Prevalence, country-specific prescribing patterns and determinants of benzodiazepine use in community-residing older adults in 7 European countries

Background: The use of benzodiazepines (BZDs) in older population is often accompanied by drug-related complications. Inappropriate BZD use significantly alters older adults’ clinical and functional status. This study compares the prevalence, prescribing patterns and factors associated with BZD use in community-dwelling older patients in 7 European countries. Methods: International, cross-sectional study was conducted in community-dwelling older adults (65 +) in the Czech Republic, Serbia, Estonia, Bulgaria, Croatia, Turkey, and Spain between Feb2019 and Mar2020. Structured and standardized questionnaire based on interRAI assessment scales was applied. Logistic regression was used to evaluate factors associated with BZD use. Results: Out of 2,865 older patients (mean age 73.2 years ± 6.8, 61.2% women) 14.9% were BZD users. The highest prevalence of BZD use was identified in Croatia (35.5%), Spain (33.5%) and Serbia (31.3%). The most frequently prescribed BZDs were diazepam (27.9% of 426 BZD users), alprazolam (23.7%), bromazepam (22.8%) and lorazepam (16.7%). Independent factors associated with BZD use were female gender (OR 1.58, 95%CI 1.19–2.10), hyperpolypharmacy (OR 1.97, 95%CI 1.22–3.16), anxiety (OR 4.26, 95%CI 2.86–6.38), sleeping problems (OR 4.47, 95%CI 3.38–5.92), depression (OR 1.95, 95%CI 1.29–2.95), repetitive anxious complaints (OR 1.77, 95%CI 1.29–2.42), problems with syncope (OR 1.78, 95%CI 1.03–3.06), and loss of appetite (OR 0.60, 95%CI 0.38–0.94). In comparison to Croatia, residing in other countries was associated with lower odds of BZD use (ORs varied from 0.49 (95%CI 0.32–0.75) in Spain to 0.01 (95%CI 0.00–0.03) in Turkey), excluding Serbia (OR 1.11, 95%CI 0.79–1.56). Conclusions: Despite well-known negative effects, BZDs are still frequently prescribed in older outpatient population in European countries. Principles of safer geriatric prescribing and effective deprescribing strategies should be individually applied in older BZD users

Applicability of EU(7)-PIM criteria in cross-national studies in European countries

[Abstract] Background: The European Union (EU)(7)-PIM (potentially inappropriate medication) list presents the most comprehensive and up-to-date tool for evaluation of PIM prescribing in Europe; however, several country-specific studies have documented lower specificity of this list on pharmaceutical markets of some countries. The aim of our study was to describe approval rates and marketing of PIMs stated by EU(7)-PIM criteria in six EU countries [in comparison with the American Geriatric Society (AGS) Beers 2015 criteria]. Methods: Research teams of six EU countries (Czech Republic, Spain, Portugal, Serbia, Hungary and Turkey) participated in this study conducted by WG1b EU COST Action IS1402 group in the period October 2015–November 2018. Data on approval rates of PIMs and their availability on pharmaceutical markets have been obtained from databases of national drugregulatory institutes and up-to-date drug compendia. The EU(7)-PIM list and AGS Beers 2015 Criteria (Section 1) were applied. Results: PIMs from EU(7)-PIM list were approved for clinical use more often than those from the AGS Beers 2015 criteria (Section 1). Approval rates for EU(7)-PIMs ranged from 42.8% in Serbia to 71.4% in Spain (for AGS criteria only from 36.4% to 65.1%, respectively). Higher percentages of approved PIMs were documented in Spain (71.4%), Portugal (67.1%) and Turkey (67.5%), lower in Hungary (55.5%), Czech Republic (50.2%) and Serbia (42.8%). The majority of approved PIMs were also currently marketed in all countries except in Turkey (19.8–21.7% not marketed PIMs) and less than 20% of PIMs were available as over-thecounter medications (except in Turkey, 46.4–48.1%). Conclusions: The EU(7)-PIM list was created for utilization in European studies; however, applicability of this list is still limited in some countries, particularly in Eastern and Central Europe. The EU project EUROAGEISM H2020 (2017–2021) that focuses on PIM prescribing and regulatory measures in Central and Eastern European countries must consider these limits.European Commision; project INOMED CZ.02.1.01/0.0/0.0/18_069/001004

Odhady kardiovaskulárního rizika na základě epidemiologických studií

1. lékařská fakultaFirst Faculty of Medicin

Závisí přesnost odhadu rizika ischemické choroby srdeční stanoveného na základě framinghamské rizikové funkce na HDL-cholesterolu?

The aim was to verify if the accuracy of the CHD risk estimation by the Framingham risk function is depended on HDL-cholesterol (HDL-CH). For each man from STULONG study (n=544) the risk was estimated using both the real HDL-CH and under the assumption that HDL-CH is equal to 1.00 mmol/l. The ability to discriminate men into those with and without CHD was comparable betwee the two methods. The calibration ability was better when using the Framingham risk function with the HDL-CH approximatio

The basic concepts and principles of the construction of age-period-cohort models

213

Applicability of EU(7)-PIM criteria in cross-national studies in European countries. Therapeutic Advances in Drugs Safety. 2019. https://doi.org/10.1177/2042098619854014

The EU project EUROAGEISM H2020 (2017–2021), ESR7 project, focuses on prescribing of high-risk medications in older adults (so called PIMs, potentially inappropriate medications) and regulatory measures related to these medications, particularly in European countries. The EU7-PIM (potentially inappropriate medication) criteria presents the most comprehensive and up-to-date list of high-risk medications in older adults utilized in research in Europe. However, several country-specific studies documented differences in approval rates of high-risk medications for geriatric patients and different regulatory measures across EU countries. This scientific article describes the differences between 6 European countries (Czech Republic, Spain, Portugal, Turkey, Hungary and Republic of Serbia) in approval rates and marketing of high-risk medications in older adults using the EU(7)-PIM criteria in comparison to the most known and most utilized American Geriatric Society (AGS) Beers 2015 PIM criteria.article in the foreign journal with the I