Factors associated with frequent physical activity among United States adults with asthma.

Objective: This study investigated factors associated with frequent moderate-to-vigorous intensity physical activity among United States (US) adults with asthma.Methods: This retrospective cross-sectional study included US adults (≥18 years) with asthma in the 2019 Medical Expenditure Panel Survey data. Logistic regression models that added sequential groups of variables were used to assess associations between predisposing (age, gender, race), enabling (marital status, poverty level, education level, insurance coverage, employment status), and need (smoking status, co-morbidities, mental health, physical health, functional limitations) factors and doing ≥30 min moderate-to-vigorous intensity physical activity ≥ five times per week. The alpha level was 0.05.Results: The study included 2,410 individuals, of which 46.9% (95% confidence interval [CI] = 44.2-49.6) reported doing frequent moderate-to-vigorous intensity physical activity. In fully adjusted analyses, the following variables were associated with a greater odds of reporting frequent moderate-to-vigorous intensity physical activity: men vs. women (adjusted odds ratio [AOR] = 1.4, 95% CI = 1.1-1.7), white vs. other races (AOR = 1.3, 95% CI = 1.0-1.6), excellent/very good/good vs. fair/poor physical health (AOR = 2.3, 95% CI = 1.7-3.0), and functional limitations no vs. yes (AOR = 1.7, 95% CI = 1.3-2.2).Conclusions: The factors identified in this study (gender, race, health status, and limitation status) may be helpful to target interventions to raise awareness and increase physical activity among US adults with asthma. Studies that can demonstrate a temporal relationship are needed to further our understanding of this topic.

The Impact of Discharged Loop Diuretic Dose to Home Dose on Hospital Readmissions in Patients with Acute Decompensated Heart Failure: A Retrospective Cohort Study.

BACKGROUND: Acute decompensated heart failure (ADHF) is associated with a high rate of hospital readmission. The aim of this study is to examine the effect of the discharge diuretic dose compared with the home diuretic dose on hospital readmission in patients with ADHF. METHODS: A single center retrospective cohort study included patients with a confirmed diagnosis of ADHF with an ejection fraction of less than 40%. The sample was divided in two groups. The first group received a total daily discharge diuretic dose that was greater than the home dose; the second group received a daily discharge diuretic that was equal to or less than the home dose. The primary outcome was all-cause 30-day readmission rate. The secondary outcomes were all-cause 60-day and 90-day readmission rates. RESULTS: A total of 206 patients met inclusion criteria; 117 patients received a higher loop diuretic dose at discharge, while 89 were discharged with a loop diuretic that was equal to or less than the home dose. Patients in the increased-dose group had an all-cause 30-day readmission rate of 20.5% compared with 37.1% of patients with equal or reduced-dose group; P = .007. Additionally, there were lower readmission rates in 60 and 90 days between the increased and equal or reduced groups (33.3% versus 52.8%, P < .017, and 41.0% versus 62.9%, P < .003, respectively. CONCLUSIONS: Among patients admitted to hospital with ADHF and reduced ejection fraction, a discharge loop diuretic dose higher than the home dose was associated with decreased all-cause 30-day, 60-day, and 90-day readmission rates.

Association between pain burden and presence of any limitation among older adults (≥50 years of age) with pain who used opioids in the United States: Cross-sectional study using 2020 medical expenditure panel survey.

This study aimed to assess the association between pain burden and presence of any limitation among older adults (≥50 years of age) with pain who used opioids in the United States. This cross-sectional study used 2020 Medical Expenditure Panel Survey data and included all adults aged 50 or older, who were alive for the 2020 calendar year, used an opioid at least once in the calendar year, and reported having pain in the past 4 weeks. Unadjusted and adjusted logistic regression models were developed to assess the association between any limitation (AL) (yes or no), pain burden (extremely, quite a bit, moderately, or little bit) and the control variables among a nationally representative sample of United States adults. A total of 844 of the 27,805 participants included in the dataset were eligible for the study. Of these, 71.2% (95% confidence interval (CI) = 67.2, 75.1%) reported the presence of AL. The adjusted logistic regression analysis showed that having extreme, quite a bit, or moderate pain (vs little pain) was associated with 10.30 (95% CI = 3.87, 27.40), 5.07 (95% CI = 2.77, 9.30), and 2.49 (95% CI = 1.40, 4.45), respectively, times greater odds of having AL. Furthermore, being unemployed (vs employed; adjusted odds ratio (aOR) = 5.26, 95% CI = 2.94, 9.09%), unmarried (vs married; aOR = 1.92, 95% CI = 1.12, 3.33%), having poor overall health (vs good overall health; aOR = 2.08, 95% CI = 1.08, 4.17), and residing in the Midwest (vs West; aOR = 2.04, 95% CI = 1.10, 3.80) were associated with greater odds of having AL. Extreme, quite a bit, and moderate pain burden were significantly associated with greater odds of reporting AL compared to little pain burden. Developing effective pain management strategies that address not only pain relief but also functional improvement among this population is of importance. Future research could then be conducted to determine the most effective pain management strategies that will provide pain relief and improve their functional abilities.

