This systematic review and meta-analysis showed a significant reduction of (major) osteoporotic fractures and hip fractures after screening using fracture risk assessment and bone densitometry ...compared with usual care. The results indicate that screening is effective for fracture risk reduction, especially hip fractures. To perform a systematic review and meta-analysis of population screening for high fracture risk on fracture prevention compared with usual care. MEDLINE and Embase were searched for studies published until June 20th 2019. Randomized studies were selected that screened for high fracture risk using at least bone densitometry, screened in a general population, provided subsequent treatment with anti-osteoporosis medication, had a usual care group as comparator, and had at least one fracture-related outcome (all fractures, (major) osteoporotic fractures, or hip fractures). The primary assessment was the hazard ratio (HR) for fracture-related outcomes. All-cause mortality was a secondary outcome. Random-effects models were used to estimate pooled HRs. We identified 1186 potentially eligible articles and included three randomized studies: the ROSE study, the SCOOP study, and the SOS with a total number of
N
= 42,009 participants. Respectively, 11%, 15%, and 18% of the participants in the intervention group started medication. Meta-analysis showed a statistically significant and clinically relevant reduction of osteoporotic fractures (HR = 0.95, 95% confidence interval (CI) = 0.89–1.00), major osteoporotic fractures (HR = 0.91; 95%CI = 0.84–0.98), and hip fractures (HR = 0.80; 95%CI = 0.71–0.91), but no reduction of all fractures (HR = 0.95; 95%CI = 0.89–1.02). The pooled HR for the secondary outcome all-cause mortality was 1.04 (95% CI = 0.95–1.14). Numbers needed to screen to prevent one fracture were 247 and 272 for osteoporotic fractures and hip fractures, respectively (corresponding to 113 and 124 performed bone densitometry examinations, and 25 and 28 persons being treated). This meta-analysis showed that population screening is effective to reduce osteoporotic fractures and hip fractures. Implementation of screening in older women should be considered as serious option to prevent osteoporotic fractures, especially hip fractures.
Nonadherence with medication is a complex and multidimensional health care problem. The causes may be related to the patient, treatment, and/or health care provider. As a consequence, substantial ...numbers of patients do not benefit optimally from pharmacotherapy, resulting in increased morbidity and mortality as well as increased societal costs. Several interventions may contribute to improved adherence. However, most interventions have only a modest effect. Thus, despite the many efforts made, there has been little progress made as yet in tackling the problem of nonadherence.
This paper summarizes the definitions and taxonomy of adherence with medication, as well as types and causes of nonadherence. In addition, interventions aimed at improvement of adherence are discussed.
There is not just one solution for the nonadherence problem that fits all patients. Most interventions to improve adherence are aimed at all patients regardless of whether they are adherent or not. Recently, a number of tailored interventions have been described in the literature. Modern techniques are useful. Electronic pill boxes combined with Short Message Service reminders are specifically designed to improve unintentional adherence and have resulted in an increase in refill adherence in diabetic patients with suboptimal adherence. Tailored Internet interventions are a possibility for influencing patient drug-taking behavior and show promising results. Tailored counseling interventions targeted at the underlying causes of nonadherence seem an attractive method for supporting patients with their use of drugs. However, despite the plausible theoretical framework, data on long-term health effects of the various interventions are not available. To improve adherence effectively, there is a need for a tailored approach based on the type and cause of nonadherence and the specific needs of the patient.
Summary
The probability of initiating with anti-osteoporosis therapy increased from 7 % in 2000 to 46 % in 2010. This improvement was greater for patients over the age of 75 years. Men, those ...overweight, having dementia or exposed to antipsychotics, sedatives/hypnotics or opioid analgesics were significantly less likely to receive anti-osteoporosis drugs.
Introduction
The objective of this study was to examine trends and determinants of anti-osteoporosis drug prescribing after hip fracture in the UK between 2000 and 2010.
Methods
Data were extracted from the UK Clinical Practice Research Datalink for patients ≥50 years who had a first hip fracture between 2000 and 2010 and who did not currently (≤6 months prior) receive anti-osteoporosis drugs (bisphosphonates, strontium ranelate, parathyroid hormone, calcitonin and raloxifene) (
n
= 27,542). The cumulative incidence probability of being prescribed anti-osteoporosis drugs within 1 year after hip fracture was estimated by Kaplan-Meier life-table analyses. Determinants for treatment initiation were estimated by Cox proportional hazards models.
Results
The probability of being prescribed any anti-osteoporosis drug after hip fracture increased from 7 % in 2000 to 46 % in 2010. This trend was more marked in patients ≥75 years. The increase in prescribing of anti-osteoporosis drugs was complemented by a similar increase in vitamin D/calcium provision. Cumulative incidence of receiving anti-osteoporosis therapy was greater at any given point in time in women (8 % in 2000, 51 % in 2010) compared to men (4 % in 2000, 34 % in 2010). In addition to male gender, multivariable Cox regression identified reduced likelihood of receiving anti-osteoporosis drugs for those being overweight, having dementia and exposed to psychotropic drugs (antipsychotics, sedatives/hypnotics) or opioid analgesics.
