Search

Background: The Medicines Intelligence (MedIntel) Data Platform is an anonymised linked data resource designed to generate real‐world evidence on prescribed medicine use, effectiveness, safety, costs and cost‐effectiveness in Australia. Results: The platform comprises Medicare‐eligible people who are ≥18 years and residing in New South Wales (NSW), Australia, any time during 2005–2020, with linked administrative data on dispensed prescription medicines (Pharmaceutical Benefits Scheme), health service use (Medicare Benefits Schedule), emergency department visits (NSW Emergency Department Data Collection), hospitalisations (NSW Admitted Patient Data Collection) plus death (National Death Index) and cancer registrations (NSW Cancer Registry). Data are currently available to 2022, with approval to update the cohort and data collections annually. The platform includes 7.4 million unique people across all years, covering 36.9% of the Australian adult population; the overall population increased from 4.8 M in 2005 to 6.0 M in 2020. As of 1 January 2019 (the last pre‐pandemic year), the cohort had a mean age of 48.7 years (51.1% female), with most people (4.4 M, 74.7%) residing in a major city. In 2019, 4.4 M people (73.3%) were dispensed a medicine, 1.2 M (20.5%) were hospitalised, 5.3 M (89.4%) had a GP or specialist appointment, and 54 003 people died. Anti‐infectives were the most prevalent medicines dispensed to the cohort in 2019 (43.1%), followed by nervous system (32.2%) and cardiovascular system medicines (30.2%). Conclusion: The MedIntel Data Platform creates opportunities for national and international research collaborations and enables us to address contemporary clinically‐ and policy‐relevant research questions about quality use of medicines and health outcomes in Australia and globally. [ABSTRACT FROM AUTHOR]

Background and aims: New therapeutic options such as lisdexamfetamine and guanfacine have recently become available for the treatment of attention deficit hyperactivity disorder. We described contemporary patterns of attention deficit hyperactivity disorder medicine use among children, adolescents and adults in Australia. Methods: This population-based study used dispensing data for a 10% random sample of Australian residents between July 2012 and December 2020. We estimated the annual prevalence and incidence of attention deficit hyperactivity disorder medicines, second-line guanfacine use and examined concurrent medicine use of both stimulants and non-stimulants. We followed incident users for up to 5 years and analysed treatment persistence using a novel proportion of people covered method. Analyses were stratified by attention deficit hyperactivity disorder medicine, sex and age group; young children (0–5 years), children (6–12 years), adolescents (13–17 years), young adults (18–24 years) and adults (⩾25 years). Results: We observed a twofold increase in the overall prevalence of attention deficit hyperactivity disorder medicine use between 2013 and 2020, from 4.9 to 9.7 per 1000 persons. Incident use also increased across all age groups and both sexes, with the most pronounced increases among adolescent females (from 1.4 to 5.3 per 1000 persons). Stimulant treatment persistence after 5 years was highest among those initiating treatment as young children (64%) and children (69%) and lowest among those initiating treatment in adolescence (19%). Concurrent use of stimulants and non-stimulants was more common among males and younger age groups. Most children (87%) initiating guanfacine had prior dispensings of attention deficit hyperactivity disorder medicines. Conclusion: We observed increasing attention deficit hyperactivity disorder medicine use in Australia, especially among young females. Nevertheless, treatment rates remain lower than the estimated prevalence of attention deficit hyperactivity disorder across all subpopulations. Poor long-term treatment persistence in adolescence may warrant improved clinical monitoring of attention deficit hyperactivity disorder in patients transitioning from paediatric to adult care. Reassuringly, use of newly approved guanfacine appeared to be in accordance with guidelines among children. [ABSTRACT FROM AUTHOR]

Background: Medicine prescribing for children is impacted by a lack of paediatric‐specific dosing, efficacy and safety data for many medicines. Objectives: To estimate the prevalence of medicine use among children and the rate of 'off‐label' prescribing according to age at dispensing. Methods: We used population‐wide primarily outpatient dispensing claims data for 15% of Australian children (0–17 years), 2013–2017 (n = 840,190). We estimated prescribed medicine use and 'off‐label' medicine use according to the child's age (<1 year, 1–5 years, 6–11 years, 12–17 years) defined as medicines without age‐appropriate dose recommendations in regulator‐approved product information. Within off‐label medicines, we also identified medicines with and without age‐specific dose recommendations in a national prescribing guide, the Australian Medicines Handbook Children's Dosing Companion (AMH CDC). Results: The overall dispensing rate was 2.0 dispensings per child per year. The medicines with the highest average yearly prevalence were systemic antibiotics (435.3 per 1000 children), greatest in children 1–5 years (546.9 per 1000). Other common medicine classes were systemic corticosteroids (92.7 per 1000), respiratory medicines (91.2 per 1000), acid‐suppressing medicines in children <1 year (47.2 per 1000), antidepressants in children 12–17 years (40.3 per 1000) and psychostimulants in children 6–11 years (27.0 per 1000). We identified 12.2% of dispensings as off‐label based on age, but 66.3% of these had age‐specific dosing recommendations in the AMH CDC. Among children <1 year, off‐label dispensings were commonly acid‐suppressing medicines (35.5%) and topical hydrocortisone (33.1%); in children 6–11 years, off‐label prescribing of clonidine (16.0%) and risperidone (13.1%) was common. Off‐label dispensings were more likely to be prescribed by a specialist (21.7%) than on‐label dispensings (7.5%). Conclusions: Prescribed medicine use is common in children, with off‐label dispensings for medicines without paediatric‐specific dosing guidelines concentrated in classes such as acid‐suppressing medicines and psychotropics. Our findings highlight a need for better evidence to support best‐practice prescribing. [ABSTRACT FROM AUTHOR]

