Homoprejudiced Violence Experiences and High-Risk Sexual Behaviors among Chinese Men Who Have Sex with Men: Depression Severity and Recreational Drug Usage as Potential Mediators.

Homoprejudiced violence is a type of aggression against an individual or a community based on their actual or perceived sexual orientation. It may be linked to risks of acquiring HIV/STI via psychosocial variables. This study explored the association between homoprejudiced violence experiences and high-risk sexual behaviors, and potential psychosocial mediators. Using cross-sectional survey data collected in China through Blued among men who have sex with men (MSM) in January 2021, this study conducted multiple mediation analyses. Standard instruments were used to collect data on depressive symptoms in the last two weeks (PHQ-9), recreational drug usage in the last three months, and ever experiencing homoprejudiced violence (12-item survey instrument). Dependent variables were having condomless anal sex and having three or more sexual partners in the last three months. Among 1828 MSM, nearly half (847, 46%) had experienced homoprejudiced violence. Twenty-three percent (427) reached a score that suggested moderate or severe depression and 35% (644) had used recreational drugs. In the last three months, 40% (731) had condomless anal sex and 34% (626) had three or more sexual partners. The indirect mediational coefficients through depression on condomless anal sex and multiple sexual partners were 0.04 (95% CI: [0.02, 0.07]) and 0.02 (95% CI: [0.001, 0.05]), respectively. The indirect mediational coefficient of homoprejudiced violence experience on multiple sexual partners through recreational drug use was 0.05 (95% CI: [0.03, 0.08]). These findings suggest that more comprehensive interventions are needed to address the syndemic of homoprejudiced violence, mental health issues, and HIV/STI-related risks.

The incidence and prevalence of proton pump inhibitor usage among internal medicine patients after hospital admission: A retrospective cohort study.

BACKGROUND: The use of proton pump inhibitors (PPIs) has increased over the past decades. One potential gateway into new PPI use is following a hospital admission. The study aimed to examine the incidence of new PPI usage following admission to internal medicine services and the ratio of new persistent users. METHODS: A retrospective descriptive study was conducted among all adults who had been admitted to internal medicine wards at the National University Hospital of Iceland from 2010-2020. Data was obtained from the Icelandic Internal Medicine Database. The proportion of patients who started treatment with PPI within 3 months of discharge (new users) and the proportion of patients who continued to use it after 3 months (persistent users) were examined. RESULTS: Among 85.942 admissions during the study period, 7238 (15.6%) became new users, and of those 4942 (68%) were new persistent users. The incidence of new PPI use was highest for patients discharged from gastroenterology (32.2%), hematology (31.8%), and oncology (29.2%). Patients with new PPI use more commonly had a history of malignancy (19.5%) and liver disease (22.7%) and more commonly were admitted to the ICU during their hospitalization. The highest ratio of persistent usage was among patients discharged from geriatric medicine (84%). CONCLUSION: One in every six patients admitted to internal medicine wards filled out a prescription for PPI within 3 months from discharge, and a large proportion of them became persistent users. The high rate of new PPI users from oncology and hematology is noteworthy and requires further research.

Evidence of shared genetic factors in the etiology of gastrointestinal disorders and endometriosis and clinical implications for disease management.

In clinical practice, the co-existence of endometriosis and gastrointestinal symptoms is often observed. Using large-scale datasets, we report a genetic correlation between endometriosis and irritable bowel syndrome (IBS), peptic ulcer disease (PUD), gastro-esophageal reflux disease (GORD), and a combined GORD/PUD medicated (GPM) phenotype. Mendelian randomization analyses support a causal relationship between genetic predisposition to endometriosis and IBS and GPM. Identification of shared risk loci highlights biological pathways that may contribute to the pathogenesis of both diseases, including estrogen regulation and inflammation, and potential therapeutic drug targets (CCKBR; PDE4B). Higher use of IBS, GORD, and PUD medications in women with endometriosis and higher use of hormone therapies in women with IBS, GORD, and PUD, support the co-occurrence of these conditions and highlight the potential for drug repositioning and drug contraindications. Our results provide evidence of shared disease etiology and have important clinical implications for diagnostic and treatment decisions for both diseases.

A Survey of Knowledge, Approaches, and Practices Surrounding Parasitic Infections and Antiparasitic Drug Usage by Veterinarians in Türkiye.

