Search

Product consumption is an important yet understudied aspect of marketing. Over-the-counter medicines present a unique consumption context because consumers are expected to follow product label instructions. For acetaminophen, a widely consumed over-the-counter drug, the authors study which consumers tend to deviate from the label instructions, why they do so, and the interventions that are most promising to mitigate such deviations. They develop a dynamic structural model of consumption that enables them to investigate the probability of different types of label deviations (e.g., >4 g per day) and drivers of such behaviors. Label deviations are infrequent "tail area" behaviors, and the model uncovers them well. The analysis is based on a unique online consumption diary in which consumers select from two classes of acetaminophen products (single ingredient or a combination of ingredients) to treat their pain or non-pain-related symptoms. Consumers have a higher probability of taking >4 g of acetaminophen when they have multiple symptoms, and a variety of observable factors explain the individual propensity to deviate from the label. The authors propose two interventions—a new label instruction and consumer education—to mitigate the observed label deviations and assess the expected impact of each. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Although guidelines recommend antiviral therapy for outpatients with COVID-19 who are at high risk of progressing to severe conditions, such as older adults, many patients do not receive appropriate treatment. Little is known, however, about the physician factors associated with the prescription of guideline-recommended antiviral therapy for patients with COVID-19. DESIGN: A cross-sectional study. SETTING: Data including outpatient visits in primary care clinics in Japan from April to August 2023. PARTICIPANTS: We analysed 30 953 outpatients aged ≥65 years treated with COVID-19 (mean (SD) age, 75.0 (7.6) years; 17 652 women (57.0%)) in 1394 primary care clinics. OUTCOME MEASURES: The primary outcome was the prescription of guideline-recommended antivirals (ie, nirmatrelvir-ritonavir or molnupiravir), adjusted for patient characteristics, months of visits and regions. RESULTS: Antiviral prescriptions were concentrated among a small proportion of physicians; for example, the top 10% of physicians that had the largest number of nirmatrelvir-ritonavir prescriptions accounted for 92.4% of all nirmatrelvir-ritonavir prescriptions. After adjusting for potential confounders, physicians with higher patient volumes were more likely to prescribe guideline-recommended antivirals to their patients (adjusted OR (aOR) for high vs low volume, 1.76; 95% CI 1.31 to 2.38; adjusted p

Introduction: With an increasing prevalence, dementia is one of the most disabling diseases among the elderly. Impaired cognitive function and behavioral and psychological symptoms predispose patients to medication non-adherence, resulting in increased morbidity, mortality, and healthcare costs. The aim of this study was to estimate the prevalence of non-adherence to antidementia medications and to identify the main predictors. Methods: A population-based registry study was conducted in 2022 in Castile and Leon, Spain. A total of 17,563 patients with dementia were included. The medication possession ratio (MPR) was used as an indirect method to measure adherence. The cut-off point for determining that a patient was nonadherent was 80% of MPR. Multivariate logistic regression was used to identify predictors of nonadherence based on sociodemographic and health-related variables. Results: In 2022, 6.2% of the population over 80 years old used antidementia medications. Of these patients, 70% were women, 28.15% were institutionalized, and over 90% were polymedicated and had multiple prescribers. The most used medicines were donepezil (43.49%), rivastigmine (36.84%), and memantine (30.7%). The combined use of an acetylcholinesterase inhibitor plus memantine was relevant (13.33%). Men were less adherent than women, and the prevalence of non-adherence decreased with age. The medication associated with the highest prevalence of non-adherence was rivastigmine (19%), followed by donepezil (17%) and memantine (13.23%). Institutionalized patients (13%) and patients on combination therapy (13.29%) had the lowest prevalence of non-adherence. Protective factors against non-adherence include institutionalization, polymedication, use of memantine or combination therapy, and comorbid mental illness. Conclusions: In Castile and Leon, one in six patients were non-adherent to antidementia medications. Younger male patients with cardiometabolic disease are more likely to be non-adherent to antidementia medications. On the other hand, institutionalization is a protective factor against non-adherence, but still 10% of nursing home patients are non-adherent to antidementia medications. [ABSTRACT FROM AUTHOR]

Background: Substance misuse is common among cancer survivors and can negatively impact cancer outcomes. Methods: We conducted a cross-sectional study using National Survey on Drug Use and Health data for 2015 to 2020. We included adult respondents with a history of solid tumor cancer. We calculated the weighted prevalence and corresponding SEs (both expressed as percentages) of substance (alcohol, opioid, sedative, stimulant, other) misuse for respondents with any history of solid tumor cancer and, in secondary analyses, respondents diagnosed with cancer in the prior 12 months. Results: The study included 6,101 respondents with any history of cancer, 1,437 diagnosed in the prior 12 months. Alcohol was the most commonly misused substance. The average prevalence of alcohol misuse was 14.4% (SE 0.60%) across cancer types; it was markedly more common among people with a history or cervical (24.2% [3.0%]) or head and neck cancer (27.4% [7.1%]). The next most common form of substance misuse was opioid misuse (average prevalence: 2.7% [0.25%]). As with alcohol misuse, the prevalence of opioid misuse was higher among those with a lifetime history of cervical cancer (5% [1%]) or head and neck cancer (5% [3%]). Results were generally consistent among cancer survivors diagnosed in the prior 12 months. Conclusions: There is a clear opportunity to address substance misuse—particularly alcohol misuse—among cancer survivors. Such efforts should focus on populations with a high prevalence of substance misuse (e.g., cervical and head and neck cancer survivors) and have strong potential to improve cancer-specific and overall health outcomes. [ABSTRACT FROM AUTHOR]

Aims Methods Results Conclusions This study evaluated the 10‐year consumption and economic patterns of classical analgesics, adjuvants and opioids in Portugal (2012‐2022), and conducted a comparative analysis between Portugal, Spain and Denmark to explore the consumption patterns among these countries for 2022.Data on sales and national health service (NHS) costs were obtained from the Portuguese National Authority of Medicines and Health Products. Sales data were converted to defined daily dose (DDD) per 1000 inhabitants per day according to the Anatomical Therapeutic Chemical (ATC) classification/DDD methodology, while comparisons between Spain and Denmark were evaluated with the chi‐square test, when appropriate.The findings reveal that classical analgesics use in Portugal remained stable during the period 2012‐2022, with ibuprofen being the most consumed. Adjuvants, specifically gabapentinoids, experienced an 84% increase in use, primarily attributed to pregabalin. Weak opioids, led by tramadol, witnessed a 117% rise in use, while strong opioid use, led by tapentadol, increased by 618%. Portugal presented the lowest overall opioid consumption when compared to Denmark and Spain in 2022. Economic trends indicated a heightened NHS expenditure on analgesics, primarily driven by increased opioid use. Notwithstanding, there was no significant burden on relative expenditure over the 10‐year period.Portugal presented a major increase in both weak and strong opioid prescriptions, aligning with the trends for Spain and Denmark. The development and approval of generic medicines and vigilant market monitoring are imperative strategies for managing the escalated costs resulting from heightened consumption, particularly concerning opioids. [ABSTRACT FROM AUTHOR]

ABSTRACT Levetiracetam (LEV) is an anti‐epileptic drug used extra‐label in dogs. Commercially available extended‐release formulations (LEV‐ER), administered twice daily, cannot be crushed or split, limiting their use in small dogs. A compounded LEV‐ER formulation (PO‐COMP) can purportedly be partitioned without loss of extended‐release properties. The aims of this study were to establish the pharmacokinetic parameters of PO‐COMP, divided at the tablet score, and determine the bioequivalence of partitioned PO‐COMP to an intact commercially available Food and Drug Administration‐approved human oral generic formulation of LEV‐ER (PO‐COMM). In a randomized crossover design, 12 healthy dogs received a single IV dose (30 mg/kg) of IV‐COMM, a single oral dose (500 mg) of intact PO‐COMM, or a single oral dose (500 mg) of partitioned PO‐COMP and underwent serial measurement of plasma LEV concentrations over 24 h. PO‐COMP was bioequivalent to PO‐COMM using the 90% confidence interval method for maximum concentration (−3.2% difference [CI −7.4% to −1.1%]) and area under the curve (−14.4% difference [CI −17.8% to 10.8%]). PO‐COMP may improve medication adherence and seizure control relative to immediate‐release LEV, which requires three times daily dosing. Efficacy studies of PO‐COMP are warranted. [ABSTRACT FROM AUTHOR]