Conclusion
Although the prescribing of anti-osteoporosis drugs after hip fracture has increased substantially since 2000, the overall rate remained inadequate, particularly in men. With the continuing increase in the absolute number of hip fractures, further research should be made into the barriers to optimise osteoporosis management.
Only a few studies reported the incidence of type 2 diabetes (T2D). Understanding recent trends in diabetes is vital for planning future diabetes care. This study updated national trends in the ...prevalence and incidence of type 2 diabetes (T2D) in the Netherlands from 2004-2020.
The DIAbetes, MANagement and Treatment (DIAMANT) cohort was used. A cross-sectional design with yearly measurements for the study period was used. The prevalence was calculated by dividing the total number of people with T2D by the total number of all residents. The incidence was calculated by dividing new cases of T2D by the resident population at risk during the calendar year of interest.
Among men, the prevalence of T2D in the Netherlands increased from 2.3% in 2004 to 6.3% in 2020. Women's prevalence increased from 2.3% in 2004 to 5.3% in 2020. During 2005-2009, the incidence rate for both men and women was relatively stable Between 2010 and 2020, the incidence rate fell about 1.5 per 1000 in both men and women.
From 2004-2020, the prevalence of T2D in the Netherlands more than doubled, with a decreasing incidence from 2010 onwards.
Summary
Long-term persistence with anti-osteoporosis drugs and determinants for discontinuation among fracture patients were examined. Persistence was 75.0 and 45.3 % after 1 and 5 years, ...respectively. Those aged ≥80 years were at increased risk of early discontinuation. Within 1 year after discontinuation, 24.3 % restarted therapy, yet 47.0 % persisted for 1 year.
Introduction
The risk of osteoporotic fracture can effectively be reduced with use of anti-osteoporosis drugs. However, little is known about persistence with these drugs after fracture where subsequent fracture risk is high. The aims were to determine long-term persistence with anti-osteoporosis drugs among fracture patients, including its determinants, and to describe restart and subsequent persistence.
Methods
A cohort study was conducted within the Dutch PHARMO Database Network. Patients aged ≥50 years (
n
= 961) who received anti-osteoporosis drugs within 1 year after fracture, but not in the preceding year, were included (2002–2011). Persistence (defined as the proportion on treatment) and the proportion restarting after discontinuation were estimated using Kaplan-Meier analyses. Time-dependent Cox regression was used to identify determinants of non-persistence including age, sex, initial dosage regime, fracture type, comorbidities, and drug use.
Results
Persistence with anti-osteoporosis drugs was 75.0 % (95 % confidence interval (CI) 72.0–77.7) and 45.3 % (95 % CI 40.4–50.0) after 1 and 5 years, respectively. A significant determinant of non-persistence was age ≥80 years (reference 50–59 years: adjusted hazard ratio adj. HR 1.65; 95 % CI 1.15–2.38). This effect was not constant over time (≤360 days following initiation: adj. HR 2.07; 95 % CI 1.27–3.37; >360 days: adj. HR 1.08; 95 % CI 0.62–1.88). Within 1 year after discontinuation, 24.3 % (95 % CI 20.1–29.2) restarted therapy, yet 47.0 % persisted for 1 year.
Conclusions
This study identified suboptimal persistence with anti-osteoporosis drugs among fracture patients. Major target groups for measures aimed to improve persistence may be those aged >80 years and those restarting therapy.
BACKGROUND: In order to improve and optimize future behavioral family lifestyle intervention programs, more information on the perceptions of obese children and their parents of these programs is ...needed. As such, the aim of this qualitative study is 1) to explore the expectations of obese children and their parents in relation to lifestyle interventions; 2) to identify barriers to making lifestyle changes that parents and children face within their social context (within the family, at school and amongst friends and peers) as well as the things that facilitate these changes and 3) to identify the needs of obese children and their parents in the context of a lifestyle intervention. METHODS: A qualitative study using semi-structured interviews was conducted. Interviewees were participants in a lifestyle intervention program in the Netherlands. RESULTS: Eighteen children (mean age 10 years) and 24 parents were interviewed. The respondents expected to lose weight by being physically active or by eating healthily. Parents struggled with adopting and adhering to new rules and the absence of support of family members. Children struggled with inconsistent parenting and a lack of support from their parents. Bullying experienced at school impeded the children in their ability to make the necessary changes. Support from peers, on the other hand, stimulated their progress. Parents identified the need for the general practitioner to discuss overweight in a non-offensive way and to show an interest in the process of weight loss. CONCLUSIONS: Participants in a lifestyle behavior intervention program benefit from parental support and help from their (extended) family, peers and friends. They would also profit from the sustained involvement of their general practitioner in assisting in the maintenance of lifestyle behavior changes.
Drug-related problems (DRP) following hospital discharge are common among elderly patients using multiple drugs for the treatment of chronic diseases. The aim of this study was to investigate the ...occurrence of DRP in these patients using a specific tool for the identification of DRP by community pharmacists.
An observational study involving 340 patients aged over 60 years using at least five prescription drugs and discharged from hospital. The occurrence of DRP was assessed by means of an identification tool specifically developed for use by community pharmacists, including a semistructured patient interview and a checklist of common DRP.
