Prescription of antibiotics and anxiolytics/hypnotics to asthmatic patients in general practice: a cross-sectional study based on French and Italian prescribing data

BACKGROUND Asthma is often poorly controlled and guidelines are often inadequately followed in medical practice. In particular, the prescription of non-asthma-specific drugs can affect the quality of care. The goal of this study was to measure the frequency of the prescription of antibiotics and anxiolytics/hypnotics to asthmatic patients and to look for associations between sex or age and the prescription of these drugs. METHODS A cross-sectional study was conducted using computerised medical records from French and Italian general practitioners' networks. Patients were selected according to criteria adapted from the HEDIS (Healthcare Effectiveness Data and Information Set) criteria. The outcome measure was the number of antibiotics or anxiolytics/hypnotics prescriptions per patient in 1 year. Parallel multivariate models were developed. RESULTS The final sample included 3,093 French patients (mean age 27.6 years, 49.7% women) and 3,872 Italian patients (mean age 29.1 years, 48.7% women). In the univariate analysis, the French patients were prescribed fewer antibiotics than the Italian patients (37.1% vs. 42.2%, p < 0.00001) but more anxiolytics/hypnotics (17.8% vs. 6.9%, p < 0.0001). In the multivariate models, the female patients were more likely to receive antibiotics (odds ratio: 1.5 [1.3-1.7]) and anxiolytics/hypnotics (odds ratio: 1.8 [1.5-2.1]). CONCLUSIONS The prescription of antibiotics and anxiolytics/hypnotics to asthmatic patients is frequent, especially in women. Asthma guidelines should address this issue by referring to other guidelines covering the prescription of non-asthma-specific drugs, and alternative non-pharmacological interventions should be considered

Mixed dyslipidemias in primary care patients in France

Laurent Laforest1, Baishali M Ambegaonkar2, Thierry Souchet3, Vasilisa Sazonov2, Eric Van Ganse11Lyon University, Lyon, France; 2Merck and Co Inc, Whitehouse Station, NJ, USA; 3Merck, Sharp &amp;amp; Dohme, Paris, FranceObjective: To determine the prevalence of single and mixed dyslipidemias among patients treated with statins in clinical practice in France.Methods: This is a prospective, observational, cross-sectional, pharmacoepidemiologic study with a total of 2544 consecutive patients treated with a statin for at least 6 months.Main outcome measures: Prevalence of isolated and mixed dyslipidemias of low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), and triglycerides among all patients and among patients at high cardiovascular risk; clinical variables associated with attainment of lipid targets/normal levels in French national guidelines.Results: At least one dyslipidemia was present in 50.8% of all patients and in 71.1% of high-risk patients. Dyslipidemias of LDL-C, HDL-C, and triglycerides were present in 27.7%, 12.4%, and 28.7% of all patients, respectively, and in 51.0%, 18.2%, and 32.5% of high-risk patients, respectively. Among all subjects with any dyslipidemia, 30.9% had mixed dyslipidemias and 69.4% had low HDL-C and/or elevated triglycerides, while 30.6% had isolated elevated LDL-C; corresponding values for high-risk patients were 36.8%, 58.9%, and 41.1%. Age, gender, body mass index and Framingham Risk Score &amp;gt;20% were the factors significantly associated with attainment of normal levels for &amp;ge;2 lipid levels.Conclusions: At least one dyslipidemia persisted in half of all patients and two-thirds of high cardiovascular risk patients treated with a statin. Dyslipidemias of HDL-C and/or triglycerides were as prevalent as elevated LDL-C among high cardiovascular risk patients.Keywords: cholesterol, triglycerides, dyslipidemias, prevalence, treatment outcome, Franc

Correlates of quality of life of pre-obese and obese patients: a pharmacy-based cross-sectional survey

<p>Abstract</p> <p>Background</p> <p>The correlates of quality of life (QOL), as measured by the OSQOL questionnaire were investigated in a convenience sample of overweight patients recruited in pharmacies.</p> <p>Methods</p> <p>A convenience sample of patients with a Body Mass Index ≥ 28 kg/m²were recruited in community-based pharmacies. Baseline characteristics and QOL dimensions (1-Physical state, 2-Vitality-desire to do things, 3-Relations with others, 4-Psychological state) were reported in self-completed questionnaires from which the risk of obtaining a low QOL was assessed for each dimension.</p> <p>Results</p> <p>QOL was inadequate for all dimensions in the 494 patients included in the study (median age = 61, 48% women, 21% professional persons/top executives). Older pre-obese and obese patients were more likely to report impaired physical functioning (OR = 2.02, 95%CI = [1.10-3.70]), but were less severely affected socially (OR = 0.32, 95%CI = [0.15-0.69]). Pre-obese and obese professional persons and top executives showed better physical capabilities (OR = 0.35, 95%CI = [0.15-0.81]) and increased vitality (OR = 0.47, 95%CI = [0.23-0.95]). Overall, men's psychological state was better than females' (OR = 0.46, 95%CI = [0.25-0.82]). A body-mass index ≥ 35 kg/m²was significantly associated with poorer QOL scores on physical, relational and psychological dimensions.</p> <p>Conclusion</p> <p>Our data highlighted the influence of the severity of excess weight, gender, age and socioeconomic status on QOL. These factors should be taken into account when interpreting QOL in pre-obese and obese persons.</p