Background: About 80% of pregnant women use at least one medication during their pregnancy period. Many drugs that are not allowed to be used during pregnancy (from FDA Pregnancy Categories D and X) were used. Irrational use of these drugs during pregnancy may result in different birth defects, as explained by thalidomide and diethylstilbestrol's tragedy. Knowledge of drug utilization and associated factors that affect the pattern is important to enhance rational prescribing. But information about prescription patterns and associated factors among pregnant women is scarce in the Debre Tabor area and generally in Ethiopia. Objective: This study was aimed at assessing drug prescription patterns, potential teratogenicity, and associated factors among pregnant women attending the antenatal care unit at Debre Tabor Comprehensive Specialized Hospital, Debre Tabor, Northwest Ethiopia. Methods: A retrospective cross‐sectional study design was performed on 359 pregnant women attending antenatal care units from June 01, 2022, to August 30, 2022, in the hospital. Necessary data were obtained through a questionnaire by reviewing the medical charts of the women. Analysis of the data was performed using SPSS Version 23. The association of the independent variables to medication use was assessed using multivariate logistic regression. A p value of less than 0.05 was considered significant. Results: Most of the study participants (325/359) were married (90.5%). From a total of 359 participants, 350 (97.5%) were prescribed with drugs. About 64% (385/602) of the prescribed medications were iron and vitamins. The most commonly prescribed medications are iron and folic acid combination (340/602, 56.5%), albendazole (48/602, 8%), mebendazole (37/602, 6.1%), omeprazole (33/602, 5.5%), followed by amoxicillin (32/602, 5.3%). The majority (79.3%) of the drugs were from FDA Pregnancy Categories A and B. Prescribed drug utilization was more probable in women who first visited the facility at their second (AOR = 2.91, 95% CI [1.12–6.64]) and third trimesters (AOR = 4.32, 95% CI [1.37–6.81]), had chronic illness (AOR = 7.54, 95% CI [2.34–14.68]), and live in rural areas (AOR = 2.47, 95% CI [1.56–8.43]). Conclusion: The study revealed that the prescription pattern in the hospital is in line with the WHO reference. Age, gravidity, number of ANC visits, first visit to the facility, presence of chronic illness, educational status, and residency were significantly associated with prescription drug use in pregnant mothers. But still, some pregnant women received drugs that may have teratogenicity risk (FDA Category C). [ABSTRACT FROM AUTHOR]

Background and Objectives Methods Results Conclusions and Scientific Significance Nonmedical use of prescription tranquilizers/sedatives (NMUPTS) is associated with a 15‐times increased likelihood of polysubstance use (PSU). This is correlated with an increased risk for use disorders and death, therefore, to inform prevention efforts, we identified PSU profiles among adults reporting sleep‐related NMUPTS.National Survey on Drug Use and Health 2015–2019 participants with past 12‐month sleep‐related NMUPTS and use of an additional drug(s) (n = 2603) were studied. Latent class analyses identified unique latent profiles, and multivariable logistic regressions identified covariates associated with each profile.Alcohol (90.4%), tobacco (61.5%), and marijuana (55.5%) were most commonly reported, with an average of 3.6 additional substances. Two latent PSU profiles were identified: marijuana/alcohol/tobacco (MAT) (68.3%) and MAT + cocaine/hallucinogens/prescription drugs (MAT + CHPR) (31.7%). In comparison to those likely in the MAT profile, those likely in the MAT + CHPR profile had lower odds of being older than 18–25 years (26–34: adjusted odds ratio [AOR]: 0.5, 95% confidence interval [CI]: 0.3, 0.6; 35–49: AOR: 0.2, 95% CI: 0.1, 0.2; 50+: AOR: 0.1, 95% CI: 0.0, 0.1), female (AOR: 0.4, 95% CI: 0.3, 0.6), non‐Hispanic Black (AOR: 0.5, 95% CI: 0.4, 0.8) or Hispanic in comparison to non‐Hispanic White (AOR: 0.5, 95% CI: 0.4, 0.8), and to not have past 12‐month insurance coverage (AOR: 1.7, 95% CI: 1.3, 2.3).Two PSU profiles were identified among people with NMUPTS, with noted variations in sociodemographic characteristics. In comparison to previous studies, sleep‐related NMUPTS was associated with higher rates of stimulant use, suggesting stimulant use and sleep‐related NMUPTS may be related. [ABSTRACT FROM AUTHOR]

Adoption of multitarget, cost‐effective fixed‐dose medication combinations can help lower the pill load without increasing the risk of adverse events. In this study, three new 1:1 drug‐drug binary solid forms of panobinostat (PNB) and nonsteroidal anti‐inflammatory drugs (NSAIDs) were effectively synthesized by liquid‐assisted grinding and slow evaporation crystallization techniques. The obtained solid forms were extensively characterized by various analytical techniques. The structural investigation revealed that all molecular adducts formed salt with a comparable R42${\mathrm{R}}_4^2$(10) graph set pattern created by heteromeric interactions formed between PNB and corresponding salt formers. To determine the dissolving behavior of the newly developed adducts, solubility tests were performed at various pH levels (pH 1.2 and pH 7), and the results indicated that the solubility of all forms is increased at pH 7.0, particularly PNB.NIF has a solubility of 0.195 mg/mL, which is seven times higher than the parent drug. Furthermore, PXRD was used to assess the stability of the synthesized adduct at varied temperature and humidity levels and it was found that all the adducts are stable. Based on the findings, we hope that the newly found PNB drug‐drug binary adducts have possible potential to broaden the use of drug combinations without changing the chemical structures. [ABSTRACT FROM AUTHOR]

Psychedelic use has been increasingly accepted socially and legally. However, there is a gap in understanding how religion can influence the relationship between psychedelics and mental health. This study aims to explore this relationship by examining the impact of lifetime classic psychedelic use (LCPU), religious attendance, and religious salience on monthly psychological distress, using the K6 scale. The data for this project is sourced from the National Survey of Drug Use and Health (NSDUH) from 2008 to 2019, with a sample size of 458,372. The analysis utilizes several Ordinary Least Square regression models conducted in Stata 17. The results indicate that both religion and psychedelic use are associated with lower levels of psychological distress. While increased religious salience is linked to reduced distress, this effect is weakened by psychedelic use, as higher salience is associated with higher levels of distress among individuals who have used psychedelics. However, a three-way interaction analysis reveals that individuals with high religious salience and attendance experience the lowest levels of distress. [ABSTRACT FROM AUTHOR]

People living in situations of homelessness and drug use experience significant barriers when seeking to access services in the Danish welfare state. Yet rarely are journeys to services examined in depth with attention to the factors that may either support or prevent their completion. Towards this aim, the article employs a ‘service journey’ approach by unfolding an ethnographic case study of a service journey pieced together at the street-level. This is achieved through the collective efforts of outreach workers and a man encountered at a drug consumption room in urgent need of medication. The article highlights the role of serendipity in the construction of such ‘street-level’ service journeys. It thus shows how possibilities for initiating or pushing a particular service journey forward occur through serendipitous outreach encounters. Further, it is shown how service journeys of unstably housed people who use drugs are both conditioned by and come up against other shifting everyday ‘itineraries’ of clients as they seek to piece together a living at the urban margins. [ABSTRACT FROM AUTHOR]

In this study, we aimed to investigate the nationwide utilization of antipsychotic drugs (APDs) during radiotherapy and evaluate their association with survival in patients with breast cancer. This retrospective cohort study used the National Health Insurance Service database in Korea and included patients diagnosed with breast cancer from 2010 to 2020 who received radiotherapy. The APDs included in the analysis were aripiprazole, quetiapine, olanzapine, risperidone, haloperidol, and chlorpromazine, and the APD prescription details included prescription time, dosage, and duration. Among 170,226 patients with breast cancer treated with radiotherapy, 3361 (1.97%) received APD during radiotherapy. Use of APDs was significantly associated with higher mortality in all patients and in a subgroup of patients excluding those with metastasis or other cancers. Among patients taking APD during radiotherapy, those with accompanied psychiatric history and long-term APD use for ≥ 3 months were associated with lower mortality, whereas patients who started APD during radiotherapy had higher mortality than those who started APD before radiotherapy. The high mortality observed in breast cancer patients using APDs during radiotherapy could be influenced by the underlying conditions that necessitated APD use. Further studies are needed to determine the effects of APDs during radiotherapy in patients with breast cancer. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization (WHO) defines rational use of drug as a state in which medications are received by patients appropriately according to their clinical needs and individual requirement, for adequate period and at the right cost. More than 50% of all medicines are prescribed, dispensed, or sold inappropriately worldwide. This study aimed to evaluate the prescribing patterns in Adigrat general hospital, Tigrai, Ethiopia. Methods: A retrospective cross-sectional study was done to evaluate prescription patterns. A systematic random sampling technique was used to select 600 prescriptions and the prescriptions were reviewed using WHO/International Network of Rational Use of Drugs prescribing indicators. Data was collected from prescriptions dispensed from 01 March 2023 to 30 March 2024 at outpatient pharmacy of Adigrat general hospital. Data was analyzed using SPSS version 21 and a p-value < 0.05 was declared statistically significant. Results: A total of 1088 medicines were prescribed in 600 prescription encounters, giving an average number of 1.8 (± 0.83) medicines per encounter. The percentage of medicines prescribed by generic name was 91.5% while 98.7% of the medicines were prescribed from essential medicine list (EML). Besides, the percentages of encounters containing at least one antibiotic and one injection were 44.5% and 7.2%, respectively. A total of 340 antibiotics were prescribed in 267 encounters. Penicillins (34.4%), macrolides (23.8%) and fluoroquinolones (17.1%) were the most prevalent antibiotics classes. The "Access" and "Watch" groups covered 54.4% and 45.6% of the total antibiotics prescribed, respectively. Being under 18 years old [Adjusted Odds Ratio (AOR): 9.830, CI: 4.062–23.786], being prescribed with three medicines (AOR: 3.247, CI: 1.571–6.708) and certain diagnosis like diseases of the respiratory system (AOR: 3.750, CI: 2.136–6.584) were significantly associated with antibiotic prescribing. Conclusion: This study showed deviations of prescribing patterns from WHO standards. The percentage of prescriptions with antibiotic was far from WHO optimal value. The use of antibiotics from "Access" group was below WHO standard. The percentage of medicines prescribed by generic name and the percentage of encounters with injection also deviated from WHO standard. Antibiotics prescribing showed significantly association with age, number of medicines and certain diseases. [ABSTRACT FROM AUTHOR]