Despite a global background of increasing anthelmintic resistance in parasites, little is known about the current parasite control strategies adopted within the livestock industry in Türkiye. The aim of this survey is to identify the parasitic diseases encountered by veterinarians, the methods and drugs used for the diagnosis and treatment of these diseases, parasite control practices, and other related factors. This survey was conducted online between October 2018 and March 2019 with the participation of 607 veterinarians working in different areas from seven different geographical regions of Türkiye. A total of 29 questions were posed to the veterinarians in the online survey. As a result of this survey, it was determined that veterinarians should utilize laboratory methods more frequently for the detection and diagnosis of parasitic diseases and anthelmintic resistance. It was concluded that to effectively implement diagnosis, prevention, and control measures for parasitic diseases, field veterinarians need to establish closer relationships within academia and increase their participation in national and international conferences, symposia, and workshops where knowledge sharing and exchange take place. In conclusion, antiparasitic drug resistance has become increasingly important recently, and therefore measures taken to prevent the development of resistance should be increased.

Innovative perspectives in limbic surgery using deep brain stimulation.

Limbic surgery is one of the most attractive and retaken fields of functional neurosurgery in the last two decades. Psychiatric surgery emerged from the incipient work of Moniz and Lima lesioning the prefrontal cortex in agitated patients. Since the onset of stereotactic and functional neurosurgery with Spiegel and Wycis, the treatment of mental diseases gave attention to refractory illnesses mainly with the use of thalamotomies. Neurosis and some psychotic symptoms were treated by them. Several indications when lesioning the brain were included: obsessive-compulsive disorder, depression, and aggressiveness among others with a diversity of targets. The indiscriminately use of anatomical sites without enough scientific evidence, and uncertainly defined criteria for selecting patients merged with a deficiency in ethical aspects, brought a lack of procedures for a long time: only select clinics allowed this surgery around the world from 1950 to the 1990s. In 1999, Nuttin et al. began a new chapter in limbic surgery with the use of Deep Brain Stimulation, based on the experience of pain, Parkinson's disease, and epilepsy. The efforts were focused on different targets to treat depression and obsessive-compulsive disorders. Nevertheless, other diseases were added to use neuromodulation. The goal of this article is to show the new opportunities to treat neuropsychiatric diseases.

Impact of ward pharmacist-led antimicrobial stewardship in intensive care units.

Various outcomes of mortality, medical costs, and antimicrobial usage result from antimicrobial stewardship (AS) programmes. Here, we clarified the effects of AS implementation by a well-trained pharmacist in an open intensive care unit (open ICU) through a retrospective, comparative study of 5123 open ICU patients of Tokai University Hospital. The 12 months before and after AS implementation were considered the control and study periods, respectively. After AS implementation, the number of AS cases increased significantly. The period until the implementation of therapeutic drug monitoring was significantly shortened, and antimicrobial drug usage increased significantly. The methicillin-resistant Staphylococcus aureus (MRSA) detection rate decreased significantly. Earlier and more frequent AS implementation could enhance treatment effects, possibly decreasing the MRSA incidence. Despite active AS implementation, antimicrobial drug usage did not necessarily decrease. ICU pharmacists with experience in AS should take on leadership roles and implement active AS strategies in open ICU settings.

Practice of precise management of antibiotics in a children′s hospital in combination with key performance indicators / 中华医院管理杂志

Bacterial infection is the main cause of infectious diseases in children. Antibacterials play an important role in anti infection treatment of children. At present, the treatment of antimicrobial drugs in children is facing a severe situation of bacterial resistance. In January 2020, a children′s specialized hospital carried out the practice of precise management of antibiotics in combination with key performance indicators. Through the multi sectoral linkage of management and technology, eight key performance indicators and assessment methods were set up from three levels of antibiotic use, bacterial resistance and hospital infection, to standardize the clinical application of antibiotics and continue to promote the rational use of antibiotics. This practice had improved the performance indicators of antibacterial management. Among them, the use intensity of antibacterial drugs for inpatients decreased from 40.07 DDD in 2019 to 29.00 DDD in 2021, the use rate of antibacterial drugs for inpatients decreased from 81.32% to 64.40%, the percentage of antibacterial drug expenses in total drug expenses decreased from 35.41% to 26.82%, the use proportion of non restricted antibacterial drugs in antibacterial drugs increased from 71.30% to 82.21%, and the drug resistance rate of Salmonella to β-Lactam/enzyme inhibitors decreased from 4.84% to 0.03%, and the incidence of hospital infection decreased from 1.16% to 0.96%. The precise management of antibiotics in combination with key performance indicators improved the level of rational use of antibiotics, effectively curbed bacterial resistance, achieved phased results, so as to provide a reference for the scientific management of antibiotics in children′s hospitals.