Measuring medication adherence in asthma : Development of a novel self-report tool

Funding: This work was supported by European Community’s 7th Framework (FP7/2007-2013); Seventh Framework Programme [HEALTH-F5-2011-282593].Peer reviewedPublisher PD

Energy and angular momentum sharing in dissipative collisions

Primary and secondary masses of heavy reaction products have been deduced from kinematics and E-ToF measurements, respectively, for the direct and reverse collisions of 93Nb and 116Sn at 25 AMeV. Light charged particles have also been measured in coincidence with the heavy fragments. Direct experimental evidence of the correlation of energy-sharing with net mass transfer has been found using the information from both the heavy fragments and the light charged particles. The ratio of Hydrogen and Helium multiplicities points to a further correlation of angular momentum sharing with net mass transfer.Comment: 21 pages, 20 figures. Submitted to European Physics Journal

Asthma patients' self-reported behaviours toward inhaled corticosteroids

SummaryBackgroundPatient adherence to recommended use of ICS is questionable in asthma, with irregular use or interruptions occurring frequently. Factors explaining discontinuation of controller therapy could orientate interventions. The characteristics of patients with interruptions of inhaled corticosteroids (ICSs), intentional or accidental, were investigated.MethodsAsthma patients regularly prescribed ICS by GPs (Cegedim network) were included. Patients' characteristics and behaviours toward ICS (accidental/intentional interruptions, less frequent use of ICS and change in dosing) were identified from self-report questionnaires, and linked to data prescription database. Interrelations between declared behaviours toward ICS were studied with a Multiple Component Analysis (MCA) and the correlates of ICS interruptions were identified.ResultsDuring the past 3 months, 31.6% of 204 patients (mean age: 53.8 years, females: 59.3%) intentionally interrupted ICS when feeling better, 25.4% forgot ICS and 18.3% deliberately changed the doses. A quarter of patients considered constant use of respiratory medicines as unhealthy. MCA revealed that intentional, accidental interruptions and less frequent use of ICS were closely correlated. Risk of intentional interruption was increased when patients considered constant use of respiratory therapy to be unhealthy (OR=3.36, 95%CI=[1.47–7.66]). Conversely, risk was significantly lower when ICS was associated or combined with another controller (OR=0.24, 95%CI=[0.08–0.73]), compared to ICS in monotherapy. Less frequent interruptions were observed in patients older than 65 (OR=0.35, 95%CI=[0.13–0.89]).ConclusionsOur study suggests that discontinuation of use of controllers is associated with other inadequate behaviours or beliefs about inhaled controllers. Efforts should be targeted at patients' perceptions and behaviours toward controller therapy

Educational outcomes of a new curriculum on interproximal oral prophylaxis for dental students

International audienceObjective The aim of this study was to evaluate the effectiveness of a preclinical oral prophylaxis education program by examining the effectiveness of the teaching module on changes to the students' attitudes towards their individual hygiene behaviors with interdental brushes (IDBs). Methods As being part of a new didactic program on oral interproximal prophylaxis, all preclinical third-year students (n = 96) enrolled in the 2014/15 academic year received theoretical, pre-clinical, and clinical lessons on interproximal prophylaxis. The evaluation of educational outcomes was linked to observed changes in students' hygiene behaviors using interdental brushes. Knowledge, skills, attitudes, satisfaction, competence and performance were also explored. The evaluation interviews were recorded at each recall, i.e., 1 week, 1 month, 3 months and 1 year after baseline. Results Motivation to use IDBs is clearly related to the perception of the effectiveness of the brushes and the perception of bleeding reduction. At one week, 89.6% of subjects reported using IDBs. Individual use decreased significantly from one week to one month (-26%, p = 0.006) while a non-significant upward trend occurred between one month and three months. Among students reporting usage of IDBs at 1 year (20.8%), only 2.0% used IDBs daily. Most students would recommend IDBs to other people at the beginning (69.8%). However, this share dropped to 50% at 3 months. IDB-users prescribed more than non-users

Angular momentum sharing in dissipative collisions

Light charged particles emitted by the projectile-like fragment were measured in the direct and reverse collision of $^{93}$Nb and $^{116}$Sn at 25 AMeV. The experimental multiplicities of Hydrogen and Helium particles as a function of the primary mass of the emitting fragment show evidence for a correlation with net mass transfer. The ratio of Hydrogen and Helium multiplicities points to a dependence of the angular momentum sharing on the net mass transfer.Comment: 8 pages, 2 figure