Background: The use of medication for Attention-Deficit/Hyperactivity Disorder (ADHD) increased globally throughout the early 2000s. This study examine trends in prevalences and incidences of medication use in Norway from 2006 to 2022. Methods: Data from the Norwegian Prescription Database were used to present one-year-prevalence and incidence rates of ADHD medication (ATC-group N06BA and C02AC02) for the overall population (ages 6–64) and within sex and age subgroups of children (ages 6–17) and adults (ages 18–64). Incident use was defined as the dispensing of medication, with no recorded use in the previous two calendar years. Results: The overall prevalence of ADHD medication use in 6- to 64-year-olds increased from 5.2 to 19.4 per 1000 in the period, most pronounced from 2020 and onwards. While males experienced a nearly threefold increase in use (from 7.3 to 20.6 per 1000), the use among females increased almost sixfold during the study period (from 3.0 to 18.1 per 1000). Consequently, the male-to-female prevalence-ratio decreased from 2.4 to 1. Children exhibited a higher prevalence of use compared to adults throughout the period, although the largest relative increase was observed in adults, particularly in female adults. In children the male-to-female ratio decreased from 3.2 to 2.0, primarily due to an increasing use in 13–17-year-old females. Among adults, prevalences were similar across most age groups, with the highest rates observed among those aged 18–24, where female use exceeded male use by the end of the period. The male-to-female prevalence-ratio in adults decreased from 1.6 to 0.9 during the period. Parallel to prevalent use, overall incident use increased from 1.4 to 5.0 per 1000 during the period, with the most pronounced increase occurring from 2020 and onwards. From this point, incident use among females aged 13–17, 18–24, and 25–34, exceeded that of males. The male-to-female incidence-ratio decreased from 1.8 to 0.9. The overall incidence to prevalence ratio remained similar throughout the period, being 0.27 in 2006 and 0.25 in 2022. Conclusion: A sustained increase in the prevalence of ADHD medication use was observed, with the most pronounced rise occurring among females and adults from 2020 and onwards. By 2022, the overall gender disparity in ADHD medication use had diminished, which should be considered in the context of a steep increase in incident use among adolescent and young adult females starting from 2020. [ABSTRACT FROM AUTHOR]

AbstractThis study aims to investigate Polylactic Acid (PLA) and Polycaprolactone (PCL) polymers for microencapsulation of hydrophilic and hydrophobic anti-glaucoma drugs using an emulsion-based solvent evaporation technique. Microparticle size was analysed using optical microscopy, while drug-polymer interactions through Dynamic-Light-Scattering (DLS) and Fourier-Transform-Infra-red/Attenuated-Total-Reflection spectroscopy (FTIR/ATR). In vitro, drug release studies were performed to investigate drug encapsulation and release profiles. Spherical microparticles, with particle size 94 ± 6.9 μm for PCL-based and 100 ± 3.74 μm for PLA-based formulation, were obtained. Drug release studies showed 100% release over about 32 days, with encapsulation efficiency (%EE) and drug loading (%w/w) reaching up to 95 and 2.84% for PLA-based and 97 and 2.91% for PCL-based microparticles, respectively. DLS studies reveal an increase in hydrodynamic radius (RH), which correlates to enhanced drug encapsulation. So, the nature of the drug and polymer significantly impacts drug encapsulation and release, with drug-polymer interactions playing a crucial role alongside experimental parameters. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) stages 3-4 present a significant clinical challenge due to the absence of a systematic approach to managing associated medication-related problems (MRPs). This lack of a structured framework hinders the timely identification and effective intervention for these complications, potentially compromising patient safety and prognosis. Objective: This study aims to leverage the Delphi method to establish an evaluation index for a rational drug use evaluation system dedicated to CKD patients in stages 3-4. This system will function as a platform for the continuous identification and management of MRPs, ultimately contributing to improved medication safety and patient outcomes. Methods: This research uses the modified Delphi technique to develop an evaluation system for rational drug use in patients with chronic kidney disease. The initial questionnaire was developed by literature review for patients with chronic kidney disease. Twenty-six senior experts formed a panel in order to evaluate items across two Delphi rounds. Consensus was defined as at least 95% agreement (first round) and 85% agreement (second round), agreeing with an average score of at least 4.5 (first round) and 4.0 (second round). Items that fulfill the stipulated criteria are eligible for inclusion in the consensus list. Results: All experts participated in both rounds (100% response rate). Consensus was achieved on three patient-related items in the first round of 34 items. Based on expert feedback, 18 revised items were included in the second round after refining, restructuring, and removing some elements. Following two rounds of consultation, 20 items achieved consensus, encompassing aspects such as drug selection, dosage assessment, treatment duration, prescription and dispensing practices, patient-related factors, and other relevant considerations. Conclusion: This study has successfully identified 20 key evaluation indicators for a rational drug use evaluation system specifically designed for CKD patients in stages 3 and 4. This system will serve as a tool for continuous MRP identification and timely intervention, ultimately enhancing medication safety and patient prognosis. [ABSTRACT FROM AUTHOR]

Objective: To assess tablet utilization patterns and describe pre-treatment characteristics among new users of rimegepant. Background: Rimegepant is the only oral calcitonin gene-related peptide antagonist approved in the United States for both the acute and preventive treatment of migraine. Methods: We conducted a retrospective cohort study of people with migraine who initiated treatment with rimegepant using two US commercial claims databases (MarketScan and Optum). Patients (≥18 years old) with migraine who newly initiated rimegepant were included. Patients were stratified into two groups representing acute (quantity = 8) and prevention (quantity = 15 or 16) use cohorts. Baseline characteristics and medication use history were assessed on index and during the 365-day pre-index period. Rimegepant utilization periods were calculated based on days supplied and varying approaches to define use periods. Tablet quantity per 30 days was reported separately for both acute and prevention cohorts. Results: In MarketScan, a total of 14,037 rimegepant users were identified; 11,195 (79.8%) in the acute group and 1,880 (13.4%) in the prevention group. Rimegepant utilization for acute use was 4.9 ± 2.1 tablets per 30 days and for preventive use was 13.1 ± 7.7 tablets per 30 days. There was high baseline prevalence of triptan contraindications, warnings, and high cardiovascular risk, with a combined 46.2% meeting one or more of these criteria. Acute medication overuse was also common (25.1%) prior to rimegepant initiation. Results were consistent in the Optum database. Conclusion: Our analysis provides the first real-world data available on tablet utilization and characteristics of new users of rimegepant. PLAIN LANGUAGE SUMMARY: There is little information available on the characteristics of people with migraine who start to use rimegepant, which is the only medicine approved for both the prevention of migraine attacks and the acute treatment of migraine attacks after they have started. Information on new users of rimegepant at least 18 years of age was obtained from two commercial databases of US healthcare claims (MarketScan and Optum). The researchers used this information to evaluate people's age, sex, pre-existing illnesses, and prior use of migraine medications at the time they started using rimegepant, and they also used several different methods to estimate how often people used rimegepant after treatment was started. The MarketScan database contained information on 14,037 people with migraine who started using rimegepant, with this group having an average age of 43 years and being comprised mostly of females (88%). Prior to starting rimegepant, almost half (46%) of the people were considered to have high cardiovascular risk and 25% considered at risk of overusing acute migraine medications. Most of the 14,037 people (80%) who started rimegepant used it to treat migraine attacks after they started and this group used approximately 5 tablets every month. The smaller number of people who used rimegepant to prevent migraine attacks used approximately 13 tablets every month. The information obtained from the Optum database was similar to that obtained from the MarketScan database. The researchers' analysis is the first to describe the characteristics of people with migraine who start to use rimegepant outside the setting of a controlled clinical trial. Their results show that new users of rimegepant represent a complex population with a significant profile of pre-existing illness and a diverse treatment history. [ABSTRACT FROM AUTHOR]

Objective: Determine relationships between college students' student loan presence and self-rated physical and mental health, major medical problems, mental health conditions, physical, dental, and mental health care visits and delays, and medication use and reductions. Participants: A total of 3,248 undergraduates at two regional public U.S. universities, surveyed Spring 2017. Methods: OLS and Logistic regression. Results: Loan presence was related to significantly worse self-rated physical and mental health and more major medical problems, but not to mental health conditions, or physical or mental health medication use. Respondents with loans were less likely to visit the dentist and more likely to report delaying medical, dental, and mental health care, and reducing medication use to save money. Conclusions: Results provide evidence of health and health care use divides among college students by loan presence. [ABSTRACT FROM AUTHOR]

