Elevated economic burden in obstructive lung disease patients with concomitant sleep apnea syndrome

Abstract Purpose The purpose of this study is to examine the incremental economic burden of sleep apnea syndrome (SAS) among individuals with concomitant asthma, chronic obstructive pulmonary disease (COPD), or both (i.e., asthma/COPD). Methods Maryland Medicaid claims data were used to identify beneficiaries with asthma (n=3,072), COPD (n= 3,455), or both (n=2,604). We compared patient's baseline characteristics by SAS and stratified the analyses by disease cohort to examine the effect of SAS on medical utilization and cost. Results SAS was more prevalent among beneficiaries with asthma/COPD (6.72%) than beneficiaries with COPD alone (2.87%) or asthma alone (2.15%). Asthma/COPD and COPD beneficiaries with SAS had more medical service claims (p<0.001) and higher medical cost than beneficiaries without SAS: $5,773 and$4,155 in excess costs among asthma/COPD (p=0.037) and COPD patients (p=0.035), respectively. Medical utilization and cost did not differ by SAS in asthma patients (p=0.567). Conclusions SAS may add additional economic burden on beneficiaries who already have COPD or asthma/COPD

The prevalence of benzodiazepines utilization and its association with falls among Saudi older adults; results from the Saudi national survey for elderly Health (SNSEH)

Purpose: First, to determine benzodiazepines prevalence (BDZs) among Saudi older adults (SOA); Second, to quantify the association between BDZs use and falls among SOA. Third, to determine falls effect on all-cause mortality among SOA. Methods: This is a cross-sectional study that used the Saudi National Survey for Elderly Health; a nationally-representative, population-based survey. Participants were asked about BDZs use and falls history during the 12 months prior to the interview. Demographics, medications, comorbidities and housing conditions were used as covariates. Multiple imputation was used to impute missing data. Modified poisson multivariable regression was used to study the association between BDZs and falls. Cox- proportional hazard regression was used to determine falls effect on mortality over nine years period. Results: Among 2946 SOA, BDZs prevalence was 4%. Around 13% reported falls. In the multivariable regression, relative risk (RR) of falls was 2 comparing BDZs users to non-users (95CI%: 1.02–3.99). Antidepressants (RR = 1.72; 95%CI: 1.10–2.74), laxatives (RR = 1.38; 95%CI: 1.11–1.7), low body mass index (RR = 1.94; 95%CI: 1.33–2.84), mild cognitive impairment (RR = 1.56; 95%CI: 1.21–2.03), high door steps (RR = 1.54; 95%CI: 1.23–1.93) and insufficient illumination (RR = 1.38; 95%CI: 1.11–1.71) increased falls risk. Lastly, the hazard ratio of falls on death was 1.48 (95%CI: 1.17, 1.89) over nine years. Conclusion: Despite the recommendation against BDZs use among older adults, still there were subjects who were prescribed these drugs. falls are common among SOA. Preventive strategies such medication therapy management, nutrition improvement, elderly-friendly housing structures can reduce the prevalence of falls and consequent increase in mortality among SOA. Keywords: Falls, Saudi Arabia, Older adults, Benzodiazepines, Mortalit

Quality of life tools among patients on dialysis: A systematic review

Introduction:  The universal increase in obesity and diabetes has increased the chronic kidney disease (CKD) rate. In 2017, almost 800 million individuals suffered from CKD worldwide. Kidney dialysis becomes necessary as the disease progresses. Dialysis negatively impacts CKD patients' quality of life (QoL). It causes several complications that affect patients' physical, social, psychological, and spiritual aspects of life. This systematic review aims to identify condition-specific tools used to assess CKD patients' quality of life on dialysis. Material and Methods: A systematic literature search was conducted to investigate studies using QoL tools among patients on dialysis from February 2000 to June 2023. The search was conducted in several databases and followed the PRISMA guidelines. The focus was to identify tools that capture intrinsic factors, such as spiritual subdomains, rather than extrinsic factors, such as environmental subdomains. Results: The review identified five studies and seven dialysis-specific tools for assessing the QoL of CKD patients on dialysis. The physical domain was the most assessed, followed by the psychological and social domains. Fatigue, muscle weakness, sleep disorders, and pain were identified as the most common concerns in the physical domain. Conclusion: Dialysis negatively impacts all aspects of QoL in CKD patients. This review can guide clinicians in understanding the disease and treatment burden by identifying the most appropriate tools for assessing the QoL of adult CKD patients undergoing dialysis. There is a need for further studies to explore the detrimental effects of CKD treatment and better understand its impact on patients' QoL

