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  • 1.
    Axelsson, K. F.
    et al.
    Department of Orthopaedic Surgery, Skaraborg Hospital, Skövde, Sweden / Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Wallander, M.
    Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden / Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden.
    Johansson, H.
    Institute for Health and Ageing, Catholic University of Australia, Melbourne, Vic., Australia.
    Lundh, Dan
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Lorentzon, M.
    Geriatric Medicine, Department of Internal Medicine and ClinicalNutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden / Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden.
    Hip fracture risk and safety with alendronate treatment in the oldest-old2017In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 282, no 6, p. 546-559Article in journal (Refereed)
    Abstract [en]

    Background. There is high evidence for secondary prevention of fractures, including hip fracture, with alendronate treatment, but alendronate's efficacy to prevent hip fractures in the oldest-old (80 years old), the population with the highest fracture risk, has not been studied. Objective. To investigate whether alendronate treatment amongst the oldest-old with prior fracture was related to decreased hip fracture rate and sustained safety. Methods. Using a national database of men and women undergoing a fall risk assessment at a Swedish healthcare facility, we identified 90 795 patients who were 80 years or older and had a prior fracture. Propensity score matching (four to one) was then used to identify 7844 controls to 1961 alendronate-treated patients. The risk of incident hip fracture was investigated with Cox models and the interaction between age and treatment was investigated using an interaction term. Results. The case and control groups were well balanced in regard to age, sex, anthropometrics and comorbidity. Alendronate treatment was associated with a decreased risk of hip fracture in crude (hazard ratio (HR) 0.62 (0.49-0.79), P < 0.001) and multivariable models (HR 0.66 (0.51-0.86), P < 0.01). Alendronate was related to reduced mortality risk (HR 0.88 (0.82-0.95) but increased risk of mild upper gastrointestinal symptoms (UGI) (HR 1.58 (1.12-2.24). The alendronate association did not change with age for hip fractures or mild UGI. Conclusion. In old patients with prior fracture, alendronate treatment reduces the risk of hip fracture with sustained safety, indicating that this treatment should be considered in these high-risk patients.

  • 2.
    Bjerkeli, Pernilla J.
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Clinical Sciences, Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden.
    Vicente, Raquel Perez
    Department of Clinical Sciences, Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden.
    Mulinari, Shai
    Department of Sociology, Lund University, Lund, Sweden.
    Johnell, Kristina
    Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Merlo, Juan
    Department of Clinical Sciences, Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden / Center for Primary Health Care Research, Region Skåne, Malmö, Sweden.
    Overuse of methylphenidate: an analysis of Swedish pharmacy dispensing data2018In: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 10, p. 1657-1665Article in journal (Refereed)
    Abstract [en]

    Purpose: To identify overuse of methylphenidate and to investigate patterns of overuse in relation to sociodemographic and clinical characteristics. Patients and methods: Swedish national, pharmacy dispensing data were analyzed for all 56,922 individuals aged 6-79 years, who filled a methylphenidate prescription between 2010 and 2011. Overuse was defined as having above 150% days covered by the dispensed amount during 365 days from the first prescription fill, assuming use at the maximum recommended daily dose. Results: In total, 4,304 individuals (7.6% of the methylphenidate users) were categorized as overusers. The risk of overuse increased with age (OR for 46-65 years vs 6-12 years 17.5, 95% CI 14.3-21.3), and was higher in men (OR 1.4, 95% CI 1.3-1.5) and individuals with low income (OR 1.1, 95% CI 1.0-1.2), as well as in individuals with an attention deficit hyperactivity disorder (ADHD) diagnosis (OR 1.4, 95% CI 1.3-1.6), health care visits (OR 1.3, 95% CI 1.2-1.4), previous ADHD medication use (OR 2.6, 95% CI 2.4-2.8), and previous diagnosis of mental and behavioral disorders due to psychoactive substance use (OR 2.1 95% CI 2.0-2.3). Conclusion: Among individuals using methylphenidate in Sweden, 7.6% receive amounts that are larger than what they should have a medical need for, assuming that they were using the maximum recommended daily dose 365 days per year. Notably, the prevalence of overuse was associated with previous diagnosis of alcohol and drug misuse. The prevalence was also positively associated with higher age and previous use of ADHD medication. These findings may point toward a link between exposure time and overuse. However, future studies with long-term data are needed to investigate this.

  • 3.
    Mårdby, Ann-Charlotte
    et al.
    Research and Development, Sahlgrenska University Hospital, Gothenburg, Sweden / Section of Epidemiology and Social Medicine, Department of Public Health and Community Medicine at Institute of Medicine, University of Gothenburg, Gothenburg, Sweden / Novo Nordisk A/S, Malmö, Sweden.
    Schiöler, Linus
    Section of Occupational and Environmental Medicine, Department of Public Health and Community Medicine at Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Andersson Sundell, Karolina
    Section of Epidemiology and Social Medicine, Department of Public Health and Community Medicine at Institute of Medicine, University of Gothenburg, Gothenburg, Sweden / Medical Evidence and Observational Research, AstraZeneca, Mölndal, Sweden.
    Bjerkeli, Pernilla
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Nordic School of Public Health, Gothenburg, Sweden.
    Lesén, Eva
    Nordic Health Economics AB, Gothenburg, Sweden.
    Jönsson, Anna K.
    Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.
    Adherence to antidepressants among women and men described with trajectory models: a Swedish longitudinal study2016In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 72, no 11, p. 1381-1389Article in journal (Refereed)
    Abstract [en]

    The purpose of this study are to analyse adherence to antidepressant treatment over 2 years in Sweden among women and men who initiated treatment with citalopram and to identify groups at risk of non-adherence using trajectory models. The study population, including individuals 18-85 years who initiated citalopram use between 1 July 2006 and 30 June 2007, was identified in the Swedish Prescribed Drug Register and followed for 2 years. Adherence was estimated with continuous measure of medication acquisition (CMA) and group-based trajectory modelling, a method which describes adherence patterns over time by estimating trajectories of adherence and the individual's probability of belonging to a specific trajectory. The study population included 54,248 individuals, 64 % women. Mean CMA was 52 % among women and 50 % among men (p < 0.001). Five different adherence patterns (Trajectories) were identified. Similar proportion of women and men belonged to each Trajectory. Around 29 % of the women and 27 % of the men belonged to the Trajectory which showed full adherence throughout the 2-year study period. The other four Trajectories showed adherence that declined to different degrees and at different stages in time. Having low socioeconomic status was more common among individuals in Trajectories showing declining adherence than in the adherent Trajectory. Using trajectory modelling, five Trajectories describing different patterns of adherence to citalopram treatment over time were identified. A large proportion discontinued treatment early and having low socioeconomic status increased the risk of being non-adherent.

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