Background: In the randomized, phase 3, SUSA‐301 trial, celecoxib‐tramadol co‐crystal (CTC) provided significantly greater analgesia compared with celecoxib, tramadol, or placebo in adults with acute, moderate‐to‐severe, postoperative pain. This post hoc, secondary analysis further evaluated the use of rescue medication and the incidence of treatment‐emergent adverse events (TEAEs). Methods: Patients (N = 637) were randomized 2:2:2:1 to receive oral CTC 200 mg twice daily (BID; n = 184), tramadol 50 mg four times daily (QID; n = 183), celecoxib 100 mg BID (n = 181), or placebo QID (n = 89). Post hoc analyses were conducted on the use of rescue medications up to 4 and 48 h post‐study drug dose, stratified by baseline pain intensity (moderate/severe), and on the incidence of TEAEs, stratified by rescue medication use. Results: A significantly lower proportion of patients received any rescue medication within 4 h post‐study dose with CTC (49.5%) versus tramadol (61.7%, p = 0.0178), celecoxib (65.2%, p = 0.0024), and placebo (75.3%, p = 0.0001); this was also seen for oxycodone use. Fewer patients in the CTC group received ≥3 doses of rescue medication compared with the other groups, irrespective of baseline pain intensity. In patients who did not receive opioid rescue medication, CTC was associated with a lower incidence of nausea and vomiting TEAEs versus tramadol alone. In patients who received rescue oxycodone, the incidence of nausea was similar in the CTC and tramadol groups, and higher versus celecoxib and placebo. Conclusion: Celecoxib‐tramadol co‐crystal was associated with reduced rescue medication use and an acceptable tolerability profile compared with tramadol or celecoxib alone in adults with acute, moderate‐to‐severe, postoperative pain. [ABSTRACT FROM AUTHOR]

Background: Bacterial peritonitis is a common complication of peritoneal dialysis. In the absence of systemic signs of infection, adult guidelines recommend treatment with intraperitoneal vancomycin either as empiric coverage of gram‐positive organisms or as targeted therapy. However, there is no guidance on how to administer vancomycin in children on automated peritoneal dialysis. Case Report: We report vancomycin pharmacokinetics upon intraperitoneal administration for the treatment of a Staphylococcus hominis peritonitis in an 11‐year‐old patient on automated nocturnal intermittent peritoneal dialysis. While the patient was hospitalized, vancomycin was administered intraperitoneally as a continuous treatment. After hospital discharge, the nocturnal peritoneal dialysis was resumed. In the absence of treatment guidelines, intraperitoneal vancomycin was initially administered empirically only during the nocturnal dialysis exchanges which led to repetitive subtherapeutic vancomycin plasma concentrations and the persistence of S. hominis in dialysate cultures. Based on studies in adults, the dosing strategy was subsequently modified to administer vancomycin at a dosage of 15 mg kg−1 in the dialysate with a 6‐h dwell period prior to the nocturnal dialysis thereby allowing to reach optimal peak concentrations. The dosing interval was subsequently individualized using therapeutic drug monitoring to ensure residual vancomycin concentrations > 10 mg L−1 thereby leading to clinical and microbiological recovery. Conclusions: This case presents a dosing strategy based on a comprehensive review of the literature and highlights that a sufficient dwell period is critical when treating pediatric patients on automated peritoneal dialysis in order to allow vancomycin distribution and equilibration between the dialysate and the plasma. [ABSTRACT FROM AUTHOR]

This article aims to explore pharmaceuticalisation processes in professional work contexts. The approach focuses on identifying patterns of medicine and dietary supplement use for managing work performance, and on discussing the relationship between these consumption practices and work-related pressure factors. This analysis adapts the notions of 'normalisation' to understand the extent of cultural acceptability of these practices, and the notion of 'differentiated normalisation' to capture the tension between the trend towards normalisation of such consumption and its partial social (in)visibility within work settings. Empirical support for this analysis is based on a sociological study conducted in Portugal on professions under high performance pressures. The study involved three professional groups – nurses, journalists and police officers. A mixed methods approach was used, including focus groups, questionnaires and semi-structured interviews. Overall, the results show a trend towards the use of medicines and supplements for performance management, which reveals itself as a cultural response to work-related social pressures. Such consumption coexists with irregular patterns of either occasional or long-term use, as well as heterogeneous processes of 'normalisation' and 'hidden' consumption. Conclusions point to a social interconnection between the intensification of work pressures and the pharmaceuticalisation of work performance. [ABSTRACT FROM AUTHOR]

Following a High-Throughput Screening campaign to discover inhibitors of acid ceramidase, we report the novel and extremely potent covalent inhibitor, 1. Following resynthesis and stability monitoring, we discovered that 1 is chemically unstable and reacts with DMSO at room temperature. This mode of decomposition is likely general for this class of compound, and we urge caution for their use in drug discovery research. [ABSTRACT FROM AUTHOR]

Background: Prenatal exposures to xenobiotics during the masculinization programming window are suggested to impact male fecundity later in life. Frequently used nitrosatable drugs, such as penicillins and beta2‐agonists, contain amines or amides that may form teratogenic compounds in reaction with nitrite. Objectives: We explored whether maternal nitrosatable drug use during gestation was associated with biomarkers of male fecundity in adulthood; moreover, the potential modifiable effect of nitrate and vitamin intake was investigated. Method: We performed a cohort study in the Fetal Programming of Semen Quality cohort that includes semen characteristics, reproductive hormone concentrations, and measures of testis size on 1058 young adult sons in the Danish National Birth Cohort. Information on maternal use of nitrosatable drugs was obtained from questionnaires and interviews around gestational weeks 11 and 16. A multivariable negative binomial regression model was used to obtain relative differences in biomarkers of male fecundity for those whose mothers used nitrosatable drugs compared to those without such maternal use. In sub‐analyses, the exposure was categorized according to nitrosatable drug type: secondary amine, tertiary amine, or amide. We investigated dose dependency by examining the number of weeks with intake and explored potential effect modification by low versus high maternal nitrate and vitamin intake from diet and nitrate concentration in drinking water. We added selection weights and imputed values of missing covariates to limit the risk of selection bias. Results: In total, 19.6% of the study population were born of mothers with an intake of nitrosatable drugs at least once during early pregnancy. Relative differences in biomarkers related to male fecundity between exposed and unexposed participants were negligible. Imputation of missing covariates did not fundamentally alter the results. Furthermore, no sensitive subpopulations were detected. Conclusions: The results suggest that maternal use of nitrosatable drugs does not have a harmful influence on the male fecundity of the offspring. [ABSTRACT FROM AUTHOR]

Introduction: Supervised injecting facilities (SIF) have been shown to reduce negative outcomes experienced by people who inject drugs. They are often subject to intense public and media scrutiny. This article aimed to explore population attitudes to SIFs and how these changed over time in Australia. Methods: Data were drawn from the National Drug Strategy Household Survey, a national sample collecting data on illicit drug use and attitudes towards drug policy among Australians (2001–2019). Ordinal logistic regression assessed sociodemographic characteristics associated with different attitudes to SIFs and binary logistic regression assessed trends over time and by jurisdiction. Results: In 2019, 54% of respondents (95% CI 52.9, 55.1) supported SIFs, 27.5% (95% CI 26.6, 28.4) opposed and 18.4% (95% CI 17.7, 19.2) were ambivalent. Support for SIFs correlated with having a university degree (OR 1.75; 95% CI 1.58, 1.94), non‐heterosexual identity (OR 1.81, 95% CI 1.51, 2.17) and recent illicit drug use (OR = 1.74, 95% CI 1.55, 1.94). Male respondents or those living in socioeconomically disadvantaged areas had lower odds of supporting SIFs (OR 0.92, 95% CI 0.85, 1.00; OR 0.64–0.80, respectively). Between 2001 and 2019, support for SIFs increased modestly by 3.3%, those who 'don't know' by 7.4%, whereas opposition decreased by 11.7%. Between 2001 and 2019, support for SIFs increased in NSW and Queensland, whereas opposition decreased in all jurisdictions. Discussion and Conclusions: Opposition to SIFs declined over the past 20 years, but a substantial proportion of respondents are ambivalent or 'don't know enough to say'. Plain language information about SIFs and their potential benefits, targeted to those who are ambivalent/'don't know' may further increase public support. [ABSTRACT FROM AUTHOR]