Background: Children who are relatively young for their school grade are more likely to receive treatment for attention-deficit/hyperactivity disorder (ADHD). It is unclear whether the phenomenon also exists across Australia or is impacted by the school enrolment policy in place. Objective: We evaluated the association between children's relative age and initiation of ADHD medicines across Australian jurisdictions with different school enrolment policies and rates of delayed school entry. Methods: We used Australia-wide dispensing data for a 15% random sample of children 4-9 years of age in 2013-2017 to create a nationwide cohort. Due to high rates of delayed school entry in New South Wales (NSW), we used linked prescribing and education data for a cohort of NSW residents starting school in 2009 and 2012. We estimated incidence rate ratios (IRRs) for ADHD medicine across children's birth month, sex, and jurisdiction. We used asthma medicines as a negative control. Results: For girls, we observed a relative age effect in three out of five jurisdictions, with an IRR ranging from 1.3 to 2.8, comparing the youngest versus oldest birth month thirds. We observed more modest effects among boys, ranging from null to 1.5-fold. In NSW, the relatively youngest boys were less likely to initiate stimulant medicines than the oldest (IRR = 0.5, 95% confidence interval 0.29-0.78). We did not observe a relative age effect for initiation of asthma medicines. Conclusions: In jurisdictions with low rates of delayed entry, relatively young children were more likely to initiate ADHD medicines than their older classmates. We observed the inverse association in NSW where delayed entry was highest, likely reflecting the characteristics and needs of children who delay school entry for 1 year and become the oldest children in the grade. Increased awareness around children's maturity differences and school readiness may enhance appropriate diagnosis and treatment of ADHD. [ABSTRACT FROM AUTHOR]

Aim: In May 2019, Australia's Pharmaceutical Benefits Scheme (PBS) tightened the prescribing restrictions for publicly subsidized high and standard strength proton‐pump inhibitors (PPIs). We aimed to determine the impacts on PPI use in Australia. Methods: Population‐based interrupted time series analysis of PBS dispensing claims for a 10% sample of PBS‐eligible Australian residents from January 2017 to December 2020 and national prescription and over‐the‐counter sales to pharmacies from January 2017 to October 2020. We examined trends in monthly PPI dispensings, switches from higher to lower strength formulations, and volume (kg) dispensed and sold. Results: From May 2019, we observed a small, immediate decrease (−7830 [95%CI: −8818 to −6842]) in standard strength PPI dispensings/month, which rebounded to exceed pre‐intervention levels by December 2020. High strength dispensings decreased until the end of the study period to less than half their pre‐intervention average/month; low strength dispensings/month increased until the end of the study period to more than double their pre‐intervention average/month. We observed transient increases in switches to lower strength formulations post‐intervention. The kilograms of PPIs sold/month followed a similar pattern to PBS kilograms dispensed/month with the exception of standard strength formulations where PBS dispensings decreased by −74 (95%CI: −93 to −55) but total sales remained unchanged (comprising PBS and private prescriptions, and over‐the‐counter sales). Conclusions: Tightened prescribing restrictions had an immediate and sustained impact on PPI use in Australia, with decreased high strength use and increased low strength use. Some patients likely switched to private market prescriptions for standard strength PPI, given the observed patterns in total volume sold/dispensed. [ABSTRACT FROM AUTHOR]

