Pharmacological treatments in pregnant women with psoriasis in the U.S.A.

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110872/1/bjd13306.pd

Non-adherence to ivabradine and placebo and outcomes in chronic heart failure: an analysis from SHIFT

Aims In heart failure, non-adherence increases events; in turn, the effect of hospitalization on adherence is incompletely understood. We explored the relationship of non-adherence to outcomes, hospitalizations with non-adherence, and the influence of non-adherence on treatment effects of heart rate lowering with ivabradine. Methods and results In the randomized, controlled Systolic Heart failure treatment with the If-inhibitor ivabradine Trial (SHIFT), we studied the effect of non-adherence (n = 1287) compared with adherence (n = 5204) on cardiovascular outcomes. After adjustment, non-adherence was associated with the primary composite endpoint of cardiovascular death and heart failure hospitalization (hazard ratio 3.47, 95% confidence interval 2.91–4.13, P < 0.0001). No interaction with the treatment groups of placebo or ivabradine (P for interaction 0.54) occurred. Similar results for cardiovascular death and heart failure hospitalization, as well as for cardiovascular hospitalization, heart failure death, and total death were observed. The effect of ivabradine was maintained in patients being adherent or becoming non-adherent during the trial (P for interaction = 0.54). Patients with a previous hospitalization were more likely to become non-adherent thereafter. Conclusions Non-adherence identifies a group at particularly high cardiovascular event risk independent of treatment allocation. Non-adherent patients in the ivabradine group maintain a treatment benefit. Patients with previous hospitalizations are more likely to become non-adherent and represent a group of particularly high-risk patients in whom special attention to stimulate adherence may be valuable

Predictors of Long‐term Adherence to Evidence‐based Cardiovascular Disease Medications in Outpatients With Stable Atherothrombotic Disease: Findings From the REACH Registry

Background Despite overall improvements in cardiovascular‐disease therapies and outcomes, medication nonadherence remains an important barrier to effective secondary prevention of atherothrombotic disease. Hypothesis Long‐term medication adherence in outpatients with stable atherothrombotic disease is impacted by demographic and clinical factors. Methods We examined data from the prospective international Reduction of Atherothrombosis for Continued Health ( REACH ) Registry. Analyses were derived from 25 737 patients with established atherothrombotic disease with complete adherence data at enrollment and at year 4. Adherence was defined as patients' self‐report of taking medications based on class I American College of Cardiology/American Heart Association guidelines for secondary prevention as defined, including antiplatelet agents, statins, and antihypertensive medications. Results Among patients with atherothrombotic disease, 12 500 (48.6%) were deemed adherent to guideline‐recommended medications. Adherent patients were younger, white, and had less polyvascular disease. Hispanic and East Asian patients were less likely to be adherent as compared with white patients (odds ratio [ OR ]: 0.72, 95% confidence interval [ CI ]: 0.59‐0.88; and OR : 0.67, 95% CI : 0.53‐0.83, respectively). Patients who had a nonfatal MI or underwent coronary angioplasty/stenting during follow‐up were more likely to be adherent compared with patients without these events ( OR : 1.73, 95% CI : 1.25‐2.38; and OR : 2.15, 95% CI : 1.72‐2.67, respectively). On the other hand, nonfatal stroke during follow‐up was inversely associated with adherence ( OR : 0.77, 95% CI : 0.61‐0.97). Conclusions Using a large international registry of outpatients with atherothrombotic disease, we found that age, region, race/ethnicity, and incident cardiovascular events were predictive of long‐term guideline adherence for secondary prevention, suggesting that certain patient groups may benefit from targeted interventions to improve adherence.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102180/1/clc22217.pd

Sociodemographic Risk Factors of Diabetes and Hypertension Prevalence in Republic of Korea

This study examined the relationships between SES and diabetes and hypertension for Korean adults using the Korean National Health and Nutritional Examination Survey. To handle the four dummy dependent variables: Diabetes and Hypertension, Diabetes alone, Hypertension alone, and Diabetes or Hypertension, four different logistic models were conducted. The descriptive statistics showed a considerable amount of comorbidity between the combined dependent variable of diabetes and hypertension. To gauge more realistic measures of SES, education and income were combined together as four dummy categories. The SES factor indeed had significant impacts on diabetes and hypertension. Socioeconomically disadvantaged groups demonstrated to have increased likelihood of having these diseases. However, we could not find the strong compensating effect between education and income; the higher level of education but lower income variable was only significant in having both diseases, and the higher income but lower level of education variable was only significant in having hypertension alone and either one of the diseases. Only the highest SES one, the one with a higher level of education and a higher income, was significantly lowering the likelihood of having these diseases in all models. Therefore, public policy and intervention programs should focus on individuals matching these socioeconomic characteristics

Determinants of Trust in Health Care in an Older Population

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110894/1/jgs13316.pd

Coloration in different areas of facial skin is a cue to health: The role of cheek redness and periorbital luminance in health perception

Looking healthy is a desirable trait, and facial skin color is a predictor of perceived health. However, skin conditions that cause dissatisfaction with appearance are specific to particular facial areas. We investigated whether color variation in facial skin is related to perceived health. Study 1 defined three areas based on color differences between faces perceived as healthy or unhealthy: the forehead, periorbital areas, and the cheeks. Periorbital luminance and cheek redness predicted perceived health, as did global skin yellowness. In Study 2, increased luminance and redness caused faces to be perceived as healthier, but only when the increase was in the periorbital and cheek areas, respectively. Manipulating each area separately in Study 3 revealed cheek redness and periorbital luminance equally increased perceived health, with low periorbital luminance more negatively affecting perceptions. These findings show that color variation in facial skin is a cue for health perception in female faces

Self-reported predictors of depressive symptomatology in an elderly population with type 2 diabetes mellitus: a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>The prevalence of depression increases among the elderly with chronic medical conditions like diabetes. Hence, the purpose of this study was to determine predictors of depressive symptomatology in Medicare enrolled elderly population with type 2 diabetes mellitus.</p> <p>Methods</p> <p>A prospective cohort study was conducted by administrating health risk assessment questionnaire to elderly (≥65 years) with type 2 diabetes. Responses were linked with administrative claim's data. Data were obtained from elderly with type 2 diabetes who were enrolled in Medicare Health Maintenance Organization (HMO) in southeastern United States. The instrument collected information related to demographics, health status, medication use, and healthcare service utilization prior to enrollment. Responses were combined with the administrative claims data of HMO to obtain information on actual utilization of healthcare resources. The Short Form Center for Epidemiologic Studies Depression scale was used to assess depressive symptoms. Multivariable logistic regression analyses were conducted to determine predictor variables.</p> <p>Results</p> <p>Of 792 respondents, about 17% had depressive symptoms. Almost 96% of patients were using 1 or more antidiabetic medications. Overall, increased risk of depression was associated with lower health related quality of life (HRQoL) (OR: 0.97; 95% CI: 0.96–0.98) and higher impairments in instrumental activities of daily living (IADLs) (OR: 1.31; 95% CI: 1.14–0.52) in elderly patients. Poor health related quality of life (OR: 0.97, 95%CI: 0.95–0.99) was associated with higher risk of depression in patients on insulin therapy.</p> <p>Conclusion</p> <p>Impairments in daily activities and lower HRQoL were predictors of depressive symptomatology in elderly with diabetes. Determinants of depression varied according to pharmacotherapeutic class of antidiabetic medications.</p