 ± 23 msec vs. 1409 ± 22 msec), with no age-effect (P = 0.35). Females had significantly higher values for MFInter (10.4% ± 4.8% vs. 7.1% ± 2.9%) and MFIntra (2.6% ± 1.0% vs. 2.3% ± 0.8%), both of which increased with age, secondary to lower muscle volume. MOLLI and SASHA T1 values had a fat-related bias of 21.7/35.0 msec per 1% increase in fat fraction (MFFIntra), in vivo, and a constant bias of -319.8/+35.6 msec, respectively. SR-CSE provides accurate (vs. phantoms) and repeatable assessment of water-specific T1 values and muscle and fat volumes. Conventional methods (SASHA, MOLLI) have a significant fat-modulated T1-bias. T1Water values are higher in females with no significant age dependence. We developed and tested the accuracy of a new MRI approach to measure tissue damage in skeletal muscle using a method called T1 mapping. The approach also provided matching images of fat within the muscle. We measured T1 values and muscle fat volumes in the thighs of 130 healthy adults to define normal values in healthy people and to understand if these values are influenced by age, sex, or weight. We found that our MRI technique accurately measured T1 values and fat volumes within muscle and we defined normal ranges of values, which were different in healthy males and females. 2 TECHNICAL EFFICACY: Stage 1.

Glucagon-like Peptide-1 Receptor Agonist Impact on Chronic Ocular Disease Including Age-Related Macular Degeneration.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have risen exponentially in usage and have been shown to exert neuroprotective and anti-inflammatory effects across multiple organ systems. This study investigates whether GLP-1RAs influence the risk for age-related ocular diseases. Retrospective cohort study. This study utilized an electronic health records platform of patients in the United States. Patients older than 60 years of age with at least five years of ophthalmology follow-up and medication prescription documentation were included. Patients were categorized into five medication groups: GLP-1RAs, metformin, insulin, statins, or aspirin users. Cohorts were propensity-matched on demographics and chronic health conditions using a greedy matching algorithm. Outcomes of cataract, ocular hypertension, primary open angle glaucoma, non-exudative AMD, and exudative AMD were compared five years following initial medication prescription. We then examined earlier timepoints within the five-year period. Significance was defined as p<0.05 and HR threshold > 1.1 or < 0.9 to improve signal to noise ratio. Of the 9,669 patients taking GLP-1RAs, 84.4 percent were diabetic with an average BMI of 36.2. Propensity matched cohorts demonstrated GLP-1RAs were associated with reduced hazard of non-exudative AMD compared to metformin (HR 0.68, 95%CI: 0.56-0.84), insulin (HR 0.72, 95%CI: 0.58-0.89), and statins (HR 0.7, 95%CI: 0.57-0.87). These findings were validated compared to aspirin and in an independent older cohort of patients. This significant reduction appeared after three years compared to metformin (HR 0.69, 95%CI: 0.52-0.91), insulin (HR 0.66, 95%CI: 0.5-0.87), and statins (HR 0.67, 95%CI: 0.51-0.88). Time course results were validated using independent cohorts of propensity matched patients taking medications for three years. Notably, GLP-1RAs also significantly reduced the risk of exudative AMD (HR 0.7, 95%CI: 0.58-0.84) and POAG (HR 0.58, 95% CI 0.45-0.76) compared to insulin after three years. Usage of GLP-1RAs showed no persistent significant impact on the risk of cataract formation nor ocular hypertension after five years compared other medications. This study suggests GLP-1RAs may reduce the risk of multiple age-related ocular diseases and suggests the need for future prospective studies to validate these findings.

Job loss and reemployment of newly diagnosed people with epilepsy: A nationwide cohort study.

