Prescription Drug Use Research Articles

Workplace alcohol and other drug policy and support services in the United States, 2015-2019.

Despite their growing popularity, the extent and nature of workplace alcohol and other drug (AOD) policy and support services in the United States remain unclear. The present study examined the availability of AOD policies and support services in workplaces. Also, the associations between a combination of these workplace measures and the current AOD consumption (focusing on binge drinking, use of marijuana and other illicit drugs, and nonmedical use of prescription drugs) were assessed. Pooled Data from the 2015-2019 National Survey on Drug Use and Health (NSDUH) were utilized to examine a nationally representative sample of 131,751 employed adults. First, the rates of those who reported having a written AOD policy at their workplaces among the total sample and subpopulations across socioeconomic status, and those who reported an employee assistance program or other counseling services for substance use problems were estimated. Then the associations between a combination of the two workplace measures and individuals' current AOD consumption were tested using multinomial logistic regression analyses. Although 77.2% of employed individuals reported having a written AOD policy at their workplaces, only 50% of the sample had access to support services for substance use problems. The limited access to support services was most notable among traditionally disadvantaged groups (e.g., females, Hispanics, and individuals with limited English proficiency). The models suggest that having both a workplace AOD policy and support services was associated with significantly lower rates of marijuana and other illicit drug use compared to having neither of the two measures or only support services. Regardless of workplace AOD policies, the limited availability of support services, especially for disadvantaged workers, raises concerns. While further investigation is needed to understand the effectiveness of the comprehensive prevention approaches at workplaces, it is also important to advocate for the potential benefits of having employee assistance or other services available along with AOD policies.

Most common over-the-counter medications and effects on patients.

The self-medicating practice of using over-the-counter (OTC) medications are more common than prescription drug use worldwide. OTC drugs are primarily used to treat conditions that do not require direct medical attention or supervision, and OTC drugs must be demonstrated to be reasonably safe and well-tolerated. The pharmacy profession describes their role in dispensing over-the-counter (OTC) products as "selecting the best medication according to reported symptoms". This study aimed to evaluate the use of most common over-the-counter (OTC) medications and their effect on patients. A cross-sectional survey-based study was conducted on 442 participants who used OTC drugs from June to November 2021. The most common OTC drugs used by patients involved in the study were paracetamol (13.35%), followed by ibuprofen (2.04%). Gender of patients was significantly related to (duration, frequency, suggestion, and misuse) of OTC use and patient counseling by the pharmacist (p<0.05). OTC medications can easily be obtained at pharmacies for the purpose of self-treatment. The most common OTC drugs used by the studied patients were paracetamol, followed by ibuprofen. It is suggested that an awareness program among community people be conducted at the community level regarding over-the-counter (OTC) drugs.

Predictive Models for Human Cytochrome P450 3A7 Selective Inhibitors and Substrates.

Inappropriate use of prescription drugs is potentially more harmful in fetuses/neonates than in adults. Cytochrome P450 (CYP) 3A subfamily undergoes developmental changes in expression, such as a transition from CYP3A7 to CYP3A4 shortly after birth, which provides a potential way to distinguish medication effects on fetuses/neonates and adults. The purpose of this study was to build first-in-class predictive models for both inhibitors and substrates of CYP3A7/CYP3A4 using chemical structure analysis. Three metrics were used to evaluate model performance: area under the receiver operating characteristic curve (AUC-ROC), balanced accuracy (BA), and Matthews correlation coefficient (MCC). The performance varied for each CYP3A7/CYP3A4 inhibitor/substrate model depending on the data set type, model type, rebalancing method, and specific feature set. For the active inhibitor/substrate data set, the optimal models achieved AUC-ROC values ranging from 0.77 ± 0.01 to 0.84 ± 0.01. For the selective inhibitor/substrate data set, the optimal models achieved AUC-ROC values ranging from 0.72 ± 0.02 to 0.79 ± 0.04. The predictive power of the optimal models was validated by compounds with known potencies as CYP3A7/CYP3A4 inhibitors or substrates. In addition, we identified structural features significant for CYP3A7/CYP3A4 selective or common inhibitors and substrates. In summary, the top performing models can be further applied as a tool to rapidly evaluate the safety and efficacy of new drugs separately for fetuses/neonates and adults. The significant structural features could guide the design of new therapeutic drugs as well as aid in the optimization of existing medicine for fetuses/neonates.