Patterns of acetaminophen toxicity among patients with low-risk serum concentrations

Objective In 2012, the Commission on Human Medicines mandated lowering the acetaminophen toxicity nomogram treatment threshold in the UK to 100 µg/ml at 4 h post-ingestion. The present study aim was to evaluate biochemical and liver toxicity patterns in patients who presented with acetaminophen overdose and had low serum acetaminophen concentrations (150 µg/ml or an unknown ingestion time were excluded. Data were extracted from electronic medical records and are presented as mean ± SD or median (interquartile range). Results A total of 103 patients were included (median age, 17 [4–21] years) and 80 (78%) were female. The median ingested acetaminophen dose was 5000 (2850–7650) mg. At baseline, the median serum acetaminophen concentration was 42 (4.5–64.8) µg/ml, and median alanine aminotransferase and aspartate aminotransferase levels were 22 (17–28) and 27 (16–45) IU/L, respectively. Twenty patients were treated with acetylcysteine, with none developing adverse reactions. No patient developed hepatotoxicity, including patients with initial multiple product ingestion or other risk factors. Conclusions Patients presenting with an acute acetaminophen overdose with acetaminophen level <150 µg/ml, including patients with other risk factors, are at low risk of hepatotoxicity

The health of Saudi older adults; results from the Saudi National Survey for Elderly Health (SNSEH) 2006–2015

Objectives: To Describe the Saudi older adult (SOA) characteristics and Introduce the Saudi National Survey for Elderly Health (SNSEH). Methods: The SNSEH, a population-based nationally-representative survey, was used. Subjects were included in 2006–2007, using random-cluster sampling utilizing probability proportional to size approach, and followed-up to determine their vital status until June 2015. In the analyses, survey weights were incorporated. Parametric, non-parametric and logistic regression were used. Cox-proportional hazard regression was used to determine gender effects on mortality. Results: We included 2,946 SOA. The mean age was 70.1(SD = 0.3). Around, 70% were illiterate. Almost 50% had monthly income of 2500 (2007-Saudi-Riyals). The most reported diseases were hypertension, diabetes and joints pain. The most reported medications were over the counter, antidiabetics and antihypertensive. The nine-years age-adjusted death hazard was 42% higher in SOA males. Conclusion: This is an introductory paper for a series of papers that describe SOA health. These efforts will help in guiding the development of a national healthcare model for SOA, evidence-based health policies and public intervention programs that address SOA health-related issues

The Utilization of Complementary and Alternative Medicine among Saudi Older Adults: A Population-Based Study

Background. Complementary and alternative medicine (CAM) is an integral part of patients' therapeutic experience worldwide. Among Saudi older adults, less is known about CAM utilization. Objectives. To determine the prevalence, patterns, and factors associated with CAM utilization among SOA. Methods. In the Saudi National Survey for Elderly Health (SNSEH), subjects were asked about CAM use during the last twelve months before the interview. CAM use was defined as any use of herbal products, acupuncture, bloodletting, cauterization, medical massage, bones manual manipulation, honey, or religious rituals. Demographic characteristics included gender, age, marital status, region, educational level, and residence area. In addition, multiple comorbidities were included as possible factors that may be associated with CAM use. Multivariable logistic regression was used to explore factors associated with CAM utilization. All statistical analyses were done using STATA v.14. Results. Out of 2946 respondents, 50.4% were males, the mean age was 70.3 ± 8.3 years, and 70% were illiterate. CAM use was prevalent (62.5%). The most common CAM types were herbal products (25.4%), acupuncture (21.2%), bloodletting (12%), honey (9.5%), cauterization (7.4%), medical massage and bones manual manipulation (4%), and traditional bone setting (2.1%). In the multivariable regression, age, gender, and marital status did not have an impact on the odds of using CAM. Subjects from rural areas were 2.92 times more likely to use CAM compared with subjects in urban areas (OR = 2.92; 95%CI: 2.28‐3.75). Subjects with metabolic disorders (OR = 0.50; 95% CI: 0.42‐0.60) or kidney disease were less likely to use CAM (OR = 0.30; 95%CI: 0.14‐0.64). About pain, CAM is used more in neck pain (OR = 1.69; 95%CI: 1.30‐2.21) and also used in back pain (OR =  1.22; 95%CI: 1.03‐1.46). Conclusions. CAM use was very prevalent among SOA. Clinicians and pharmacists must ask about CAM use among older adults as many of CAM may interact with patients medications