Epilepsy has negative socioeconomic impacts on those affected, resulting not only from actual disability but also from social stigma. However, longitudinal studies examining occupational consequences following an epilepsy diagnosis are limited. We aimed to investigate the occupational outcomes of newly diagnosed epilepsy among Korean employees. We conducted a nationwide population-based retrospective cohort study using the Korean National Health Insurance Service database. We included newly diagnosed people with epilepsy (PWE) aged 25 to 54 years, identified by diagnostic codes and antiseizure medication (ASM) prescriptions, who were employed at diagnosis between 2004 and 2018. The employment status of PWE was determined based on their enrollment in the employer-provided health insurance scheme. We analyzed the rates of job loss and reemployment, associated factors, and income changes following diagnosis. Among the 13 122 newly diagnosed PWE, the overall first-year job loss rate across the study period was 21.7%, which was 1.62-2.54 times higher than that of the general population for each year. The excesses of job loss among PWE in safe occupations were comparable to those in safety-sensitive occupations. Central nervous system illness (adjusted hazard ratio [aHR] = 1.12), psychiatric disease (aHR = 1.19), ≥2 emergency room visits or hospitalizations (aHR = 3.00), and ≥4 ASM attempts (aHR = 1.26) increased the risk of job loss. Among individuals who lost their job during the first year, 22.4% were reemployed within 1 year, with similar risk factors hindering reemployment. The income distribution of regained jobs showed a downward shift compared to previous jobs. Newly diagnosed PWE were at risk of job loss, irrespective of the occupational hazards related to seizures. Poor disease control and comorbidities partially contributed to unemployment. Alongside active seizure management, guidance for suitable occupations and the implementation of tailored restrictions based on occupational risk stratification are imperative to improve the job security of PWE.

Navigating the evolving landscape in the prescribing of medications for insomnia in Singapore: Principles and considerations from a psychiatrist’s perspective

Navigating the evolving landscape in the prescribing of medications for insomnia in Singapore: Principles and considerations from a psychiatrist’s perspective

Automated process assessment of primary healthcare for hyperlipidemia: preliminary findings and implications form Anhui, China

BackgroundPrimary healthcare (PHC) plays a key role in hyperlipidemia (HL) management yet lacks adequate monitoring and feedback. This study aims at identifying pragmatic measures out from routinely collected electronic records to enable automatic monitoring and inform continuous optimization of HL-management at PHC settings.MethodsThe study used randomly selected electronic records of PHC (from the province-wide data center of Anhui-province, China) as the main data source and generated both procedure-based and encounter-based measures for assessing HL-management. The procedure-based measures were derived from specific quality-facts of 21 stages/procedures (e.g., lipid lowering medication prescription) using self-designed algorithms. While the encounter-based measures included number or rate of visits for HL, currently-noticed hyperlipidemia (CNHL, or HL noticed during the current consultation), and ever-diagnosed hyperlipidemia (EDHL). Analysis of these measures employed mainly simple descriptives and linear regression modeling.ResultsThe study revealed interesting findings including: low and varied rates of visits for HL(from 0.01 to 1.43%) and visits by patients with EDHL/CNHL(from 0.13 to 20.54% or from 0.02 to 2.99%) between regions; large differences (5.14 to 22.20 times) between the mean or cumulative proportions of visits by patients with EDHL versus CNHL among clinician groups; consistent increase in the ratio of visits for HL in all cause visits over the study period (from 0.087 to 1.000%) accompanied with relatively stable proportions of patients with CNHL/EDHL; Relatively low scores in the procedure-based measures (ranged from 0.00 to 36.08% for specific procedures by seasons).ConclusionsThe measures identified are not only feasible from real-world PHC records but also give some useful metrics about how well current HL-management is going and what future actions are needed.