When Substance Use Is Underreported: Comparing Self-Reports and Hair Toxicology in an Urban Cohort of Young Adults

Large-scale epidemiological research often uses self-reports to determine the prevalence of illicit substance use. Self-reports may suffer from inaccurate reporting but can be verified with objective measures. This study examined the following: the prevalence of illicit and non-medical substance use with self-reports and hair toxicology, the convergence of self-reported and objectively quantified substance use, and the correlates of under- and overreporting. The data came from a large urban cohort study of young adults (n= 1,002, mean age= 20.6 years, 50% female). The participants provided 3 cm of hair (covering the previous 3 months) and reported their illicit and non-medical substance use and their sociodemographic, psychological, and behavioral characteristics. Hair toxicology analyses targeted cannabinoids, ketamine, opiates/opioids, stimulants including 3,4-methylenedioxymethamphetamine, and relevant metabolites. Self-reports underestimated the prevalence of most substances by 30% to 60% compared to hair tests. The average detection ratio (hair test/self-report) was 1.50. Hair tests were typically more sensitive than self-reports. Underreporting was associated with a low level of that substance in hair. Self-reported delinquency and psychopathology were correlated with an increased likelihood of concordant positive self-reports and hair tests compared to underreporting. Overreporting was associated with infrequent self-reported use. Our study suggests that self-reports underestimate young adults' exposure to illicit substances and non-medical use of prescription drugs. Consequently, estimates of associations between substance use and risk factors or outcomes are likely biased. Combining self-reports with hair tests may be most beneficial in study samples with occasional substance use. Researchers can use specific factors (eg, detection ratios) to adjust prevalence estimates and correlations based on self-reports.

Clinical and Economic Assessment in Early-Stage Dementia by Severity and Amyloid-β Status: A 5-Year Retrospective Claims Study of GERAS-US Patients.

The high burden of dementia and Alzheimer's disease (AD) increases substantially as disease progresses. Characterizing early patterns of health care utilization among patients who develop cognitive impairment may deepen our understanding of early disease trajectory and potentially facilitate timely diagnosis and management. Describe clinical characteristics, healthcare utilization, and costs in early-stage dementia by disease severity and amyloid-β status before enrollment in an observational study (GERAS-US). Consented patients' GERAS-US data were linked to available five-years of Medicare claims history before GERAS-US enrollment. Clinical characteristics, comorbidity, and pre-/post-diagnosis healthcare use and costs were assessed. Continuous and categorical variables were compared between severity and amyloid-status cohorts using t-test and Chi-square statistics; linear regression models were used to compare cost and utilization measures after adjusting for differences in patients' observation time. Relative likelihood of observed diagnoses, comorbidity, and prescription drug use among cohorts were presented as OR and 90% confidence interval (CI). Of 174 patients clinically diagnosed with early dementia (mild cognitive impairment (MCI): 101; mild dementia (MILD): 73), 55% were amyloid-positive. Memory loss was more likely in MILD versus MCI (OR:1.85, 90% CI 1.10-3.09) and in amyloid-positive versus amyloid-negative cohorts (OR:1.98, 90% CI 1.19-3.29). Mean annual healthcare costs after cognitive impairment/dementia diagnosis were significantly higher for MILD versus MCI ($1191 versus $712, p = 0.067) and amyloid-negative versus amyloid-positive ($1281 versus $701, p = 0.034). Diabetes was more prevalent in MILD and amyloid-negative cohorts. Comorbidity and economic burden increased in earliest stages of MCI and MILD and were higher in patients who were amyloid-negative.

