Implementation of a Level III neonatal intensive care unit was associated with reduced NICU mortality in a resource limited public tertiary care hospital in Guyana, South America.

Neonatal mortality is a significant contributor to child mortality, and there is increasing interest in low resource settings to implement neonatal intensive care practices to lower neonatal mortality. In Guyana, South America neonatal mortality remains relatively high. At Georgetown Public Hospital Corporation (GPHC), the only tertiary referral hospital in Guyana, a Level III NICU was developed starting in January, 2012 with full implementation in September, 2015. In this study, we report the association of the implementation of a Level III NICU with in-hospital neonatal survival at GPHC. Using an observational study design, available data were collected from January 1, 2015 through September 30, 2020. During the study period, there were 30,733 deliveries at GPHC and 4,467 admissions to the NICU at GPHC. There were no significant changes in the numbers of births or NICU admissions during the time of the study. The survival rate for patients admitted to the NICU was ~64% during the first 3 quarters of 2015 with most deaths were caused by sepsis or respiratory failure. By the last quarter of 2015, the NICU survival rate increased dramatically and has been sustained at ~87% (p<0.0001). The inborn mortality rate at GPHC, calculated as a percentage of all live births at GPHC, was 2.9% prior to the full implementation of the NICU and was 1.4% after the full implementation of the NICU (p<0.0001). These findings suggest that the implementation of a Level III NICU at GPHC was associated with an improvement in survival to NICU discharge in a resource limited setting.

Guyana's paediatric training program: a global health partnership for medical education.

Guyana is a low-middle income country on the northern coast of South America between Venezuela and Suriname. Guyana has relatively high child mortality and a notable gap in health care provision. As of 2011, there were no paediatricians in the public sector where approximately 90% of the population seek care. In response to this unmet need, Guyanese diaspora living in Canada, in partnership with Canadian paediatricians and the main teaching hospital, Georgetown Public Hospital Corporation (GPHC), developed a Master's program in paediatrics. The postgraduate program was designed with adapted training objectives from the Royal College of Physicians and Surgeons of Canada and the American Board of Paediatrics. Innovative strategies to overcome the lack of qualified paediatric faculty in Guyana included web-conferencing and a volunteer North American paediatric faculty presence at GPHC with a goal of 1-2 weeks every month. By November 2016, 10 graduates will have passed through a rigorous program of assessment including a two-day final examination with an objective structured clinical examination (OSCE) component.

Diagnostic value of diffusion tensor imaging derived metrics as biomarkers of cerebral changes in developmental delay.

CONTEXT: Children with developmental delay (DD) can be rehabilitated if an early diagnosis and intervention is done. A negative magnetic resonance imaging (MRI) study utilizing routine sequences makes it difficult for the clinician to convince the family toward a long-term rehabilitation schedule. Diffusion tensor imaging (DTI) can demonstrate deranged myelination in developmentally delayed children having normal routine MRI. AIM: To evaluate the role of DTI-derived metrics for assessment of deranged myelination in developmentally delayed children having normal routine MRI. STUDY SETTING AND DESIGN: Prospective case control observational study conducted over a cross-section of referrals at a university-based teaching institute over a period of 2 years. PATIENTS AND METHODS: Fifty cases of DD and 15 age-sex matched controls (age group of 2-12 years) were included from those presenting voluntarily to the pediatric out-patient services. Routine MRI and DTI were performed in both the groups following a standard protocol. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) were calculated in certain pre-defined regions. STATISTICAL ANALYSIS: Central tendency was measured for each of the metrics using mean. Inter- and intra-group comparisons were performed using t-test. RESULTS: Twenty-three regions of interest with 46 variables were included in the final analysis. Nineteen (82.60%) regions of interest showed at least one statistically significant variable, while 24 out of 46 (54.34%) variables showed statistical significance for future consideration. The important regions to be evaluated in a case of DD are the corpus callosum, bilateral forceps minor and forceps major, bilateral parietal lobes, bilateral post-central gyrus, and bilateral posterior limb internal capsule (PLIC). The regions which did not show any significance are bilateral pars triangularis and right frontal lobe. Other regions remained indeterminate and need further evaluation. CONCLUSION: DTI demonstrates myelination abnormality in children with DD, having a normal routine MRI.

Clopidogrel with proton pump inhibitors: safe or not?

Gastrointestinal (GI) bleeding is a serious complication associated with use of antiplatelet therapy, and proton pump inhibitors (PPIs) are known to be beneficial in decreasing such risk. Several studies in the recent past have suggested concerns regarding interaction between clopidogrel and PPIs, presumably due to inhibition of clopidogrel activity and thus attenuation of its antiplatelet activity. A web-based literature and guidelines search was done using the keywords "clopidogrel," "omeprazole," "proton pump inhibitors" and "interaction." Of the available results, relevant studies (n = 11) were then systematically reviewed and summarized. The studies were categorized based on their retrospective or prospective nature. Most of the retrospective, observational studies suggested a link between the 2; however, recent prospective studies have shown no interaction, as well as a positive influence of PPIs in preventing the GI side effects of antiplatelet therapy. There is currently insufficient clinical evidence to suggest interaction between clopidogrel and PPIs and decision to add PPI therapy to clopidogrel should be guided by its clinical indications rather than as a routine prophylactic measure.