The epidemiology and unmet need of migraine in five european countries: results from the national health and wellness survey

BackgroundDespite the high global prevalence, burden, and direct and indicated costs, migraines are often under-diagnosed and undertreated. Understanding the prevalence of migraine and unmet needs is crucial for improving diagnosis and treatment across Europe (EU) countries; however, real-world studies are limited.MethodsThis retrospective cross-sectional survey utilized weighted patient-reported data from the 2020 National Health and Wellness Survey (NHWS) in five EU (5EU) countries (France, Germany, United Kingdom [UK], Italy, and Spain). The survey included adults aged ≥ 18 years who self-reported experiencing migraines in the past 12 months and had a physician’s diagnosis. The survey assessed migraine prevalence by age and sex. Other measures included migraine characteristics, disability assessment, migraine frequency (monthly migraine days [MMDs] and monthly headache days [MHDs], menstrually-related migraine, treatment patterns, and provider characteristics.ResultsThe study included 7,311 respondents with diagnosed migraines, representing an estimated 30.5 million adults with a weighted prevalence of 11.5% in the 5EU. Spain had the highest prevalence (14.0%), followed by Italy, France, UK, and Germany. Migraine prevalence was highest in the age group of 30–39 years, and females had nearly twice the prevalence compared to males. About 56% of respondents reported disability due to migraines, with highest percentage reported in Germany (66.0%). About 46% of female respondents reported experiencing menstrually-related migraines. One-fourth of the study respondents reported > 4 MMDs and 56.2% reported > 4 MHD. Current treatment patterns revealed that 79.7% of respondents were receiving some form of migraine treatment, with non-steroidal anti-inflammatory drugs (NSAIDs), analgesics, and triptans being the most commonly reported prescription medications. Primary care physicians (PCPs) were the most common providers diagnosing migraines, followed by neurologists.ConclusionsIn the 5EU, one-fourth of diagnosed respondents reported > 4 MMDs, and 56.2% reported > 4 MHDs. Nearly half of females experienced menstrually-related migraines. Although most patients reported taking medication for migraine, severe disability and medication overuse were observed. PCPs were the main treatment providers, highlighting the need for improved expertise and referrals to specialists. Further research is required for a better understanding of the disparities between migraine frequency and treatment approaches.

Prevalence of prescription medication use that can exacerbate heart failure among US adults with heart failure.

Heart failure (HF) affects more than 6 million adults in the United States, contributing to substantial morbidity, mortality, and health care costs. Despite advances in medical care, many medications can exacerbate HF, yet their prevalence of use remains unknown. This study examined the national use of prescription medications that could exacerbate HF in adults with self-reported HF. We analyzed data from US adults with self-reported HF in the National Health and Nutrition Examination Survey (NHANES) from 2011 to March 2020. Medications known to exacerbate HF, identified from HF guidelines, were documented through pill bottle reviews. Weighted estimates were used to calculate prevalence overall and by sex, race and ethnicity, and level of evidence for avoidance. Multivariable logistic regression models calculated adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) for the use of these high-risk medications by sex and race and ethnicity. A total of 687 participants, representing 5.2 million U.S. adults with HF after applying sampling weights, were included (mean age, 66.1 [95% CI 64.9, 67.4] years; 50.4% female [95% CI 45.9%, 55.0%]). Overall, 14.5% (95% CI 10.4%, 19.5%; n = 92) of adults with HF were prescribed at least one medication known to exacerbate HF, with the most common being diltiazem, meloxicam, and ibuprofen. Use of these medications was not significantly different by sex nor by race and ethnicity. Of these medications, 21.7% (95% CI 10.7%, 38.8%) had level A evidence warning against use, and 78.3% (95% CI 61.2%, 89.3%) had B level evidence. Over one-seventh of U.S. adults with HF were likely to have been prescribed medications that could exacerbate the condition, underscoring the need to optimize care. Reducing high-risk medication use may mitigate HF exacerbations and improve outcomes in this vulnerable population.

Public knowledge, attitudes, and practices regarding antibiotics use and resistance in Montenegro.

