Can risk area designation help increase vaccination coverage for Tick-Borne Encephalitis? Evidence from German claims data.

BACKGROUND AND OBJECTIVES: Although vaccine preventable, the incidence of tick-borne encephalitis (TBE) increased in Germany from 2001 to 2021 by on average 2% each year, with a peak of more than 700 TBE infections documented in 2020. TBE-risk areas, as designated by district based on incidence of human cases, expanded north- and northeastward, present in 11 of the 16 Federal States as of 2022. Using claims data from a German statutory health insurance in the Federal States of Saxony and Thuringia (AOK PLUS), we aimed to assess whether official assignment of a district to a risk area had an impact on vaccination rates in Germany. METHODS: The data covered the period from 01/01/2010 to 31/12/2018 and included information on vaccine administrations from outpatient physicians. Yearly incident vaccination rates were reported overall and by district. To investigate the association between a new designation of an incident TBE-risk area and vaccination rates, a difference-in-difference analysis was conducted. RESULTS: Overall, the incident vaccination rates increased from 6.2 to 9.5 per 1,000 person-years between 2012 and 2018, with a peak of 12.2 in 2015. While districts that had been risk-areas for the whole study period had always a higher vaccination rate compared to districts that were never categorized as risk areas, the increase between 2012 and 2018 was comparable in the two groups (3.0 and 3.2 per 1,000 person-years, respectively). In contrast, districts that were newly designated risk districts during the study period experienced a significantly larger increase in vaccination rates, going from 5.8 to 14.7 per 1,000 person-years between 2012 and 2018, with a peak of 19.6 in 2015. CONCLUSION: The results suggest that the new designation of a district as risk area has a significant positive impact on vaccination rates, which is strongest immediately after designation of risk area.

Characterization of vascular reactivity in dorsal hand veins after oral rosiglitazone treatment in healthy subjects.

OBJECTIVE: In clinical studies with diabetic patients thiazolidinediones have been shown to restore abnormal vascular function which might be attributed to improved blood sugar control or to restoration of vascular endothelium and smooth muscle responsiveness. The present study was undertaken to investigate whether rosiglitazone modulates vascular responsiveness to different vasoactive agents and exerts renin-angiotensin-system (RAS)-inhibiting properties in healthy subjects in vivo. METHODS: 24 healthy male subjects were randomized to receive either rosiglitazone or placebo. Venoconstrictor responses to angiotensin II (Ang II) and phenylephrine, and endothelium-dependent response to histamine and insulin, and endothelium-independent response to glyceroltrinitrate were compared using the dorsal hand vein compliance method. Effects on the RAS were investigated by plasma level determinations of Ang II and angiotensin-(1-7). Treatment effects on the systemic arterial system were investigated by standardized pulse-wave-analysis. RESULTS: Rosiglitazone significantly inhibited venoconstrictor responses to Ang II by 19% (-70% vs. -51% constriction, p = 0.034) and in the presence of rosiglitazone the ED80 for phenylephrine was increased (ED80: 317 A+/- 86 ng vs. 531 A+/- 102 ng; p = 0.010). Rosiglitazone treatment was without effect on endothelium-dependent dilation, blood pressure, pulse-wave-velocity and plasma angiotensin peptide levels. CONCLUSIONS: The data of the present study in veins of healthy subjects are consistent with data from in vitro and animal studies supporting a direct effect of rosiglitazone on venous tone by modulation of the vascular smooth muscle response via AT1-receptor-downregulation.

[Drug information services for physicians and patients. Acceptance and benefits]. / Arzneimittelberatungsdienste für Arzte und Patienten. Akzeptanz und Nutzenbewertung.

The growing number of medicinal products and innovations has led to great complexity in the pharmaceutical market. The variety of possible drug interactions and side effects can only be overviewed with difficulty. Therefore, it is necessary that services for physicians be offered in order to provide critically evaluated and independent drug information for pharmacotherapy. In recent decades, a series of hospital based drug information centres have been established. Their quality and usefulness for patients have been positively evaluated by the users. Many patients are also insufficiently informed on their own drug therapy. This deficit is based on a general lack in communication between the patient and physician. Patient-orientated drug information services can help strengthen patients in their drug therapy and self management of symptoms, and to improve compliance. Such services have also been positively evaluated by patients.

Continuity of long-term medication use after surgical hospital stay.