Most common inappropriate drug usage factors in anthelmintic treatment on sheep farms in Latvia.

Background and Aim: There is little understanding about antiparasitic drug prescription trends and implementation to reduce possible drug overuse or misuse worldwide. This study aimed to review sheep parasite control strategies and antiparasitic drug use habits in Latvia. To the best of the author's knowledge, this is the first study in the world that describes how antiparasitic drugs are used and what are the most common drug usage errors in a sheep farm. Materials and Methods: A semi-structured questionnaire was designed to collect relevant information from face-to-face interviews to assess 22 sheep farmers' knowledge and management procedures in farms. We collected information about animal feeding, herding, parasite diagnostics, and antiparasitic drug usage. The questionnaire summary included information on pasture use, parasite control management, and anthelmintic drug choice/use. Results: Only 36% of farms regularly managed parasite control by analyzing fecal samples for parasites, but prophylactic dewormingwas employed in all farms. Ivermectin, albendazole, levamisole, and monepantel were used on the farms and most of the farms were multidrug users; 77.3% of the farms used albendazole and 72.7% used ivermectin. Conclusion: The results indicated a lack of parasitological examination and parasite control of the flock, mostly empiric drug selection, incorrect dosing, inaccurate drug administration, drug storage, and use errors. A proactive approach to herd health planning, regular parasitic control, and prophylactic measures may benefit farmers and veterinarians.

Forecasting of Future Medical Care Expenditure in Japan Using a System Dynamics Model.

BACKGROUND: The aim of this study was to construct a system dynamics (SD) model to estimate the future medical care expenditure and to address the dynamic issues of health care that should be resolved. In particular, the measures for promoting the spread of generic drug (GE drug) usage in Japan and reducing cancer-related medical expenses were investigated regarding their future impact on medical finances. METHODS: The SD model was constructed from FY 2018 to FY 2050. The change in the future GE drug quantity share was analyzed by using a regression equation. The impact of the increase in medical expense for cancer and the change in the future national medical care expenditure were also estimated. RESULTS: The annual total medical care expenditure in FY 2050 would arrive at 58.9-64.2 trillion JPY (US$ 535.1-584.0 billion) (1.3-1.5 times higher than that in FY 2018) with different trends in age groups. The cumulative total medical care expenditure was expected to decrease by about 787.0-989.4 billion JPY (US$ 7.2-9.0 billion) if the impact of the spread of GE drug usage was considered. On the other hand, due to the continuous increase in the cancer-related medical expense, the cumulative total medical care expenditure was estimated to increase about 7554.3-11715.0 billion JPY (US$ 68.7-106.5 billion). CONCLUSIONS: If the cancer-related medical expense continues to increase in the future, an increase of 686.4-1104.2 billion JPY (US$ 6.2-10.0 billion) in FY 2050 is expected which suggests that this disease field should be prioritized regarding the measures to maintain medical finances.

Optimization assisted Kalman filter for cancer chemotherapy dosage estimation.

Cancer is regarded to be the earth's most deadly disease, with one of the highest mortality rates among people. "Surgery, radiotherapy, chemotherapy, hormone therapy, and immunotherapy" were all options for treat cancer. Chemotherapy is a medication that is most often deployed for treating cancer, as cancer cells develop and proliferate faster than other cells in the body. Even though chemotherapy is an effective method to treatment various kinds of cancers, the treatment includes risk as it causes side effects due to improper drug usage. The application of a controller-based strategy for determining the optimal rate of drug injection during treatment has risen dramatically in recent years. Thereby, this work develops a robust controller for controlling the dosage of drugs that is carried out under parameter estimation. In addition, a Modified Regularized Error Function-based Extended Kalman filter (MREF-EKF) is introduced for estimating the tumor cells and it can be exploited for diverse conditions. Moreover, the overfitting issue that occurs during drug dosage estimation is also solved using this approach. Further, to improve the performance of the developed approach, the initial state of EKF is fine-tuned via Mean fitness-based Particle Swarm Update (MF-PSU), which is the enhanced version of Particle Swarm Optimization (PSO). At last, the supremacy of the presented approach is proved with respect to convergence analysis and error analysis. For instance, our method outperforms existing GWO + ek + m, AGWO + ek + m, and PSO + ek + m approaches in convergence analysis at noise level 0.41 by 0.009%, 0.002%, and 4.9% respectively. In error analysis, the error values for tumor cells have reached a minimum error value of zero for all noise levels (0.41, 0.43, and 0.55). The findings of this study can help for a better understanding of our presented robust controller's effectiveness in controlling the dosage of drugs.