In total, 992 potential DRP were observed in the 340 patients (mean 2.9 ± 1.7). No drug prescribed but clear indication, an unnecessarily long duration of treatment, dose too low, and incorrect drug selection were the DRP most commonly observed. Ten percent of DRP occurring in 71 patients were drug-drug interactions. The number of DRP was related to the number of drugs prescribed. Frequently occurring DRP found using the patient interview were fear of side effects and no or insufficient knowledge of drug use. Medication of patients discharged from the pulmonary department and of those with type 2 diabetes was particularly associated with occurrence of DRP.
Following hospital discharge, DRP occur frequently among elderly patients using five or more drugs for the treatment of chronic disease. The number of DRP increased with the number of drugs used. An important task for community pharmacists is to identify, resolve, and prevent the occurrence of DRP among this patient group. Since DRP are associated with an increased risk of hospital readmissions, morbidity, and mortality, it is very important to develop intervention strategies to resolve and prevent DRP.
Samenvatting
In deze review onderzoeken we wat de potentiële waarde is van precisiegeneeskunde op basis van psychische stoornissen binnen diabetespreventie en -behandeling. Dit doen we aan de hand ...van de vier componenten van precisiegeneeskunde. Als eerste presenteren we een overzicht van de beschikbare literatuur over de rol van psychische stoornissen bij het ontstaan van diabetes, ofwel
precisiepreventie
en diabetesgerelateerde complicaties ofwel
precisieprognose
. Vervolgens beschrijven we de mogelijke interventies voor het behandelen van psychische stoornissen bij mensen met diabetes en de waargenomen effecten hiervan, ofwel
precisiebehandeling
. Ook bespreken we hoe psychische stoornissen te meten en volgen over de tijd met behulp van mobiele gezondheidsapplicaties, ofwel
precisiemonitoring.
Als laatste beschouwen we recente ontwikkelingen in wetenschappelijk onderzoek en de praktijk. Ook bespreken we suggesties voor toekomstig onderzoek en de uitdagingen die ons staan te wachten.
We laten zien dat verschillende psychische stoornissen geassocieerd zijn met een hoger risico op type 2-diabetes en bijbehorende complicaties, waarbij dus een basis is voor precisiepreventie en precisieprognose. Ook zijn er aanwijzingen dat het behandelen van psychische stoornissen kan bijdragen aan preventie van diabetes en de ziekte-uitkomsten van mensen met diabetes kan verbeteren, kortom precisiebehandeling. Ook voor precisiemonitoring lijkt een basis, met mobiele gezondheidsapplicaties die effectief lijken te zijn in het opsporen van psychische stoornissen en daarmee het identificeren van patiënten die baat kunnen hebben bij de behandeling hiervan. Maar we laten in onze review ook zien dat er nog aanzienlijke kennislacunes bestaan, die nu verhinderen dat we precisiegeneeskunde kunnen toepassen op basis van psychische stoornissen voor diabetes. Samengevat laat deze review zien dat precisiegeneeskunde op basis van psychische stoornissen voor diabetes kan bijdragen aan de verbetering van diabetespreventie, evenals diabeteszorg en ziekte-uitkomsten.
Dit artikel is een aangepaste versie van: Kremers SHM, Wild SH, Elders PJM, Beulens JWJ, Campbell DJT, Pouwer F, Lindekilde N, de Wit M, Loyd C, Rutters F, The role of mental disorders in precision medicine for diabetes: a narrative review. Diabetologia Special issue on precision medicine (2022).
https://doi.org/10.1007/s00125-022-05738-x
Studies based on pharmacy medication records have shown suboptimal adherence and persistence of osteoporosis treatment with oral bone sparing drugs (OBSD). Little is known about adherence and ...persistence of OBSD treatment in primary care. We assessed adherence and persistence of OBSD use of patients in general practices and identified associated factors.
Using electronic medical records, adherence and persistence of newly prescribed treatment with OBSD in patients from 16 general practices was retrospectively assessed. The Medication Possession Ratio (MPR) was calculated as a proxy for adherence (MPR > 75%), persistence rates were estimated using survival analysis. Determinants of adherence and persistence using logistic regression and Cox regression analysis were assessed.
OBSD treatment was initiated in 957 patients. Seventy-five percent and 45% of the patients persisted OBSD treatment for one and five years, respectively. Being adherent in the first year decreased the risk of long-term non-persistence hazard ratio (HR) 0.41; 95% confidence interval (CI) 0.3-0.57; P < 0.001. Patients receiving the majority of their prescriptions by a specialist tended to be more non-persistent (HR 1.37; 96%; CI 0.96-1.94; P = 0.08). Adherence was 62.5% in the first year and 60.8% in the overall treatment period. Non-adherence was associated with the specialist being the main prescriber odds ratio (OR) 3.76; 95% CI 2.43-5.82; P < 0.001 and younger age (<65 years, OR 1.44; 95% CI 1.01-2.08; P = 0.04).
Older age of the patients and the GP prescribing the majority of medication were associated with better adherence and persistence. Good adherence in the first prescription year was associated with better persistence.
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