Polypharmacy and potentially inappropriate prescribing of benzodiazepines in older nursing home residents.

INTRODUCTION: Previous research has raised concerns about high prevalence of drug-related problems, polypharmacy and inappropriate benzodiazepine prescribing in nursing homes (NHs) and confirmed lack of studies from Central and South-Eastern Europe. The aim of our study was to determine the prevalence and characteristics of polypharmacy, hyperpolypharmacy and inappropriate benzodiazepine prescribing in NH residents in Croatia. METHODS: Data from 226 older NH residents from five Croatian NHs were collected using the InterRAI Long-Term Care Facilities assessment form. The prevalence and determinants of polypharmacy/hyperpolypharmacy and patterns of inappropriate benzodiazepine prescribing were documented. RESULTS: The prevalence of polypharmacy (49.6%) and hyperpolypharmacy (25.7%) among NH residents was high. In our study, 72.1% of NH residents were prescribed at least one psychotropic agent, 36.7% used 2-3 psychotropics and 6.6% used 4+ psychotropics. Among benzodiazepine users (55.8%), 28% of residents were prescribed benzodiazepines in higher than recommended geriatric doses, 75% used them for the long term and 48% were prescribed concomitant interacting medications. The odds of being prescribed polypharmacy/hyperpolypharmacy were significantly higher for older patients with polymorbidity (6+ disorders, proportional odds ratio (POR) = 19.8), type II diabetes (POR = 5.2), ischemic heart disease (POR = 4.6), higher frailty (Clinical Frailty Scale (CFS ≥5); POR = 4.3) and gastrointestinal problems (POR = 4.8). CONCLUSIONS: Our research underscores the persistent challenge of inappropriate medication use and drug-related harms among older NH residents, despite existing evidence and professional campaigns. Effective regulatory and policy interventions, including the implementation of geriatrician and clinical pharmacy services, are essential to address this critical issue and ensure optimal medication management for vulnerable NH populations.

Prevalence, country-specific prescribing patterns and determinants of benzodiazepine use in community-residing older adults in 7 European countries.

BACKGROUND: The use of benzodiazepines (BZDs) in older population is often accompanied by drug-related complications. Inappropriate BZD use significantly alters older adults' clinical and functional status. This study compares the prevalence, prescribing patterns and factors associated with BZD use in community-dwelling older patients in 7 European countries. METHODS: International, cross-sectional study was conducted in community-dwelling older adults (65 +) in the Czech Republic, Serbia, Estonia, Bulgaria, Croatia, Turkey, and Spain between Feb2019 and Mar2020. Structured and standardized questionnaire based on interRAI assessment scales was applied. Logistic regression was used to evaluate factors associated with BZD use. RESULTS: Out of 2,865 older patients (mean age 73.2 years ± 6.8, 61.2% women) 14.9% were BZD users. The highest prevalence of BZD use was identified in Croatia (35.5%), Spain (33.5%) and Serbia (31.3%). The most frequently prescribed BZDs were diazepam (27.9% of 426 BZD users), alprazolam (23.7%), bromazepam (22.8%) and lorazepam (16.7%). Independent factors associated with BZD use were female gender (OR 1.58, 95%CI 1.19-2.10), hyperpolypharmacy (OR 1.97, 95%CI 1.22-3.16), anxiety (OR 4.26, 95%CI 2.86-6.38), sleeping problems (OR 4.47, 95%CI 3.38-5.92), depression (OR 1.95, 95%CI 1.29-2.95), repetitive anxious complaints (OR 1.77, 95%CI 1.29-2.42), problems with syncope (OR 1.78, 95%CI 1.03-3.06), and loss of appetite (OR 0.60, 95%CI 0.38-0.94). In comparison to Croatia, residing in other countries was associated with lower odds of BZD use (ORs varied from 0.49 (95%CI 0.32-0.75) in Spain to 0.01 (95%CI 0.00-0.03) in Turkey), excluding Serbia (OR 1.11, 95%CI 0.79-1.56). CONCLUSIONS: Despite well-known negative effects, BZDs are still frequently prescribed in older outpatient population in European countries. Principles of safer geriatric prescribing and effective deprescribing strategies should be individually applied in older BZD users.

Reliability of Autoantibodies Against a Tissue Transglutaminase Neo-Epitope for the Diagnosis of Pediatric Celiac Disease.