A drug consumption monitoring revealed that Montenegro is one of the major consumers of antimicrobial drugs in Europe. The aim of this study is to obtain the first data on the knowledge, attitudes, and practices of the general population in Montenegro regarding antibiotics use. This cross-sectional study was designed according to the methodology of Eurobarometer survey on antimicrobial resistance, created by the European Commission. The standardized questionnaire was conducted in Podgorica, in October-November 2022. A total of 532 participants completed the questionnaire. More than a half of responders (60.9%) have received antibiotics within the last 12 months and among them 33.4% was missing a medical prescription, nor the antibiotic was administered by a medical practitioner. The rest of the responders mostly had some antibiotics left over from a previous course (13.0%), had taken it from a pharmacy (11.4%), or elsewhere without a prescription. The most frequent reasons for antimicrobial therapy were "cold" (22.5%), "sore throat" (21.0%), "cough" (19.4%), and "COVID-19" (coronavirus disease 2019) (17.9%). Throat swab, blood test, urine test, or other test that could identify the cause of the illness preceded antimicrobial therapy in 46.3% participants. Only one-half of the participants were convinced that antibiotics are ineffective in viral infection treatment. This study is the first report on public knowledge, attitudes and practices regarding antibiotics use and resistance in Montenegro and it highlights the need for the knowledge improvement among general population, better regulations for antibiotics procurement and a campaign regarding appropriate antibiotics use among youth.

O CONSUMO DOS MEDICAMENTOS UTILIZADOS NO TRATAMENTO DA DEPRESSÃO E ANSIEDADE NOS ÚLTIMOS 3 ANOS NA CIDADE DE SANTA LUZIA D’OESTE - RO

This observational, descriptive and retrospective article aims to evaluate prescription and dispensing data for antidepressant and anxiolytic medications. These data were obtained through the G-MUS system of the basic pharmacy in Santa Luzia d'Oeste, using the following screening: data from the period (01/01/2022 to 10/31/2024) and therapeutic classes used in the therapy of depression and anxiety, after analyzing all the data collected, it was determined that During the entire period, around 9,751 patients were served in the basic pharmacy, with the most prescribed medications being: amitriptyline, fluoxetine and escitalopram, thus, we can consider that the prescription and dispensing of medications has a profile similar to that of other Brazilian municipalities , with only a few differences in the most prescribed medication.

Online interest in ADHD predicts ADHD medication prescriptions in Australia from 2004 to 2023: A time-series analysis revealing COVID-19-related acceleration.

Attention-deficit hyperactivity disorder (ADHD) medication prescriptions in Australia have grown sharply in recent years. We examined the association between online interest in ADHD and prescriptions. Monthly Pharmaceutical Benefits Scheme (PBS) and Repatriation PBS (RPBS) Item Reports of ADHD prescriptions and Australian ADHD-related Google Trends (GT) data (2004-2023) were sourced. We modelled the lagged effect of GT on ADHD medication prescriptions, using an autoregressive moving average model with autoregressive conditional heteroskedasticity, adjusting for COVID-19 lockdown effects. Results were compared to a model of GT for pain-related searches and PBS/RPBS opioid prescriptions, and counterfactual alternatives: (1) ADHD-related GT and opioid prescriptions and (2) pain-related GT and ADHD prescriptions. We descriptively analysed additional ADHD-related online news data. Annual prescriptions doubled from 1,424,904 in 2020 to 3,112,072 in 2023. ADHD medication prescriptions and ADHD-related GT considerably increased since the COVID-19 pandemic. GT had a statistically significant positive lagged association with ADHD prescriptions. Comparator models did not show statistically significant associations between GT and prescriptions. Online news data supported recently increased public interest in ADHD. ADHD-related online interest predicts increased ADHD prescriptions, which was accentuated during the pandemic. Studies are needed to evaluate causal pathways, health information quality and sociodemographic determinants.

Treatment-resistant depression: role of genetic factors in the perspective of clinical stratification and treatment personalisation.

