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In 2011, about 1.1-1.4 million patients with dementia were living in Germany, a number expected to rise to three million by 2050. Dementia poses a major challenge to the healthcare system and neuropharmacological service provision. The aim of this study was to determine prescription rates for anti-dementia drugs as well as for neuroleptics, sedative-hypnotics and antidepressants in dementia using the complete nationwide outpatient claims data pertaining to the services of statutory health insurance. We controlled for gender, age, dementia diagnosis, physician specialty (general practitioner GP versus neuropsychiatry specialist physician NPSP), and rural and urban living area. In about one million prevalent dementia patients (N=1,014,710) in 2011, the prescription prevalence rate of anti-dementia drugs was 24.6%; it varied with gender, age, and diagnosis (highest in Alzheimer's disease; 42%), and was higher in patients treated by NPSPs (48% vs. 25% in GPs). At the same time, we found an alarmingly high rate of treatment with neuroleptics in dementia patients (35%), with an only slightly decreased risk in patients treated exclusively by NPSPs (OR=0.86). We found marginal differences between rural and urban areas. Our results show that the majority of anti-dementia drug prescriptions appear guideline-oriented, yet prescription rates are overall comparatively low. On the other hand, neuroleptic drugs, which are associated with excess morbidity and mortality in dementia, were prescribed very frequently, suggesting excess use given current guidelines. We therefore suggest that guideline implementation measures and increasing quality control procedures are needed with respect to the pharmacotherapy of this vulnerable population. (C) 2015 Elsevier B.V. and ECNR All rights reserved.
Since 1998, elite athletes’ sport injuries have been monitored in single sport event, which leads to the development of first comprehensive injury surveillance system in multi-sport Olympic Games in 2008. However, injury and illness occurred in training phases have not been systematically studied due to its multi-facets, potentially interactive risk related factors. The present thesis aim to address issues of feasibility of establishing a validated measure for injury/illness, training environment and psychosocial risk factors by creating the evaluation tool namely risk of injury questionnaire (Risk-IQ) for elite athletes, which based on IOC consensus statement 2009 recommended content of preparticipation evaluation(PPE) and periodic health exam (PHE).
A total of 335 top level athletes and a total of 88 medical care providers from Germany and Taiwan participated in tow “cross-sectional plus longitudinal” Risk-IQ and MCPQ surveys respectively. Four categories of injury/illness related risk factors questions were asked in Risk-IQ for athletes while injury risk and psychological related questions were asked in MCPQ for MCP cohorts. Answers were quantified scales wise/subscales wise before analyzed with other factors/scales. In addition, adapted variables such as sport format were introduced for difference task of analysis.
Validated with 2-wyas translation and test-retest reliabilities, the Risk-IQ was proved to be in good standard which were further confirmed by analyzed results from official surveys in both Germany and Taiwan. The result of Risk-IQ revealed that elite athletes’ accumulated total injuries, in general, were multi-factor dependent; influencing factors including but not limited to background experiences, medical history, PHE and PPE medical resources as well as stress from life events. Injuries of different body parts were sport format and location specific. Additionally, medical support of PPE and PHE indicated significant difference between German and Taiwan.
The result of the present thesis confirmed that it is feasible to construct a comprehensive evalua-tion instrument for heterogeneous elite athletes cohorts’ risk factor analysis for injury/illness oc-curred during their non-competition periods. In average and with many moderators involved, Ger-man elite athletes have superior medical care support yet suffered more severe injuries than Tai-wanese counterparts. Opinions of injury related psychological issues reflected differently on vari-ous MCP groups irrespective of different nationalities. In general, influencing factors and interac-tions existed among relevant factors in both studies which implied further investigation with multiple regression analysis is needed for better understanding.