OBJECTIVES: To investigate changes in long-term medication during the transfer between surgical hospital and primary care. To examine differences in defined daily doses (DDDs) versus real prescribed daily doses (PDDs). METHODS: During a 15-month period, patients from three surgical wards in a university-based teaching hospital were asked about their medication at admission (T1), at discharge (T2), and 3 months after discharge (T3). Complete data were obtained for 299 patients (169 women, 130 men; mean age 69.5 years). Both DDD and PDD were calculated for each drug. Analysis of data was performed using a relational database. RESULTS: Patients took 3.6 drugs (+/-2.2) at T1, 5 (+/-2.4) at T2, and 3.8 (+/-3.1) at T3. After surgical intervention, a discontinuation of analgesic, anti-rheumatic, and thyroid medication was observed frequently (35% of discontinued drugs at T2). We found more drug alterations at T3 than at T2 (263 versus 87). Family doctors mostly changed medications prescribed for the cardiovascular system (22% of all cardiovascular agents were discontinued and/or started at T3). We could not determine those changes to be methodical. The total of PDDs and DDDs did not differ, but the mean PDDs of statins and beta-blocking agents were significantly below the DDDs (P<0.005). CONCLUSION: The observed changes in medication after hospitalization can be only partially attributed to a successful surgical intervention and to the hospital stay. Those alterations seemed not to be initiated by the intention of saving costs.

[Drug information for patients -- unmet needs, evaluation and influence on the compliance]. / Arzneimittelberatung für Patienten -- Bedarfsanalyse, Evaluation und Einfluss auf die Compliance.

BACKGROUND: Many German patients are only insufficiently informed on their own drug therapy. Therefore, they have unmet drug information needs. We report the three-year experiences with the first drug information service for patients in Germany. We evaluate the impact of the advice on outcomes, patient sovereignty and Compliance. METHODS: All inquiries to the project within 36 months were analysed. Every patient calling within the first 24 months got a questionnaire for evaluation after the advice. The data were documented and analysed using a relational database. RESULTS: We registered 3316 inquiries. 66.2 % of the callers were female and 33,8 % male. The majority (64.5 %) was older than 65 years. The questions were mainly related to adverse drug reactions and interactions (26.6 %) as well as to information on efficacy of specific therapies (27.2 %). In 81,0 % of the patients, uncertainties regarding their medication were reduced by the advice. 37,9 % of the callers discussed the advice with their physician and 18,3 % reported a decreased consultation frequency after the advice. The patient-physician-relationship was mainly unaffected after using the service. A better compliance was reported by more than the half of the callers affected by non-compliance at the time of the advice. CONCLUSIONS: The drug information service for patients is effective in providing medical expert information to the patients regarding their own medication. Additionally, the interaction competence of the patients was strengthened. We observed a general drug information deficit. A qualified advice may reduce medical problems caused by information deficits and reduce the use of ambulatory care. At the individual patient, the trust in its pharmacotherapy was strengthened and the compliance improved.

Cardiovascular Parameters during Submaximal Exercise following Submucous Administration of Articaine : A Comparison with Lidocaine and Placebo in Young Healthy Volunteers.

OBJECTIVE: Local anaesthetics have been shown to exert pronounced cardiodepressant effects after intravenous administration in high doses. Thus, we compared the cardiovascular effects of articaine with those of lidocaine and placebo after submucous administration in healthy volunteers during bicycle exercise ergometry. PARTICIPANTS AND METHODS: A single-blind, randomised, placebo-controlled, crossover study design with washout periods of 1 week each between the three treatment days was used. Articaine 40mg (A), lidocaine 40mg (L) and placebo (P) were injected submucously in the upper jaw in 12 healthy male volunteers who had had cardiovascular diseases excluded. Parameters measured at baseline and at 15 minutes, 60 minutes and 105 minutes were systolic blood pressure (BP) and heart rate at 50W, 100W and 150W, and cardiac output at 100W. Tolerability was assessed by ECG measurements and through reporting of adverse events. RESULTS: 15 minutes after drug administration, cardiac output was reduced by -3.8% (P), -6.8% (A), and -4.2% (L) [difference between groups was not significant]. There were also no statistically significant differences between groups for cardiac output at 60 and 105 minutes, or for all BP and heart rate measurements. CONCLUSIONS: Neither drug exhibited significant effects on selected cardiovascular parameters during submaximal exercise when compared with placebo.