Treatment-resistant depression (TRD) is associated with chronic depression, suicidal behaviours, and reduced quality of life. TRD has a demonstrated genetic component, estimated around 8% based on common genetic variation in unrelated individuals. However, only six genome-wide association studies of TRD were published, and no replicated signals at locus or gene level have been identified; furthermore, apparently opposite results were reported in terms of genetic overlap between TRD and other traits. Other than limited power, an important issue of previous studies was the scarce consideration of TRD heterogeneity, as TRD likely comprises different groups and talking about TRDs could be more appropriate. This review points out important issues in the definition of TRD and differences across samples included in previous studies, which can be partly responsible for the inconsistency across results. Different definitions of TRD should not be expected to have similar genetic profiles, and the whole TRD group can partitioned into subgroups, based on clinical and biological features, to increase reproducibility, as exemplified by recent findings. This can be a key factor to develop/repurpose targeted treatments, or simply to aid a more personalised prescription of available medications compared to current clinical practice, that is largely concentrated on the prescription of a limited number of antidepressants compared to those available.

Association of social determinants of health with first antiseizure medication prescription for patients with newly diagnosed epilepsy: A systematic review and meta-analysis.

To assess whether social determinants of health (SDOHs) are associated with the first antiseizure medication (ASM) prescribed for newly diagnosed epilepsy. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards were followed, and the protocol registered (CRD42023448998). Embase, Medline, and Web of Science were searched up to July 31, 2023. Two reviewers independently screened studies and reached mutual consensus for inclusion. Studies reporting the first ASM prescribed for patients with new epilepsy in all age groups, countries, and languages were eligible for inclusion. Review articles, conference abstracts, and studies with fewer than 15 participants were not eligible for inclusion. Studies were meta-analyzed using fixed-effects models. Quality assessment was performed using the Newcastle-Ottawa Scale. Thirteen studies (total participants = 380,785) contained SDOH data and their association with the first ASM prescription after epilepsy diagnosis. Meta-analysis of studies with compatible data revealed that Black (pooled odds ratio [OR] .94, 95% confidence interval [CI] .90-.98) and Hispanic (pooled OR .89, 95% CI .82-.97) patients with U.S. Medicare/Medicaid had a lower odds of receiving a newer ASM compared to White patients. Three studies revealed that rural epilepsy patients had a lower odds of receiving new ASMs compared to urban patients (pooled OR .84, 95% CI .80-.89). The relationship between income levels and ASM prescription patterns differed across countries, highlighting inconsistencies that warrant further investigation. Among studies identified for inclusion, relatively few had combinable data, thereby limiting the scope of our meta-analysis to two SDOHs. Significant disparities exist in first-line ASM prescription for non-White and rural persons with epilepsy. There exist few data on other SDOHs including gender identity and socioeconomic background. Future work leveraging large data sets may reveal additional ASM prescription inequities. Developing care pathways to rectify known prescribing disparities may improve health equity among PWE.

Time to evaluation and characteristics of patients evaluated at epilepsy centers within an integrated health care delivery system.

Rapid patient referral to epilepsy centers may facilitate subsequent disease-modifying surgical and non-surgical treatments. Delays of 15-18years have been reported from time of epilepsy diagnosis to surgical evaluation in some settings, though patterns for timely guideline-concordant referrals within integrated care models are not well known and could inform strategies for optimizing guideline-concordant access. We performed a retrospective cohort study of 1088 patients undergoing epilepsy center evaluation from January 1, 2008 through June 30, 2023 in a Northern California integrated healthcare delivery system (IDS) with a Level 4 Epilepsy Center. Using electronic health record (EHR) data, we summarized time from diagnosis and other major care time points until first visit at the epilepsy center. A multivariate linear model was used to evaluate the relationship of select demographic, socioeconomic, and clinical characteristics with the time to first epilepsy center visit. The mean times to epilepsy center visit from first prescription of an anti-seizure medication (ASM), diagnosis of epilepsy or seizures, and first visit with a general neurologist, were 3.9years (SD = 4.5), 3.2years (SD = 3.2) and 2.7years (SD = 3.2), respectively, for the full cohort of patients prescribed any number of ASMs. Comparable time frames were seen for patients prescribed two or more ASMs at the time of first visit. Significantly longer time to epilepsy center visit was seen in patients with multiple ASMs prescribed, a concordant diagnosis of developmental delay, and those age 40 and above. Longer times to epilepsy center visit were not seen among patients with psychiatric comorbidities, public health insurance coverage, and among patients in traditionally underserved groups. Patients evaluated at an epilepsy clinic within an IDS system did so within less than four years of diagnosis and initial treatment, with few disparities by demographics or comorbidities. Future studies can identify specific health system features that are key to shorter time frames to test transferable strategies to reduce time to epilepsy centers.

