Association Between Depression and Maintenance Medication Adherence Among Medicare Beneficiaries With Chronic Obstructive Pulmonary Disease.

Association between depression and maintenance medication adherence among Medicare beneficiaries with chronic obstructive pulmonary disease.

Int J Geriatr Psychiatry. 2013 Apr 19;
Qian J, Simoni-Wastila L, Rattinger GB, Zuckerman IH, Lehmann S, Wei YJ, Stuart B

OBJECTIVE: Depression is a significant comorbidity in patients with chronic obstructive pulmonary disease (COPD). Although comorbid depression is associated with low use and poor adherence to medications treating other chronic conditions, evidence of the relationship between depression and COPD management is limited. This study estimated the association between depression and COPD maintenance medication (MM) adherence among patients with COPD. METHODS: This cross-sectional study used a 5% random sample of 2006-2007 Chronic Condition Warehouse data. Medicare beneficiaries enrolled in Parts A, B, and D plans with diagnosed COPD who survived through 2006 were included (n?=?74,863). COPD MM adherence was measured as medication discontinuation and proportion of days covered (PDC). Depression was identified through the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Multivariable models with modified generalized estimating equations were used to estimate adjusted association between depression diagnosis and medication adherence, controlling for sociodemographics, comorbidities, and disease severity. RESULTS: Among the sample, about one third (33.6%) had diagnosed depression. More than half (61.8%) of beneficiaries with COPD filled at least one COPD MM prescription. Depressed beneficiaries had a higher likelihood of using COPD MM than non-depressed beneficiaries (adjusted prevalence ratios [PR]?=?1.02; 95% confidence intervals [CI]?=?1.01, 1.03). Among COPD MM users, depressed beneficiaries were more likely to discontinue medications (PR?=?1.09; 95% CI?=?1.04, 1.14) and less likely to exhibit PDC???0.80 (PR?=?0.89; 95% CI?=?0.86, 0.92) than non-depressed beneficiaries. CONCLUSIONS: Depression is prevalent in Medicare beneficiaries with COPD and independently associated with lower COPD MM adherence. Interventions to improve medication adherence for COPD patients may consider management of comorbidities such as depression. Copyright © 2013 John Wiley & Sons, Ltd. HubMed – depression

 

CORTISOL REACTIVITY TO EXPERIMENTALLY MANIPULATED PSYCHOSOCIAL STRESS IN YOUNG ADULTS AT VARIED RISK FOR DEPRESSION.

Depress Anxiety. 2013 Apr 19;
Morris MC, Rao U, Wang L, Garber J

This study examined cortisol and affective reactivity to a psychosocial stress task in 102 young adults who varied in risk for depression (56 remitted depressed, 46 never depressed). Participants were randomly assigned to either a stress (i.e., social-evaluative threat) or control (i.e., no social-evaluative threat) condition. For never-depressed individuals, cortisol responses were significantly greater in the stress compared to the control condition. Moreover, cortisol responses were significantly greater for never-depressed than remitted-depressed individuals in the stress condition. For individuals with a history of depression, cortisol responses did not differ significantly between the stress and control conditions. Negative affective reactivity also was higher for never depressed, but not remitted depressed, individuals in the stress compared to the control condition. Moreover, cortisol responses were inversely related to negative affect during the recovery phase in both stress and control conditions. Findings indicate the lack of a robust cortisol response to social evaluation stress among remitted-depressed individuals as compared to that of never-depressed controls. Future studies should investigate unique and interactive links between these hypothalamic-pituitary-adrenal and affective reactivity alterations and risk for subsequent depressive episodes. HubMed – depression

 

Humic substances failed to prevent the systemic absorption of deoxynivalenol (DON) and its adverse effects on piglets.

Mycotoxin Res. 2012 Nov; 28(4): 253-60
Dänicke S, Valenta H, Kersten S

The aim of this study was to examine the effects of a control diet (CON, 0.25 mg DON/kg diet) or a Fusarium toxin-contaminated diet (FUS, 4.49 mg DON/kg diet) without and with humic substances (HS) (CON-HS and FUS-HS, 0.23 and 4.56 mg DON/kg diet, respectively) on piglets during a 5-week growth trial starting after weaning (6.7?±?0.9 kg live weight, n?=?20/group). Feed intake was significantly reduced by feeding the FUS containing diets by approximately 21% compared with the CON diet irrespective of HS supplementation. The decrease in live weight gain paralleled the feed intake depression and amounted to approximately 26%. Feeding the FUS diet was clearly reflected by the DON levels in blood. While only traces of DON with median concentrations of 3 ng/ml (2-5 ng/ml) and 2 ng/ml (0-3 ng/ml) were detected in piglets fed the CON and CON-HS diets, respectively, significantly higher levels of 22.5 ng/ml (7-30 ng/ml) and 23.5 ng/ml (15-32 ng/ml) were found in piglets fed the FUS and FUS-HS diet, respectively. The urinary excretion of DON and its metabolite de-epoxy-DON as percentage of DON intake was not significantly influenced by HS supplementation and amounted to 24.1 and 20.2% for groups FUS and FUS-HS, respectively. In conclusion, the tested HS preparation cannot be recommended as a DON inactivating feed supplement for pigs. HubMed – depression