Dapagliflozin reduces albuminuria in patients with diabetes and hypertension receiving renin-angiotensin blockers.

AIMS: To characterize the effect of dapagliflozin on albuminuria and estimated glomerular filtration rate (eGFR) and to determine whether effects on albuminuria were mediated through changes in glycated haemoblogin (HbA1c), systolic blood pressure (SBP), body weight or eGFR. METHODS: We conducted a post hoc analysis of data pooled from two phase III clinical trials in hypertensive patients with type 2 diabetes (T2DM) on stable angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy, randomly assigned to dapagliflozin 10 mg/day or matched placebo. This analysis included only patients with microalbuminuria or macroalbuminuria at baseline. RESULTS: Patients were randomized to receive dapagliflozin 10 mg (n = 167) or placebo (n = 189). Dapagliflozin resulted in greater 12-week reductions in albuminuria compared with placebo: -33.2% [95% confidence interval (CI) -45.4, -18.2]. The reduction in albuminuria was also present after adjusting for age, sex and changes in HbA1c, SBP, body weight and eGFR: -23.5% (95% CI -37.6, -6.3). There was a decrease in eGFR with dapagliflozin versus placebo that was readily reversed 1 week after last dose. No serious renal-related adverse events were observed in any group. CONCLUSIONS: Dapagliflozin was effective in lowering albuminuria in patients with T2DM and hypertension using renin-angiotensin system blockade therapy. Reductions in albuminuria were still present after adjusting for changes in HbA1c, SBP, body weight and eGFR. Dapagliflozin-induced improvements in glycaemic control and reductions in SBP, coupled with other potentially beneficial renal effects, may lead to a reduced long-term renal and cardiovascular risk.

Using a nursing protocol to assure equitable delivery of cancer-related prevention services.

A nurse-administered, protocol-driven model (NP) for preventive services delivery was compared with a traditional physician reminder (PR) model with nursing back-up among 473 patients attending Internal Medicine and Family Medicine clinics. A total of 240 patients were randomized to the NP group and 233 to the PR group. Demographic characteristics including gender [71% female (NP) and 71% female (PR)], race (78% and 75% African American, respectively) and age (numbers of persons aged 18-54, 55-64 and 65+ years) were similar in each group. In the NP group 244/244 screening tests for breast, cervical and colon cancers and alcohol abuse were initiated or completed by nurses, while in the PR group 110/215 (51%) were initiated or completed by physicians. The NP group received 552/552 counseling services from nurses for tobacco, alcohol, nutrition, exercise and prostate screening, while in the PR group, physicians delivered 10% of the needed services (56/560). Aside from counseling for prostate cancer screening, which was 100% in both the NP and PR groups, all other between-group differences for each service were significant at the level of p<0.001. Results show the feasibility of a nursing protocol for initiating equitable cancer prevention services in a primary care setting.

Predictors of breast cancer screening in a panel study of African American women.

PURPOSE: This study examines the predictors of breast cancer screening participation in a panel study of African American women over age 40. We examine the effect of depression, age, beliefs and concerns about breast cancer and its risk, communication with social networks regarding screening, marital status, participation in religious organizations, breast cancer family history, and participation in a breast cancer education program. METHODS: Participants were recruited from 30 African American churches, two low-income housing projects, and from a health fair at a historically African American University (N = 364). Participants were interviewed upon recruitment, and three months later. Multinomial logistic regression models are estimated to assess the relative impact of covariates on the odds of getting a mammogram while controlling for other factors. We also assess predicted probabilities of screening at specific levels of covariates. RESULTS: We find that age, marriage, an educational intervention, talking with friends, and believing that early detection can lead to cure had a positive impact on getting a mammogram between T1 and T2. In contrast, depression significantly reduces the odds of getting a mammogram. Family histories of breast cancer and church participation have no effect on rates of mammography net of other factors.

Depression, service utilization, and treatment costs among Medicare elderly: gender differences.

OBJECTIVE: To compare gender differences in mood disorders, service utilization, and health care costs among a random sample of Medicare elderly beneficiaries of Tennessee. DATA SOURCES: Medicare expenditure data from a 5% random sample of Tennessee Medicare beneficiaries (n = 35,673) were examined for 1991-1993. The physician reimbursement files provided data relative to ICD-9 diagnostic codes, physician visits, and the cost of physician services provided. Other service utilization and cost data were obtained for the sample from the outpatient, home health, skilled nursing, hospice and inpatient files. STUDY DESIGN: The dependent variables were: (i) patients with ICD-9 diagnosis for a mood disorder (major depression and other depression), (ii) service utilization (number of outpatient visits, skilled nursing visits, home health visits, physician visits, emergency visits, and inpatient days), and (iii) health care costs (dollar amount of physician cost, outpatient cost, inpatient cost, total mental health cost, total health cost, and other cost). The independent variable was gender. PRINCIPLE FINDINGS: Chi-square tests showed that among the patients with a mood disorder, females had a significantly higher incidence than males of major depression (1.3% vs. .4%, respectively, p < .001) and other depression (1.6% vs. .6%, respectively, p < .001). Further, t-test results indicated that females diagnosed with major depression utilized significantly more outpatient services than males (3.2 vs. 2.6, respectively, p < .04). Total health care costs for those with other depression were significantly higher for males than females ($15,060 vs. $10,240, respectively, p < .002). CONCLUSIONS: The results indicate that mood disorders, outpatient services, and total mental health costs are higher for females than males; however, total health care costs are higher for males than females.