Comparing demographic/clinical characteristics, health care resource utilization, and costs among patients with type 2 diabetes and established atherosclerotic cardiovascular disease with and without the use of cardioprotective medications.

Type 2 diabetes (T2D) causes increased health care resource utilization (HCRU) and costs in the United States. People with T2D are more likely to have atherosclerotic cardiovascular disease (ASCVD), which is associated with significant morbidity and mortality. Medical associations recommend cardioprotective antidiabetic medications, including sodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide 1 receptor agonists (GLP-1 RAs), to reduce the risk of cardiovascular events in patients with T2D with established, or a high risk of, ASCVD, but not all eligible patients receive these medications. To describe demographic/clinical characteristics and antidiabetic medication prescription patterns and compare HCRU and costs among patients with T2D and ASCVD with or without SGLT2i and/or GLP-1 RA use. We conducted a retrospective cohort study using the Merative MarketScan database of longitudinal US health care claims data with patients enrolled from July 1, 2014, to December 31, 2022. Patients with T2D and ASCVD receiving SGLT2is and/or GLP-1 RAs (case cohort) were compared with patients with T2D and ASCVD not receiving SGLT2is and/or GLP-1 RAs (control cohort) during a 12-month baseline period pre-index and a 12-month follow-up period post-index. The index date was SGLT2i/GLP-1 RA prescription for the case cohort and random health care visit for the control cohort. Baseline patient characteristics are reported before propensity score matching (PSM); HCRU and medical costs are reported after PSM. Before PSM, each cohort included 3,386 patients; after PSM, each cohort included 2,351 patients. Patients in the case cohort were significantly more likely to experience myocardial infarction (case, 26.2%; control, 21.5%; P < 0.001) or peripheral artery disease (case, 28.6%; control, 26.1%; P < 0.024) during the baseline period. Patients in the case cohort had significantly lower baseline Charlson Comorbidity Index scores than patients in the control cohort (case, 1.8; control, 2.1; P < 0.001). Patients in the case cohort had significantly fewer all-cause inpatient visits per patient (case, 0.4; control, 0.6; P < 0.001) and all-cause emergency department visits per patient (case, 0.9; control, 1.0; P = 0.024). Patients in the case cohort had significantly lower all-cause inpatient costs (case, $13,977; control, $22,056; P < 0.001), other all-cause outpatient costs (case, $16,504; control, $24,739; P < 0.001), and all-cause total medical costs including pharmacy costs (case, $51,143; control, $58,648; P = 0.01) in the 12-month follow-up period. Patients with T2D and ASCVD receiving SGLT2is and/or GLP-1 RAs within 12 months of ASCVD diagnosis may benefit from lower HCRU and costs.

Exploring the Potential of Psychedelics in the Treatment of Headache Disorders: Clinical Considerations and Exploratory Insights.

Exploration of the potential of serotonergic psychedelic drugs, such as psilocybin and LSD, as potential treatments for headache disorders. This review addresses the need for well-informed physician guidelines and discusses mechanisms, safety, and efficacy of these treatments. Further research, including the consideration of combination with psychotherapy, is needed. Psychedelics demonstrate promising outcomes as treatments for headache disorders. Recent findings indicated that some patients who underwent brief periods of treatment with psychedelics experienced a reduction in headache attack frequency, severity, or duration. When prescription medications are ineffective at treating headache disorders, or are habit-forming, patients often turn to alternative options. There is anecdotal evidence that psychedelic drugs like LSD and psilocybin can effectively treat and prevent pain in patients with headache disorders, such as migraine or cluster headache. It is vital that physicians treating patients who self-treat with psychedelics be well-informed about the mechanisms and their effects to best advise their patients and coordinate their care well. This is a review assessing the literature on the mechanisms, safety, and efficacy of psychedelic drugs as a headache management intervention. We believe there is evidence that may support further investigation into the clinical use of psychedelic medications to treat cluster headache and migraine, including the consideration of use in conjunction with other interventions like cognitive behavioral therapy or acceptance and commitment training.