Evaluation of Systemic Medications Associated With Surgically Treated Cataract Among US Adults

To comprehensively determine the associations between systemic medications and surgically treated cataract in the US population. Retrospective cross-sectional study. Participants aged ≥40 years from the 1999-2008 National Health andNutritionExamination Survey (NHANES) were included. Surgically treated cataract was defined as cataract requiring a procedure. Data on prescription drug use over the past 30 days were collected via home interviews. Drug categories for ophthalmic indications and those prescribed in less than 0.5% of the participants were excluded from the analysis. Separate logistic regression models were used to explore associations between each drug category and surgically treated cataract. The Benjamin-Hochberg procedure was used to control the false discovery rate. A total of 14,931 were included in the present analysis. The weighted prevalence of surgically treated cataract was 9.6% (n=2010). We identified 20 drug categories that had significant associations with surgically treated cataract, of which 8 associations remained statistically significant after further adjustment for pertinent comorbidities. The 3 drug categories with the highest odds ratio (OR) values were tricyclic antidepressants (OR, 2.21; 95% CI, 1.38-3.51; P=.001), insulin (OR, 2.13; 95% CI, 1.48-3.07; P=9.41×10-5) and group III antiarrhythmic agents (OR, 2.00; 95% CI, 1.25-3.19; P=.004). The use of sex hormone combinations among women reduced the risk of having surgically treated cataract (OR, 0.011; 95% CI, 0.001-0.089; P=5.98×10-5). Dose-response relationships were observed for all 8 drug categories. Our comprehensive evaluation provides new knowledge on the complex relationships between systemic medications and surgically treated cataract.

Use of substances to cope during the COVID-19 pandemic among transgender and gender diverse adults

ABSTRACT Background: Studies have found changes in substance use during the COVID-19 pandemic in specific populations. Transgender and gender diverse (TGD) individuals have experienced greater distress compared to cisgender individuals during the pandemic; however, there is little research on substance use among TGD individuals during this sensitive time period. Objectives: The objective of this study is to examine distress from COVID-19 and coping via substance use including alcohol, cannabis, tobacco, and non-medical use of prescription drugs (NMUPD) among TGD adults. Method: An online survey assessing substance use, general psychiatric symptoms, and COVID-19 anxiety was completed by 342 TGD individuals (16.4% transfeminine, 19.6% transmasculine, 64.0% Gender Diverse) in June/July 2020. Chi-square and structural equation modeling (SEM) analyses examined the connections between distress, coping, and substance use. Results: Seventy-one percent of participants reported no changes in substance use since the start of the pandemic and 22% reported an increase in substance use. Increased substance use was associated with alcohol (p < .001), cannabis (p < .001), and combustible tobacco (p < .001) use in the prior three months. SEM showed significant direct effects between distress and substance use coping, substance use coping and recent drug use, and an indirect effect of distress on recent drug use through substance use coping (β = .31, p = .001). Conclusion: Results highlight the risk of substance use to cope with COVID-19-related stress in a large sample of a minoritized population with mental health disparities. Transmasculine and gender diverse participants were especially likely to report using substances to cope.

Nemedicinska upotreba lekova koji se izdaju na recept u Srbiji - rezultati nacionalnog istraživanja o stilovima života - zloupotreba supstanci i kockanje

Background: Non-medical prescription drug use (NMPDU) of anti-anxiety medications is a growing public health concern. The aim of this study was to examine the prevalence of the use of anti-anxiety medications, as well as the factors associated with the NMPDU of these medications among adults in Serbia. Materials and methods: The study is a secondary analysis of the data from the National Survey on Lifestyles in Serbia - Substance Abuse and Gambling, conducted in 2014 and 2018, with 7,385 participants. Results: The prevalence of prescription only use of anti-anxiety medications was 13.5% (995/7,385), while the prevalence of the non-medical prescription drug use was 5.04% (372/7,385). Multinomial logistic regression analysis showed an association between non-medical prescription use of anti-anxiety medications and the female sex (OR: 3.23), the age between 35 and 44 years (OR: 1.91), the age between 45 and 54 years (OR: 2.40), or the age between 55 and 64 years (OR: 2.97), reporting a low (OR: 2.40) or average (OR:1.67) satisfaction with health status, being a smoker (OR: 1.62), having moderate (OR: 2.35) or high (OR: 4.56) psychological distress, and having a low/moderate risk for pathological gambling (OR: 1.86). Conclusion: There is a clear need for the inclusion of health care professionals and media in the education of patients on the risks of self-medication, medication exchange, or illegal purchase of these medications.