A Cross-Sectional Study on Single-Day Use of Proton Pump Inhibitors in Tertiary Care Hospitals of South India.

Background: Proton pump inhibitors (PPIs) are the most potent antacids used in clinical practice with greater safety and efficacy. Limited data are available on the usage of PPIs in Indian health-care settings. Our aim was to understand the usage pattern and potential drug interactions with concurrently administered medications employing a single-day cross-sectional study design. Methods: A prospective observational cross-sectional study conducted on a single day, at two tertiary care teaching hospitals in South India. Inpatients of above 18 years of age were included. Case profiles were reviewed and data were collected in predesigned forms and analyzed. Drug interactions were identified using Micromedex and Medscape drug-interaction databases. Results: A total of 797 case profiles screened from both the centers; 714 were prescribed with PPIs. In intensive care units (ICUs), the use of PPIs was highest with 95% of cases getting these drugs. A PPI was seen in about 93% of patients, who had more than or equal to 4 drugs in their prescriptions. Pantoprazole was the mostly prescribed PPI in around 90% of the cases. Around 33% of the PPIs usage was through IV (intravenous) route, and 75% of that use was seen in wards. Around 134 drug interactions were identified, of which 10 were of major severity. Conclusions: Around 90% of inpatients were prescribed with PPIs. Pantoprazole is the most commonly prescribed PPI (90%). The IV administration was seen more in wards than ICUs, and 10 major drug interactions were observed in this single-day study. Careful monitoring is needed to avoid serious drug interactions involving PPIs, and training programs should sensitize the clinicians on the evidence-based use of PPIs.

Burnout Syndrome and Consumption of Alcohol and Illicit Substances in University Students / Síndrome de Burnout e Consumo de Álcool e Substâncias Ilícitas em Universitários / Síndrome de Burnout y Consumo de Alcohol y de Sustancias Ilícitas por Universitarios

Abstract The consumption of alcohol and illicit substances has shown alarming levels among young university students, and its use may be associated with the coping strategy of academic burnout. This review aimed to synthesize the scientific evidence related to the consumption of alcohol and illicit substances associated with burnout syndrome in university students. Searches were carried out in: Biblioteca Virtual em Saúde, PubMed, Web of Science, PsycNet and Scopus databases, with no year limitation and based on the PRISMA guideline. Among the 2.269 articles identified, 16 met the inclusion criteria. All studies evaluated students in the health area, 12 studies found an association between the variables, with alcohol and illicit substances consumption strongly related to burnout syndrome. It was concluded that there is an association between the studied variables, indicating that the presence of burnout syndrome in university students can result in the use of negative strategies as a coping measure.

Resumo O consumo de álcool e substâncias ilícita tem apresentado níveis alarmantes entre jovens universitários, e seu uso pode estar associado à estratégia de enfrentamento do burnout acadêmico. Esta revisão teve por objetivo sintetizar as evidências científicas relacionadas ao consumo de álcool e substâncias ilícitas associadas a síndrome de burnout em estudantes universitários. Foram realizadas buscas nas bases: Biblioteca Virtual em Saúde, PubMed, Web of Science, PsycNet e Scopus, sem limitação de ano e baseado na guia PRISMA. Entre os 2.269 artigos identificados, 16 atenderam aos critérios de inclusão. Todos os estudos avaliaram estudantes da área da saúde, 12 estudos encontraram associação entre as variáveis, sendo o consumo de álcool e substâncias ilícitas fortemente relacionado à sindrome de burnout. Concluiu-se que há associação entre as variáveis estudadas, indicando que a presença da síndrome de burnout em universitários pode resultar no uso de estratégias negativas como medida de enfrentamento.

