Patient Characteristics Associated With Medication Adherence.

Patient Characteristics Associated with Medication Adherence.

Clin Med Res. 2013 Apr 11;
Rolnick SJ, Pawloski PA, Hedblom BD, Asche SE, Bruzek RJ

ObjectiveDespite evidence indicating therapeutic benefit for adhering to a prescribed regimen, many patients do not take their medications as prescribed. Non-adherence often leads to morbidity and to higher health care costs. The objective of the study was to assess patient characteristics associated with medication adherence across eight diseases.DesignRetrospective data from a repository within an integrated health system was used to identify patients ?18 with ICD-9-CM codes for primary or secondary diagnoses for any of eight conditions (depression, hypertension, hyperlipidemia, diabetes, asthma or chronic obstructive pulmonary disease, multiple sclerosis, cancer, or osteoporosis). Electronic pharmacy data was then obtained for 128 medications used for treatment.MethodsMedication possession ratios (MPR) were calculated for those with one condition and one drug (n=15,334) and then for the total population having any of the eight diseases (n=31, 636). The proportion of patients adherent (MPR?80%) was summarized by patient and living-area (census) characteristics. Bivariate associations between drug adherence and patient characteristics (age, sex, race, education, and comorbidity) were tested using contingency tables and chi-square tests. Logistic regression analysis examined predictors of adherence from patient and living area characteristics.ResultsMedication adherence for those with one condition was higher in males, Caucasians, older patients, and those living in areas with higher education rates and higher income. In the total population, adherence increased with lower comorbidity and increased number of medications. Substantial variation in adherence was found by condition with the lowest adherence for diabetes (51%) and asthma (33%).ConclusionsThe expectation of high adherence due to a covered pharmacy benefit, and to enhanced medication access did not hold. Differences in medication adherence were found across condition and by patient characteristics. Great room for improvement remains, specifically for diabetes and asthma. HubMed – depression


Thermal physiology of the fingered limpet Lottia digitalis under emersion and immersion.

J Exp Biol. 2013 Apr 11;
Bjelde B, Todgham A

Marine animals living high in the rocky intertidal zone experience long durations of aerial-emersion, sometimes enduring rapid increases in temperature. To date, much of our understanding of the thermal physiology of intertidal organisms comes from studies in which organisms are exposed to increasing temperatures when immersed, with the added effect of aerial emersion rarely considered. In this study, we examined the physiological response of the finger limpet, Lottia digitalis, to increases in temperature under both immersed and emersed conditions. We investigated the thermal sensitivity and upper temperature tolerance of limpets through assessments of cardiac performance, metabolic rate, glycogen depletion and maintenance of protein integrity. Cardiac performance in response to ecologically relevant increases in temperature was similar in emersed and immersed limpets from 15 to 35°C and showed multiple break patterns in heart rate as temperature was increased. Overall, emersed limpets had a greater upper thermal limit on cardiac performance with the ability to maintain heart rate 3-5°C higher than immersed limpets. Metabolism in limpets also differed significantly between emersion and immersion, where a significant depression in aerobic metabolic rate was observed under immersion with increasing temperature. Greater levels of ubiquitin-conjugated proteins were found under emersed conditions compared to immersed limpets. Maintaining cardiac performance and aerobic metabolism to higher temperatures under emersed conditions is likely reflective of physiological adaptations to live in an aerially exposed environment. Measured field temperatures where fingered limpets were collected demonstrated that limpets have a narrow thermal safety margin for aerobic performance, and currently experience multiple days where summer temperatures might exceed their threshold limits. HubMed – depression


Swift Onset of Central Nervous System Depression and Asystole Following an Overdose of Guaifenesin.

J Anal Toxicol. 2013 Apr 11;
Okic M, Johnson T, Crifasi JA, Long C, Mitchell EK

Guaifenesin is an over-the-counter expectorant used for chest congestion and is available both in single-ingredient formulations and in combination with antihistamines, cough suppressants and decongestants. The documented side-effects of guaifenesin are generally mild. We present the case of a 23-year-old female who committed suicide by ingestion of guaifenesin along with small amounts of cetirizine, ethanol and sertraline. Approximately 2 h after  ingestion, the patient experienced central nervous system depression followed by asystole. No anatomic cause of death could be determined at autopsy. The initial toxicology detected only ethanol, which was found at a concentration insufficient to cause death. Upon further analysis, guaifenesin was detected in femoral blood at 25.0 ?g/mL, urine at >50.0 ?g/mL, vitreous fluid at 9.2 ?g/mL, brain at 17.0 ?g/g and liver at 25.0 ?g/g. This is the first reported human case that can be considered a death to which  guaifenesin was the significant pharmacologic contributor. Guaifenesin is not detected by the primary screening methods employed by some labs and may be missed in toxicological analyses of overdoses unless specifically suspected. HubMed – depression



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