Quantitative Survey on Prevalence of Prescription Pain Medications and Stimulants Use in Young Adults

Prescription drug use including pain relievers and stimulants has been a growing problem in young adults and the issue has been a public health concern for years. This Quantitative Cross-sectional study aimed to collect preliminary data regarding prescription opioid use, prescription stimulant drug use and overdose treatment knowledge in young adults between 18 and 24 years old in a southern New Jersey university through administering an online survey. Of the 1663 students who completed the survey, 33% reported using prescription pain relievers and 15% reported using prescription stimulant drugs. Stimulant drug users were found to be more likely to use prescription pain relievers (49%) as compared to non-stimulant users (30%). Furthermore, students with overdose treatment knowledge of opioids were more likely to report misuse of prescription drugs (15%) than students with less knowledge (8%). This study reiterates the increasing usage of prescription drugs and stimulant use among college students. There is a need for effective education strategies to inform students about the prescription medication uses and misuse to reduce nonmedical use of prescription medications.

Kırsalda Yaşayan Yaşlılarda Polifarmasi Yaygınlığı: Kesitsel Bir Çalışma

Objective: This study aimed to determine the prevalence of polypharmacy and its associated factors in older adults living in rural areas. Material and Methods: This cross-sectional study included a total of 585 older adults aged ≥65 years living in a town in western Türkiye. Data were collected through face-to-face interviews at family health centers using a questionnaire prepared by the authors in line with the literature. The data collected for the research were analyzed using the SPSS for Windows 25.0. Descriptive statistical methods were used to evaluate data. In addition, a logistic regression analysis was performed to identify the influential factors in the presence of polypharmacy. The results were evaluated at a significance level of p<0.05. Results: The prevalence of polypharmacy was 24.1%. In addition, 51.6%, 52.1%, and 12.1% older adults used at least one over-thecounter drug, herbal medicines along with prescribed medications, and alternative treatment methods, respectively. However, older patients with four or more chronic diseases were exposed to polypharmacy approximately nine times (95% confidence interval 3.02-26.75) more than those with 1-3 chronic diseases. Conclusion: Approximately one-quarter of the older adults had polypharmacy, which was affected by multiple variables. The older adults should be evaluated for prescription and non-prescription drug use, and the rational drug use education should be provided.

Alcohol related disorders among elite male football players in Sweden: nationwide cohort study

ObjectivesTo assess whether male elite football players are at increased risk of alcohol related disorders compared with men from the general population, and whether such an increased risk would vary...

BURDEN OF FALL-RISK INCREASING DRUGS IN OLDER ADULTS PRESENTING WITH FALLS TO THE EMERGENCY ROOM

Abstract Prescribing of fall-risk increasing drugs (FRIDs) may be an important driver of falls in older adults. Understanding the types and frequencies of FRIDs prescribed to older adults presenting with falls to an emergency department (ED) may help identify opportunities for deprescribing. We performed a cross sectional analysis of data collected from a pharmacist-led fall-prevention program focused on older adults presenting with a fall to an academic ED in the southeastern United States between August 2020 – December 2021. ED pharmacists identified older adults (≥65 years old) presenting with a chief complaint of ‘fall’ and then performed a medication reconciliations to verify and obtain data on outpatient prescription drug use. FRIDs were identified in accord with the 2019 American Geriatrics Society Beers Criteria and the Centers for Disease Control and Prevention Stopping Elderly Accidents, Deaths, &amp; Injuries (STEADI-Rx) list. The ED pharmacists performed medication reconciliations on 424 unique older adults presenting with a fall. The cohort had a mean age of 81.3 years and were mostly female (63.3%) and white (84.9%). Prescription use of FRIDs were identified in 45.8% (194/424) of older adults presenting with a fall. An estimated 25.5% (108/424) of the subjects were prescribed 2 or more FRIDs. The most common FRIDs identified were antidepressants (25.9%), anticonvulsants (18.6%), opioids (12.7%), benzodiazepines (8.5%), and antipyschotics (3.1%). . Prescription use of FRIDs, including use of 2 or more FRIDs, was common in older adults presenting with a fall to the ED.

Determinants of long-term opioid use in hospitalized patients.