Non-ST-segment elevation myocardial infarction in the setting of sexual intercourse following the use of cocaine and sildenafil.

Acute myocardial infarction (MI) in the setting of sexual intercourse following the concomitant use of cocaine, alcohol, and sildenafil has not been previously reported. We present a case of a middle-aged patient with no previous history of angina pectoris or coronary artery disease who presents with severe ischemic chest pain and an MI induced by cocaine, alcohol, sildenafil, and sexual intercourse.

Positive vasodilator stress ECG with normal myocardial perfusion imaging and its correlation with coronary angiographic findings in African Americans and Hispanics.

BACKGROUND: Ischemic electrocardiographic (ECG) changes during vasodilator stress testing (VST) in the presence of abnormal myocardial perfusion imaging (MPI) are uncommon and are associated with presence of multivessel coronary artery disease (CAD). However, there is a paucity of data regarding the significance of ischemic ECG changes during VST with normal MPI in general, and especially among African Americans and Hispanics. HYPOTHESIS: Ischemic changes during VST with normal MPI are associated with significant CAD. METHODS: A retrospective review was done of 2945 patients undergoing VST. RESULTS: Only 20 patients (0.7%) had positive ECG changes with normal MPI. Their demographics were: 60% Hispanic, 40% African American; 85% female; mean age 63 ± 11 years; history of hypertension 80%, diabetes 50%, and dyslipidemia 75%; smokers 30%; atypical chest pain 60%, and typical chest pain 40%. Of these 20 patients, 12 patients underwent coronary angiography. All 12 had significant CAD; nine (75%) had multivessel disease and 3 (25%) had single-vessel disease. Prevalence of clinical variables and risk factors for CAD were similar among both the groups who did and did not undergo coronary angiography. CONCLUSIONS: Among African Americans and Hispanics, ischemic ECG changes during VST with normal MPI are likely to be associated with significant CAD and may warrant coronary angiography to assess presence and extent of CAD.

Development of a floating dosage form of ranitidine hydrochloride by statistical optimization technique.

The objective of this study was to evaluate the effect of formulation variables on the release properties, floating lag time, and hardness, when developing floating tablets of Ranitidine hydrochloride, by the statistical optimization technique. The formulations were prepared based on 3(2) factorial design, with polymer ratio (HPMC 100 KM: Xanthan gum) and the amount of aerosil, as two independent formulation variables. The four dependent (response) variables considered were: percentage of drug release at the first hour, T(50%) (time taken to release 50% of the drug), floating lag time, and hardness of the tablet. The release profile data was subjected to a curve fitting analysis, to describe the release mechanism of the drug from the floating tablet. An increase in drug release was observed with an increase in the polymer ratio, and as the amount of aerosil increased, the hardness of the tablet also increased, without causing any change in the floating lag time. The desirability function was used to optimize the response variables, each having a different target, and the observed responses were in accordance with the experimental values. The results demonstrate the feasibility of the model in the development of floating tablets containing Ranitidine hydrochloride.

Development of extended zero-order release gliclazide tablets by central composite design.

The purpose of this study was to develop an extended release tablet formulation containing gliclazide as a model drug by optimization technique. A central composite design was employed with pH-dependent matrix forming polymers like keltone-HVCR (X1) and eudragit-EPO (X2) as independent variables. Five dependent variables were considered: hardness, percent drug release after 1 hr, percent drug release after 6 hr, diffusion exponent and time required for 50% of drug release. Response surface methodology and multiple response optimization utilizing a quadratic polynomial equation were used to obtain an optimal formulation. The results indicate that Factor X1 along its interaction with Factor X2 was found to be significantly affecting the studied response variables. An optimized formulation, containing 8 mg of keltone-HVCR and 14.10mg of eudragit-EPO, provides a sufficient hardness (> 4.5 kg/cm2) and optimal release properties. The desirability function was used to optimize the response variables, each having a different target and the observed responses were highly agreed with experimental values. The release kinetics of gliclazide from optimized formulation followed zero-order release pattern. The dissolution profiles of optimized formulation before and after stability studies were evaluated by using similarity factor (f2) and were found to be similar. The results demonstrate the feasibility of the model in the development of extended release dosage form.

Optimization of bilayer floating tablet containing metoprolol tartrate as a model drug for gastric retention.

The purpose of the present study was to develop an optimized gastric floating drug delivery system (GFDDS) containing metoprolol tartrate (MT) as a model drug by the optimization technique. A 2(3) factorial design was employed in formulating the GFDDS with total polymer content-to-drug ratio (X1), polymer-to-polymer ratio (X2), and different viscosity grades of hydroxypropyl methyl cellulose (HPMC) (X3) as independent variables. Four dependent variables were considered: percentage of MT release at 8 hours, T50%, diffusion coefficient, and floating time. The main effect and interaction terms were quantitatively evaluated using a mathematical model. The results indicate that X1 and X2 significantly affected the floating time and release properties, but the effect of different viscosity grades of HPMC (K4M and K10M) was nonsignificant. Regression analysis and numerical optimization were performed to identify the best formulation. Fickian release transport was confirmed as the release mechanism from the optimized formulation. The predicted values agreed well with the experimental values, and the results demonstrate the feasibility of the model in the development of GFDDS.

