Blood Pressure Control and Maintenance in a Prospective Cohort of Younger Veterans: Roles of Sex, Race, Ethnicity, and Social Determinants of Health.

Background: Proactive blood pressure (BP) management is particularly beneficial for younger Veterans, who have a greater prevalence and earlier onset of cardiovascular disease than non-Veterans. It is unknown what proportion of younger Veterans achieve and maintain BP control after hypertension onset and if BP control differs by demographics and social deprivation. Methods: Electronic health records were merged from Veterans who enrolled in VA care 10/1/2001-9/30/2017 and met criteria for hypertension - first diagnosis or antihypertensive fill. BP control (140/90 mmHg), was estimated 1, 2, and 5 years post-hypertension documentation, and characterized by sex, race, and ethnicity. Adjusted logistic regressions assessed likelihood of BP control by these demographics and with the Social Deprivation Index (SDI). Results: Overall, 17% patients met criteria for hypertension (n=198,367; 11% of women, median age 41). One year later, 59% of men and 65% of women achieved BP control. After adjustment, women had a 72% greater odds of BP control than men, with minimal change over 5 years. Black adults had a 22% lower odds of BP control than White adults. SDI did not significantly change these results. Conclusions: In the largest study of hypertension in younger Veterans, 41% of men and 35% of women did not have BP control after 1 year, and BP control was consistently better for women through 5 years. Thus, the first year of hypertension management portends future, long-term BP control. As social deprivation did not affect BP control, the VA system may protect against disadvantages observed in the general U.S. population.

Validation of the multiple disability multidimensional attitudes scale toward persons with disabilities.

PURPOSE/OBJECTIVE: This study investigated the psychometric properties of a Multiple Disability Multidimensional Attitudes Scale Toward Persons with Disabilities (MD-MAS), focusing on four types of disabilities: anxiety disorder, autism spectrum disorder (ASD), blindness, and schizophrenia. We developed new vignettes describing the situation of interacting with an individual with each type of disability. RESEARCH METHOD/DESIGN: We recruited 991 participants from a crowdsourcing data collection tool (i.e., Prolific). Participants were randomly assigned to one of four online surveys depending on the disability type. Five MAS models were selected from the previous literature to conduct confirmatory factor analyses (CFA). RESULTS: CFA supported the German model of MAS with a four-factor structure (i.e., calm, negative affect, positive cognition, behavioral avoidance) as a good fit for the MD-MAS for four disability types. High internal consistency was found for four subscales across the disability types. CONCLUSIONS/IMPLICATIONS: This study modified the original MAS to assess attitudes toward persons with different types of disabilities. The adequate reliability and fit of the factor structure of the MD-MAS same across the four disability types allow researchers to compare attitudes based on disability types. This will provide significant implications for research and practice in understanding the nature of different attitudes by disability types. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Pharmacist Identification of Medication Therapy Problems Involving Cognition Among Older Adults Followed by a Home-Based Care Team.

BACKGROUND: Dementia, depression, and delirium alone or in combination (3Ds) can threaten independence among older adults, and polypharmacy may further accelerate decline. Clinical pharmacists can play an important role on multidisciplinary home-based care teams by identifying medication therapy problems (MTPs) involving cognition. Within a larger ongoing clinical trial, this paper describes cognition-related MTPs and pharmacist recommendations among older adults with 3Ds followed by a home-based care team. METHODS: We conducted a retrospective analysis of medication data among Medicare Advantage members aged ≥ 65 years living at home in Connecticut with International Statistical Classification of Diseases and Related Health Problems, 10th Revision codes related to 3Ds; analyses include the first 105 subjects randomized to the home-based care team from March 2017 to January 2019. Advanced practice registered nurses conducted in-home medication reconciliations along with medical and cognitive assessments. Clinical pharmacists then conducted medication reviews centered on agents treating or exacerbating 3Ds. After review by the study advanced practice registered nurse, geriatrician, and psychiatrist, salient recommendations were forwarded to primary care providers for consideration. Medication therapy problems related to cognition were retrospectively abstracted and classified as: (1) indication: underuse or overuse; (2) effectiveness: ineffective agent or low dose (mainly for antidepressants); and (3) safety: undesirable effect (e.g., impaired cognition, dementia treatment side effects), unsafe medication (e.g., potentially inappropriate medications that can harm cognition), drug interaction, or high dose. RESULTS: Pharmacists identified 166 cognitive MTPs, with a mean (standard deviation) of 1.58 (1.35) [range 0-6] MTPs per subject. Indication MTPs represented 34% of total MTPs, of which 79% involved underuse and 21% overuse; effectiveness represented 13% of total MTPs; and safety represented over half (52%) of all MTPs, with benzodiazepines and anticholinergics frequently implicated. Recommendations commonly included medication reduction (discontinuation 23% and dose reduction 19%). We found MTPs involving cognition among most (79%) patients. CONCLUSIONS: Our study findings support the role of pharmacists on multidisciplinary teams to identify cognitively harmful medications, dementia treatment side effects, and untreated cognitive conditions. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT02945085.

Discrimination at every turn: An intersectional ecological lens for rehabilitation.

PURPOSE: Intersectionality has been increasingly prevalent in the rehabilitation literature. It has been warned, however, that there can be a flattening of intersectionality should social scientists exclude the various systemic paradigms which contribute to, and sustain, marginalization. In seeking a remedy to this issue, the article establishes an intersectional ecological framework for use in rehabilitation psychology. Using Bronfenbrenner's ecological systems theory, the article posits a framework both visually and conceptually, that can be used to discuss the intersection of identities in each system. DESIGN: The current article is a review of literature about intersectionality, disability, and discrimination, for the purpose of establishing a gap in theory that makes the current paper necessary. RESULTS: The establishment of an intersectional ecological framework for use in rehabilitation psychology and its related fields. The newly developed framework is then exemplified using discrimination. IMPLICATIONS: The intersectional ecological framework provides myriad opportunities for researchers, practitioners, and educators. The ability to theoretically discuss intersectionality through the lens of ecological systems theory will allow for thorough work in this area. Specifically, this framework will allow researchers to consider multiple systemic levels in exploration of identity-related issues for individuals with disabilities and provides a way for practitioners to see the complicated intersections individuals are experiencing at any given time. Ultimately, this framework has the potential to improve much of the understanding and treatment of people with disabilities. (PsycINFO Database Record (c) 2019 APA, all rights reserved).