Bruk av skjermbaserte medier blant eldre under covid-19-pandemien : en HUNT studie

Bakgrunn: Eldre er spesielt sårbare for alvorlig sykdom og død ved covid-19 og har blitt oppfordret til selvisolering under koronapandemien. Skjermbaserte medier og telefon har blitt fremhevet som viktige hjelpemidler for å unngå ensomhet, opprettholde kontakten med venner og familie samt sikre oppfølging av nødvendig helsehjelp. Det har imidlertid manglet kunnskap om hvordan eldre har brukt skjermbaserte medier under pandemien. Hensikt: Formålet med studien var å undersøke hvordan eldre over 70 år har benyttet skjermbaserte medier til underholdning, informasjon og kontakt med venner, sosialt nettverk og helsepersonell. Videre ønsket vi å se på hvordan kjønn og alder påvirket bruken. Metode: I januar 2021 sendte vi et spørreskjema i posten til 12 772 personer som var 70 år eller eldre da de deltok i den fjerde runden av Helseundersøkelsen i Nord-Trøndelag (HUNT 4) i perioden 2017–19. Deltakerne ble bedt om å angi hvor mye tid per dag de hadde brukt på henholdsvis underholdning, kontakt med venner eller nettverk og innhenting av kunnskap eller informasjon på skjermbaserte medier. Resultat: Totalt 9391 personer (73,5 prosent) (72–106 år) svarte på spørreundersøkelsen. Av disse brukte 83,9 prosent skjermbaserte medier til å holde kontakten med venner og sosialt nettverk. Åtte prosent svarte at de hadde hatt kontakt med helsepersonell på skjermbaserte medier. Flere kvinner enn menn og flere under 80 år enn over holdt kontakten med andre via skjerm. Konklusjon: En stor andel eldre har brukt skjermbaserte medier under pandemien. Studien avdekket at det har vært lite kontakt mellom eldre og helsepersonell via telefon eller skjerm. Slik kontakt bør styrkes, samtidig som det må settes søkelys på de i den eldste delen av befolkningen som ikke benytter seg av kommunikasjonsteknologi.publishedVersio

Psychotropic drugs: Use and side effects in older psychiatric patients

Background Use of psychotropic drugs is widespread for older patients in general, and more knowledge on the use and complications of use is needed for the population of geriatric psychiatric patients. Aims We wanted to investigate the use and unreported use of psychotropic drugs on admission to a geriatric psychiatric hospital in relation to serum concentrations. We also evaluated drug side effects by a comprehensive side effect interview and performed cognitive tests on admission and after four weeks. We further wanted to investigate whether change in cognitive function was related to the cessation of benzodiazepines. Methods This observational cross-sectional study was performed in the years 2006-2008, and 236 patients were included in the study. Blood samples were taken the day after admission, and in addition to routine biochemical tests, serum analyses for 56 psychotropic drugs were performed. The UKU side effect rating scale was performed on admission to hospital, as well as several cognitive tests, including the Mini Mental Status Examination, the Hopkins Verbal Learning Test, the Digit Vigilance Test and the Stroop test. Somatic comorbidity was measured using the Charlson Comorbidity Index. Severity of depression was examined with the Montgomery and Aasberg Depression Rating Scale. Psychiatric diagnoses were based on all available information, and registered on discharge. Results We found that most patients used psychotropic drugs on admission to a geriatric psychiatric hospital, and almost half of the patients had unreported use of psychotropic drugs. Psychotropic polypharmacy (the use of tree or more concurrent drugs) was detected in half (47 %) of the patients. The dosages of the drugs were below 1 Defined Daily Dose (DDD) for all drug groups except for antidepressants, where the average dose was 1.2 (1.1-1.4) DDD. Supra therapeutic concentrations of all drugs were uncommon. The patients who were considered to have major side effects of psychotropic drugs were more often female patients with a diagnose of affective disorder, using a higher number of psychotropic drugs, a higher number of somatic drugs, unreported use of psychotropic drugs and having a higher score on the Charlson comorbidity index. On admission to hospital, several cognitive tests were performed. After four weeks of hospital treatment, cognitive function improved slightly, but only for one of the memory tests, improvement was related to the cessation of benzodiazepines. Conclusions Most of the older patients used psychotropic drugs when admitted to a geriatric psychiatric hospital, and unreported use of these drugs was common. Few patients had serum levels above reference range, and the doses of drugs were moderate. As for side effects of these drugs, clinicians should be especially aware of female patients using a high number of drugs and suffering from somatic comorbidity. The results on cognitive tests improved slightly after four weeks of inpatient treatment, but relation to the cessation of benzodiazepines was found only for one memory test

