The Association Between the Use of Zolpidem and the Risk of Alzheimer's Disease Among Older People.

OBJECTIVES: To evaluate the association between zolpidem use and the risk of Alzheimer's disease among older people. DESIGN: A retrospective cohort study using data from 2001 to 2011 from the National Health Insurance Research Database. SETTING: Taiwan. PARTICIPANTS: A total of 6,922 patients aged 65 years or older enrolled from January 2002 to December 2004 (the enrollment period). INTERVENTION (EXPOSURE): Zolpidem users were identified as patients who used zolpidem during the enrollment period. The index date was the date of the first zolpidem prescription. Dosage of zolpidem use was defined using cumulative defined daily dose (cDDD) based on the cumulative dosage that patients took within one year after the index date (grouped as: less than 28, 28-90, 91-180, and more than 180 cDDD). MEASUREMENTS: The occurrence of Alzheimer's disease was defined as the time period from the end of one year after the index date to the date of the Alzheimer's disease diagnosis. The propensity score was used to adjust the measured confounders of Alzheimer's disease. Cox proportional hazards models were used to evaluate the association between zolpidem use and the incidence of Alzheimer's disease. RESULTS: Zolpidem users with a high cumulative dose (>180 cDDD) in the first year after initiation had a significantly greater risk of Alzheimer's disease than non-zolpidem users (HR = 2.97, 95% CI = 1.61-5.49) and low cumulative dose (<28 cDDD) users (HR = 4.18, 95% CI = 1.77-9.86). CONCLUSION: We found the use of a high cumulative dose of zolpidem was associated with an increased risk of Alzheimer's disease among older people living in Taiwan. It is advised to use caution when considering long-term use of zolpidem in older patients.

Masters Swimmers Use More Dietary Supplements Than a Large National Comparison Population in the United States.

The use of dietary supplements was compared between a cohort of committed exercisers, U.S. Masters Swimming (USMS) members (n = 1,042), and the general U.S. population, exemplified by respondents to the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2010 (n = 6,209). USMS swimmers were significantly more likely to take dietary supplements (62%) than the general U.S. adult population, as represented by the NHANES population (37%). Those taking dietary supplements were older, more likely to be female and Caucasian, and more highly educated and affluent than those not taking supplements (p < .001 for all). When adjusted for age, race, gender, annual income, and education, masters swimmers were still more likely (p < .001) to use dietary supplements than the NHANES cohort. In addition, masters swimmers were significantly more likely (p < .001) to use either creatine or dehydroepiandrosterone or testosterone than those in the NHANES cohort.

Services provided by community pharmacies in Wayne County, Michigan: a comparison by ZIP code characteristics.

OBJECTIVE: To document the availability of selected pharmacy services and out-of-pocket cost of medication throughout a diverse county in Michigan and to assess possible associations between availability of services and price of medication and characteristics of residents of the ZIP codes in which the pharmacies were located. DESIGN: Cross-sectional telephone survey of pharmacies coupled with ZIP code-level census data. SETTING: 503 pharmacies throughout the 63 ZIP codes of Wayne County, MI. MAIN OUTCOME MEASURES: The out-of-pocket cost for a 30 days' supply of levothyroxine 50 mcg and brand-name atorvastatin (Lipitor-Pfizer) 20 mg, availability of discount generic drug programs, home delivery of medications, hours of pharmacy operation, and availability of pharmacy-based immunization services. Census data aggregated at the ZIP code level included race, annual household income, age, and number of residents per pharmacy. RESULTS: The overall results per ZIP code showed that the average cost for levothyroxine was $10.01 ± $2.29 and $140.45 + $14.70 for Lipitor. Per ZIP code, the mean (± SD) percentages of pharmacies offering discount generic drug programs was 66.9% ± 15.0%; home delivery of medications was 44.5% ± 22.7%; and immunization for influenza was 46.7% ± 24.3% of pharmacies. The mean (± SD) hours of operation per pharmacy per ZIP code was 67.0 ± 25.2. ZIP codes with higher household income as well as higher percentage of residents being white had lower levothyroxine price, greater percentage of pharmacies offering discount generic drug programs, more hours of operation per week, and more pharmacy-based immunization services. The cost of Lipitor was not associated with any ZIP code characteristic. CONCLUSION: Disparities in the cost of generic levothyroxine, the availability of services such as discount generic drug programs, hours of operation, and pharmacy-based immunization services are evident based on race and household income within this diverse metropolitan county.