Browsing by Subject "MEDICATIONS"

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  • Inkeri, Niina-Mari; Karjalainen, Merja; Haanpaa, Maija; Kautiainen, Hannu; Saltevo, Juha; Mantyselka, Pekka; Tiihonen, Miia (2019)
    What is known and objective Anticholinergic drug use has been associated with a risk of central and peripheral adverse effects. There is a lack of information on anticholinergic drug use in persons with diabetes. The aim of this study is to investigate anticholinergic drug use and the association between anticholinergic drug use and self-reported symptoms in older community-dwelling persons with and without diabetes. Methods The basic population was comprised of Finnish community-dwelling primary care patients aged 65 and older. Persons with diabetes were identified according to the ICD-10 diagnostic codes from electronic patient records. Two controls adjusted by age and gender were selected for each person with diabetes. This cross-sectional study was based on electronic primary care patient records and a structured health questionnaire. The health questionnaire was returned by 430 (81.6%) persons with diabetes and 654 (73.5%) persons without diabetes. Data on prescribed drugs were obtained from the electronic patient records. Anticholinergic drug use was measured according to the Anticholinergic Risk Scale. The presence and strength of anticholinergic symptoms were asked in the health questionnaire. Results and discussion The prevalence of anticholinergic drug use was 8.9% in the total study cohort. There were no significant differences in anticholinergic drug use between persons with and without diabetes. There was no consistent association between anticholinergic drug use and self-reported symptoms. What is new and conclusion There is no difference in anticholinergic drug use in older community-dwelling persons with and without diabetes. Anticholinergic drug use should be considered individually and monitored carefully.
  • Bazelier, Marloes T.; Eriksson, Irene; de Vries, Frank; Schmidt, Marjanka K.; Raitanen, Jani; Haukka, Jari; Starup-Linde, Jakob; De Bruin, Marie L.; Andersen, Morten (2015)
    PurposeTo identify pharmacoepidemiological multi-database studies and to describe data management and data analysis techniques used for combining data. MethodsSystematic literature searches were conducted in PubMed and Embase complemented by a manual literature search. We included pharmacoepidemiological multi-database studies published from 2007 onwards that combined data for a pre-planned common analysis or quantitative synthesis. Information was retrieved about study characteristics, methods used for individual-level analyses and meta-analyses, data management and motivations for performing the study. ResultsWe found 3083 articles by the systematic searches and an additional 176 by the manual search. After full-text screening of 75 articles, 22 were selected for final inclusion. The number of databases used per study ranged from 2 to 17 (median=4.0). Most studies used a cohort design (82%) instead of a case-control design (18%). Logistic regression was most often used for individual-level analyses (41%), followed by Cox regression (23%) and Poisson regression (14%). As meta-analysis method, a majority of the studies combined individual patient data (73%). Six studies performed an aggregate meta-analysis (27%), while a semi-aggregate approach was applied in three studies (14%). Information on central programming or heterogeneity assessment was missing in approximately half of the publications. Most studies were motivated by improving power (86%). ConclusionsPharmacoepidemiological multi-database studies are a well-powered strategy to address safety issues and have increased in popularity. To be able to correctly interpret the results of these studies, it is important to systematically report on database management and analysis techniques, including central programming and heterogeneity testing. (c) 2015 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons, Ltd.
  • Elfving, P.; Puolakka, K.; Kautiainen, H.; Virta, L. J.; Pohjolainen, T.; Kaipiainen-Seppanen, O. (2016)
    The objectives of the study were to examine the initial, first-year anti-rheumatic outpatient therapy in patients with incident SLE, as well as the concomitant use of drugs for certain comorbidities, compared to the use in the general population. The Finnish nationwide register data on special reimbursements for medication costs was screened to identify the inception cohort of 566 adult SLE patients (87% females, mean age 46.5 +/- 15.9 years) over the years 2000-2007. The patients were linked to the national Drug Purchase Register. Of those, 90% had purchased at least once some disease-modifying anti-rheumatic drugs (DMARDs) during the first year. Hydroxychloroquine was the most common (76%), followed by azathioprine (15%) and methotrexate (13%). With the exception of increase in mycophenolate mofetil, the proportions remained stable over the whole study period 2000-2007. Drugs for cardiovascular diseases, dyslipidemia, diabetes mellitus, hypothyroidism and obstructive pulmonary disease were more frequently purchased than in the sex- and age-adjusted population, with rate ratios ranging from 1.6 to 7.8. Over the years 2000-2007, almost all the patients with incident SLE in Finland started with a DMARD. Higher percentages of SLE patients were on medication for several common chronic diseases than in the population as a whole.