Introduction: Given structural barriers, access to services is key for preventing drug‐related harms and managing chronic disease among people who inject drugs (PWID). The Patient Activation Measure (PAM), a validated scale to assess self‐efficacy in navigating one's own health care, was operationalised to improve service utilisation and outcomes but has not been assessed among PWID. We characterised PAM and its association with healthcare and harm reduction utilisation among PWID in the AIDS Linked to IntraVenous Experience cohort in Baltimore. Methods: From 2019 to 2020, participants completed surveys on PAM, service utilisation and drug use. We used log‐binomial regression to identify correlates of "Lower" PAM and modelled the association between lower PAM and service utilisation, stratified by recent IDU. Results: Participants (n = 351) were primarily male (67%), Black (85%) and 24% reported recent IDU. Lower PAM was significantly more common in those reporting IDU (aPR 1.45; 95% CI 1.03, 2.04), heavy alcohol (aPR 1.77; 95% CI 1.24, 2.51) and marijuana (aPR: 1.70; 95% CI 1.23, 2.36) but less common among women (aPR 0.57; 95% CI 0.38, 0.84) and those living with HIV (APR 0.52; 95% CI 0.35, 0.78). In modelling service utilisation, lower PAM was associated with a lower prevalence of methadone utilisation (aPR 0.27; 95% CI 0.09, 0.84) among those reporting IDU, but a higher prevalence of methadone utilisation (aPR 2.72; 95% CI 1.46, 5.08) among those not reporting IDU, after controlling for correlates of PAM. Discussion and Conclusion: PAM‐tailored interventions targeting methadone utilisation warrant consideration but should account for socio‐structural barriers to utilisation and correlates of PAM among PWID. [ABSTRACT FROM AUTHOR]

Introduction: Despite recommendations for ambulatory withdrawal programs appearing in many contemporary alcohol and other drug treatment guidelines, to date there have been few studies exploring such programs from client and service stakeholder perspectives. The aim of this study was to explore both individual and service stakeholder perceptions of a nurse practitioner‐led ambulatory withdrawal service on the Gold Coast, Queensland, Australia. Methods: Data were obtained from three groups: clinicians with knowledge of the service (n = 6); relatives of clients who had used the service (n = 2); and clients who had used the service (n = 10) using a Qualitative Descriptive design. Saldaña's (Saldaña, The coding manual for qualitative researchers. 2013) structural coding framework was used to analyse and code data into themes, with the study reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist (Tong et al. Int J Qual Health Care 2017;19:349–57). Results: Participants noted advantages of the nurse practitioner‐led ambulatory withdrawal service, including rapid availability of admission to the service and a person‐centred approach. Compared with other ambulatory withdrawal options, clients valued the ability to remain in their own environment, however participants suggested greater follow‐up after withdrawal, with the potential of a home visiting service for greater client engagement and treatment retention. Discussion and Conclusions: Findings provide evidence to suggest that nurse practitioner‐led ambulatory withdrawal services are an acceptable option for a proportion of clients who need rapid access to services when they wish to make changes to their alcohol and/or other drug use. Furthermore, they can provide person‐centred care for comorbid physical and mental ill health occurring in addition to psychosocial issues associated with alcohol and/or other drug use. [ABSTRACT FROM AUTHOR]

Introduction: Limited data exists on psychological impacts of the COVID‐19 pandemic among people who use drugs (PWUD). This study aimed to determine the prevalence and correlates of severe psychological distress (PD) among PWUD in Montreal around the beginning of the pandemic. Methods: We conducted a rapid assessment study from May to December 2020 among PWUD recruited via a community‐based cohort of people who inject drugs in Montreal (Hepatitis C cohort [HEPCO], N = 128) and community organisations (N = 98). We analysed self‐reported data on changes in drug use behaviours and social determinants since the declaration of COVID‐19 as a public health emergency, and assessed past‐month PD using the Kessler K6 scale. Multivariable logistic regression was conducted to examine correlates of PD distress (score ≥13). Results: Of 226 survey participants, a quarter (n = 56) were screened positive for severe PD. In multivariable analyses, age (1‐year increment) (adjusted odds ratio = 0.94, 95% confidence interval [0.90, 0.98]) and a decrease in non‐injection drug use versus no change (0.26 [0.07, 0.92]) were protective against severe PD, while positive associations were found for any alcohol use in the past 6 months (3.73 [1.42, 9.78]), increased food insecurity (2.88 [1.19, 6.93]) and both moving around between neighbourhoods more (8.71 [2.63, 28.88]) and less (3.03 [1.18, 7.74]) often compared to no change. Discussion and Conclusions: This study documented a high prevalence of severe PD among PWUD during the COVID‐19 pandemic compared with pre‐COVID‐19 data. Social determinants such as food insecurity and mobility issues, alongside demographic and substance use‐related factors, were linked to distress. Evidence‐based risk mitigation strategies for this population could reduce negative consequences in future pandemics or disruptions. [ABSTRACT FROM AUTHOR]

Although alcohol and other drug use is increasingly the focus of policy and research efforts, there are challenges identifying and applying evidence‐based strategies to minimise harms for alcohol and other drugs in health care and community settings. These challenges include limited available research, variability across settings, and lack of 'fit' between research evidence and their intended settings. In this commentary, we describe a novel approach to develop and evaluate tailored, sustainable strategies to enhance the uptake of evidence‐based activities into health services and community settings. Our approach involves four key principles: (i) identifying evidence‐based alcohol and other drug harm minimisation strategies; (ii) partnering with local experts to identify and tailor strategies; (iii) implementing strategies into existing practice/infrastructure to build in sustainability; and (iv) using sustainable co‐designed outcome measures including value‐based health‐care principles to measure uptake, feasibility and acceptability, health outcomes and economic implications. We propose that this approach offers a way forward to enhance the relevance and suitability of research in health services and community settings and has potential to be applied in other sectors. [ABSTRACT FROM AUTHOR]

Most individuals use medication during pregnancy. However, decision making on antenatal pharmacotherapy presents considerable ethical and scientific challenges. Amid a sociocultural paradigm prioritising the elimination of fetal risks, available evidence and guidance are limited, and current decision making on antenatal drugs mostly proceeds in an ad-hoc and, often, biased manner. This approach might undermine the health of both mother and child. The need for a systematic approach towards antenatal drug decisions is becoming even more pressing with the growing knowledge of pregnancy-induced changes in drug disposition and effects. With this new complexity, pregnancy-specific doses might be necessary, potentially altering the balance between maternal and fetal benefits and risks. In this Viewpoint, we argue that ethical principles and a pregnant individual's values must be integrated alongside existing evidence when making decisions on antenatal drug use and dosing. We use the example of sertraline to outline practical strategies for achieving this goal. This approach is urgently needed to foster better-informed and balanced decisions on antenatal pharmacotherapy. [ABSTRACT FROM AUTHOR]

Objective: This proposed scoping review aims to examine studies assessing the impact of drug shortages on population-level drug utilization trends. The objectives of this review are to a) assess which drugs have been studied and describe associated drug characteristics, b) determine jurisdictions and healthcare settings that have conducted these studies, and c) describe how changes in drug use and the extent of shortage impacts are reported in literature. Introduction: Drug shortages continue to impair drug access and delivery of quality care across the world. However, the impact of drug supply disruptions on availability and drug use are understudied in current literature. This proposed scoping review will identify this gap and inform future research initiatives aimed at determining the real-world impacts of drug shortages. Inclusion criteria: Published and unpublished observational studies reporting on the effects of drug supply chain disruptions (shortages, discontinuations, and safety-based withdrawals) on consequent utilization trends faced by pharmaceutical products (i.e. prescription drugs, over-the-counter drugs, vaccines, therapy products, pharmaceutical solutions). Literature reviews, meta-analyses, randomized control trials, case series, case reports, and opinion pieces will be excluded. Methods: The search strategy will combine two key search concepts: drug shortages and drug utilization. The search will be conducted in MEDLINE and EMBASE. This will be followed by an extensive grey literature search in grey literature databases, targeted websites and Google. Furthermore, reference lists of included articles will be searched. Articles will be independently screened, selected and extracted by two reviewers. Data will be descriptively analyzed and presented in tables. Trial registration: Review registration number: Open Science Framework, https://osf.io/2p6e5. [ABSTRACT FROM AUTHOR]

Dietary supplements including vitamins, minerals, and natural health products are commonly consumed by those aiming to optimize fertility and pregnancy outcomes. The aim of this survey was to describe supplementation practices among individuals who were pregnant or trying to conceive in Vancouver, Canada. An online survey was conducted among 500 individuals who were pregnant (n = 250) or trying to conceive (n = 250). Participants met a substantial proportion of vitamin and mineral recommendations through supplements alone. Exceptions included calcium, magnesium, and choline, with median (interquartile range (IQR)) supplementation doses reported by those who were pregnant and trying to conceive, respectively, of: 250 (200 and 250 mg) and 250 (200 and 250 mg), 50 (50 and 75 mg) and 50 (50 and 90 mg), and 53 (10 and 150 mg) and 55 (10 and 100 mg), as compared to perinatal recommendations of 1000 mg/day (calcium), 350 mg/day (magnesium), and 450 mg/day (choline). Conversely, median (IQR) doses of folate reported by those who were pregnant and trying to conceive, respectively, were: 1000 (780 and 1000 µg) and 1000 (800 and 1000 µg), with ∼70% overall (337/471) reporting doses ≥1000 µg (the tolerable upper intake level). Most participants (451/500; 90%) reported supplementation with a prenatal multivitamin; of these, 83% reported that supplementation occurred daily. Overall, as diet was not considered, we cannot ascertain whether recommendations for calcium, magnesium, and choline were met through the combination of supplements and foods; however, we believe that additional supplementation with choline may be required to meet recommendations in pregnancy. Excessive folate supplementation has been previously identified as a concern throughout North America; here, we provide further evidence for excessively high doses consumed via supplements. [ABSTRACT FROM AUTHOR]