Use of Pharmacological and Non-Pharmacological Strategies by Community-Dwelling Adults to Manage Migraine: A Systematic Review.

Migraine is a prevalent disease associated with high levels of disability and is often underdiagnosed and undertreated. This systematic literature review aimed to identify the types of pharmacological and non-pharmacological strategies that community-dwelling adults report using to manage migraine. A systematic literature review of relevant databases, grey literature, websites, and journals was conducted from 1 January 1989 to 21 December 2021. Study selection, data extraction, and risk of bias assessment were completed independently by multiple reviewers. Data were extracted on migraine management strategies and categorized as opioid and non-opioid medications and medical, physical, psychological, or self-initiated strategies. A total of 20 studies were included. The sample sizes ranged from 138 to 46,941, with a mean age of 34.7 to 79.9 years. The data were typically collected using self-administered questionnaires (nine studies), interviews (five studies), online surveys (three studies), paper-based surveys (two studies), and a retrospective database (one study). Community-dwelling adults with migraine reported they primarily used medications, specifically triptans (range 9-73%) and non-steroidal anti-inflammatory drugs (NSAIDs) (range 13-85%) to manage migraine. Except for medical strategies, the use of other non-pharmacological strategies was low. Common non-pharmacological strategies included consulting physicians (range 14-79%) and heat or cold therapy (35%).

Evaluating the reliability and validity of a questionnaire used to measure experiences of teamwork among student pharmacists in a quality improvement course.

INTRODUCTION: The psychometric properties of instruments used to capture student pharmacists' perspectives of teamwork have not been well assessed. This study measured the reliability and validity of an instrument designed to assess teamwork experiences among student pharmacists in a quality improvement (QI) class at one United States pharmacy school. METHODS: The psychometric properties of a previously conducted 17-item questionnaire (response options: "strongly agree," "agree," "disagree," or "strongly disagree") about second-year student pharmacists' teamworking experiences were assessed. A Rasch rating scale model was used to construct measures of teamwork experience. Principal component analysis (PCA) assessed unidimensionality. Item- and person-fit statistics were assessed. Construct and content validity and reliability were estimated utilizing student and item separation indices (SI) and reliability coefficients (RC). RESULTS: Sixty student pharmacists were included. PCA conveyed a unidimensional construct. Four items with infit and outfit mean-squared values outside the suggested range were removed. Item responses "disagree" and "strongly disagree" were merged to improve scale functionality. The average person measure was 1.74 ± 2.03 logits. Student and item RC were 0.81 (SI = 2.04) and 0.97 (SI = 2.17), respectively. The easiest item endorsed was team's ability to reach consensus, while the most difficult item was interest to do collaborative work again. Mismatch of student experience and item difficulty level on the continuum scale suggested additional items are needed to match student teamwork experience. CONCLUSION: The instrument demonstrated evidence of reliability and validity to measure student pharmacists' teamwork experience in a QI class, but additional instrument modifications are recommended.

Assessing student pharmacists' confidence and knowledge of basic diabetes self-management skills.

INTRODUCTION: The significance of diabetes self-management and recent advances in diabetes medications call for healthcare professionals' preparedness in educating patients. This study assessed correlations between student pharmacists' confidence and knowledge of diabetes self-management skills. METHODS: An online questionnaire was administered to third-year student pharmacists at one United States college of pharmacy. Students indicated their level of agreement (strongly disagree, disagree, agree, strongly agree) with nine confidence items and identified the correct multiple-choice response for nine knowledge items. Correlations between confidence and knowledge scores were assessed using simple linear regression, logistic regression, and Spearman rank (Rho) test. RESULTS: Forty-five students completed the questionnaire. The majority agreed/strongly agreed that they were confident in their knowledge for eight of the nine confidence items. The majority correctly answered six of the nine knowledge items. No associations were identified between confidence and knowledge scores in the linear regression (beta scaled = 0.25) or Spearman's correlation test (r = 0.294). In the logistic regression model, confidence and knowledge scores were associated positively for three domains: glucose meter use (odds ratio [OR] = 4.88), glucagon-like peptide-1 receptor agonist use (OR = 4.23) and hyperglycemia treatment (OR = 3.33); confidence and knowledge scores were associated negatively with one domain: insulin syringe administration (OR = 0.41). CONCLUSIONS: This study found no overall association between confidence and knowledge scores in third-year student pharmacists' basic diabetes self-management skills, although there were significant associations with four specific domains. Student pharmacists may require additional training to improve their diabetes self-management skills.