Long-term opioid use is an increasingly important problem related to the ongoing opioid epidemic. The purpose of this study was to identify patient, hospitalization and system-level determinants of long term opioid therapy (LTOT) among patients recently discharged from hospital. To be eligible for this study, patient needed to have filled at least one opioid prescription three-months post-discharge. We retrieved data from the provincial health insurance agency to measure medical service and prescription drug use in the year prior to and after hospitalization. A multivariable Cox Proportional Hazards model was utilized to determine factors associated with time to the first LTOT occurrence, defined as time-varying cumulative opioid duration of ≥ 60 days. Overall, 22.4% of the 1,551 study patients were classified as LTOT, who had a mean age of 66.3 years (SD = 14.3). Having no drug copay status (adjusted hazard ratio (aHR) 1.91, 95% CI: 1.40-2.60), being a LTOT user before the index hospitalization (aHR 6.05, 95% CI: 4.22-8.68) or having history of benzodiazepine use (aHR 1.43, 95% CI: 1.12-1.83) were all associated with an increased likelihood of LTOT. Cardiothoracic surgical patients had a 40% lower LTOT risk (aHR 0.55, 95% CI: 0.31-0.96) as compared to medical patients. Initial opioid dispensation of > 90 milligram morphine equivalents (MME) was also associated with higher likelihood of LTOT (aHR 2.08, 95% CI: 1.17-3.69). Several patient-level characteristics associated with an increased risk of ≥ 60 days of cumulative opioid use. The results could be used to help identify patients who are at high-risk of continuing opioids beyond guideline recommendations and inform policies to curb excessive opioid prescribing.

Fall Risk Factors in Parkinson's Disease

<h3>Objective(s)</h3> To determine the risk factors of accidental falls in individuals diagnosed with Parkinson's Disease. <h3>Data Sources</h3> A comprehensive search conducted on PubMed between August 2021 and January 2022. Searches were based on key phrases including: Parkinson's Disease (PD), accidental falls, postural balance. Searches limited to full free text availability, human subjects, and English language. <h3>Study Selection</h3> A total of 315 articles were selected and further refined using inclusion and exclusion criteria, Six studies were selected detailing factors that had an impact on falls in patients with PD. Inclusion criteria: discussed one or more risk factors for falls in PD, published within the last 10 years, patients diagnosed with PD from a medical doctor or based on UK Brain Bank Criteria. This criteria was applied via multiple reviewers. <h3>Data Extraction</h3> Independent extraction and assessment of the validity of the data was conducted by the authors of this review. Data surrounding risk factors of falling including: Weakness, Impaired Balance, Freezing Gait, Disease duration, Pharmacologic Influences, Fear of Falling, Perceived Disability, Cognitive Impairments, and others (depression, anxiety, comorbidities) was extracted. <h3>Data Synthesis</h3> It appears that impaired postural stability and delayed balance reactions are the most common risk factor for accidental falls in individuals with PD who experienced falls. Weakness, especially of the lower extremity extensors i.e. the quadriceps, further limited participants' abilities to perform functional mobility leading to future falls. The use of prescription drugs, disease duration, fear of falling, cognitive impairments, perceived disability, and/or other comorbidities such as CVD, depression, or anxiety each played a role in individual studies but were less consistent across the literature. <h3>Conclusions</h3> This review indicates that balance deficits and weakness are two of the largest risk factors for future or recurrent falls in PD. Future research should focus on approaches that benefit postural stability in standing and strength during functional activities in individuals with PD to decrease risk of future falls. <h3>Author(s) Disclosures</h3> There are no conflict of interest associated with this study for any of the authors.

Prescription pattern and associated factors among pregnant women attending antenatal clinics in University of Gondar, North West Ethiopia

