AGING WITH HEMOPHILIA: THE CHALLENGE OF APPROPRIATE DRUG PRESCRIPTION

In high-income countries persons with severe hemophilia (PWH) A and B are aging, like their age-matched peers without hemophilia from the general population. Aging is associated not only with the comorbidities stemming from their inherited bleeding disorder (arthropathy, chronic viral infections such as hepatitis and AIDS) but also with the multiple chronic ailments associated with aging (cancer, cardiovascular disease, COPD). Multimorbidity is inevitably associated with polypharmacy, i.e., the chronic daily intake of at least five drugs, and with the related risk of severe adverse events associated with the use of inappropriate drugs and drug-drug interactions. Information on the pattern of drug prescription and usage by PWH is relatively scanty, but on the whole, the available data indicate that the rate of polypharmacy, as well as the risk of drug-drug interaction, is relatively low in PWH and better than that in their age peers without hemophilia followed by general practitioners. It is believed that this advantage results from the collaborative coordination on drug prescribing exerted, through their integration with practitioners and organ specialists, by specialized hemophilia treatment centers in the frame of comprehensive care programs. However, the available cross-sectional data were mainly obtained in relatively young PWH, so that there is a need to obtain more accurate data from the ongoing prospective studies that are being carried out in more and more progressively aging PWH. Keywords: Hemophilia; Aging; Comorbidity; Drugs Interaction.

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Clustering of Obesity-Related Risk Behaviors Among Families With Preschool Children Using a Socioecological Approach: Cross-Sectional Study (Preprint)

10.2196/preprints.10320 ◽

2018 ◽

Author(s):

Virginia Quick

Keyword(s):

Physical Activity ◽

Screen Time ◽

Vegetable Intake ◽

Daily Intake ◽

Cross Sectional Study ◽

Activity Level ◽

Cross Sectional ◽

Sugar Sweetened Beverage ◽

Sweetened Beverage ◽

Related Risk

BACKGROUND Limited attention has been given to assessing home environments of parents with preschool-aged children using a socioecological approach to better understand potential influencers of obesity risk. OBJECTIVE The purpose of this cross-sectional study was to examine the clustering of obesity-related risk behaviors among mothers with preschool children. METHODS Mothers with preschool-aged children (ages 2 to 5 years) who participated in the online Home Obesogenic Measure of Environments (HOMES) survey were examined in clustering of four healthy recommended behaviors (ie, mother’s fruit and vegetable intake ≥5 per day, sedentary screen time <4 hours per day, sugar-sweetened beverage intake <1 time/day, and increased physical activity level). Frequencies and percents of the clustering variables were conducted along with Spearman rank order correlations to determine significant associations. Ward’s method with squared Euclidean distances were performed for the cluster analysis using the four standardized continuous variables. Identification of total cluster number was determined by visually inspecting the dendogram. Sociodemographic, intrapersonal, social environment, and home physical environment characteristic differences between cluster groups were further examined by independent t tests and chi-square analysis to validate findings. RESULTS Of the 496 participants (72.6%, 360/496 white; age mean 32.36, SD 5.68 years), only a third (37.1%, 184/496) consumed five or more servings of fruits/vegetables daily, had low sedentary screen time of <4 hours/day, and reported moderate to high levels of physical activity (34.1%, 169/496). More than half (57.7%, 286/496) consumed <1 sugar-sweetened beverage serving daily. A positive correlation (r=.34, P<.001) between physical activity level and fruit/vegetable intake (≥5 servings/day), and a positive correlation (r=.15, P=.001) between low sedentary screen time (<4 hours/day) and low sugar-sweetened beverage intake (<1 serving/day) were found. Ward’s hierarchical analysis revealed a two-cluster solution: less healthy/inactive moms (n=280) and health conscious/active moms (n=216). Health conscious/active moms were significantly (P<.010) likely to be more physically active, have lower sedentary screen time, lower daily intake of sugar-sweetened beverages, and greater daily intake of fruits and vegetables compared to less healthy/inactive moms. Less healthy/inactive moms were significantly more likely to have a higher body mass index and waist circumference compared to the other cluster; however, there were no significant sociodemographic differences. There were many intrapersonal (eg, importance of physical activity for child and self) and home physical environment (eg, home availability of fruits/vegetables and salty/fatty snacks) characteristic differences between clusters, but few significant differences emerged for social environment characteristics (eg, family meals, family cohesion). CONCLUSIONS Findings may have implications in tailoring future obesity prevention interventions among families with young children.