Self-appraised health, HIV infection, and depression in female clients of AIDS counseling centers.

The development of effective coping strategies may require that women and men with HIV have an accurate, and to the greatest extent possible, positive, perception of their own health status. This has been found to be lacking among HIV-infected persons with limited education/information, including many minority adults. The objective of this study is to test several hypotheses that predict depression and perceived health in female adults with HIV. Data were obtained from 103 HIV-infected women (age > or = 18) who sought support, counseling, and maintenance services from one of four HIV care and referral centers in the mid-South. The results emphasize that perceived health status may fulfill a psychological distress-moderating or distress-aggravating function for women with HIV/AIDS.

Perceived health, HIV illness, and mental distress in African-American clients of AIDS counseling centers.

The development of effective coping strategies may require that adults with HIV disease have an accurate, and to the extent possible, positive perception of their own health status. This has been found to be lacking among HIV-infected people with limited education/information, including many minority adults. The objective of this study was to test several hypotheses that predict depression and perceived health in African-American adults with HIV disease. Data were obtained from 255 HIV-infected black adults (age > 18) who sought support, counseling, and maintenance services from one of three HIV care and referral centers in the Mid-South. The results emphasized that perceived health status may fulfill a psychological distress moderating or distress-aggravating function for persons with HIV/AIDS.

Psychosocial outcomes of HIV illness in male and female African American clients.

With the rapid growth of HIV infection among African Americans, the issue of how medical problems relate to psychological functioning in the black community population has acquired new meaning and urgency for health care policy. To develop effective strategies to meet the mental health needs of infected African Americans we need a better understanding of the pattern of Association between HIV and psychological distress. The objective of this study is to test several hypotheses that predict depression and anxiety in black adults infected with HIV. Our conceptual model is derived from learned helplessness theory (Seligman, 1975), the concept of perceived coherence (Antonovsky, 1980; Lewis & Gallison, 1989), and social support theory (Cohen & Willis, 1985). Instruments used in the study include: The Center for Epidemiological Studies-Depression (CES-D) Scale (Radloff, 1977), the Anxiety Scale (Lewis, Firsich, and Parsell, 1979), and the Perceived Coherence Scale (Lewis, 1989). Data were obtained from 255 HIV infected black males and females (age > or = 18) who sought support, counseling, and maintenance services from one of three HIV care and referral centers in the Mid-South. The results of the study emphasize the relative importance of perceived physical symptoms over stage of illness for psychological functioning among African American adults with HIV. Further, the findings also demonstrate the potential importance of perceived coherence for psychological functioning. Black clients who reported higher perceived coherence, regardless of the stage of illness or level of HIV symptoms, had lower anxiety and depression. Significant gender differences in depression are also observed and implications are drawn for strategies to address HIV related mental health care needs of African Americans.

Stage of illness, level of HIV symptoms, sense of coherence and psychological functioning in clients of community-based AIDS counseling centers.

The psychological functioning of HIV-infected individuals in community populations has taken on new meaning and urgency for healthcare policymakers responding to the special challenges of the AIDS epidemic. The authors' objective is to test several hypotheses that predict depression and anxiety in adults infected with HIV. Data were obtained from 156 HIV-infected adults (age > or = 18) who sought support, counseling, and maintenance services from one of three HIV care and referral centers in the Mid-South. The results of the study emphasize the relative importance of perceived physical symptoms over stage of illness for psychological functioning among adults with HIV.

HIV-illness, social support, sense of coherence, and psychosocial well-being in a sample of help-seeking adults.

This study tests a set of hypotheses that predict self-esteem and anxiety in adults infected with human immunodeficiency virus (HIV). The analysis is motivated by the following question: Is the level of perceived coherence, i.e., the extent to which individuals derive meaning and purpose in their lives despite their HIV-illness, related to their levels of self-esteem and anxiety? Data were obtained from one of three HIV care and referral centers in the Midsouth. The results demonstrate that clients who experienced a greater sense of derived meaning and purpose (perceived coherence) from their situations and those with more confidants (social support) reported higher self-esteem and lower anxiety than other HIV-infected adults seeking counseling and maintenance services. Implications are drawn for strategies to meet HIV-related mental health care needs.