Routinely collected data have been increasingly used to assess long‐term opioid therapy (LTOT) patterns, with very little guidance on how to measure LTOT from these data sources. We conducted a systematic review of studies published between January 2000 and July 2019 to catalogue LTOT definitions, the rationale for definitions and LTOT rates in observational research using routinely collected data in nonsurgical settings. We screened 4056 abstracts, 210 full‐text manuscripts and included 128 studies, mostly from the United States (81%) and published between 2015 and 2019 (69%). We identified 78 definitions of LTOT, commonly operationalised as 90 days of use within a year (23%). Studies often used multiple criteria to derive definitions (60%), mostly based on measures of duration, such as supply days/days of use (66%), episode length (21%) or prescription fills within specified time periods (12%). Definitions were based on previous publications (63%), clinical judgment (16%) or empirical data (3%); 10% of studies applied more than one definition. LTOT definition was not provided with enough details for replication in 14 studies and 38 studies did not specify the opioids evaluated. Rates of LTOT within study populations ranged from 0.2% to 57% according to study design and definition used. We observed a substantial rise in the last 5 years in studies evaluating LTOT with large variability in the definitions used and poor reporting of the rationale and implementation of definitions. This variation impacts on research reproducibility, comparability of findings and the development of strategies aiming to curb therapy that is not guideline‐recommended. [ABSTRACT FROM AUTHOR]

Copyright of Rivista Italiana di Conflittolgia is the property of Edizioni Labrys and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Proton pump inhibitor (PPI) use is widespread. There have been increasing concerns about overuse of high-dose PPIs for durations longer than clinically necessary. Objective To evaluate the impact of national education initiatives on reducing PPI use in Australia. Design Population-based, controlled interrupted time series analysis of PPI dispensing claims data for Australian adults from July 2012 to June 2018; we used statin dispensing as a control. Interventions A year-long educational initiative led by NPS MedicineWise (previously the National Prescribing Service) from April 2015. Simultaneously, Choosing Wisely released recommendations in April 2015 and May 2016. Both promoted review of prolonged PPI use and encouraged stepping down or ceasing treatment, where appropriate. Measurements We examined monthly changes in PPI (and statin) dispensing (stratified by high, standard and low tablet strength), rates of switching from higher to lower strength PPIs and rates of PPI (and statin) discontinuation. Results We observed 12 040 021 PPI dispensings to 579 594 people. We observed a sustained -1.7% (95% CI: -2.7 to -0.7%) decline in monthly dispensing of standard strength PPIs following the initiatives until the end of the study period. There were no significant changes in high or low strength PPI (or statin) dispensings, switching to lower strength PPIs, or PPI (and statin) treatment discontinuation. Conclusion Our findings suggest that these educational initiatives alone were insufficient in curbing overuse of PPIs on a national level. Concerted efforts with policy levers such as imposing tighter restrictions on subsidised use of PPIs may be more effective. Noting low strength esomeprazole is not publicly subsidised in Australia, availability of these preparations may also facilitate more appropriate practice [ABSTRACT FROM AUTHOR]

Background: Proton-pump inhibitors (PPIs) are among the most prescribed medicines worldwide and concern about their long-term use is growing. We used dispensing claims for every person in Australia dispensed publicly subsidized PPIs between 2013 and 2016 to determine the incidence and prevalence of PPI use and to examine the patterns and durations of PPI treatment among individuals continuing treatment beyond the guideline-recommended maximum 12 weeks. Methods: We estimated annual prevalence and incidence per 100 people and duration of treatment for every Australian dispensed publicly subsidized PPIs between 2013 and 2016. We examined patterns of PPI treatment in three patient subgroups using PPIs for more than 12 weeks duration; people receiving maintenance, long-term continuous or long-term intermittent treatment. We calculated the proportion in each subgroup stepping down from higher to lower PPI strengths, stepping up from lower to higher PPI strength and discontinuing treatment. Results: PPIs were dispensed to 4,388,586 people; 60% were women; median age at initiation was 52 years [interquartile range (IQR): 36–65]. Standard and high strength PPIs accounted for 95% of dispensings. Annual incidence and prevalence were 3.9/100 and 12.5/100, respectively, in 2016 and highest among individuals over 65 years (prevalence range: 33–43/100). Most people (67%) stopped treatment after one dispensing; while 25%, 6% and 10% continued on maintenance, long-term continuous and long-term intermittent treatment, respectively. Median duration of treatment in people continuing treatment was 501 days (IQR: 180–not reached) for maintenance treated individuals and 'not reached' for long-term treated individuals. We observed 35%, 20% and 47% of people stepping down from higher to lower treatment strengths on maintenance, long-term continuous and long-term intermittent treatment, respectively. Conclusions: Longer-term treatment with higher strength PPIs is common. Targeted regulation of PPI prescribing may improve the uptake of lower strength formulations and reduce both harms and costs associated with long-term PPI treatment. [ABSTRACT FROM AUTHOR]