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Feeding Your Himalayan Expedition: Nutritional Signatures and Body Composition Adaptations of Trekkers and Porters

Nutrients ◽

10.3390/nu13020460 ◽

2021 ◽

Vol 13 (2) ◽

pp. 460

Author(s):

Danilo Bondi ◽

Anna Maria Aloisi ◽

Tiziana Pietrangelo ◽

Raffaela Piccinelli ◽

Cinzia Le Donne ◽

...

Keyword(s):

Vastus Lateralis ◽

Daily Intake ◽

Fat Free Mass ◽

Cross Sectional ◽

Altitude Exposure ◽

Related Risk ◽

Before And After ◽

Total Body ◽

Muscle Ultrasound

High-altitude exposure leads to many physiological challenges, such as weight loss and dehydration. However, little attention has been posed to the role of nutrition and ethnic differences. Aiming to fulfill this gap, five Italian trekkers and seven Nepalese porters, all males, recorded their diet in diaries during a Himalayan expedition (19 days), and the average daily intake of micro and macro-nutrients were calculated. Bioimpedance analysis was performed five times during the trek; muscle ultrasound was performed before and after the expedition, only for the Italians. The Nepalese group consumed a lot of rice and only Italians consumed cheese. Water intake was slightly over 3000 g/d for both groups. Nepalese diet had a higher density of dietary fibre and lower density of riboflavin, vitamins A, K, and B12. Intake of calcium was lower than recommended levels. Body mass index, waist circumference, fat-free mass, and total body water decreased in both groups, whereas resistance (Rz) increased. Italians reactance (Xc) increased at day 9, whereas that of Nepalese occurred at days 5, 9, and 16. The cross-sectional area of the Vastus lateralis was reduced after the expedition. Specific nutritional and food-related risk factors guidance is needed for diverse expedition groups. Loss of muscle mass and balance of fluids both deserve a particular focus as concerns altitude expeditions.

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Potentially Inappropriate Medications Use in A Population of Iraqi Geriatric Outpatients According to Beers Criteria

International Journal of Pharmaceutical Quality Assurance ◽

10.25258/ijpqa.10.2.18 ◽

2019 ◽

Vol 10 (02) ◽

Author(s):

Ola Albaghdadi ◽

Salam , Mohammad Hassan Morteza, Firas A Ahjel ◽

Mohammad Hassan Morteza ◽

Firas Aziz Rahi

Keyword(s):

Health Care ◽

Health Care Professionals ◽

Public Health Issue ◽

Beers Criteria ◽

Potentially Inappropriate Medications ◽

Cross Sectional ◽

Face To Face ◽

Inappropriate Drugs ◽

Elderly Outpatients ◽

Inappropriate Medications

Aims: Elderly in Iraq kept suffering multiple burdens, as they are a truly fragile and vulnerable segment. A major public health issue among elderly is adverse drug reactions. This study is aimed at contributing in overcoming this treatment gap by determining the prevalence of inappropriate medications used by a group of Iraqi elderly outpatients. Methods: A cross-sectional, questionnaire-based study was conducted in a sample of 85 Iraqi elderly aged ≥65 years of either gender. Participants had face-to-face interviews to answer a comprehensive questionnaire. Each drug taken by the patient was evaluated according to Beers criteria. Results: Females constituted 45.9% of the total. The average age was 69.9 years (± 4.6). Nearly 30% of the patients had 3 different diseases, and 17.8% had ≥4 different ones, with cardiovascular diseases were the most prevalent. Polypharmacy was notably identified in 47.1% of the total studied population. Twenty-eight out of 85 patients did not know the actual reason of taking at least one of their medications, and 42% were not taking their drugs as directed. Remarkably, 43.5% of patients were recognized as taking at least one medication to be avoided in elderly people according to the Beers criteria. The most common inappropriate drugs were glyburide, and proton-pump inhibitors. Conclusion: There was an obvious absence of any role of pharmacists in the health care system for our studied population. Health care professionals are encouraged to review the medications prescribed for geriatric patients using updated safety guidelines to prevent the risks associated with potentially inappropriate medications.

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Blood-Borne Chronic Viral Infections in a Large Cohort of Immigrants in Southern Italy

SSRN Electronic Journal ◽

10.2139/ssrn.3396024 ◽

2019 ◽

Author(s):

Nicola Coppola ◽

Caterina Monari ◽

Loredana Alessio ◽

Lorenzo Onorato ◽

Luciano Gualderi ◽

...