BackgroundAn inappropriate use of drug during pregnancy may harm the fetus. There is no enough study on drug use among pregnant women at the University of Gondar referral hospital. Most studies are carried out in developed countries but not in developing countries. Thus, the aim of this study was to evaluate prescription of drug and associated factors among pregnant women attending antenatal care service in University of Gondar referral hospital. MethodsInstitution based cross sectional study was used among 334 pregnant women who attended antenatal care units of the University of Gondar referral hospital. Data were collected from the pregnant women medical records and registration logbook and analyzed using SPSS version 23. Multivariate logistic regression used to analyze the association of the independent variables with drug use. P-values <0.05 were considered significant. ResultA total of 334 pregnant women's medical records showed a total of 631 drugs prescribed. The average numbers of drugs per pregnant women was 1.88. All pregnant women (100%) were prescribed with iron folat. Most pregnant women 185 (55.2%) were in the third trimester followed by third trimester 91 (27.25%). Moreover, 23.77%, 42.95%, 33%, and 7% pregnant women encountered with drugs from category A, B, C and D respectively. From the bivariate regression analysis, Age of women, maternal illness, trimester at the first visit, and gravidity were significantly associated with exposure to prescribed drug use during pregnancy. ConclusionThe present study showed the deviation of drug use pattern from the WHO optimal levels proposing the hospitals had inappropriate use of drug. Implementing corrective measures are required to achieve the recommended standards of appropriate drug use.

Clinical and Neuropathological Correlates of Substance Use Disorders in Brain Donors Exposed to Repetitive Head Impacts

AbstractBackgroundChronic traumatic encephalopathy (CTE) is a neurodegenerative tauopathy associated with repetitive head impacts (RHI) like those from American football. Causes of cognitive and neuropsychiatric symptoms (e.g., neurobehavioral dysregulation) in CTE are unclear. Substance use disorders (SUDs) are common among individuals with autopsy‐confirmed CTE, but their association with CTE and related symptoms are unknown. We examined the association between SUDs and CTE pathology, and cognitive and neuropsychiatric symptoms in deceased football players.MethodsThe sample included 429 deceased football players from the UNITE brain bank. CTE was neuropathologically diagnosed. Informant interviews assessed SUD history. The independent variable included substance use treatment history, an indicator of SUD less influenced by recall error. Informants completed standardized scales of cognitive function (Cognitive Difficulties Scale, Functional Activities Questionnaire, BRIEF‐A Metacognition Index [MI]), mood (Geriatric Depression Scale [GDS‐15]), and neurobehavioral dysregulation (BRIEF‐A Behavioral Regulation Index [BRI], Barratt Impulsiveness Scale [BIS‐11]). Linear or logistic regressions test the association between substance use treatment history and CTE status, cumulative p‐tau burden (sum of p‐tau severity ratings across 11 brain regions, n = 370), and each clinical scale, controlling for age and years of football play. Cumulative p‐tau burden was added as a covariate in clinical models.ResultsTables 1–3 show sample characteristics. 313/429 had autopsy‐confirmed CTE. Alcohol use disorders were more common (n = 177, 41.3%) than illicit (n = 70,16.3%) and prescription (n = 47, 11%) drug use disorders. Approx. 23% (n = 100) had a substance use treatment history, which was not associated with CTE (p = 0.21) or p‐tau burden (p = 0.14). Substance use treatment history was associated with neurobehavioral dysregulation (BRI: beta = 8.17, 95% CI = 3.92‐12.41, p&lt;0.01; BIS‐11: beta = 8.90, 95% CI = 5.11‐12.69, p&lt;0.01) and greater depression symptoms (GDS‐15: beta = 2.17, 95% CI = 1.08‐3.26, p&lt;0.01). Besides the MI (beta = 5.09, 95% CI = 0.67‐9.51, p = 0.02), there was no association with cognitive scales (ps&gt;0.05). Cumulative p‐tau burden was associated with neurobehavioral dysregulation (BRI, p&lt;0.01) and all cognitive scales (ps&lt;0.05).ConclusionsIn former football players, SUDs are unlikely to affect risk for CTE, but can contribute to clinical symptoms especially neurobehavioral dysregulation. These findings stress the role of tau and non‐tau causes of neurobehavioral dysregulation among football players. However, p‐tau is likely a key driver of cognitive symptoms.

