1,721,015 research outputs found
Statins for the primary prevention of cardiovascular events in elderly patients: a picture from clinical practice without strong evidence from clinical trials.
No full textBurden of cardiovascular disease in elderly with Parkinson's disease who start a dopamine agonist agent
No full textIn recent years, some concerns have been raised about the association between the use of pergolide or cabergoline, ergotderived DA, and the development of fibrotic valvular heart disease.
AIM: To characterize the users of ergot-derived DAs and those that are not ergot derived in clinical practice, with particular regard to cardiovascular diseases, using a general practice database.
Of almost 120,000 subjects registered in the lists of 93 general practitioners enrolled, 1-year incident users of ergot- (cabergoline, lisuride, pergolide, and bromocriptine) and non-ergot-derived (pramipexole and ropinirole) DAs who had PD in 2004 or 2005 were selected.
Almost 70% of incident users of ergot-derived DAs were aged 65 and older (less than users
of non-ergot-derived DAs), in contrast with international guidelines.
A higher proportion (20%) of users of ergot-derived DAs have more than three concomitant CV diseases than do users of non-ergot-derived DAs (8%). Patients who start a therapy with ergotderived DAs are more likely (Po.05) to have heart failurethan those who use non-ergot-derived DAs. a significantly higher proportion (Po.05) of patients starting treatment with ergotderived DAs concomitantly received three or more cardiovascular medications than of users of non-ergotderived DAs. Overall, incident users of ergot-derived DAs ( 85% of these being cabergoline users) seem to have a worse cardiovascular profile than users of non-ergotderived DAs.
This finding should be considered in light of the warning of the heart valvular fibrosis risk associated with use of ergot-derived DAs in patients with P
Newer and older antiepileptic drug use in Southern Italy; a population-based study durino the years 2003-2005
No full textAIM: To analyse the prescribing pattern of newer and older antiepileptic drugs (AEDs) during the years 2003-2005.
METHODS:
From the Caserta-1 Local Health Service database, 93 general practitioners (GPs) were recruited. Among 127,389 individuals aged > or =15 years registered in the lists of these GPs, we selected patients who received at least one AED prescription during the study period. Use of newer and older AEDs was calculated as 1-year prevalence and incidence as well as defined daily dose (DDD) per 1000 inhabitants/day. Sub-analyses by gender, age and indication of use were performed.
RESULTS:
Overall, prevalence and incidence of use remained stable for older AEDs, while it strongly increased for newer AEDs. In particular, 25% increase of incident treatments with newer AED have been reported from 2004 to 2005. The total volume of AED use remained stable during the study years, despite the proportion of newer AEDs slightly increased (from 24.6% in 2003 to 30.1% in 2005). The main indication of use was epileptic disorders for older AEDs (56% of users), and neuropathic pain for newer AEDs (69%).
CONCLUSIONS:
Prevalence and incidence of use of newer AED strongly increased during the years 2003-2005 in a general practice of Southern Italy. Significant differences are shown in the prescribing pattern of newer and older medications: older AEDs are mainly used in the treatment of epileptic disorders, while newer compounds are preferred for conditions other than epilepsy, in particular neuropathic pain
Safety and tolerability of psychotropic medications in childhood: preliminary data of a pharmacovigilance study
No full textAim: The aim of this study is to evaluate Adverse Drug Reactions (ADRs) of psychotropic medications in childhood. Methods: 102 children and adolescents (M 82,4%, F 17,6%) followed up at the Division of Child Neurology and Psychiatry at the University of Messina, and at the Scientific Institute Child Neurology and Psychiatry, IRCCS Stella Maris, Calambrone, Pisa, were recruited between January 2009 and December 2011. All participants met DSM-IV diagnostic criteria for psychiatric disorders. The data were collected using a recording sheet for ADRs. An electronic database was also used. The recording sheet was designed to note all relevant information about drug treatment and ADRs according to AIFA (Agenzia Italiana del Farmaco) suggestions. The most prescribed drugs were: risperidone (19,6%), Aripiprazole (18,4%) and Valproic Acid (14,8%). The ADRs more frequently recorded had been: weight gain (12,6%), sleepiness (8,4%), and irritability (6,7%). None of recorded ADRs were classified as “serious”. Conclusions: this study can provide a basic model to collect information on safety and tolerability of psychotropic drugs in childhood
The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes
Full text link: (1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes' comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called "Diabetes Comorbidome". (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The "Diabetes Comorbidome" represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes
Lipid-lowering drug use in Italian primary care: effects of reimbursement criteria revision
Full text linkOBJECTIVE:
To assess whether the prescribing pattern of lipid-lowering drugs (LLD) changed after reimbursement criteria revision in a general practice in southern Italy.