Preoperative Acute Depressive Episodes are Associated with Increased Medication Prescribing and Inpatient Services Following Primary Arthroscopic Rotator Cuff Repair.

The purpose of this study is to compare postoperative healthcare utilization, prescriptions, and shoulder surgery between patients with an acute depressive episode (ADE) and those without an acute depressive episode (NADE) within 3 months before arthroscopic rotator cuff repair. Diagnostic and procedural codes were used to identify patients in the TriNetX Research Network at least 18 years of age and underwent arthroscopic rotator cuff repair between January 2010 and November 2021. Patients with a previous rotator cuff repair or diagnosis of recurrent major depressive disorder were excluded. Patients were stratified into ADE and NADE cohorts and propensity matched. Outcomes were measured by healthcare utilization and medication prescribing up to 3 months and incidence of future shoulder surgery up to 2 years postoperatively. After propensity matching, the ADE cohort included 1,514 patients and were compared to 1,514 patients in the NADE cohort. Preoperative characteristics were similar including female sex (62.1 % and 63.0% respectively, P = 0.599). A greater percentage of the ADE cohort received inpatient services within 3 months (4.5% vs 3.0%, OR 1.54; CI 1.05-2.25, P = 0.027) following surgery. Patients with ADE were prescribed a greater percentage of antidepressants (32.8% vs 24.4%, OR 1.51, 95% CI 1.29-1.77, P < 0.0001), sedatives (25.2% vs 20.5%, OR 1.31, CI 1.11-1.55, P = 0.002), and opioid analgesics (63.4% vs 55.7%, OR 1.38 CI 1.19-1.59) P < 0.0001) within 3 months. Within 2 years, incidence of future surgery were similar for arthroscopy (7.9% vs 7.3%) and arthroplasty (2.2% vs 1.6%). Acute depressive episodes prior to primary arthroscopic rotator cuff repair are associated with increased utilization of inpatient services and postoperative analgesic prescriptions. Incidence of future shoulder surgery for arthroscopy and arthroplasty was similar between patients with or without ADEs.

Telehealth as a Substitute for a Usual Source of Care for Prescription Medications

This study investigates how effectively telehealth utilization (THU) can substitute for a usual source of care (USC) for taking prescription medication using data from the 2020-2022 National Health Interview Survey. We analyzed data for 69,581 patients. Of these, 5,994 patients (8.6%) lacked a USC. THU was 37.3% for patients with a USC and 15.8% for those without. For patients with no USC or THU, 25.4% had taken a prescription medication within 12 months, while patients with THU but no USC had a rate of 75.4%. In essentially all subgroups, telehealth was associated with substantially higher rates of taking prescription medications. Multivariate logistic regression showed that THU was associated with a 7.39-fold increase (95% CI: 6.19-8.84) in the odds of taking a prescription medication.