Use of Psychotropic Prescription Drugs and Mental Health in Adult Patients with Primary Immune Thrombocytopenia - a Danish Nationwide Cohort Study

Background: Patients with primary immune thrombocytopenia (ITP) suffer from fatigue, reduced quality of life, and social isolation - well-known risks factors for depression. High-dose corticosteroids remains first-line treatment of ITP, but prolonged exposure to steroids is associated with psychiatric side-effects such as sleep disturbances, mania, and depression. However, it is not known whether the combination of disease and treatment exposure in ITP leads to a higher use of prescriptionary psychotropic drugs, or an increased incidence of psychiatric conditions. Aims: In this nationwide study we examined mental health burden in patients with ITP compared with the general population by quantifying the use of psychotropic drugs and incidences of psychiatric conditions. Methods: We established a cohort of patients aged 18+ years with ITP using the designated ICD-10 diagnosis in the Danish National Patient Register 1997-2016, and age-sex-matched each patient with up to 40 comparators from the general population. Start of follow-up was date of first ITP registration and comparators were assigned the same start date. Patients and comparators were followed in parallel from start date until the registration of new psychiatric conditions and prescriptions of a psychotropic drug. Accumulated numbers of dispensed psychotropic drug prescriptions were also estimated for each individual. We grouped psychotropic drugs into six categories: antidepressants, antipsychotics, opioids, melatonin, benzodiazepines, and an accumulated group of the first encountered of any of the mentioned. We registered all dispensed prescriptions after start date within each category for each individual. We estimated incidence-rates per 100 person-years, incidence-rate-ratios (IRR) and incidence-rate-differences (IRD) in 6-month and monthly intervals two years before and after start date. We also calculated prevalence proportions of patients and comparators receiving a minimum of one prescription of a given group of psychotropic drugs in the years before and after inclusion. Psychiatric conditions were categorized into six categories: schizophrenia/psychoses, depression, mania/bipolarity, anxiety/obsessive-compulsive disorder (OCD), fatigue, and an accumulated group consisting of the first encountered of any of the mentioned. We estimated 1, 5, 10-year, and overall cumulative incidences, Cox cause-specific hazard (csHR) and Fine-Gray subhazard ratios (subHR). Results: We identified 3,749 patients and 149,849 comparators. In both groups, median age was 59.9 years and 53% were women. Use of any psychotropic drug was increased amongst patients and highest in the first 6 months after ITP diagnosis, IRR0-6: 1.79 [1.69; 1.89], but dropped to 1.33 [1.24; 1.42] in the 18-24 months interval after diagnosis. This also applied to benzodiazepines, IRR0-6: 1.85 [1.69; 2.02], and to opioids, IRR0-6: 2.21 [1.97; 2.47]. Prevalence proportions for use of any psychiatric drug increased in temporal relation to diagnosis of ITP (Figure 1), but diminished thereafter. Cumulative incidences of psychiatric conditions were generally higher in years following ITP diagnosis, particularly for depression, anxiety/OCD and fatigue. Differences diminished, but remained overt over time (Figure 2). First year adjusted csHR for any psychiatric disease was 3.57 [2.84; 4.50], while the same adjusted csHR for any psychiatric disease across entire study period was 1.56 [1.38; 1.76]. There were no differences between age groups or sex. Adjusted overall csHR was 1.36 [1.14; 1.63] for depression, 1.81 [1.43; 2.28] for anxiety/OCD, and 1.86 [1.56; 2.22] for fatigue, with highest risks found during the first year for all. Conclusions: The use of psychotropic drugs and the risk of incident psychiatric conditions are elevated in patients with primary ITP compared with the general population, particularly shortly after ITP diagnosis. Providing clinicians with this new knowledge can help introduce preventive measures in clinical practice and improve mental outcomes for patients with primary ITP. Detailed data and results for subgroups of psychotropic drugs and psychiatric conditions will be presented with the abstract. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Relationship between Awareness of Morbidity Risk and Psychosocial Wellness of Students in Public Secondary Schools in Nairobi County, Kenya