METHODS:
From the Caserta-1 Local Health Service database, 93 general practitioners (GPs) who had consistently sent data about their patients during the years 2003-2005 were recruited. Prevalence of use and incidence of new treatments were calculated for each year, stratified by three drug cohorts: statins, omega-3 fatty acids, and fibrates. Subanalyses by gender, age, and indication of use were performed.
RESULTS:
Overall, 1-year prevalence of LLD use increased from 2003 to 2004. After reimbursement criteria revision (November 2004), a slight decrease was observed for statins, from 41.1 (95% CI: 39.9-42.2) per 1,000 inhabitants in 2004 to 40.3 (39.2-41.5) in 2005, while omega-3 utilization fell markedly: 14.6 (13.9-15.3) vs. 5.4 (5.0-5.8). The use of both statins and omega-3 fatty acids was reduced particularly for primary prevention. On the other hand, utilization of statins increased in diabetic patients and as secondary prevention from 2004 to 2005. Concerning individual molecules, 1-year prevalence of use of any statin declined from 2004 to 2005, except for rosuvastatin.
CONCLUSIONS:
Revision of reimbursement criteria led to significant changes in the trend in LLD use in general practice in southern Italy: (1) statin utilization was slightly reduced in 2005, although it increased in certain categories, such as diabetic patients, and (2) omega-3 fatty acid use was strongly reduced even though a higher use in postinfarction cases was reporte
Statin-macrolide interaction risk: a population-based study throughout a general practice database
No full textIntroduction: The myopathy risk associated with statin use increases in case of concomitant prescription of certain drugs, such as cytochrome P-450 (CYP) system inhibitors (i.e., macrolides). The aim of this study was to assess whether concurrent statin/macrolide prescriptions at high interaction risk are commonly written in a general practice setting. Methods: For this study, 156 general practitioners (GPs) with a patient population of almost 200,000 individuals, and participating in the Arianna database set up by "Caserta-1" Local health-Service Agency (ASL), were recruited. Within such a study sample, subjects receiving at least one statin/macrolide concomitant prescription during the year 2003 were identified. Sensitivity analysis was performed to assess the time distribution of high-risk macrolide prescriptions written within +/- 10 days from the statin prescription date. Results: Among 190,124 patients included in the study, 7,176 (3.8%) received at least one statin prescription during the observation period. Of these, 228 (3.2%) were occasionally co-prescribed with any macrolide on the same date, in 153 cases (2.1% of statin users) the macrolide being of high interaction risk. In particular, 2.1% (55) of simvastatin users and 2.2% (64) of patients on atorvastatin were prescribed with high-risk macrolide on the same date versus 0.6% and 1.8% of patients prescribed with fluvastatin and pravastatin, respectively. Concerning GPs, 99 (63.5%) co-administered statin and macrolide at high interaction risk at least once. Conclusions: Most GPs occasionally prescribed statin/macrolide at high interaction risk on the same date, despite the availability of therapeutic alternatives. Prevention strategies targeted to increase awareness of health professionals about the interaction risks of widely prescribed drugs are needed
Lipid-lowering drug use in general practice of Southern Italy: Effects of reimbursement criteria revision
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