Youth and acne - a survey among 14- and 15-year-olds

Acne is a condition which can give both physical and psychological scars. Young persons are vulnerable to the negative effects of acne. Our survey investigates whether the knowledge about causes and treatment of acne is satisfactory among 14- and 15-year-olds. How does acne effect their self-esteem and well-being in school? Is there a need for information and how is their help-seeking behaviour? Our survey included 304 students from 5 different schools. The response rate was 99%. The results show that 57,6% found acne a troublesome condition, 27,1% reported a negative impact on their self-esteem and 11,5% reduced well-being in school. The knowledge of causes was scored on a scale from 0-10. The average was 5,43, which defines a need for distribution of information. 63,8% still think that chocolate is a cause of acne. Among options of treatment Clearasil is best known, despite being less effective than other products not on prescription. It is worrysome that 62,8 % think bad hygiene is a cause of acne, highlighting the harmful prejudice that acne is a filthy disease. 59,7% reported washing their face more frequently to avoid acne. Our survey confirms that most young people are affected by acne, but very few contact a doctor (3,9%). There is a need for information about causes and effective treatment to help battle the stigma of a condition which is easy to treat. It is important to lower the threshold for seeking medical help

Impact of age and CYP2D6 genotype on exposure of zuclopenthixol in patients using long-acting injectable versus oral formulation-an observational study including 2044 patients

Purpose Zuclopenthixol is an antipsychotic available as oral and long-acting injectable (LAI) formulations. The aim of this study was to investigate the effect of age on zuclopenthixol exposure during oral and LAI administrations without and with adjustment for CYP2D6 genotype. Methods Data on serum concentrations of zuclopenthixol and CYP2D6 genotype (available for 28.2% of the population) from patients using oral or LAI zuclopenthixol were included retrospectively from a therapeutic drug monitoring service during the period 2005–2019. As a measure of exposure, dose-adjusted serum concentration (C/D ratio) was used. Based on age, patients were grouped to older (≥ 65 years) or younger (18–64 years). Linear mixed model analyses without and with adjustment for CYP2D6 genotype were used. Results Serum concentrations of zuclopenthixol from 1145 (14.1% older) and 899 patients (24.6% older) in the LAI and oral groups were included, respectively. Compared with younger patients, older patients had a higher C/D ratio of zuclopenthixol for LAI (+ 25–33%, p < 0.001) and oral formulation (+ 25–29%, p ≤ 0.003) without and with adjustment for CYP2D6 genotype. The doses were lower in older versus younger patients (oral: − 30%; LAI: − 20%; p < 0.001). Compared with the younger LAI users without reduced CYP2D6 function, a higher C/D ratio was observed in the older LAI users with reduced CYP2D6 function (+ 104%, p < 0.001). Conclusion The present study showed that zuclopenthixol exposure increases in older patients and that the older LAI users with reduced CYP2D6 function are exposed to high serum concentrations. Also, the present study showed that similar dose reductions are required for oral and LAI users

Correlates of major medication side effects interfering with daily performance: results from a cross-sectional cohort study of older psychiatric patients

Background: Polypharmacy is common among older persons who are also vulnerable to side effects. We aimed to characterize patients who on admission to a geriatric psychiatric hospital had major medication side effects interfering with daily performance. Methods: Cross-sectional cohort study of patients consecutively admitted to a geriatric psychiatric hospital from 2006, 06 December to 2008, 24 October. The UKU side effect rating scale was performed, and patients were divided into those with no/minor side effects versus those with major side effects. Blood levels of 56 psychotropic drugs and 27 safety laboratory tests were measured upon admission. Results: Of 206 patients included in the analysis, 70 (34%) had major side effects related to drug treatment. The most frequent side effects were asthenia (31%), reduced salivation (31%), concentration difficulties (28%), memory impairment (24%), and orthostatic dizziness (18%). The significant characteristics predicting major side effects were female gender (OR = 2.4, 95% confidence interval (CI) = 1.1–5.5), main diagnosis of affective disorder (OR = 4.3, 95% CI = 1.5–12.3), unreported use of psychotropic medications (OR = 2.0, 95% CI = 1.0–4.1), a higher number of reported psychotropic medications (OR = 1.7, 95% CI = 1.2–2.3), a higher number of reported medications for somatic disorders (OR = 1.2, 95% CI = 1.1–1.5), and a higher score on the Charlson comorbidity index (OR = 1.2, 95% CI = 1.0–1.4) (r2 = 0.238, p < 0.001). Conclusions: Clinicians should be especially aware of side effects related to drug treatment in geriatric psychiatric female patients with a high use of psychotropic and other medications and somatic comorbidity. Unreported use of psychotropic medications was also related to the risk for side effects, and clinicians should make an effort to ascertain all medications taken by geriatric psychiatric patients