This article addresses the debate on drugs use in the Partido Obrero during 1996-2009. In light of an international turn on the subject, we wonder about its impact on this trotskyist organization and worker's intervention in the discussion. To achieve this, we will analyze internal documents and the party's newspaper, in addition to recovering testimonies from former militants. Our approach will be from a marxist point of view, taking up the contributions on the subject of its first organizations, which problematized its impact on the working class. We registered the existence of three slogans: legalization, decriminalization, and the creation of alternative therapeutic communities. These are combined with a series of valuations on consumption, which strain the Argentinian left's traditional conceptions. We conclude that the labor sectors had little participation in the discussion, which has not been altered by the changes in world drug policy. [ABSTRACT FROM AUTHOR]

Background and Objectives: As overdose rates rise among non‐White Americans, understanding barriers to substance use disorder (SUD) treatment access by race and ethnicity is important. This study explores self‐reported barriers to SUD treatment by race and ethnicity in emergency department (ED) populations. Methods: We conducted a secondary, exploratory analysis of a randomized trial of patients not seeking SUD treatment who endorsed active drug use at six academic EDs. Responses to the Barriers to Treatment Inventory were compared by race, ethnicity, and drug severity, using χ2 tests (N = 858), followed by adjusted logistic regression models. Results: Absence of a perceived drug problem (39% non‐Hispanic Black, 38% Hispanic, 50% non‐Hispanic White; p ≤.001) was the most prevalent barrier to SUD treatment. Non‐Hispanic Black participants were less likely to state that they could handle their drug use on their own (OR = 0.69, CI = 0.50–0.95), and were more likely to report disliking personal questions than non‐Hispanic White participants (OR = 1.49, CI = 1.07–2.09). Non‐Hispanic Black participants were less likely than Hispanic participants to agree that treatment availability (OR = 0.46, CI = 0.28–0.76) and family disapproval (OR = 0.38, CI = 0.16–0.91) were treatment barriers. Discussion and Conclusions: Screening and counseling may help address the barrier, common to all groups, that drug use was not seen as problematic. Expanding access to diverse treatment options may also address the range of barriers reported by our study population. Scientific Significance: Our study is one of the first in the U.S. to examine both individual and structural barriers to accessing treatment and to examine the association with drug use severity by race/ethnicity. [ABSTRACT FROM AUTHOR]

Objectives: Previous evidence suggests that bisphosphonates (BPs) may lower the risk of recurrent fractures and enhance functional recovery in patients with fractures. However, there has been controversy regarding the optimal timing of treatment initiation for patients with fragility fractures. We conducted a meta-analysis to evaluate the available evidence on the use of BPs during the perioperative period and compared it to both non-perioperative periods and non-usage. Methods: Electronic searches were performed using PubMed, EMBASE, Web of Science and the Cochrane Library published before February 2023, without any language restrictions. The primary outcomes included fracture healing rate, healing time, and new fractures. We also examined a wide range of secondary outcomes. Random effects meta-analysis was used. Results: A total of 19 clinical trials involving 2543 patients were included in this meta-analysis. When comparing patients with non-perioperative BPs use in 4-6 weeks and approximately 10-12 weeks post-surgically, the overall risk ratios (RRs) of perioperative BPs use for healing rate were 1.06 (95% CI: 0.81, 1.38, p=0.69) and 1.02 (95% CI: 0.94, 1.11, p=0.65), respectively, suggesting no difference in healing rate between perioperative and non-perioperative BP initiation. For healing time, the overall mean difference between perioperative and non-perioperative periods was -0.19 week (95% CI: -1.03, 0.64, p=0.65) at approximately 10-12 weeks, indicating no significant impact of perioperative BP initiation on healing time. In terms of new fractures, the overall RR with BP use was 0.35 (95% CI: 0.17-0.73, p=0.005), when compared to patients without BPs use. This suggests a protective impact of BP use against new fractures compared to patients without BP use. Perioperative BP use was associated with a markedly higher likelihood of having adverse experiences, including fever (RR: 23.78, 95% CI: 8.29, 68.21, p< 0.001), arthralgia (RR: 10.20, 95% CI: 2.41, 43.16, p=0.002), and myalgia (RR: 9.42, 95% CI: 2.54, 34.87, p< 0.001), compared with non-BPs use. Conclusions: Treatment with BP during the perioperative period does not affect the healing process and has positive effects on therapy for patients with fragility fractures. These compelling findings underscore the potential efficacy of BP use during the perioperative period as a viable treatment option for patients with fragility fractures. [ABSTRACT FROM AUTHOR]

Background and Aims: Hepatitis C virus (HCV) burden is higher among people in prison given high prevalence of injecting drug use. This study evaluated direct‐acting antiviral (DAA) treatment outcome in prisons. Methods: The Surveillance and Treatment of Prisoners with hepatitis C (SToP‐C) study enrolled individuals incarcerated in four Australian prisons (2017–2019). Participants with detectable HCV RNA were offered sofosbuvir‐velpatasvir for 12 weeks. Sustained virological response (SVR) was assessed in intention‐to‐treat (ITT; participants commencing treatment and due for SVR assessment before study close) and per‐protocol (PP; participants with documented treatment completion and SVR assessment) populations. Results: Among 799 participants with HCV, 324 (41%) commenced treatment (94% male; median age, 32 years; median duration of incarceration, 9 months). In ITT population (n = 310), 201 had documented treatment completion (65% [95% CI: 59–70]), and 137 achieved SVR (ITT‐SVR: 44% [95% CI: 39–50]). In PP population (n = 143), 137 achieved SVR (PP‐SVR: 96% [95% CI: 91–98]). Six participants had quantifiable HCV RNA at SVR assessment from treatment failure (n = 2) or reinfection (n = 4). Release or inter‐prison transfer was common reasons for no documented treatment completion (n = 106/109 [97%]) and no SVR assessment (n = 57/58 [98%]). In ITT analysis, longer incarceration was associated with increased SVR (adjusted OR per month 1.03 [95% CI: 1.01–1.04]). Conclusion: Among participants who completed DAA treatment and were assessed for SVR, treatment outcome was consistent with non‐prison clinical studies. However, most individuals did not complete treatment or lacked study‐documented treatment outcome due to release or transfer. Strategies to accommodate dynamic prisoner populations are required to ensure continuity of HCV care, including treatment completion and post‐treatment care. [ABSTRACT FROM AUTHOR]

Introduction: Biologic disease-modifying antirheumatic drugs (bDMARD) are often discontinued when a patient with rheumatoid arthritis (RA) is diagnosed with cancer. Our aim was to determine trends in bDMARD utilization in patients with RA and recently diagnosed cancer. Method: We examined two national claims databases to identify adults with RA and recently diagnosed colorectal, lung, or prostate cancer (Optum's de-identified Clinformatics® Data Mart Database 2008–2022, and Surveillance, Epidemiology, and End Results Program (SEER) Medicare-linked 2008–2017). We determined time trends in bDMARD and tumor necrosis factor inhibitor (TNFi) prescriptions during the first 3 years after cancer with Cochram-Armitage tests and multivariable logistic regression. Cancer cohorts were analyzed separately. Results: We included 3595 patients in all six cohorts (in Clinformatics® 503 with colorectal, 468 with lung, and 440 with prostate cancer; in SEER-Medicare 580 with colorectal, 1010 with lung, and 594 with prostate cancer). No significant increase was observed in bDMARD or TNFi utilization over time. Overall, use of bDMARD within the first 3 years of follow-up ranged from 16.7% (Clinformatics® lung cohort) to 29.7% (SEER-Medicare colorectal cohort). The major predictor of bDMARD utilization was prior use in the 3 months before cancer diagnosis (p < 0.001 for all cancers) and earlier cancer stage (p < 0.001 in colorectal and lung cancer and p = 0.05 in prostate cancer). Conclusions: Use of bDMARD in patients with RA and recently diagnosed common cancers has not increased since 2008. Additional evidence on the safety of bDMARD in patients with early cancer is needed to ensure appropriate management of their RA. Key Points • Use of bDMARD and TNFi in patients with RA and early colorectal, lung, or prostate cancer has been stable since 2008, with no significant increases over time. • The major determinant of receiving bDMARD after cancer diagnosis was prior treatment with bDMARD in the prior 3 months before cancer. • Patients with advanced cancer stage and distant metastases were less likely to receive bDMARD and TNFi than those at early stages of disease. [ABSTRACT FROM AUTHOR]

