No abstract

No abstract

Maternal influenza infection is known to cause substantial morbidity and mortality among pregnant women and young children. Many professional healthcare bodies including the World Health Organization (WHO) have identified pregnant women as a priority risk group for receipt of inactivated seasonal influenza vaccination. However influenza prevention in this group is not yet a public health priority in India. This literature review was undertaken to examine the Indian studies of influenza among pregnant women. Eight Indian studies describing influenza burden and/or outcomes among pregnant women with influenza were identified. In most studies, influenza A (pH1N1) was associated with increased maternal mortality (25–75%), greater disease severity, and adverse fetal outcomes as compared to nonpregnant women. Surveillance for seasonal influenza infections along with higher quality prospective studies among pregnant women is needed to quantify disease burden, improve awareness among antenatal care providers, and formulate antenatal influenza vaccine policies.

Objectives To describe population-based use of cognitive-enhancing and psychopharmacological medications across care settings among Medicare beneficiaries with dementia. Design One-year (2008) cross-sectional study Setting Medicare administrative claims froma 5% random sample Participants 52,754 Medicare beneficiaries with dementia aged ≥65 years with continuous Medicare Parts A, B, and D coverage and alive throughout 2008. To ascertain dementia, ≥1 medical claim with a dementia ICD-9-CM code was required prior to 2008 and an additional claim was required in 2008 to confirm active disease. Measurements Use of medications commonly prescribed in managing dementia (cognitive enhancers, antidepressants, antipsychotics, and mood stabilizers) was assessed using three separate measures: 1) Annual prevalence of use; 2) Consistency of use; 3) Count of psychopharmacological medication classes. Care setting was determined using the number of months of nursing home (NH) residency: no-NH (zero months), partial-NH (1–11 months), and full-NH (12 months). Results Community-dwellers represented 41.3% of the cohort, while 42.4% and 16.3% resided partially and fully in a NH, respectively. Annual prevalence of use was 57.1% for cognitive enhancers, 56.4% for antidepressants, 34.0% for antipsychotics, and 8.8% for mood stabilizers. Cognitive enhancer use was significantly lower among those with any NH-stay [adjusted-prevalence-ratio (99% CI) partial-NH vs. no-NH 0.84 (0.83–0.86); full-NH versus no-NH0.83 (0.81–0.85)]. In contrast, those with any NH residence had significantly higher use for all psychopharmacological medication classes compared with community-dwellers. Over half the cohort had consistent medication regimens during 2008 (64.8%). The number of psychopharmacological medication classes used increased with increasing NH-stay duration. Conclusion This population-based study documents significant differences in medication use for managing dementia across care settings and substantial use of psychopharmacological medications among older adults with dementia.

Objectives To assess effectiveness of medications used in management of Alzheimer’s Disease and Related Dementias (ADRD) on cognition and activities of daily living (ADL) trajectories and to determine whether sex modifies these effects. Design Two-year (2007–2008) longitudinal study Setting Medicare enrollment and claims data linked to the Minimum Dataset 2.0 Participants 18,950 older nursing home (NH) residents with newly-diagnosed ADRD Measurements Exposures included four medication classes: anti-dementia medications (ADM), antipsychotics, antidepressants, and mood stabilizers. Outcomes included ADLs and cognition [Cognitive Performance Scale (CPS)]. Marginal structural models were employed to account for time-dependent confounding. Results The mean age was 83.6 years and 76% of the sample was female. Baseline use for ADMs, antidepressants, antipsychotics, and mood stabilizers was 15%, 40%, 13% and 3%, respectively. The mean baseline ADL and CPS scores were 16.6 and 2.1, respectively. ADM use was not associated with a change in ADLs over time but was associated with a slower CPS decline (slope difference: −0.09 points/year, 99% CI −0.14, −0.03). Antidepressant use was associated with slower declines in ADL (slope difference: −0.36 points/year, 99% CI −0.58, −0.14) and CPS (slope difference: −0.12 points/year, 99% CI −0.17, −0.08). Sex modified the effect of both antipsychotic and mood stabilizer use on ADLs; female users declined most quickly. Antipsychotic use was associated with slower CPS decline (slope difference: −0.11 points/year, 99% CI −0.17, −0.06), while mood stabilizer use had no effect. Conclusion Despite the observed statistically significant slower declines in cognition with ADMs, antidepressants, and antipsychotics, and the slower ADL decline found with antidepressants, these benefits are not likely of clinical significance.

During the study period, out of 12 010 AE reports mentioning bevacizumab, it was listed as the suspect drug in 94.2% of the reports. Our disproportionality analysis identified many events that are already recognized as AEs of bevacizumab, but it also identified a number of clinically important unlabelled terms, which if confirmed in future studies would have potential implications for use of bevacizumab in clinical practice.

There have been numerous changes in AE reporting, particularly a huge increase in overall annual report volume, since the Weber effect was first reported. Our results suggest that a Weber-type reporting pattern should not be assumed in the design or interpretation of analyses based on AE reports.

Background Alzheimer disease and related disorders (ADRD) are prevalent in older adults, increase the costs of chronic heart failure (CHF) management, and may be associated with undertreatment of cardiovascular disease. Objective The purpose of our study was to determine the relationship between comorbid ADRD and CHF medication use and adherence among Medicare beneficiaries with CHF. Methods This 2-year (1/1/2006–12/31/2007) cross-sectional study used data from the Chronic Condition Data Warehouse of the Centers for Medicare and Medicaid Services. Medicare beneficiaries with evidence of CHF who had systolic dysfunction and Medicare Parts A, B, and D coverage during the entire study period were included. ADRD was identified based on diagnostic codes using the Chronic Condition Data Warehouse algorithm. CHF evidence-based medications (EBMs) were selected based on published guidelines: angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, selected β-blockers, aldosterone antagonists, and selected vasodilators. Measures of EBMs included a binary measure of any EBM use and medication possession ratio among users. Results Of 9827 beneficiaries with CHF and systolic dysfunction, 24.2% had a diagnosis of ADRD. Beneficiaries with ADRD were older (80.8 vs 73.6 years; P < 0.0001) and more likely to be female (69.3% vs 58.1%; P < 0.0001). Overall EBM use was lower in patients with CHF and ADRD compared with patients with CHF but no ADRD (85.3% vs 91.2%; P < 0.0001). Lower use among those with ADRD was consistent across all EBM classes except vasodilators. Among beneficiaries receiving EBM, those with ADRD had a slightly higher mean medication possession ratio for EBM compared with those without ADRD (0.86 vs 0.84; P = 0.0001). Conclusions EBM medication adherence was high in this population, regardless of ADRD status. However, patients with ADRD had lower EBM use compared with those without ADRD. Low use of specific EBM medications such as β-blockers was found in both groups. Therefore, interventions targeting increased treatment with specific EBMs for CHF, even among patients with ADRD, may be of benefit and could help reduce CHF-related hospitalizations.