  • Smits, Dins; Brigis, Girts; Pavare, Jana; Urtane, Inga; Kovalovs, Sandis; Barengo, Noel Christopher (2020)
    Background The problem of nonadherence to therapy is a key reason of insufficient asthma control. Evaluating the beliefs about asthma medication, cognitive and emotional perceptions may help to identify patients with poor adherence to treatment in clinical practice which need additional attention in order to increase the likelihood of them taking their asthma medication according to the prescribed treatment protocol. The purpose of this study is to assess whether beliefs about asthma medication, cognitive and emotional factors are related to poor treatment adherence of asthma medication in a sample of asthma patients in Latvia. Methods Study subjects were asthma patients attending outpatient pulmonologist consultations in Latvia during September 2013 to December 2015. Beliefs about asthma medicine, cognitive and emotional factors related to asthma were determined in a cross-sectional, self-administered survey. The validated Beliefs about Medicines Questionnaire (BMQ) and the Brief Illness Perception Questionnaire (brief IPQ) were used. Treatment adherence was assessed using 5-item version of the Medication Adherence Reporting Scale (MARS). The total sample size was 352 patients. Logistic regression models were used to predict poor adherence to asthma treatment. The validity of each logistic regression model was assessed by the Hosmer/Lemeshow test. The main outcome measure was self-reported adherence to treatment. Results The more the patients agreed with the statement "My future health depends on my asthma medication" the lower the possibility of poor adherence to asthma treatment (OR 0.42; 95% CI 0.24-0.74). The more concerned the patients were in regard to long-term effects of their medication (OR 2; 95% CI 1.22-3.27), the higher the probability of poor treatment adherence. Conclusions Screening asthma patients using the BMQ may help to identify those to benefit from interventions targeting their concerns and medication beliefs in order to improve adherence to asthma medication.
  • Heinjoki, Marjo; Karjalainen, Merja; Saltevo, Juha; Tiihonen, Miia; Haanpaa, Maija; Kautiainen, Hannu; Mäntyselkä, Pekka (2020)
    Background Due to these changes in kidney function, aging kidneys are more prone to drug-induced impairments in renal properties. Diabetes has been associated with the declined kidney function and an elevated risk of renal failure. The aim of this study is to compare kidney function and potentially nephrotoxic drug use among home-dwelling older persons with or without diabetes. Methods A total of 259 persons with and 259 persons without diabetes and aged >= 65 years were randomly selected to participate in a health examination with complete data gathered from 363 individuals (187 with diabetes and 176 without diabetes). The estimated glomerular filtration rate (eGFR) was calculated using CKD-EPI equation. Each participant was categorized based on the nephrotoxic profile of their medications. Results There were no differences in mean eGFR values (77.5 +/- 18.8 vs. 80.5 +/- 14.8 ml/min/1.73m(2), p = 0.089) or in the proportion of participants with eGFR <60 ml/min/1.73m(2) among persons with diabetes (16% vs. 10%, p = 0.070), compared to persons without diabetes. Potentially nephrotoxic drug use was similar between the groups. The mean number of potentially nephrotoxic drugs was 1.06 +/- 0.88 in those with and 0.97 +/- 1.05 in those without diabetes (p = 0.39). Conclusions The kidney function of older persons with diabetes does not differ from that of older persons without diabetes and furthermore potentially nephrotoxic drug use seem to play only a minor role in the decline in kidney function among home-dwelling persons in the Inner-Savo district.
