Persistence and treatment patterns of fixed combination drugs for glaucoma: a retrospective claims database study in Japan.

BACKGROUND: Poor persistence with glaucoma therapy can lead to disease progression and subsequent blindness. Persistence with second-line glaucoma combination treatment in a Japanese real-world setting and whether it differed from fixed and unfixed combination drugs was investigated. METHODS: This was a retrospective, non-interventional, cohort study using data from a Japanese medical claims database. Patients with glaucoma aged ≥20 years with a first drug claim for glaucoma treatment between 01 July 2005 and 30 October 2014 and with data for > 6 months before and after this first prescription were included. The primary endpoint was duration of drug persistence among glaucoma patients with and without the use of fixed combination drugs in the year following initiation of second-line combination treatment. RESULTS: Of 1403 patients included in the analysis, 364 (25.94%) received fixed combination drugs and 1039 (74.06%) received unfixed combination drugs as second-line treatment. Baseline characteristics were generally comparable between the groups. A total of 39.01% of patients on fixed combination drugs, compared with 41.67% of patients on unfixed combination drugs, persisted on their glaucoma drugs 12 months post second-index date. Median persistence durations for the fixed combination drugs and unfixed combination drugs groups were 6 (95% confidence interval [CI]: 5-8) and 7 months (95% CI 6-9), respectively. Patients who received prostaglandin analogs (PGAs) were the most persistent with their treatment (n = 99, 12.84%). Patients diagnosed with primary open-angle glaucoma were less likely to experience treatment modification (hazard ratio [HR]: 0.800, 95% CI 0.649-0.986, P = 0.036), while those diagnosed with secondary glaucoma were more likely to experience treatment modification (HR: 1.678, 95% CI 1.231-2.288, P = 0.001) compared with glaucoma suspects. CONCLUSIONS: In this retrospective claims database study, the persistence rate of second-line glaucoma combination treatment was low, with no difference in persistence between glaucoma patients receiving unfixed combination drugs compared with fixed combination drugs. Patients on PGA showed greater persistence rates compared with other treatments.

[Possible causes of unspecific reduced productivity in dairy herds in SchIeswig-Holstein: an explorative case-control study]. / Mögliche Ursachen für unspezifische Leistungsminderung in Milchkuhherden in Schleswig-Holstein: eine explorative Fall-Kontroll-Studie.

Recently unspecific productivity losses were observed in dairy herds in Schleswig Holstein, Germany. This case-control study on cattle health investigated the possible association between a multifactorial event and the occurrence of unspecific productivity losses. 35 dairy farms were defined as cases and 65 farms as controls, when they met two out of three eligibility criteria, respectively (cell count, mortality and life production of cows). Case farms had relevantly more often problems with forage collection (too low cutting height), feed storage (no foil used), and energy supply of dairy cattle (insufficient feeding of corn silage and lowered energy content of grass silage). Case farms had relevantly more often dirty lying areas, feeding and walking alleys, feed bunks and watering places as well as more cows with dirty udders, flanks and legs than control farms. Farm individual self-control as well as veterinarian and agricultural consultancy should focus on these management areas. Furthermore, the health situation should be checked regularly on an individual animal level for diseases of the locomotor (especially by intensifying claw care), metabolic and reproductive systems. Additionally, 22 so-called intermediate farms with considerable herd health problem during the study period were investigated for possible exogenous influences on the farm performance. There were no indications for influences by the soil type, weather conditions at harvesting or wild bird occurrence on cropland, which might be as well due to the explorative nature of the study. However, herd health problems were apparent in case and intermediate farms more often and more diversely than in control farms.

Epidemiology of influences on the performance in broiler flocks--a field study in Germany.

To establish which factors influence performance and bird welfare during a fattening period and to identify those factors to be investigated during routine monitoring of farms by veterinary authorities, a questionnaire-based field study was conducted in districts of Lower Saxony, Germany, with the highest density of broiler chickens. Mortality and BW of farms with different stocking densities (≤33, 33.1-39, and >39 kg/m(2)) were investigated. Analyses of 79 farms with 176 stables and 634 fattening periods revealed that flock mortality and BW appeared to be greatly influenced by weather conditions and litter material. In general, it is an advantage to grow broilers under warm weather conditions. However, the longer the fattening period lasts the more important it becomes that the outside weather conditions are not too warm. Therefore, weather conditions should be considered when determining the length of the fattening period, especially before the background of the growing demands of broilers regarding ventilation, absorption of feces by the litter material, and so on. Apart from the length of the fattening period, the weather conditions determine the choice of the litter material, as well. Under cold-humid weather conditions, it is better to use litter material other than wood shavings. In particular in older buildings it is not possible to provide the required conditions, which results in a lower weight gain the longer the fattening period lasts. The study identified differences in the final BW of flocks, which indicate different (farm) management policies. Regardless of the underlying policy, the performance of a fattening period can be improved by optimizing the farm management according to the prevalent conditions. Future routine monitoring, which should be cost effective regarding personnel and finance, should be generally risk based and consider weather conditions, litter material, the age of the building, and the length of the fattening period.