Total hip arthroplasty (THA) improve the patients’ quality of life, and one of the most important problems after surgery is to optimize postoperative pain management. It has been shown that pain is intimately linked to the fear of movement, the so-called kinesiophobia, which can affect the entire perioperative period and quality of life in people undergoing THA. In this study, we aimed to present a new integrative approach called IARA model specifically focused on educational interventions such as knowledge and awareness of illness, guided imagery, and drawings to help the patient achieve full autonomy and confidence about the perioperative period and surgery. The Hip Injury and Osteoarthritis Outcome Score (HOOS), Tampa Scale Kinesiophobia (TSK) questionnaire, and Numeric Rating Scale 0-10 have been used to test the efficacy of IARA. The main finding in the present study was the effectiveness of IARA model in improving indexes of pain (p < 0.01) and QoL (p < 0.01) and to keep kinesiophobia levels low in patients undergoing THA. [ABSTRACT FROM AUTHOR]

The study area of the Costa Viola mountain ridge is strongly exposed to shallow landslides triggered by rainfall. Starting from a susceptibility map, recently published by the same team, the related risk has been assessed, limitedly to landslide sources. The hazard has first been evaluated by considering the recurrence periods of triggering events. Economic value and physical vulnerability of the types of elements at risk have been assumed by considering land-use and the effects of similar events in Southern Italy, respectively. The 1:30,000-scale risk map (Main Map) has been produced by combining the above-mentioned layers. Low risk prevails in the study area, whilst the highest values are concentrated along the coast, where villages and the main infrastructure are located. The expected annual damage exceeds 570 million € (about 68% pertaining to low-risk cells). Risk maps produced through similar simplified geographic information system-based procedures may play a crucial role in accurate land-use planning and effective decision-making. [ABSTRACT FROM AUTHOR]

The article discusses ecohistory and the history of women's interventions on behalf of trees and forests, including international ecofeminism and women's activism against deforestation during the period from the 1950s to 2013. Topics discussed include practical and theoretical elements of women's activism in India involving embracing trees, women's environmental activism involving planting trees in Nairobi, Kenya and activism involving activists climbing in trees, such as the activism of American environmentalist Julia Hill in California.

• Fishery operations induced biases in predator diet and cannibalism estimation. • Methods to estimate daily ration and consumption based on stomach content are underestimated. • Bioenergetic methods are better estimators of daily ration and consumption. Only few studies on the feeding and cannibalism behavior of the jumbo squid have been conducted in the Humboldt Current System despite this species is currently considered an important economic resource. It is possible that the diet of this ommastrephid squid varies throughout the year, among areas and body size. Therefore, we herein collected jumbo squids from commercial catches during January to December 2014 using purse-seine nets. The stomach contents were analyzed in terms of frequency of occurrence, number, and weight of prey items. The diet composition was analyzed using Detrended Correspondence Analysis. The variation of jumbo squid diet composition was evaluated from different biological and temporal predictors (sex, maturity, body size and months), considering and analyzing cannibalism. Daily ration was estimated using three methods to calculate consumption and consumption/biomass ratio. Our results suggest that there are significant differences in diet throughout the year, among sizes, and between sexes, however, no differences were found according to the interactions of these factors, except for the interaction between sex and month. In addition, significant differences were detected for each factor (sex, month and body size) when evaluating cannibalism, although these differences were only significant when factors were evaluated independently. Body size was the best predictor of diet composition, richness and cannibalism variation. Stomach content weight was highly biased due to the advanced level of digestion, which in turn biased the diet based on weight, daily ration and consumption analyses. In this sense, the bioenergetic model based on water temperature fitted better than models based on stomach content weight and body mass. These results showed that D. gigas mostly predates on crustaceans and cephalopods, which contrasts with most ecosystem models that suggest that this species highly predates on commercially-exploited fish species. [ABSTRACT FROM AUTHOR]

Introduction: Postoperative complications in TKA are well-known, especially regarding kinesiophobia which affects both perception of pain and good post-operation recovery, preventing the normal course and sometimes leading to a new intervention even in the presence of a technically successful operation. Methods The study had a quasi-experimental, controlled, before-and-after design and was conducted on 84 patients; 44 were assigned to IARA and 40 to control group. According to IARA model three meetings were performed (two pre- and one postoperative). The control group received normal pre- and postoperative interaction. With the purpose of evaluating pain, kinesiophobia and health-related Quality of Life (QoL), we used respectively the NRS 0-10, TSK, and KOOS questionnaires. Results: Applying two-way mixed design ANOVA we found significant Time x Group interaction in all KOOS subscales: Pain (F1,82=10.808, p<0.001); Symptom (F1,82=15.497, p<0.001); ADL (F1,82=20.342, p<0.001); Sport/Rec (F1,82=20.451, p<0.001); QOL (F1,82=4.275, p<0.001) and also in TSK questionnaire (F1,82=4.275, P=0.042). Conclusion: IARA turned out to be a short and effective approach to reducing kinesiophobia and pain at 40th day after surgery, significantly improving QoL indexes in patient undergoing TKA. Level of evidence: III. [ABSTRACT FROM AUTHOR]