Risky Behaviors Amongst Medical Students Within the United States

Introduction The lifestyle of medical students may drive them to engage in risky behaviors to seek solace from their academic lives. Despite studies having been conducted on the mental health of medical students, very little is known regarding practices these individuals engage in to relieve stress. Methods An anonymous Qualtrics survey was created using the CDC’s 2021 Behavioral Risk Factor Surveillance System to assess the risky behaviors of medical students. The survey was then sent to medical students across the United States during the 2023 fall academic semester. Statistical analysis was then conducted to determine the significance of the findings. Results Five hundred and sixty-one medical students who attend medical schools in 21 US states completed the survey. 9.30% of first years disclosed engaging in more risky behaviors to cope with medical school compared to 26.86% of second years. 10.47% of first years increased their alcohol intake, compared to 21.71% of second years. 5.81% of first years admitted to increasing episodes of alcohol binge drinking compared to 16.57% of second years. 2.33% of first years reported an increase in recreational drug use, compared to 14.29% of second years. 20.35% of first years described worsened diets, compared to 40.57% of second-year students. 19.19% of first years disclosed initiating care with a mental health professional, compared to 44.57% of second years. 7.56% of first years started a new prescription medication to cope with stressors, compared to 24.0% of second years. 95.93% of first years have no diagnosed psychiatric disorders, which decreases to 85.71% of second years, 72.41% of third years, and 62.32% of fourth years. Conclusion First-year medical students engage in less risky behaviors than their peers. We propose that medical schools can attenuate these risky coping mechanisms by offering campaigns discussing the potential harms of substance use by their students.

Epidemiological trends and healthcare disparities in onychomycosis: An analysis of the All of Us research program.

Onychomycosis is a common, difficult to treat nail disorder. Our objective was to explore disparities in current clinical management practices for onychomycosis in patients from underrepresented groups and with specific comorbidities. We conducted a cross-sectional study using the All of Us (AoU) research program. The AoU program gathers survey, and electronic health records from participants in the United States with the aim of increasing the representation of minorities groups in health research under the framework of precision medicine. We identified 18,763 onychomycosis patients (2017-2022) and compared the rates of diagnostic testing, prescription medications and surgical procedures. Younger patients were more likely to receive oral medications, while older patients were more likely to undergo surgical nail procedures. Patients with lower income and education, Black and Hispanic patients were less likely to receive testing to confirm diagnosis, and less likely to receive prescription medications (topical and/or oral) except in the case of fluconazole. Lower income and education were associated with a higher likelihood of debridement and trimming procedures, while Black and Hispanic patients were less likely to undergo these procedures. Patients with disabilities also received different treatments when compared to able-bodied individuals, being less likely to receive ciclopirox, efinaconazole and terbinafine, but more likely to undergo debridement and trimming procedures. There are clear differences in the management of onychomycosis in the different demographic and comorbid populations that we studied. Efforts to reduce these inequalities, such as expanded health coverage, reducing communication barriers and increasing patient and physician education are needed.

Nationwide cohort study of primary open angle glaucoma risk and cardiovascular factors among in Korean glaucoma suspects

This retrospective study investigated the risk of primary open-angle glaucoma (POAG) among individuals identified as glaucoma suspects and examined associated cardiovascular risk factors. We conducted a longitudinal, nationwide cohort study using data from the Korean National Health Insurance Service (KNHIS) and included 362,285 participants aged ≥ 40 years from the Korean National Health Screening Program (NHSP) without pre-existing POAG in 2009 and 2010. Of these, glaucoma suspects (n = 32,220) were defined as individuals with at least two recorded instances of the KCD code H400 for glaucoma suspect and no prior antiglaucoma medication prescriptions before health screening. The primary outcome was the diagnosis of POAG and the prescription of antiglaucoma medications. Over a 6-year follow-up, 4.92% of glaucoma suspects developed POAG. Through multivariate Cox regression analysis, glaucoma suspects with diabetes, hypertension, dyslipidemia, or coronary heart disease exhibited a greater risk of conversion to POAG than those without these comorbidities ([HR, 1.354; 95%CI, 1.201 to 1.527] for diabetes, [HR, 1.139; 95%CI, 1.019 to 1.273] for systemic hypertension, [HR, 1.128; 95%CI, 1.013 to 1.26] for dyslipidemia, [HR, 1.124, 95%CI, 1.007 to 1.254] for coronary heart disease).This nationwide study observed that among glaucoma suspects, having cardiovascular risk factors/disease was associated with higher risk of developing POAG.