Resumen El consumo de alcohol y de sustancias ilícitas ha mostrado niveles alarmantes entre los jóvenes universitarios, y su uso puede estar asociado con estrategias de enfrentamiento del burnout académico. Esta revisión tuvo como objetivo sintetizar la evidencia científica relacionada con el consumo de alcohol y de sustancias ilícitas asociadas al síndrome de burnout en estudiantes universitarios. Las búsquedas se realizaron en las bases Biblioteca Virtual en Salud, PubMed, Web of Science, PsycNet y Scopus, sin limitación de año y basándose en la guía PRISMA. De los 2.269 artículos encontrados, 16 cumplieron los criterios de inclusión. Todos los estudios evaluaron estudiantes del área de salud y 12 estudios encontraron asociación entre las variables, entre los que el consumo de alcohol y de sustancias ilícitas estuvo fuertemente relacionado con el síndrome de burnout. Se concluyó que existe asociación entre las variables estudiadas, indicando que la presencia de síndrome de burnout en estudiantes universitarios puede resultar en el uso de estrategias negativas como medida de enfrentamiento.

Developing and Testing the Populi Needle Exchange Point Finder: An App to Reduce Harm Associated With Intravenous Drug Consumption Among Homeless and Non-homeless Drug Users.

The spread of viral infections remains a serious public health problem. People who inject drugs represent one of the highest-risk groups. eHealth and mHealth have been shown to be effective in improving individuals' management of their own health and their access to health care and to contribute to reducing the costs associated with certain medical interventions. People who inject drugs, including homeless people, tend to have access to technology. Young homeless people in particular are likely to use smartphones and social networking sites in ways that are similar to the general population. Despite this widespread use of technology, there are no apps designed specifically to reduce harm in people who inject drugs. The objective of this study is to analyze the development and usability testing process for an application for mobile devices, designed to complement the Needle Exchange Program. This app-the first of its kind-was developed by a public health agency, specialized professionals and people who inject drugs. We analyzed the differences in how health providers and drug users experienced the usability of the app. The participants were 61 members of multidisciplinary professional group and 16 people who inject drugs. We used a cross-sectional quantitative, observational design. First, we created and administered a questionnaire to collect the sociodemographic characteristics that could mediate the use of technology. Next participants tried the app and filled out a second questionnaire in which they rated their experience on a Likert scale from 1 to 7 in the following dimensions: overall attractiveness of the app, ease/difficulty of use, the extent to which they believed the app could improve access to injection materials, the extent to which they thought it would improve PWID's participation in the needle exchange program, overall utility, the degree to which they thought PWID would use the app, and the need for the app. To analyze the answers, we used contingency tables and compared means using a Student's t test. Finally, we conducted six audio-recorded focus groups about how the participants experienced the usability of the app. The objective of this part of the study was to classify and quantify the contributions of individuals and the group according to three predefined categories: potential benefits and positive aspects, potential obstacles or difficulties in carrying out the project, and concrete suggestions for improving the interface. There were not significant differences between the sociodemographic variables and the variables related to use of the app between professionals and PWID. Both professionals and PWID rated the app as intuitive and useful, especially the geolocation function for NEPs. Both groups also thought that the interface contained too much information and that this excess could be confusing for users. Both groups also had similar opinions about the app and its uses. An important difference between the two groups is that PWID reported that they would use the app, while professionals reported that they didn't think PWID would use it. All participants proposed improvements on the prototype, suggestions that will be applied in the creation of the definitive interface. Including professionals and patients in this sort of usability test enables researchers and developers to detect the needs of potential app users.

Uso de álcool e outras substâncias psicoativas por estudantes universitários de psicologia / Use of alcohol and other psychoactive substances by psychology students / Uso de alcohol y otras sustancias psicoactivas por estudiantes universitarios de psicología