Background and Objective: An increasing number of observational studies have investigated the risk of using drugs during pregnancy on congenital malformations. However, the credibility of the causal relationships drawn from these studies remains uncertain. This study aims to evaluate the potential methodological issues in existing observational studies. Methods: We used a stepwise approach to investigate this issue. First, we identified observational studies published in 2020 that examined the risk of congenital malformations associated with medication use during pregnancy. We assessed the methodological characteristics for establishing causality, including study design, confounding control, and sensitivity analysis, and compared them between "core clinical journals" and "general journals." For studies reporting an increased risk of congenital malformations in core clinical journals, we searched for subsequent studies addressing the same research question published between January 2021 and May 2023 to assess the consistency of the literature. Results: A total of 40 eligible studies were published in 2020, primarily focused on the safety of vitamin B12 and folic acid (n = 4), antidepressants (n = 4), and others (n = 32). Our findings suggest that only two (5.00%) studies used causal models to guide the identification of confounding, and only eight (20.00%) studies assessed the potential dose–response relationship. In all, 15 (37.50%) studies used propensity score analysis strategy to achieve "mimic-randomization." In addition, 22 studies (55.00%) performed sensitivity analyses, while 10 (45.45%) showed inconsistency with the primary outcome. Furthermore, 5 studies reported positive outcomes, whereas only 1 out of 11 studies demonstrated a positive correlation between drug usage during pregnancy and major malformations in subsequent studies. Conclusion: A significant portion of the studies has failed to sufficiently consider the essential methodological characteristics required to improve the credibility of causal inferences. The increased risk of congenital malformations documented in core clinical journal was not adequately replicated in subsequent studies. [ABSTRACT FROM AUTHOR]

Summary: Background: There are a plethora of therapeutic options for the management of inflammatory bowel disease (IBD). Despite this, clinical outcomes with standard dosing often fall short of established targets. While efforts centre on developing novel therapies, there is an ongoing need to optimise the use of existing agents. Aims: To focus on strategies to optimise response to biologic (monoclonal antibody) therapies in IBD, including use of therapeutic drug monitoring (TDM). Methods: An extensive review of the published literature. Results: TDM is a strategy aimed at enhancing the effectiveness of drugs with variable exposure‐response relationships by measuring serum concentrations of biologic therapies and detecting neutralising antibodies. Reactive TDM is performed when therapeutic goals have not been achieved. Tumour necrosis factor alpha (TNF) inhibitors are the treatment class most frequently associated with immunogenicity and loss of response. Immunogenicity can be reduced through avoidance of low serum drug concentrations by dose optimisation or use of concomitant immunomodulator therapy. Subtherapeutic dosing in the absence of antidrug antibodies is best managed by dose escalation or dose interval reduction. Persistent neutralising drug antibodies necessitate switching to an alternative therapy. Proactively ensuring adequate serum trough levels might help sustain treatment durability and prevent loss of response. Newer non‐TNF inhibitors demonstrate less robust exposure‐response relationships, and TDM may not prove as beneficial. Conclusions: In the treat‐to‐target paradigm of IBD treatment, optimising treatment effect with dose optimisation, which may involve strategies including TDM, increases the likelihood of achieving clinical remission and may accomplish deeper levels of remission beyond symptom control. [ABSTRACT FROM AUTHOR]

Substance use is a global phenomenon that is particularly affecting the prison population. This study aimed to describe the prevalence of drug use among people in prison before and during incarceration in seven European countries and to compare it with the prevalence in the general population. Individual data collection was carried out between 2014 and 2018 with a model European Questionnaire on Drug Use among people in prison. A total of 12,918 people living in prison filled in the survey. People in prison report higher level of drug use when compared with the general population and the use of drug inside prison exist, although at lower levels when compared with predetention. Prisons can represent a point of access to engage individuals who use drugs in interventions that address drug use and risk factors related to both drug use and imprisonment. [ABSTRACT FROM AUTHOR]

Identifying biomarkers that predict substance use disorder propensity may better strategize antiaddiction treatment. Melanin-concentrating hormone (MCH) neurons in the lateral hypothalamus critically mediate interactions between sleep and substance use; however, their activities are largely obscured in surface electroencephalogram (EEG) measures, hindering the development of biomarkers. Surface EEG signals and real-time calcium (Ca2+) activities of lateral hypothalamus MCH neurons (Ca2+ MCH) were simultaneously recorded in male and female adult rats. Mathematical modeling and machine learning were then applied to predict Ca2+ MCH using EEG derivatives. The robustness of the predictions was tested across sex and treatment conditions. Finally, features extracted from the EEG-predicted Ca2+ MCH either before or after cocaine experience were used to predict future drug-seeking behaviors. An EEG waveform derivative—a modified theta-delta-theta peak ratio (EEG TDT ratio)—accurately tracked real-time Ca2+ MCH in rats. The prediction was robust during rapid eye movement sleep (REMS), persisted through vigilance states, sleep manipulations, and circadian phases, and was consistent across sex. Moreover, cocaine self-administration and long-term withdrawal altered EEG TDT ratio, suggesting shortening and circadian redistribution of synchronous MCH neuron activities. In addition, features of EEG TDT ratio indicative of prolonged synchronous MCH neuron activities predicted lower subsequent cocaine seeking. EEG TDT ratio also exhibited advantages over conventional REMS measures for the predictions. The identified EEG TDT ratio may serve as a noninvasive measure for assessing MCH neuron activities in vivo and evaluating REMS; it may also serve as a potential biomarker for predicting drug use propensity. [ABSTRACT FROM AUTHOR]

Purpose: Biological treatment has been a game changer in the management of moderate‐to‐severe psoriasis. In Denmark, biological treatment for psoriasis is registered in two data sources. We aimed to describe the utilization of biologics for psoriasis in Denmark using data from both data sources separately. Methods: We used data from two different nationwide Danish data sources: The healthcare registries and the clinical quality database, Dermbio. Utilization patterns were described by three different parameters: (1) distribution of drugs used in the first treatment episodes, (2) treatment cascade on a population level, and (3) drug survival using Kaplan Meier (KM) analysis and the proportion of patients covered (PPC) method. Results: From January 1, 2011, to December 31, 2018, we found 1878 users of biologics in the healthcare registries and 2264 in Dermbio. Adalimumab, ustekinumab, and secukinumab were the most common first‐choice treatments throughout the study period. According to the healthcare registries, it was most common to have more than one treatment episode with the same drug. In Dermbio, most were registered to have only one observable treatment episode overall in the study period. Ustekinumab showed the longest drug survival in both databases. Drug survival was longer for all biologics in Dermbio than in the healthcare registries. Conclusion: Adalimumab, ustekinumab, and secukinumab were the most common first‐choice treatments in Denmark. Overall, ustekinumab showed the longest drug survival. We observed important differences in treatment cascades and drug survival between Dermbio and the healthcare registries, which should be considered when using these data sources to perform drug utilization studies on biologics. [ABSTRACT FROM AUTHOR]

Copyright of Nachrichten aus der Chemie is the property of Wiley-Blackwell 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.)

In recent years, several threatening developments regarding antibacterial drugs, such as rising bacterial resistance and delivery bottlenecks, have occurred. Since antibacterial drugs are crucial for modern medicine, understanding events and influencing factors relevant for long-term developments is essential. Therefore, we analyzed the number of prescriptions and costs, defined daily dose (DDD) and DDD costs of antibacterial drugs in Germany, based on the Arzneiverordnungsreport (AVR, Drug description report) between 1985 and 2022. Based on prescription rates in 2022, we selected the TOP15 and TOP5. For a more in-depth analysis, we analyzed data from the wissenschaftliches Institut der AOK (WidO, scientific institute of the AOK). The number of prescriptions increased between 1985 and 2013, but since 2014, there has been a declining trend with a noticeable COVID-related dip. Over the years, a shift in drug classes occurred. Once very popular drugs like penicillins and tetracyclines are no longer as important. Conversely, aminopenicillins and cephalosporins have become more relevant. Particularly, the TOP5 drugs have seen an increasing proportion. DDD costs have decreased in most substance classes over time. There is a strong association between decreasing costs and rising prescriptions. Falling costs have a stronger immediate impact on prescriptions that rising costs. When costs are very low, drugs might be prescribed excessively. Supply bottlenecks can also result. The main prescribers are mainly in primary care. Their share of prescription has changed little over the years, but is decreasing regarding total consumption. In comparison to other European countries, Germany ranks in the lower third regarding prescriptions. In most countries, the COVID pandemic has led to a reduced prescription of antibacterial drugs. In conclusion, we provided a comprehensive overview of the antibacterial drug market in Germany over the past four decades and identified costs as a major driver of antibacterial drug prescriptions. Increased costs may reduce uncritical prescription of antibacterial drugs, development of bacterial resistance, supply shortages and occurrence of adverse effects. [ABSTRACT FROM AUTHOR]