BACKGROUND: This study aimed to assess the declared benefits of the new test using antibodies against tissue transglutaminase in complex with gliadin representing a neo-epitope in the IgA and IgG class of immunoglobulins compared with currently used tissue transglutaminase antibodies in the IgA class of immunoglobulins among children. METHODS: In the cross-sectional study (P1 study, n = 406) and two small-size prospective observational studies (P2 study, n = 59 and P3 study, n = 12), serum samples from all children were simultaneously tested for endomysial antibodies, IgA tissue transglutaminase antibodies, and antibodies against tissue transglutaminase in complex with gliadin in the IgA and IgG class of immunoglobulins. The exact McNemar test, Wilcoxon test, and Spearman's correlation coefficient were used to analyze the data. RESULTS: We found a significant asymmetry of the tissue transglutaminase antibodies test compared with the antibodies against tissue transglutaminase neo-epitope test (P1). More patients (1.5%) had tissue transglutaminase an¬tibodies positive and antibodies against tissue transglutaminase neo-epitope negative results, whereas no patients had tissue transglutaminase antibodies negative and antibodies against tissue transglutaminase neo-epitope positive results. Of 59 children with tissue transglutaminase antibodies and/or endomysial antibodies positive results (P2), one (1.7%) did not have celiac disease. In agreement with the P1 study, four patients (6.8%) with confirmed celiac disease were tissue transglutaminase antibodies positive and antibodies against tissue transglutaminase neo-epitope negative. In this group, the sensitivity of the antibodies against tissue transglutaminase neo-epitope test for diagnosis of celiac disease was 91.4% (95% confidence interval, 81.0 - 97.1%). Among children diagnosed with functional gastrointestinal disorder (P3), all had negative serological test results, and none was diagnosed with celiac disease. CONCLUSIONS: The results do not indicate that antibodies against tissue transglutaminase neo-epitope test would be an unambiguously better test than the currently used tissue transglutaminase antibodies.

Applicability of EU(7)-PIM criteria in cross-national studies in European countries.

BACKGROUND: The European Union (EU)(7)-PIM (potentially inappropriate medication) list presents the most comprehensive and up-to-date tool for evaluation of PIM prescribing in Europe; however, several country-specific studies have documented lower specificity of this list on pharmaceutical markets of some countries. The aim of our study was to describe approval rates and marketing of PIMs stated by EU(7)-PIM criteria in six EU countries [in comparison with the American Geriatric Society (AGS) Beers 2015 criteria]. METHODS: Research teams of six EU countries (Czech Republic, Spain, Portugal, Serbia, Hungary and Turkey) participated in this study conducted by WG1b EU COST Action IS1402 group in the period October 2015-November 2018. Data on approval rates of PIMs and their availability on pharmaceutical markets have been obtained from databases of national drug-regulatory institutes and up-to-date drug compendia. The EU(7)-PIM list and AGS Beers 2015 Criteria (Section 1) were applied. RESULTS: PIMs from EU(7)-PIM list were approved for clinical use more often than those from the AGS Beers 2015 criteria (Section 1). Approval rates for EU(7)-PIMs ranged from 42.8% in Serbia to 71.4% in Spain (for AGS criteria only from 36.4% to 65.1%, respectively). Higher percentages of approved PIMs were documented in Spain (71.4%), Portugal (67.1%) and Turkey (67.5%), lower in Hungary (55.5%), Czech Republic (50.2%) and Serbia (42.8%). The majority of approved PIMs were also currently marketed in all countries except in Turkey (19.8-21.7% not marketed PIMs) and less than 20% of PIMs were available as over-the-counter medications (except in Turkey, 46.4-48.1%). CONCLUSIONS: The EU(7)-PIM list was created for utilization in European studies; however, applicability of this list is still limited in some countries, particularly in Eastern and Central Europe. The EU project EUROAGEISM H2020 (2017-2021) that focuses on PIM prescribing and regulatory measures in Central and Eastern European countries must consider these limits.

Short-term prediction of coronary heart disease mortality in the Czech Republic based on data from 1968-2014.

OBJECTIVES: The aim was to explore the patterns of the coronary heart disease (CHD) mortality rates over the past almost 50 years (1968-2014) in the Czech Republic, and to predict the mortality rates in 2015-2019. METHODS: The number of deaths from CHD and the population size were stratified by sex and age. The mortality rates were age-standardized to European population. Their values in 2015-2019 were estimated using the joinpoint log-linear regression, local log-linear regression and negative binomial log-linear regression, separately for males and females. RESULTS: A positive change in the trend of the age-standardized mortality rates from CHD was detected after the collapse of communism in 1989. In 1991-2000, the mortality trend was sharply downward, with an annual percent change of -5.8 % for males and -5.2 % for females. In 2000-2014, the decreasing trend was not so sharp (-1.3 % for males and -0.7% for females), yet it should continue in 2015-2019. The crude mortality rates for females are slightly higher than those for males since 2007, however, they are increasing for both sexes. The mortality rates are rising mainly in the age group of 85+ years (in 2014, 25.4% of CHD deaths of males and 54.4% of females occurred at the age of 85+ years). CONCLUSIONS: The age-standardized mortality rates are predicted to decrease in 2015-2019, but the crude mortality rates should increase due to increase in average life expectancy. The burden of deaths is moving to the age group of 85 years and older, mainly in females. A total of 26,039 CHD deaths were registered in the Czech Republic in 2014, and 29,653 are predicted for 2019, if the current trends continue.

Structural alterations of the language connectome in children with specific language impairment.