Keyword(s):

Southern Italy ◽

Viral Infections ◽

Large Cohort ◽

Chronic Viral Infections

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Assessment of Knowledge, Attitudes, and Practices Regarding Dengue among Physicians: A Web-Based Cross-Sectional Survey

Behavioral Sciences ◽

10.3390/bs11080105 ◽

2021 ◽

Vol 11 (8) ◽

pp. 105

Author(s):

Kranthi Swaroop Koonisetty ◽

Ubydul Haque ◽

Rajesh Nandy ◽

Nasrin Aghamohammadi ◽

Tamanna Urmi ◽

...

Keyword(s):

Dengue Fever ◽

Viral Infections ◽

Diagnosis And Treatment ◽

Cross Sectional Survey ◽

Accurate Identification ◽

Cross Sectional ◽

Web Based ◽

Attitudes And Practices ◽

Aedes Mosquitoes ◽

Knowledge Attitudes And Practices

Dengue fever is one of the most important viral infections transmitted by Aedes mosquitoes and a major cause of morbidity and mortality globally. Accurate identification of cases and treatment of dengue patients at the early stages can reduce medical complications and dengue mortality rate. This survey aims to determine the knowledge, attitude, and practices (KAP) among physicians in dengue diagnosis and treatment. This study was conducted among physicians in Turkey as one nonendemic country and Bangladesh, India, and Malaysia as three dengue-endemic countries. The dosing frequencies, maximum doses, and contraindications in dengue fever were examined. The results found that physicians from Bangladesh, India, and Malaysia have higher KAP scores in dengue diagnosis and treatment compared to physicians in Turkey. This may be due to a lack of physician’s exposure to a dengue patient as Turkey is considered a nonendemic country. This assessment may help establish a guideline for intervention strategies among physicians to have successful treatment outcomes and reduce dengue mortality.

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Assessment of Inorganic Phosphate Intake by the Measurement of the Phosphate/Urea Nitrogen Ratio in Urine

Nutrients ◽

10.3390/nu13020292 ◽

2021 ◽

Vol 13 (2) ◽

pp. 292

Author(s):

María Victoria Pendón-Ruiz de Mier ◽

Noemí Vergara ◽

Cristian Rodelo-Haad ◽

María Dolores López-Zamorano ◽

Cristina Membrives-González ◽

...

Keyword(s):

Inorganic Phosphate ◽

Daily Intake ◽

Cross Sectional Study ◽

Normal Serum ◽

Dietary Recommendations ◽

Clinical Practices ◽

Cross Sectional ◽

Urea Nitrogen ◽

Inorganic P ◽

Nitrogen Ratio

In chronic kidney disease (CKD) patients, it would be desirable to reduce the intake of inorganic phosphate (P) rather than limit the intake of P contained in proteins. Urinary excretion of P should reflect intestinal absorption of P(inorganic plus protein-derived). The aim of the present study is to determine whether the ratio of urinary P to urinary urea nitrogen (P/UUN ratio) helps identify patients with a high intake of inorganic P.A cross-sectional study was performed in 71 patients affected by metabolic syndrome with CKD (stages 2–3) with normal serum P concentration. A 3-day dietary survey was performed to estimate the average daily amount and the source of P ingested. The daily intake of P was 1086.5 ± 361.3 mg/day; 64% contained in animal proteins, 22% in vegetable proteins, and 14% as inorganic P. The total amount of P ingested did not correlate with daily phosphaturia, but it did correlate with the P/UUN ratio (p < 0.018). Patients with the highest tertile of the P/UUN ratio >71.1 mg/g presented more abundant inorganic P intake (p < 0.038).The P/UUN ratio is suggested to be a marker of inorganic P intake. This finding might be useful in clinical practices to identify the source of dietary P and to make personalized dietary recommendations directed to reduce inorganic P intake.

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Drug Prescription Profiles in Patients with Polypharmacy in Spain: A Large-Scale Pharmacoepidemiologic Study Using Real-World Data

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094754 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4754

Author(s):

Miguel Ángel Hernández-Rodríguez ◽

Ermengol Sempere-Verdú ◽

Caterina Vicens-Caldentey ◽

Francisca González-Rubio ◽

Félix Miguel-García ◽

...