As governments deploy immense resources to reign in on the trafficking and abuse of illegal drugs such as marijuana, heroin, and cocaine, it remains untenable controlling the abuse of prescription drugs. This study set out to examine the relationship between awareness of morbidity risk and psychosocial wellness of students in public secondary schools in Nairobi. Based on the situated rationality theory, this study adopted the correlational research design. Quantitative data was analyzed descriptively by use of frequencies, percentages and means. It was also analyzed inferentially by use of t-test, Pearson correlation and multivariate regression analysis. Data from interviews and secondary data sources were analyzed using thematic and content analysis procedures. The study sampled 255 respondents. These included 100 students, 96 teachers, 42 principals and, 17 MOE officials. Out of these, 100 students (100%), 77 teachers (80.2%), 34 principals (81%) and 11 MOE officials (64.7%) responded. The findings show that prescription drug misuse is rampant among students, posing a threat not only to the kids who abuse the medications, but also to the nation's well-being, as the youth represent the people's future. The presence of risk and protective factors influences prescription medication addiction. Despite the fact that the students were aware of the risks associated with prescription drugs they continued abusing them. This was buttressed by Pearson correlation showed that awareness of morbidity risk had statistically significant relationships with psychosocial wellness among students (r=0.468, p&lt;0.05). The study concludes that drug usage is widespread among secondary school students in Nairobi County, in terms of the types, quantity, and frequency of use irrespective of students’ awareness of the morbidity risks they posed. The study recommends that there was need to enhance the awareness of morbidity risk associated with prescription drug use through awareness campaigns among other interventions.

Signal and Noise: Proton Pump Inhibitors and the Risk of Dementia?

The association between proton pump inhibitor (PPI) use and dementia remains controversial. This cohort study re-examines this issue, addressing shortcomings identified in previous publications using a population-based and a high-dimension propensity-score matched cohort to follow patients for up to 22 years. Cox regression models using baseline characteristics, a lag period, and time-varying variables were used to examine the risk of dementia by cumulative PPI exposure. High-dose PPI users (> 180 days of use) had significantly higher risk of dementia in crude Cox models. After adjustment for medical diagnoses and prescription drug use, these associations disappeared. Among high-dose users starting PPI therapy between 46 and 55 years old, the unadjusted hazard ratio (HR) was 1.55 (95% confidence interval (CI) 1.14, 2.10); the adjusted hazard ratio (aHR) was 1.10 (95% CI 0.80, 1.51). For high-dose users starting therapy between 56 and 65 years, HR=1.22 (95% CI1.03, 1.44); aHR=0.99 (95% CI 0.83, 1.17). High-dose users between the ages of 66 and 75 years had no association with the risk of dementia. The use of lag models or time-varying parameters similarly found some association with dementia in crude, but not multivariable Cox models. Although high-dose PPI users were more likely to develop dementia, they were more likely to be diagnosed with dementia risk factors, such as diabetes and cardiovascular disease, which are risk factors for dementia. Controlling for these conditions using multivariable models or a propensity-score matched cohort eliminated this association.

The role of home medication storage location in increasing medication adherence for middle-aged and older adults.

Over 50% of US adults do not take their prescriptions as prescribed, which is responsible for 33%-69% of hospital admissions and 125,000 deaths annually. Given the higher prevalence of prescription drug use among middle-aged and older adult populations, promoting medication adherence is of particular importance with these age groups. Two speculated facilitators of medication adherence are home medication storage location and the use of digital health devices. Our objective was to use survey data to investigate the associations between medication storage location and medication adherence among adults 40 years and older. Additionally, we aimed to report preliminary findings about the associations between use of devices and medication adherence in this same population. We conducted primary analysis of data sampled from a home medication management survey deployed in November 2021 (n = 580). We conducted exploratory analyses by way of chi2 tests and creation of bivariate logistic regression models. The most commonly used storage locations by our sample were nightstand drawers (27%), kitchen cabinets (25%), and atop bedroom nightstands (23%). Several medication storage locations were significantly associated with decreased odds of having ever forgotten to take a medication, including kitchen drawers, in refrigerators, atop bedroom nightstands, in nightstand drawers, and backpacks, purses, or bags. Two home medication storage locations were significantly associated with increased odds of having ever forgotten to take a medication: kitchen cabinets and bathroom vanities. Further, most (94%) survey respondents indicated they would be receptive to guidance about where to store their medications. Given that some home medication storage locations are associated with adherence, an intervention to guide storage location selection may support increased adherence, especially with high receptivity expressed for such guidance. Increased adherence may also accrue from device usage paired with optimized home medication storage location. We plan to investigate that further, as well as how new device designs can incorporate contextual cues related to location to promote medication adherence more effectively in middle aged and older adults.