Ten-year trend in prescriptions of z-hypnotics among the elderly: A nationwide, cross-sectional study in Taiwan

AbstractBackground/PurposeThe objective of this study was to characterize the 10-year trend in prescriptions of z-hypnotics among the elderly in Taiwan, focusing on duration and dosages of the z-hypnotics prescribed. Data from the 2001–2010 Taiwan National Health Insurance Research Database (NHIRD) were used for this study.MethodsIncident users of hypnotics[z-hypnotics and benzodiazepine (BZD)], aged ≥65 years, for each fiscal year from 2001 to 2010 were identified from the Longitudinal Health Insurance Database 2000 and 2005 of NHIRD. The annual prevalence of z-hypnotic and BZD prescriptions was reported for each fiscal year during 2001–2010. Demographics of patients who received z-hypnotics and characteristics of their providers were described. Several measures, including prescription duration, daily pills, and daily dosage, were used to quantify the use of z-hypnotics in the elderly.ResultsDuring 2001–2010, the annual use of z-hypnotics per elderly patient was doubled: from 3.1 prescriptions in 2001 to 5.8 prescriptions of z-hypnotics annually in 2010. A similar pattern was observed in the annual use of BZD per elderly patient (3.2 prescriptions in 2001 to 5.5 prescriptions of BZD in 2010). The frequency of z-hypnotic prescriptions from medical centers decreased from 33.6% in the fiscal year 2001 to 19.7% in the fiscal year 2010. In recent years, most z-hypnotics were prescribed by clinics (38.6% in 2010) and by physicians not specializing in psychiatry. The frequency of zolpidem prescriptions was 66.6% in 2001, which increased to 86.7% in 2010. The most frequent prescription duration of z-hypnotics was 8–30 days, followed by 4–7 days and ≤3 days. Over 70–80% of the z-hypnotic prescriptions contained more than 1 weeks' supply of z-hypnotics.ConclusionOur empirical findings revealed a significant nationwide outpatient consumption of z-hypnotics in Taiwan. To our knowledge, our study was the first one to conduct an in-depth examination of patients' and providers' characteristics associated with z-hypnotics use among the elderly

Usage of the Claim Database of National Health Insurance Programme for Analysis of Cisapride-Erythromycin Co-Medication in Taiwan

Purpose: This study aimed to use the National Health Insurance Research Database, Taiwan for risk analysis of concomitant use of cisapride and erythromycin. Methods: The sample consisted of subjects identified in the Outpatient Sampling Database (OSD) and Longitudinal Health Insurance Database 2000 (LHID 2000), derived from the original claim data of the National Health Insurance Research Database, Taiwan. Results: According to the LHID 2000, a total of 464 individuals experienced 685 episodes of cisapride- erythromycin co-medication prescribed by 295 physicians, revealing a prevalence of 4.5% concomitant use, with higher prevalence in clinics (9.2%) than in other medical institutes (3.7-5.4%). Among the co- medication episodes, 81. 9% and 61.2% were prescribed from the same health institutes and by the same physicians, respectively. No medical record of cardiac arrhythmias was found among these patients in 2001 and 2002, probably due to the fact that 78. 9% of the 464 individuals were under age 16, 84.0% had short exposure duration (1-4 days) and 98.0% of the episodes were prescribed with a cisapride dose of less than 0.8 mg/ kg/ day. Conclusions: Findings from this study suggest that there exists an urgent need for accreditation in terms of pharmacovigilance of clinical sites and their practicing physicians for the prevention of irrational concomitant prescription in Taiwan. Our findings also indicate that it is necessary to investigate other possible conditions of potentially dangerous comedication in Taiwan and other developing countries. Copyright (c) 2006 John Wiley & Sons, Ltd

Valinomycin和DPPC混合單分子層在空氣/水界面之探討

　　本篇研究係將一巨環抗生素離子傳遞團(Ionophore)－Valinomycin與磷脂質化合 物 Dipalmitoylphosphatidyl Choline ( DPPC)，在空氣/水界面形成混合型單分子 層(Mixed monolayers)，藉由測量在不同平均分子佔用面積(A)下單分子層之表面壓 力(π)及表面電位(ΔV)，所建立之π-A，ΔV-A等溫曲線，來探討它們在界面的相互 作用關係。將以預先混合之Valinomycin-DPPC分散溶液所分散(spread)形成之混合型 單分子層之π-A實驗結果，與理論曲線相比較，可觀察到Valinomycin與DPPC分子間 有些微互斥的現象。若將DPPC先分散在空氣/水界面上，再將Valinomycin分散在已有 DPPC存在之面時，所形成混合單分子層之π-A等溫曲線與理曲線無任何差異，且在10 mN/m左右現出具DPPC特性之"轉換相"，可推知Valinomycin與DPPC形成之混合單分子 層在界面的分佈極為可能是"不可混合的"( immiscible)，即兩相異分子各自聚集成 區在界面成島狀般分佈( Island like distribution)。一系列以不同DPPC起始分子 佔用面積所作的有關Valinomycin-DPPC 1:1混合膜之實驗中，可觀察所得到具DPPC特 性之轉換相在混合膜之π-A曲線的顯現程度，因初分散時分子間距不同，而有明顯的 不同，此實驗的結果亦可進一步支持我們的推論。　　若以0.01 M KCl或0.01 M NaCl溶液取代水為下層液，DPPC及Valinomycin單分子層及其混合單分子層在界面的 性質並無多大改變。雖然Valinomycin在以1.0 M KCl溶液為下層液之實驗中，可能因 其與K+形成錯合物的關係，而呈現出極為不同之π-A，ΔV-A等溫曲線，但 Valinomycin-DPPC混合膜在此高濃度KCl溶液之界面，所得實驗曲線與理論曲線並無 明顯差別，可知兩者在界面的相對分佈，並不會因KCl之存在而有不同，極為可能亦 是"不可混合的"