Keyword(s):

Psychotropic Drugs ◽

Large Scale ◽

Anatomical Therapeutic Chemical ◽

Drug Prescription ◽

Age Groups ◽

System Level ◽

Real World Data ◽

Converting Enzyme Inhibitors ◽

Cross Sectional ◽

Β Blockers

We aimed to identify and compare medication profiles in populations with polypharmacy between 2005 and 2015. We conducted a cross-sectional study using information from the Computerized Database for Pharmacoepidemiologic Studies in Primary Care (BIFAP, Spain). We estimated the prevalence of therapeutic subgroups in all individuals 15 years of age and older with polypharmacy (≥5 drugs during ≥6 months) using the Anatomical Therapeutic Chemical classification system level 4, by sex and age group, for both calendar years. The most prescribed drugs were proton-pump inhibitors (PPIs), statins, antiplatelet agents, benzodiazepine derivatives, and angiotensin-converting enzyme inhibitors. The greatest increases between 2005 and 2015 were observed in PPIs, statins, other antidepressants, and β-blockers, while the prevalence of antiepileptics was almost tripled. We observed increases in psychotropic drugs in women and cardiovascular medications in men. By patient´s age groups, there were notable increases in antipsychotics, antidepressants, and antiepileptics (15–44 years); antidepressants, PPIs, and selective β-blockers (45–64 years); selective β-blockers, biguanides, PPIs, and statins (65–79 years); and in statins, selective β-blockers, and PPIs (80 years and older). Our results revealed important increases in the use of specific therapeutic subgroups, like PPIs, statins, and psychotropic drugs, highlighting opportunities to design and implement strategies to analyze such prescriptions’ appropriateness.

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Potential intravenous drug incompatibilities in a pediatric unit

Einstein (São Paulo) ◽

10.1590/s1679-45082016ao3723 ◽

2016 ◽

Vol 14 (2) ◽

pp. 185-189 ◽

Cited By ~ 4

Author(s):

Karla Dalliane Batista Leal ◽

Ramon Weyler Duarte Leopoldino ◽

Rand Randall Martins ◽

Lourena Mafra Veríssimo

Keyword(s):

Risk Factors ◽

University Hospital ◽

Intravenous Drug ◽

Penicillin G ◽

Cross Sectional ◽

Relative Risks ◽

Related Risk ◽

Student’S T ◽

Level Of Significance ◽

Student’S T Test

ABSTRACT Objective To investigate potential intravenous drug incompatibilities and related risk factors in a pediatric unit. Methods A cross-sectional analytical study conducted in the pediatric unit of a university hospital in Brazil. Data on prescriptions given to children aged 0-15 years from June to October 2014 were collected. Prescriptions that did not include intravenous drugs and prescriptions with incomplete dosage regimen or written in poor handwriting were excluded. Associations between variables and the risk of potential incompatibility were investigated using the Student’s t test and ANOVA; the level of significance was set at 5% (p<0.05). Relative risks were calculated for each drug involved in potential incompatibility with 95% confidence interval. Results A total of 222 children participated in the study; 132 (59.5%) children were male and 118 (53.2%) were aged between 0 and 2 years. The mean length of stay was 7.7±2.3 days. Dipyrone, penicillin G and ceftriaxona were the most commonly prescribed drugs. At least one potential incompatibility was detected in about 85% of children (1.2 incompatibility/patient ratio). Most incompatibilities detected fell into the non-tested (93.4%), precipitation (5.5%), turbidity (0.7%) or chemical decomposition (0.4%) categories. The number of drugs and prescription of diazepam, phenytoin, phenobarbital or metronidazole were risk factors for potential incompatibility. Conclusion Most pediatric prescriptions involved potential incompatibilities, with higher prevalence of non-tested incompatibilities. The number of drugs and prescription of diazepam, phenobarbital, phenytoin or metronidazole were risk factors for potential incompatibilities.

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An analysis of heavy metals contamination and estimating the daily intakes of vegetables from Uganda

Toxicology Research and Application ◽

10.1177/2397847320985255 ◽

2021 ◽

Vol 5 ◽

pp. 239784732098525

Author(s):

Keneth Iceland Kasozi ◽

Eric Oloya Otim ◽

Herbert Izo Ninsiima ◽

Gerald Zirintunda ◽

Andrew Tamale ◽

...