Objectives: On January 31, 2023, a three-year exemption from the Controlled Drugs and Substances Act was granted to the Canadian province British Columbia (BC), allowing the cumulative possession of 2.5 g of specific unregulated drugs amongst adults. The goals of the policy are to reduce health, social, and economic harms associated with criminalization, stigma, drug overdose deaths, as well as drug seizures, arrests, and associated enforcement and court costs. As the inaugural year has passed, we aimed to assess people who use drugs' awareness and knowledge of the, as well as the policy's impact on their drug use patterns and overdose risk. Methods: We conducted 100 telephone-based semi-structured interviews with people who use drugs from across BC, exploring changes in drug use experiences and perceived overdose risk since the implementation of the policy. Participants also completed an interviewer-administered survey assessing socio-demographics and substance use patterns. We utilized a qualitative content analysis approach to analyze the interview data. Results: Our findings indicate a general awareness of the policy among participants, although some policy details were often misunderstood, and participants expressed the need for more widespread dissemination of policy information. While the majority of participants reported that their drug use patterns remained unchanged after decriminalization, some made subtle adjustments, such as carrying under the 2.5 g threshold to minimize the risk of criminalization. Participants highlighted several policy benefits and concerns, including its potential to reduce criminalization and stigmatization, but also increase public drug consumption. Participants offered suggestions for policy improvement. Conclusion: These findings underscore the need for ongoing monitoring of the impacts of decriminalization regarding its potential impact on people who use drugs' drug use patterns and related risks. Reevaluation of the possession threshold and efforts to enhance education and awareness about the policy could help achieve the policy's goals. [ABSTRACT FROM AUTHOR]

Cancer, ranked as the second leading cause of global mortality with a prevalence of 1 in 6 deaths, necessitates innovative approaches for effective treatment. Combinatorial drug therapy for cancer treatment targets several key pathways simultaneously and potentially enhances anti-cancer efficacy without intolerable side effects. However, it demands precise and accurate control of drug-dose combinations and their release. In this study, we demonstrated a selectively cross-linked hydrogel-based platform that can quantify and release drugs simultaneously for in-parallel cocktail drug screening. PDMS was used as the flow channel substrate and the poly (ethylene glycol) diacrylate (PEGDA) hydrogel array was formed by UV exposure using the photomask. Employing our platform, cocktails of anticancer drugs are precisely loaded and simultaneously released in-parallel into HCT-116 colon cancer cells, facilitating combinatorial drug screening. The integration of an artificial intelligence-based complex system response (AI-CSR) platform successfully identifies optimal drug-dose combinations from a pool of ten approved drugs. Notably, our cocktail drug chip demonstrates exceptional efficiency, screening 155 drug-dose combinations within a brief two and a half hours, a marked improvement over traditional methods. Furthermore, the device exhibits low drug consumption, requiring a mere 1 μL per patch of chip. Thus, our developed PDMS drug-loaded hydrogel platform presents a novel and expedited approach to quantifying drug concentrations, promising to be a faster, efficient and more precise approach for conducting cocktail drug screening experiments. [ABSTRACT FROM AUTHOR]

\nIntroduction: Drug use is a significant health, economic and social concern globally. Research indicates that personality traits are crucial in explaining drug use. This paper contributes to the expanding literature by exploring how personality traits at age 10 affect the likelihood of having used any drug at age 30. Methods: Data were extracted from the British Cohort Study 1970. The Big Five dimensions were derived by aggregating items related to distinct traits. Furthermore, probit regression analysis was conducted to ascertain the relationship between personality traits at age 10 and drug use by age 30. Results: Children with low levels of conscientiousness, or agreeableness; or high levels of extraversion, or internal locus of control at the age of 10 are more likely to use any drug in adulthood. In addition, significant differences were observed across gender and types of drugs. Conclusions: These findings suggest that early personality traits play a pivotal role in predicting the likelihood of drug use in adulthood. The results interest policymakers, as they could guide the implementation of personality-targeted interventions to mitigate the adverse effects of specific personality traits. For instance, emotional regulation training could benefit children with low conscientiousness; while stimulating activities such as sports, creative arts, or music could engage children with high extraversion. Drug use presents significant concerns for health, economics, and society globally. Research highlights the pivotal role of personality traits in understanding drug use. This study aims to contribute to the existing literature by exploring how personality traits at age 10 correlate with drug use at age 30. Utilizing data from the British Cohort Study 1970, we obtained five personality traits from both teacher-completed and self-completion questionnaires when participants were 10 years old. The relationship between personality traits and drug use was examined by employing a probit model. Children exhibiting lower levels of conscientiousness/agreeableness or higher levels of extraversion/internal locus of control at age 10 were more inclined to engage in drug use in adulthood. Moreover, significant differences based on gender and the types of drugs used were observed. These findings might be valuable to policymakers, as they could introduce interventions tailored to specific personality traits to mitigate their adverse effects. For instance, they could offer emotional regulation training for children with low levels of conscientiousness or engage children with high extraversion in stimulating activities such as sports, creative arts, or music. [ABSTRACT FROM AUTHOR]

Metal‐organic framework materials (MOFs) are highly porous and are the subject of growing interest among scientists globally for their utilization in drug delivery. In this work, iron‐based metal‐organic frameworks (MOFs) MIL‐100(Fe) were synthesized by ultrasonic method and studied for the loading of the chloroquine phosphate (CQP). The CQP‐release behavior of the material was investigated in water media with various pH solutions of 1.2, 2, 4.5, and phosphate‐buffered saline (PBS) at temperatures of 25 °C to 45 °C. MIL‐100(Fe) material had a high surface area of up to 1080 m2/g and could completely release the CQP at a pH of 1.2 after 25 hours. At other pH conditions, the drug exhibited an initial rapid release, followed by a gradual slowdown, ultimately achieving complete release after 96 hours. The maximal loading capacity for the CQP by the MIL‐100(Fe) was determined to be approximately 30 % at the pH solution of 2 (stomach environment). The findings from the activity assessment against the K1 malaria parasite strain (P. falciparum) indicated that the concentration at which the active ingredient, when carried by the material, exhibited inhibition was 193 nM/L. The evaluation outcomes for acute toxicity of the drug carrier material revealed an LD50 value exceeding 5000 mg/kg (equivalent to 1500 mg of CQP base). In contrast, when using the active substance alone, acute toxicity resulted in an LD50 value of 675 mg/kg. [ABSTRACT FROM AUTHOR]

Background/Objectives: Aggregate prescribing behavior for inflammatory lesions of rosacea has been described, but individual physician behavior has not been characterized. This study aims to assess the modern state of topical rosacea drug selection by analyzing prescribing patterns among individual dermatologists. Methods: We assessed utilization patterns of four topical papulopustular rosacea agents in 2021 Medicare Part-D data. K-means cluster analysis identified prescriber phenotypes based on the proportion of claims for each drug by physician. Results: Cluster analysis identified four prescriber phenotypes for topical rosacea agents, with the majority favoring metronidazole. In each of the other clusters, metronidazole was co-prescribed alongside the primary agent. Significant predictors of phenotype included patient ages, patient risk scores, and a group practice setting. Conclusions: The study reveals nonuniform prescribing patterns for topical papulopustular rosacea treatments among U.S. dermatologists. While aggregate data indicate diverse drug utilization, cluster analysis suggests that individual prescribers tend to use a limited selection of agents. [ABSTRACT FROM AUTHOR]

The effects of learners’ alcohol and other drug (AOD) use have far-reaching implications for educators and the teaching environment. The Schools Act 84 of 1996 describes the consequences of misconduct, with its revisions stipulating the conditions and procedures for searching, testing, and drug possession in an attempt to reduce learner substance use. There seem to be inconsistencies in the implementation of guidelines and the current practices at the school level. This research aimed to explore the response by schools to alcohol and other drug use among learners, and the guidelines to identify and address substance use. The study employed a qualitative approach and sampled 14 high schools located in seven municipality clusters in the Cape Town metropole. In-depth semi-structured interviews were conducted with teaching and management personnel. A total of 23 personnel from 11 high schools were interviewed. Thematic analysis was used to identify themes and patterns. Three themes emerged from the data, namely Practices of educators in response to AOD use; Policy-implementation gap; and Lack of agency to effect change. There is a lack of cohesive guidelines for educators to address substance use in schools. Consequently, schools use their own discretion to handle the situation; given their resources and social capital. Educators feel uninformed and ill-equipped to assist learners beyond referral. Further, there is a dearth of knowledge on aftercare and relapse in the contexts of the school/learning environment, both of which are critical components of effectively managing substance use. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodResultsConclusionResearch on legal minors who inject drugs is rare and beset with methodological problems. We explore the potential of register data for researching this population and present illustrative analyses contributing to the knowledge base.We obtained register data with national coverage from three high-income countries and assessed its analytic potential across two research themes. Descriptive analyses of the obtained data explored prevalence, mean age of debut, delay to accessing services, and treatment needs.There were differences in register types and variables collected within and between each country. The analytical potential of register data was assessed as good. Prevalence of injecting debut before the age of 18 (IDU < 18) was 29% (Sweden), 23% (Switzerland), and 5%–9% (Wales). IDU < 18 took longer to access services in each country than those with debut as adults. Complex treatment needs were identified, including mental health, education, and housing.Register data is a viable method for better understanding this small, ‘hidden’ population, albeit with important caveats. Adolescent drug services may need to deliver or link to a range of treatment responses beyond drug use. Innovative outreach, and legal and policy change may be needed to ensure harm reduction access while injecting continues. [ABSTRACT FROM AUTHOR]