  • Groop, Per-Henrik; Cooper, Mark E.; Perkovic, Vlado; Hocher, Berthold; Kanasaki, Keizo; Haneda, Masakazu; Schernthaner, Guntram; Sharma, Kumar; Stanton, Robert C.; Toto, Robert; Cescutti, Jessica; Gordat, Maud; Meinicke, Thomas; Koitka-Weber, Audrey; Thiemann, Sandra; von Eynatten, Maximilian (2017)
    Aims: The MARLINA-T2D study (ClinicalTrials. gov, NCT01792518) was designed to investigate the glycaemic and renal effects of linagliptin added to standard-of-care in individuals with type 2 diabetes and albuminuria. Methods: A total of 360 individuals with type 2 diabetes, HbA1c 6.5% to 10.0% (48-86 mmol/ mol), estimated glomerular filtration rate (eGFR) >= 30 mL/min/1.73 m(2) and urinary albumin-tocreatinine ratio (UACR) 30-3000 mg/g despite single agent renin-angiotensin-system blockade were randomized to double-blind linagliptin (n = 182) or placebo (n = 178) for 24 weeks. The primary and key secondary endpoints were change from baseline in HbA1c at week 24 and time-weighted average of percentage change from baseline in UACR over 24 weeks, respectively. Results: Baseline mean HbA1c and geometric mean (gMean) UACR were 7.8% +/- 0.9% (62.2 +/- 9.6 mmol/mol) and 126 mg/g, respectively; 73.7% and 20.3% of participants had microalbuminuria or macroalbuminuria, respectively. After 24 weeks, the placebo-adjusted mean change in HbA1c from baseline was -0.60% (-6.6 mmol/mol) (95% confidence interval [CI], -0.78 to -0.43 [-8.5 to -4.7 mmol/mol]; P Conclusions: In individuals at early stages of diabetic kidney disease, linagliptin significantly improved glycaemic control but did not significantly lower albuminuria. There was no significant change in placebo-adjusted eGFR. Detection of clinically relevant renal effects of linagliptin may require longer treatment, as its main experimental effects in animal studies have been to reduce interstitial fibrosis rather than alter glomerular haemodynamics.
  • Varimo, Eveliina; Saastamoinen, Leena K.; Rättö, Hanna; Mogk, Hannu; Aronen, Eeva T. (2020)
    IntroductionRecently, prescribing antipsychotics for children and adolescents has been increasing in many countries. These drugs are often prescribed off-label, although antipsychotics have been associated with adverse effects. We determined the recent incidence of antipsychotic use among children and adolescents in Finland.MethodsFinnish National Prescription Register including all Finnish inhabitants receiving reimbursement for pharmaceuticals was searched for subjects of 1 to 17 years of age who had started an antipsychotic drug between January 1, 2008, and December 31, 2017 (n = 26,353). Between 2008 and 2017, the range of number of Finnish children and adolescents aged 1 to 17 years was 1.01 to 1.03 million/year. The incidence was calculated by dividing the number of new users by all age- and sex-matched Finnish inhabitants in the year.ResultsBetween 2008 and 2017, the incidence of antipsychotic use among children and adolescents increased from 2.1 to 3.8 per 1000 individuals, respectively. In children aged 7 to 12 years, the incidence of antipsychotic use 1.4-folded (from 1.9 (95% CI: 1.8–2.0) to 2.7 (95% CI: 2.5–2.9) per 1000) with a cumulative increase of 0.2% per year (χ2 = 51.0, p <0.0001). In adolescents aged 13 to 17 years, the incidence 2.2-folded (from 4.3 (95% CI: 4.1–4.5) to 9.4 (95% CI: 9.1–9.8) per 1000) with a cumulative increase of 0.6% per year (χ2 = 590.3, p <0.0001). The increase in the incidence of use was steeper in girls (2.3-fold) than in boys (1.4-fold) (χ2 = 85.6, p <0.0001), especially between 2015 and 2017 (1.6-fold and 1.2-fold, respectively) (χ2 = 151.7, p <0.0001). The year 2011 was the turning point when the incidence in girls exceeded the incidence in boys, and the incidence of quetiapine use exceeded that of risperidone use.ConclusionsThe incidence of antipsychotic use increased between 2008 and 2017, especially in adolescent girls. The use of quetiapine increased, although it has few official indications in children and adolescents. Future studies should investigate the reasons for increasing use of antipsychotics, especially quetiapine, in children and adolescents.