O consumo de substâncias psicoativas (SPAs) cresce em escala global, especialmente entre universitários. Este estudo tem como objetivo avaliar o padrão de uso de álcool e outras SPAs em estudantes universitários. A amostra foi composta por 180 graduandos de Psicologia que preencheram um questionário sociodemográfico e instrumentos de rastreamento do uso de SPAs validados para o contexto brasileiro. Os resultados evidenciaram maior prevalência do uso de álcool: 81,7% na vida, 67,6% nos últimos três meses e 55% no padrão binge. Dentre os motivos endossados para o consumo destaca-se o convívio universitário, porém o fator mais valorizado foi o álcool como potencializador do desejo de fumar, seguido de sua percepção como fator gregário em festas/reuniões sociais e como facilitador do enfrentamento de estresse. As pressões da vida universitária geram insegurança e instabilidade que deixam os jovens universitários mais suscetíveis à influência dos pares e à busca de diversão e descontração em ambientes de festas, nas quais o consumo é estimulado e facilitado, o que pode favorecer o beber em quantidade excessiva. Esse padrão de consumo pode se associar a outros comportamentos de risco, como dirigir sob efeito do álcool, manter relações sexuais sem proteção ou envolver-se em distúrbios da ordem pública e infrações à lei. Considerando que os jovens fazem uso em excesso de SPAs sem um suporte social comunitário adequado, é necessário investir em programas de prevenção e políticas públicas guiadas pelas noções de autocuidado, protagonismo e participação ativa na própria reabilitação...(AU)

The consumption of psychoactive substances (SPAs) grows worldwide, especially among university students. This study evaluated the pattern of alcohol use and other SPAs in psychology students. The sample consisted of 180 Psychology undergraduates who filled out a sociodemographic questionnaire and instruments for tracking the use of SPAs validated for the Brazilian context. The results showed a higher prevalence of alcohol use: 81.7% in life, 67.6% in the last three months and 55% following a binge pattern. Among the reasons endorsed for the consumption stand out university conviviality, but the most valued factor was alcohol as a potentiator of the desire to smoke, followed by its perception as a gregarious factor in parties/social gatherings and as a facilitator to cope with stress situations. The pressures of university life create insecurity and instability, which make university students more susceptible to peer influence and the search for fun and relaxation in party environments where drinking is stimulated and facilitated, which may favor binge drinking. This pattern of consumption may be associated to other risk behaviors, such as driving under the influence of alcohol, having unprotected sex, or engaging in public order disturbances and infractions of the law. Considering that these young people make excessive use of SPAs without adequate social and community support, it is necessary to invest in prevention programs and public policies guided by the notions of self-care, protagonism and active participation in self rehabilitation...(AU)

El consumo de sustancias psicoactivas (SPA) crece a escala global, especialmente entre universitarios. Este estudio tuvo como objetivo evaluar el patrón de uso de alcohol y otras SPA por estudiantes universitarios. Compusieron la muestra 180 estudiantes de graduación en Psicología, que respondieron a un cuestionario sociodemográfico e instrumentos de rastreo del uso de SPA validados para el contexto nacional. Los resultados evidenciaron mayor prevalencia del uso de alcohol: el 81,7% en la vida, el 67,6% en los últimos tres meses y el 55% en el patrón binge. Entre los motivos endosados para el consumo se destaca la convivencia universitaria, pero el factor más valorado fue el alcohol como potenciador del deseo de fumar, seguido de su percepción como factor gregario en fiestas/reuniones sociales y como facilitador del enfrentamiento de situaciones de estrés. Las presiones de la vida universitaria generan inseguridad e inestabilidad que dejan a los jóvenes universitarios más susceptibles a la influencia de los pares y a la búsqueda de diversión y relajación en fiestas y discotecas donde se estimula y facilita el consumo de alcohol, lo que puede favorecer la costumbre de beber en cantidad excesiva. Ese patrón de consumo puede asociarse a otros comportamientos de riesgo, como conducir bajo el efecto del alcohol, mantener relaciones sexuales sin protección o involucrarse en disturbios del orden público e infracciones a la ley. Considerando que estos jóvenes hacen uso excesivo de SPA sin un soporte social-comunitario adecuado, son necesarios programas de prevención y políticas públicas guiadas por las nociones de autocuidado, protagonismo y participación activa en la propia rehabilitación...(AU)

Pre-fracture medication use as a predictor of 30-day mortality in hip fracture patients: an analysis of 141,201 patients.

