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Use of repurposed and adjuvant drugs in hospital patients with covid-19: multinational network cohort study
AbstractObjectiveTo investigate the use of repurposed and adjuvant drugs in patients admitted to hospital with covid-19 across three continents.DesignMultinational network cohort study.SettingHospital electronic health records from the United States, Spain, and China, and nationwide claims data from South Korea.Participants303 264 patients admitted to hospital with covid-19 from January 2020 to December 2020.Main outcome measuresPrescriptions or dispensations of any drug on or 30 days after the date of hospital admission for covid-19.ResultsOf the 303 264 patients included, 290 131 were from the US, 7599 from South Korea, 5230 from Spain, and 304 from China. 3455 drugs were identified. Common repurposed drugs were hydroxychloroquine (used in from <5 (<2%) patients in China to 2165 (85.1%) in Spain), azithromycin (from 15 (4.9%) in China to 1473 (57.9%) in Spain), combined lopinavir and ritonavir (from 156 (<2%) in the VA-OMOP US to 2,652 (34.9%) in South Korea and 1285 (50.5%) in Spain), and umifenovir (0% in the US, South Korea, and Spain and 238 (78.3%) in China). Use of adjunctive drugs varied greatly, with the five most used treatments being enoxaparin, fluoroquinolones, ceftriaxone, vitamin D, and corticosteroids. Hydroxychloroquine use increased rapidly from March to April 2020 but declined steeply in May to June and remained low for the rest of the year. The use of dexamethasone and corticosteroids increased steadily during 2020.ConclusionsMultiple drugs were used in the first few months of the covid-19 pandemic, with substantial geographical and temporal variation. Hydroxychloroquine, azithromycin, lopinavir-ritonavir, and umifenovir (in China only) were the most prescribed repurposed drugs. Antithrombotics, antibiotics, H2 receptor antagonists, and corticosteroids were often used as adjunctive treatments. Research is needed on the comparative risk and benefit of these treatments in the management of covid-19.
Journal Article
Evaluation of the Nutritional Quality of Breakfast Cereals Sold on the Italian Market: The Food Labelling of Italian Products (FLIP) Study
Breakfast cereals are present on the market as different types and, in general, are one of the food categories in which voluntary information, such as nutrition or health claims (NHC) or gluten free (GF) declarations, have the largest distribution. The aims of the present study were to compare (i) the nutritional declaration among different types of breakfast cereals, as well as among products with and without NHC or GF declarations; and (ii) the salt and sugar contents with the “Italian shared objectives for the improvement of the nutritional characteristics of food”. To this aim, the nutrition declarations of 371 different breakfast cereal items, available in 13 retailers present on the Italian market, were analysed. Data showed an elevated inter-product variability, with cereal bars and muesli having the highest energy, total fat, and saturate contents per 100 g. Limited differences were found comparing products with and without NHC, as well as those with GF declaration. Most of the breakfast cereals were compliant to the shared objectives, although some items with NHC or GF declaration still have sugar or salt contents higher than these objectives. In conclusion, these data suggest that the different characteristics and the regulated information reported on the food label should not be considered as a marker of the overall nutritional quality. Thus, this study supports the importance of reading and understanding the information made on food label.
Journal Article
European consumers and health claims: attitudes, understanding and purchasing behaviour
Health claims on food products are often used as a means to highlight scientifically proven health benefits associated with consuming those foods. But do consumers understand and trust health claims? This paper provides an overview of recent research on consumers and health claims including attitudes, understanding and purchasing behaviour. A majority of studies investigated selective product–claim combinations, with ambiguous findings apart from consumers’ self-reported generic interest in health claims. There are clear indications that consumer responses differ substantially according to the nature of carrier product, the type of health claim, functional ingredient used or a combination of these components. Health claims tend to be perceived more positively when linked to a product with an overall positive health image, whereas some studies demonstrate higher perceived credibility of products with general health claims (e.g. omega-3 and brain development) compared to disease risk reduction claims (e.g. bioactive peptides to reduce risk of heart disease), others report the opposite. Inconsistent evidence also exists on the correlation between having a positive attitude towards products with health claims and purchase intentions. Familiarity with the functional ingredient and/or its claimed health effect seems to result in a more favourable evaluation. Better nutritional knowledge, however, does not automatically lead to a positive attitude towards products carrying health messages. Legislation in the European Union requires that the claim is understood by the average consumer. As most studies on consumers’ understanding of health claims are based on subjective understanding, this remains an area for more investigation.
Journal Article
German Consumers’ Attitude towards Selenium-Biofortified Apples and Acceptance of Related Nutrition and Health Claims
The present study investigates consumers’ acceptance of Se-biofortified apples, as well as Se health and nutrition claims that have been approved by the European Commission. Despite indications that such statements are more likely to be accepted if the carrier product itself has a healthy image, unprocessed fruits biofortified with Se have not been investigated in this context yet. Apples as the most frequently-consumed type of fresh fruit in Germany may offer the potential to improve the Se status of consumers when the produce is enriched with Se. Therefore, an online survey of 356 German adults was conducted to analyze different aspects that could affect the perception of and preference for the proposed product concept by consumers. The findings indicate a moderate acceptance of Se-biofortified apples, as well as of Se health and nutrition claims among the participants. Additional information about beneficial health effects of Se had a significant impact on consumer acceptance. People who regularly eat convenience food and prefer to buy apples at supermarkets were particularly attracted by the product idea. In conclusion, the results of the study indicate good prospects for a successful introduction of Se-rich apples in the German food market, if the produce is advertised with approved health and nutrition claims.