  • Hohtari-Kivimaki, Ulla; Salminen, Marika; Vahlberg, Tero; Kivelä, Sirkka-Liisa (2021)
    Objectives: To assess the prevalence of orthostatic hypotension (OH) and the association of OH with the risk of falls among community-dwelling older adults with a previous fall. Design: Longitudinal study. Setting and Participants: The subjects (n = 561) were participants in fall prevention conducted in western Finland. Methods: Blood pressure (BP) was measured in supine position and at 30 seconds and 3 minutes after standing. The participants were divided according to the consensus definition to an OH group (OHG) and a non-OH group (non-OHG). Falls were recorded by fall diaries during 12 months. Falls requiring treatment were gathered from health center and hospital registers during 12 and 36 months. Results: The prevalence of OH was 23.4% (30 seconds) and 7.3% (3 minutes). The 30-second measurement showed that the incidence of falls and that of falls requiring treatment were significantly higher in OHG compared with non-OHG during 12 months. After adjustments, the incidence of falls remained higher in all 5 adjusted models whereas that of falls requiring treatment remained higher only after adjustment for functional balance. The 3-minute measurement showed that the incidence of falls was higher in OHG compared with non-OHG during 12 months and remained higher after adjustments for functional balance and for age and functional balance. During the 36-month follow-up, OH measured at 30 seconds or 3 minutes after standing was not associated with the occurrence of falls leading to treatment. Conclusions and Implications: OH at 30 seconds or 3 minutes after standing is associated with a greater risk for falling within 12 months in older adults. The 30-second blood pressure measurement is more reliable to detect the risk than the 3-minute measurement. The results support the usability of 30-second measurement in determining OH and the risk for falling among older persons. (C) 2021 The Authors. Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
  • Aalto, Ulla L.; Roitto, Hanna-Maria; Finne-Soveri, Harriet; Kautiainen, Hannu; Pitkälä, Kaisu H. (2020)
    Background The use of drugs with anticholinergic properties (DAPs) is common among older adults despite their known adverse effects, such as cognitive decline. Professionals should pay attention to DAPs, since evidence on their adverse effects has been accumulating during the last decade. However, to our knowledge previous studies exploring temporal trends in the use of DAPs are scarce. Objective The aim of this study was to assess temporal trends in the use of DAPs from 2003 to 2017 in long-term care facilities in Helsinki. Methods Four cross-sectional studies were conducted in 2003, 2007, 2011, and 2017. Participants included older people (>= 65 years) living in nursing homes (NHs) in 2003 (n = 1979), 2011 (n = 1568), and 2017 (n = 750), and in assisted living facilities (ALFs) in 2007 (n = 1336), 2011 (n = 1556), and 2017 (n = 1673) in Helsinki, Finland. Data on demographics, medication use, and diagnoses were collected by structured questionnaires. The assessments were conducted as a point prevalence over 1 day. The use of DAPs and the total anticholinergic burden were defined by the Anticholinergic Risk Scale (ARS). Results In ALFs, there has been an increasing trend in the use of DAPs over a 10-year period (41.2% in 2007 and 53.7% in 2017). In NHs, by contrast, the use of DAPs remained quite stable (52.3% in 2003 and 52.4% in 2017). The burden of DAPs measured by ARS score decreased in NHs and remained stable in ALFs. Marked changes occurred in the DAPs used; antidepressants, especially mirtazapine, increased in both settings, whereas the use of hydroxyzine and urinary antispasmodics nearly disappeared. The proportion of users of DAP antipsychotics increased in ALFs. Participants with dementia had a lower anticholinergic burden than those without dementia, in both settings. Conclusions Despite increased knowledge of the harms of DAPs, they remain widely used. Physicians seem to be aware of the harms of DAPs among people with dementia, and some other favorable trends in prescribing were also observed. Clinicians should especially consider the indications behind the use of DAP antidepressants and antipsychotics, and carefully weigh their potential benefits and harms.
  • Aalto, Ulla L.; Finne-Soveri, Harriet; Kautiainen, Hannu; Roitto, Hanna-Maria; Öhman, Hannareeta; Pitkälä, Kaisu H. (2019)
    Objectives: To compare 3 internationally established criteria for drugs with anticholinergic properties (DAPs) and their associated factors in long-term care facilities, and to investigate the association between use of DAPs and psychological well-being (PWB) or mortality. Design: Cross-sectional study and 1-year follow-up of all-cause mortality. Setting and Participants: Of all 4449 residents living in long-term care facilities in Helsinki in 2011, 2432 (>= 65 years of age) participated after exclusion of residents with severe dementia. Measurements: Data on demographics, medication use, and active diagnoses were collected by trained staff using structured questionnaires. DAP use was defined by the following 3 international criteria: Chew's list, the Anticholinergic Risk Scale, and the Anticholinergic Drug Scale. The total number of DAPs was counted and referred to as anticholinergic burden. PWB was assessed by a questionnaire and yielded a score ranging from 0 to 1. Mortality data was retrieved from central registers. Results: Of all participants, 85% were DAP users according to at least 1 of the 3 criteria used. Overlap between the 3 criteria was only moderate. DAP users were younger and a larger proportion of them had better cognition. However, they suffered more often from depression and other psychiatric diagnoses than nonusers. DAP users had lower PWB scores than those not using DAPs, and PWB decreased linearly in the overlapping groups from nonusers to those using DAPs according to all 3 criteria. The total number of DAPs used predicted mortality. Conclusions and Implications: DAP use and PWB appear to be negatively associated. When combining several criteria of DAPs, their burden predicted mortality. Clinicians should carefully consider the potential benefits and harms when prescribing DAPs to older persons. (C) 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.