PURPOSE: To evaluate the predictive value of pre-fracture medication usage on 30-day mortality following a hip fracture. METHODS: Information on age, sex, fracture type, time of death and Charlson co-morbidity index (CCI) was collected from the Danish National Patient Registry on all patients above 60 years, sustaining a hip fracture during the period January 1995 to December 2013. Information on drug usage was obtained from the Danish National Prescription Database. Hazard ratios were calculated with 30-day mortality as the outcome. A univariate and 3 multivariate analyses were conducted with increasing adjustments, starting with age, sex and fracture type, adding co-morbidity and dose in the latter. RESULTS: 141,201 patients were included and a total of 12 drugs/drug groups were identified for analysis. Increased mortality was evident in all analyses for antiarrhythmics, beta blockers, proton pump inhibitors, loop diuretics, opioids, acetaminophen and for psycholeptics. For ACE-inhibitors, increased mortality was found in all analyses, except after adjustment for co-morbidity and dose. For thiazide diuretics, a significantly reduced mortality was evident in all but the univariate analyses while NSAIDs and statins were associated with a significantly reduced mortality in all analyses. For calcium channel blockers, an insignificant decrease was found after adjustment for dose. Further analysis showed a dose-response relationship for all drugs except ACE-inhibitors and calcium channel blockers. CONCLUSION: The study shows a correlation between pre-fracture usage of certain drugs and 30 day mortality after a hip fracture.

Antimicrobial Usage Among Different Age Categories and Herd Sizes in Swiss Farrow-to-Finish Farms.

In the Swiss pig sector, the usage of antimicrobials has been recorded, evaluated and systematically reduced on a voluntary basis since 2015. This monitoring has been carried out using various methods thereby enabling continuous national scrutiny as well as international comparisons. To gain a better understanding of the dynamics of the antimicrobial usage on Swiss farms, consumption data of farrow-to-finish farms were analyzed for (i) the within-herd relationships among different age categories and (ii) the influence of the herd size. The data were collected on 71 farms for the year 2017, encompassing the amount of active ingredients and number of defined daily doses Switzerland (nDDDch) in total, and stratified for the different age categories of piglets, weaners, fattening pigs, and sows. The differences in nDDDch per animal among the age categories were determined by a Wilcoxon test and subsequent post-hoc analysis according to Bonferroni. The within-herd relationship among the individual age categories as well as the influence of the herd size on nDDDch per animal measured as kept sows were analyzed by simple linear regression. The evaluation of the treatment days showed that 50% of the nDDDch were used in piglets, 44% for weaners, and 3% each for fattening pigs and sows. Compared to the other age categories, the examination of the number of nDDDch per animal showed a significantly higher number for sows, whereas for fattening pigs the number was significantly lower (P < 0.01). The farm-based analysis using linear regression showed a relationship between antimicrobial usage in sows and piglets (P < 0.001; adj. R 2 = 0.19). Similarly, a significant relationship between larger herd size and increased antimicrobial usage was observed (P = 0.02; adj. R 2 = 0.06). The present study provides an insight into the antimicrobial treatment dynamics of farrow-to-finish farms. In particular, the age categories piglets and sows-with their higher number of treatment days in total or per animal-are of interest regarding the potential reduction in antimicrobial usage. Likewise, larger farms with higher management requirements were found to be of particular importance for the reduction of antimicrobial usage. Monitoring programs should therefore evaluate different age categories separately to identify problems for individual farms.

Antimicrobial Drug Consumption on Swiss Pig Farms: A Comparison of Swiss and European Defined Daily and Course Doses in the Field.

Defined Daily Doses (DDD) and Defined Course Doses (DCD) have been established in both human and veterinary medicine in order to standardize the measurement of treatments in a population. In 2016 the European Medicines Agency published average defined daily dose (DDDvet) and defined course dose (DCDvet) values for antimicrobial agents used in livestock production. Similarly, national defined doses (DDDch and DCDch) for the pig sector in Switzerland have recently been determined. The aim of this study was to compare the outcome of calculating antimicrobial consumption based on either DDDvet/DCDvet or DDDch/DCDch. Data from 227 Swiss pig farms describing antimicrobial use in 2015 was collected. The numbers of treatment days and treatments were calculated using DDDvet/DCDvet and DDDch/DCDch respectively, for each farm in total and for different antimicrobial classes. Associations between calculated numbers of DDDvet/DCDvet and DDDch/DCDch on farm level were investigated. In addition, differences concerning antimicrobial use were investigated between different production types of farms (piglet-producer, finishing farm or farrow-to-finishing farm). Using DDDch/DCDch values we calculated 1,805,494 treatment days and 433,678 treatments compared to 1,456,771 treatment days (19% ratio) and 303,913 treatments (30% ratio) based on DDDvet/DCDvet. Penicillins (21.4/26.6%), polypeptides (18.6/27.6%) and fluoroquinolones (9.5/8.8%) were the most frequently used classes of antimicrobials based on calculation using both DDDch and DDDvet. Similar findings were observed for complete treatments (DCDch/vet) (penicillins: 52.8/39.6%; polypeptides: 7.8/14.2%; fluoroquinolones: 13.2/12.9%). The number of treatment days or treatments per farm was higher for piglet-producers and farrow-to-finishing farms compared to finisher farms regardless of whether Swiss or European DDD or DCD values were used for the calculation (each P < 0.001). Similar results for antimicrobial use (AMU) obtained at farm level were observed when calculated either by Swiss or European definitions. Nevertheless, marked differences could be observed in the assessment of the use of specific antimicrobial classes in the field based on DDDvet/DCDvet compared to DDDch/DCDch.