Journal Article
Oat and Barley in the Food Supply and Use of Beta Glucan Health Claims
Beta glucan is a type of soluble dietary fibre found in oats and barley with known cholesterol-lowering benefits. Many countries globally have an approved beta glucan health claim related to lowering blood cholesterol, an important biomarker for cardiovascular disease. However, the use of these claims has not been examined. The aim of this study was to explore the range and variety of oat and barley products in the Australian and global market within a defined range of grain food and beverage categories and examine the frequency of beta glucan health claims. Australian data were collected via a recognised nutrition audit process from the four major Australian supermarkets in metropolitan Sydney (January 2018 and September 2020) and Mintel Global New Product Database was used for global markets where a claim is permitted. Categories included breakfast cereals, bread, savoury biscuits, grain-based muesli bars, flour, noodles/pasta and plant-based milk alternatives and information collected included ingredients lists and nutrition and health claims. Products from Australia (n = 2462) and globally (n = 44,894) were examined. In Australia, 37 products (1.5%) made use of the beta glucan claim (84% related to oat beta glucan and 16% related to barley beta glucan, specifically BARLEYmax®). Of products launched globally, 0.9% (n = 403) displayed beta glucan cholesterol-lowering claims. Despite the number of products potentially eligible to make beta glucan claims, their use in Australia and globally is limited. The value of dietary modification in cardiovascular disease treatment and disease progression deserves greater focus, and health claims are an opportunity to assist in communicating the role of food in the management of health and disease. Further assessment of consumer understanding of the available claims would be of value.
Journal Article
Health claims databases used for kidney research around the world
Health claims databases offer opportunities for studies on large populations of patients with kidney disease and health outcomes in a non-experimental setting. Among others, their unique features enable studies on healthcare costs or on longitudinal, epidemiological data with nationwide coverage. However, health claims databases also have several limitations. Because clinical data and information on renal function are often lacking, the identification of patients with kidney disease depends on the actual presence of diagnosis codes only. Investigating the validity of these data is therefore crucial to assess whether outcomes derived from health claims data are truly meaningful. Also, one should take into account the coverage and content of a health claims database, especially when making international comparisons. In this article, an overview is provided of international health claims databases and their main publications in the area of nephrology. The structure and contents of the Dutch health claims database will be described, as well as an initiative to use the outcomes for research and the development of the Dutch Kidney Atlas. Finally, we will discuss to what extent one might be able to identify patients with kidney disease using health claims databases, as well as their strengths and limitations.
Journal Article
Impact of incorporating olive leaves during the industrial extraction of cv. Arbequina oils on the physicochemical–sensory quality and health claim fulfillment
The effect of olive leaves addition (1%, w/w, cvs. Arbequina or Santulhana), during the industrial extraction of Arbequina oils, on their physicochemical, color, phenolic profile, and sensory characteristics, was studied. Leaves’ incorporation reduced the primary oxidation (peroxide value by 33% and K232 by 17%) and increased the oxidative stability (19%), with the impact being more pronounced for Arbequina leaves. For these latter oils, leaves incorporation increased the total phenolic content (293 ± 9 mg GAE/kg), which became richer in secoiridoid derivatives (143.7 ± 3.0 mg/kg). Also, only Arbequina oils extracted with their own leaves supported the health claim regarding the protection of blood lipids against oxidative stress (hydroxytyrosol and tyrosol derivatives content greater than 5 mg per 20 g of olive oil). On the other hand, the incorporation of leaves from cvs. Arbequina and Santulhana during extraction enhanced the bitterness (55–59%) and decreased the pungency (25–33%). Santulhana leaves promoted an increase of the green-fruitiness (5.3 ± 0.5), while Arbequina leaves enhanced the oils’ sweetness (7.0 ± 0.4). Moreover, a potentiometric laboratory-made electronic tongue was applied, as a taste sensor device, being capable of successfully discriminating Arbequina oils extracted without or with addition of leaves, allowing the identification of (un)deliberated leaves incorporation during oils’ extraction. Lastly, it was found that the quality and composition of Arbequina oils industrially extracted were leaf cultivar dependent, with the low level of phenolics of control oils promoted by the incorporation of Arbequina leaves.Graphic abstract
Journal Article
Trends in psychiatric occupational therapy in Japan: A nationwide analysis using the National Database of Health Insurance Claims and Specific Health Checkups of Japan from 2014 to 2022
Mental health issues are a significant global concern, with psychiatric occupational therapy (OT) playing a crucial role in non-pharmacological treatment. In Japan, psychiatric OT is reimbursed under the national medical fee system. This study aimed to elucidate changes in psychiatric OT claims in Japan and analyze these changes by gender and age group.
The National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) Open Data from fiscal years 2014-2022 was used. The number of psychiatric OT claims was analyzed by fiscal year, age group, sex, and region. Simple regression analysis, Mann-Whitney
test, and Spearman's rank correlation were used for statistical analysis.
Inpatient psychiatric OT claims significantly increased from 2014 to 2022, particularly among the elderly (≥70 years) and those aged < 20 years. Outpatient claims significantly decreased after the onset of the COVID-19 pandemic. Females had significantly higher inpatient claims than males, but no significant difference was observed for outpatients. Substantial regional disparities were found in the implementation of psychiatric OT.
The increase in inpatient psychiatric OT claims, especially among the elderly and younger populations, highlights the growing importance of age-specific interventions. The decline in outpatient claims raises concerns about the impact of the pandemic on community-based rehabilitation. Policymakers should consider revising reimbursement schemes to support sustained outpatient OT provision and ensure its integration as a core component of inclusive mental health care systems.
Journal Article