We evaluated brain white matter pathways associated with language processing in 37 children with specific language impairment aged 6-12 years and 34 controls, matched for age, sex and handedness. Arcuate fascicle (AF), inferior fronto-occipital fascicle (IFOF), inferior longitudinal fascicle (ILF) and uncinate fascicle (UF) were identified using magnetic resonance diffusion tensor imaging (DTI). Diffusivity parameters and volume of the tracts were compared between the SLI and control group. Children with SLI showed decreased fractional anisotropy in all investigated tracts, increased mean diffusivity and radial diffusivity component in arcuate fascicle bilaterally, left IFOF and left ILF. Further, bilaterally increased volume of the ILF in children with SLI was found. We confirmed previous findings indicating deficient connectivity of the arcuate fascicle and as a novel finding, demonstrate abnormal development of the ventral language stream in patients with SLI.

Destacan la utilidad del mapeo de superficie corporal en la pesquisa de la enfermedad coronaria / Myocardial ischemia screening in middle-aged and elderly men

En un estudio de prevención primaria de la enfermedad coronaria (EC), 164 varones con factores de riesgo (FR) al inicio del ensayo (1975 a 1979) se evaluaron durante el período comprendido entre 1996 y 2002 mediante un mapeo de superficie corporal (MSC). Los resultados se dividieron en dos grupos, uno con 71 varones (43.3%) con buen pronóstico (MSC normal y síndrome X) y el otro grupo con 93 sujetos (56.7%) con pronóstico desfavorable (MSC avanzado con EC moderada). Esta división hizo posible el análisis estadístico, ya que de otro modo los grupos hubieran resultado pequeños. En el análisis univariado, entre los fumadores se observó un efecto significativo del patrón de MSC sobre la EC, en comparación con los no fumadores (p = 0.002). La hipertensión sistólica (HTS) y el colesterol total no influyeron significativamente sobre el MSC. En el análisis multivariado, la probabilidad de que los fumadores presentaran un patrón de EC en el MSC fue 2.6 veces mayor en comparación con los no fumadores (p = 0.007). Los resultados del MSC se relacionaron parcialmente con la HTS (p = 0.074). Las probabilidades fueron 1.9 veces mayores en los varones con HTS > 140 mm Hg en comparación con los sujetos con presión arterial sistólica normal. No se encontraron diferencias estadísticamente significativas para el colesterol total. Los motivos de estos resultados se discuten en relación con los datos del estudio a largo plazo. Se comparan los resultados del MSC con los obtenidos en 2 pequeños ensayos sobre angina de pecho (AP) en los cuales se utilizaron electrocardiogramas.

Potentially inappropriate medication use among elderly home care patients in Europe.

CONTEXT: Criteria for potentially inappropriate medication use among elderly patients have been used in the past decade in large US epidemiological surveys to identify populations at risk and specifically target risk-management strategies. In contrast, in Europe little information is available about potentially inappropriate medication use and is based on small studies with uncertain generalizability. OBJECTIVE: To estimate the prevalence and associated factors of potentially inappropriate medication use among elderly home care patients in European countries. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cross-sectional study of 2707 elderly patients receiving home care (mean [SD] age, 82.2 [ 7.2] years) representatively enrolled in metropolitan areas of the Czech Republic, Denmark, Finland, Iceland, Italy, the Netherlands, Norway, and the United Kingdom. Patients were prospectively assessed between September 2001 and January 2002 using the Minimum Data Set in Home Care instrument. MAIN OUTCOME MEASURES: Prevalence of potentially inappropriate medication use was documented using all expert panels criteria for community-living elderly persons (Beers and McLeod). Patient-related characteristics independently associated with inappropriate medication use were identified with a multiple logistic regression model. RESULTS: Combining all 3 sets of criteria, we found that 19.8% of patients in the total sample used at least 1 inappropriate medication; using older 1997 criteria it was 9.8% to 10.9%. Substantial differences were documented between Eastern Europe (41.1% in the Czech Republic) and Western Europe (mean 15.8%, ranging from 5.8% in Denmark to 26.5% in Italy). Potentially inappropriate medication use was associated with patient's poor economic situation (adjusted relative risk [RR], 1.96; 95% confidence interval [CI], 1.58-2.36), polypharmacy (RR, 1.91; 95% CI, 1.62- 2.22), anxiolytic drug use (RR, 1.82; 95% CI, 1.51-2.15), and depression (RR, 1.29; 95% CI, 1.06-1.55). Negatively associated factors were age 85 years and older (RR, 0.78; 95% CI, 0.65-0.92) and living alone (RR, 0.76; 95% CI, 0.64-0.89). The odds of potentially inappropriate medication use significantly increased with the number of associated factors (P<.001). CONCLUSIONS: Substantial differences in potentially inappropriate medication use exist between European countries and might be a consequence of different regulatory measures, clinical practices, or inequalities in socioeconomic background. Since financial resources and selected patient-related characteristics are associated with such prescribing, specific educational strategies and regulations should reflect these factors to improve prescribing quality in elderly individuals in Europe.