Keyword(s):

Heavy Metals ◽

Daily Intake ◽

Principal Component ◽

Absorption Spectrometry ◽

Cross Sectional Study ◽

Essential Elements ◽

World Health ◽

Cross Sectional ◽

Health Organization ◽

Daily Intakes

Background: Environmental contamination with elevated levels of copper (Cu), cobalt (Co), iron (Fe), zinc (Zn), lead (Pb), chromium (Cr6+), cadmium (Cd), and nickel (Ni)—all states of which are found in Uganda—raises health risk to the public. Pb, Cr6+, Cd, and Ni for instance are generally considered nonessential to cellular functions, notwithstanding the importance of the oxidative state of the metals in bioavailability. As such, we aimed in this study (i) to evaluate heavy metal concentrations in four vegetables from a typical open-air market in Uganda, (ii) to assess the safety of consuming these vegetables against the World Health Organization (WHO) recommended limits of heavy metals consumption, and (iii) to formulate a model of estimated daily intake (EDI) among consumers in the country. Methods: This was a cross-sectional study conducted in five georeferenced markets of Bushenyi district in January 2020. Amaranthus, cabbages, scarlet eggplants, and tomatoes were collected from open markets, processed, and analyzed by atomic absorption spectrometry. Modeled EDI, principal component (PCA) and cluster analysis (CA) were conducted to identify relationships in the samples. Results: The levels of essential elements in the four vegetables were found to fall from Co > Cu > Fe > Zn. Those of non-essential metals were significantly higher and followed the pattern Cd > Cr > Pb > Ni. The highest EDI values were those of Cu in scarlet eggplants, Zn in amaranthus, Fe in amaranthus, Co in amaranthus, Pb in cabbages, total Cr in scarlet eggplant, Cd in cabbages and tomatoes, and Ni in cabbages. In comparison to international limits, EDIs for Zn, Cu, Co and Fe were low while Ni in cabbages were high. PCA showed high variations in scarlet eggplant and amaranthus. The study vegetables were found to be related with each other, not according to the location of the markets from where they were obtained, but according to their species by CA. Conclusion: The presence of non-essential elements above WHO limits raises policy challenges for the consumption and marketing of vegetables in the study area. Furthermore, low EDIs of essential elements in the vegetables create demand for nutritious foods to promote healthy communities.

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Levels of Polychlorinated Dibenzo-p-Dioxins/Furans (PCDD/Fs) and Dioxin-Like Polychlorinated Biphenyls (DL-PCBs) in Human Breast Milk in Chile: A Pilot Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094825 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4825

Author(s):

Claudia Foerster ◽

Liliana Zúñiga-Venegas ◽

Pedro Enríquez ◽

Jacqueline Rojas ◽

Claudia Zamora ◽

...

Keyword(s):

High Resolution ◽

Breast Milk ◽

Polychlorinated Biphenyls ◽

High Resolution Mass Spectrometry ◽

Daily Intake ◽

Human Breast Milk ◽

International Studies ◽

Cross Sectional ◽

Pooled Samples ◽

Chilean Women

Persistent organic pollutants (POPs) are organic compounds that resist biochemical degradation, moving long distances across the atmosphere before deposition occurs. Our goal was to provide up-to-date data on the levels of polychlorinated dibenzo-p-dioxins/furans (PCDD/Fs) and dioxin-like polychlorinated biphenyls (DL-PCBs) in breast milk from Chilean women and to estimate the exposure of infants due to breast milk consumption. In Chile, we conducted a cross-sectional study based on methodologies proposed by the WHO, with a sample of 30 women recruited from three defined areas: 10 from the Arica Region (urban; Arica and Parinacota Region), 10 from Coltauco (rural; O’Higgins Region), and 10 from Molina (40% rural; Maule Region). High-resolution gas chromatography coupled with high-resolution mass spectrometry (HRGC/HRMS) was performed on pooled samples from each area. We calculated equivalent toxic concentrations (WHO-TEQ) based on the current WHO Toxic Equivalency Factors (TEF). The minimum and maximum values of ∑ PCDDs/Fs + DL-PCBs-TEQ were 4.317 pg TEQ/g fat in Coltauco and 6.31 pg TEQ/g fat in Arica. Molina had a total TEQ of 5.50 pg TEQ/g fat. The contribution of PCDD/Fs was approximately five-fold higher than that of DL-PCBs. The Estimated Daily Intake (EDI) of ∑ PCDDs/Fs + DL-PCBs based on the three pooled samples ranged between 6.71 and 26.28 pg TEQ/kg body weight (bw)/day, with a mean intake of 16.11 (±6.71) pg TEQ/kg bw/day in breastfed children from 0 to 24 months old. These levels were lower than those reported in international studies. Despite the fact that the observed levels were low compared to those in most industrialized countries, the detection of a variety of POPs in breast milk from Chilean women indicates the need for follow-up studies to determine whether such exposures during childhood could represent a health risk in adulthood.

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