Increasing Prevalence of ESBL-Producing Multidrug Resistance Escherichia coli From Diseased Pets in Beijing, China From 2012 to 2017.

We investigated antimicrobial resistance trends and characteristics of ESBL-producing Escherichia coli isolates from pets and whether this correlates with antibiotic usage in the clinic. Clinical samples containing E. coli from diseased cats and dogs were screened for antibiotic sensitivity and associated genotypic features. We identified 127 E. coli isolates from 1886 samples from dogs (n = 1565) and cats (n = 321) with the majority from urinary tract infections (n = 108, 85%). High rates of resistance were observed for ß-lactams and fluoroquinolones and resistance to > 3 antibiotic classes (MDR) increased from 67% in 2012 to 75% in 2017 (P < 0.0001). This was especially true for strains resistant to 6-9 antibiotics that increased from 26.67 to 60.71%. Increased rates in ß-lactam use for clinical treatment accompanied these increasing resistance rates. Accordingly, the most frequently encountered subtypes were bla CTX-M (n = 44, 34.65%), bla CTX-M-65 (n = 19) and bla CTX-M-15 (n = 18) and qnrB (n = 119, 93.70%). The bla CTX-M-isolates possessed 36 unique pulsed field electrophoretic types (PFGEs) and 28 different sequence types (STs) in ST405 (7, 15.9%), ST131 (3, 6.8%), ST73, ST101, ST372, and ST827 (2, 4.5% each) were the most prevalent. This data demonstrated a high level of diversity for the bla CTX-M-positive E. coli isolates. Additionally, bla NDM-5 was detected in three isolates (n = 3, 2.36%), comprised of two ST101 and one ST405 isolates, and mcr-1 was also observed in three colistin-resistant E. coli with three different STs (ST6316, ST405, and ST46). Our study demonstrates an increasing trend in MDR and ESBL-producing E. coli and this correlated with ß-lactam antibiotic usage for treatment of these animals. This data indicates that there is significant risk for the spread of resistant bacteria from pets to humans and antibiotic use for pets should be more strictly regulated.

Successful treatment of intravenous drug use-related pigmentation with Q-switched Alexandrite laser: a case report of two patients.

Patients with a history of intravenous drug usage (IVDU) often develop pathognomonic linear hyperpigmented dermatoses near injection sites. This drug use-related pigmentation can be very distressing for patients as they persist for life, are very difficult to treat, and remain a constant reminder of prior drug usage. The difficulty of treatment is due to the location of the deposited material and its exogenous nature. This article reports two cases of linear hyperpigmentation due to IVDU successfully treated using the Q-switched Alexandrite laser.

Perceived Risk, Expected Benefits and Pig Farmers' Behaviors of Veterinary Drug Usage.

To guarantee the pork quality and safety and the steady development of the pig-breeding industry in China, it is important to control veterinary drugs usage in the pig farming sector. In order to develop an effective intervention that control veterinary drug usage, it is important to perform an in-depth analysis of those factors that can affect the standardized use of veterinary drugs in the pig-breeding process. In this paper, hierarchical regression analysis is used to examine how perceived risk, expected benefits, and self-efficacy influence on the standardized use of veterinary drugs. Data were collected using a multi-stage sampling method from four provinces in China. The results show that expected benefit and self-efficacy have positive impacts on the standardized use of veterinary drugs. Self-efficacy significantly moderated the positive relationships between expected benefits and the negative relationships between perceived risk and standardized use of veterinary drugs.