Accuracy of the ratio of triglycerides to high-density lipoprotein cholesterol for predicting low-density lipoprotein cholesterol particle sizes, phenotype B, and particle concentrations among Asian Indians.

Asian Indians have unusually high rates of coronary artery disease. Small low-density lipoprotein (LDL) particle predominance (phenotype B) is associated with a fourfold atherogenic risk. This study examined the accuracy of a triglyceride/high-density lipoprotein cholesterol (HDL) ratio of > or =3.8 (determined from the Adult Treatment Panel III guidelines, normal triglycerides <150 mg/dl and HDL >40 mg/dl) for predicting phenotype B in Asian Indians. Fasting blood samples were collected from 150 healthy Asian Indians. LDL size analysis was performed by nuclear magnetic resonance spectroscopy. The triglyceride/HDL cholesterol ratio correlated inversely with the LDL size and positively with the particle concentration. A triglyceride/HDL cholesterol ratio of > or =3.8 had 76% sensitivity, 93% specificity, and 83% positive and 89% negative predictive values for predicting phenotype B.

Differences by age and race/ethnicity in knowledge about hypercholesterolemia.

This investigation sought to identify gaps in patients' knowledge about hypercholesterolemia and lipid-lowering therapy in an inner-city US population. Chart reviews and interviews were conducted for drug-treated hypercholesterolemic patients at 3 hospital-based cardiology practices in Bronx, NY. Univariate and multivariate analyses were used to assess whether race/ethnicity, sex, and age were predictors of knowledge. Subjects (n = 467, age 65.3 years) were 55% female, 38% Hispanic, 32% black, and 25% white. Most recognized hypercholesterolemia as a cause of heart disease (88%) and stroke (76%), although older subjects (>70 years) and Hispanic subjects, particularly non-English speakers, were significantly less likely to know about cardiovascular disease risks associated with hypercholesterolemia. Only 14% recalled their recent cholesterol levels, and recall was significantly lower among black, Hispanic, and older subjects. Overall, 31% expected to require lipid-lowering medications indefinitely in the future, while 66% did not know how long they would need to continue using medications. Blacks and Hispanics were significantly less likely to believe that they would need to continue taking medications indefinitely. Achieved lipid levels and self-reported medication adherence were relatively favorable although were unrelated to knowledge levels. In summary, among hypercholesterolemic patients in an urban population, relatively few knew their own cholesterol levels or expected to require medications indefinitely in the future. Older patients, black and Hispanic patients, and non-English speakers were significantly less likely to have accurate knowledge about hypercholesterolemia. Therefore, patient and community education efforts targeted to specific populations may lead to improved management of hypercholesterolemia in inner-city regions.

Caracterización fisicoquímica de los complejos de hidroxietil-Beta-ciclodextrina y Beta-ciclodextrina de rifampicina / Physicochemical characterization of Beta-cyclodextrin and hydroxy ethyl Beta-cyclodextrin complexes of rifampicin

Se realizó un ensayo con el objetivo de optimizar la administración oral de rifampicina mediante la formación decomplejos de inclusión con ciclodextrinas, incluida la Beta-ciclodextrina (Beta-CD) y la hidroxietil-Beta-ciclodextrina (HEBeta-CD). El objetivo del estudio era incrementar la solubilidad y estabilidad de la rifampicina mediante la formaciónde complejos, y evaluar el efecto de la ciclodextrina en el tratamiento de la tuberculosis. Los estudios de solubilidadde fase mostraron que seguía una curva de solubilidad de tipo A y que la pendiente de la línea es inferior a uno,indicando la presencia de fármaco y agente aglutinante en una fracción molar de 1:1. Los complejos de ciclodextrinase prepararon mediante métodos de amasado (AM) y de disolvente común (DC). Las mezclas físicas también se prepararonen la misma proporción. En el caso de los complejos de Beta-CD, se observó una solubilidad dos veces mayoren el complejo preparado mediante disolvente común. Una espectometría infrarroja por transformada de Fourier(FTIR) confi rmó la formación de un complejo con (4-metil-1-piperazinil)-imino-metil de rifampicina de cadena lateral.La formación del complejo se confi rmó mediante estudios de difracción de rayos-x de polvo, microscopía electrónicade barrido (MEB) y calorimetría diferencial de barrido (CDB). Se demostró que la actividad antituberculosa in vitrode la rifampicina se vio mejorada en el caso de todos los complejos indicados mediante una reducción a la mitadde la concentración inhibitoria mínima (CIM) de rifampicina. La formación de complejos de inclusión con Beta-CD ehidroxietil-Beta-ciclodextrina mejoró sus propiedades fi sicoquímicas y su actividad antituberculosa in vitro

An attempt was made to optimize the oral delivery of rifampicin by formation of inclusion complexes with cyclodextrinsincluding Beta-Cyclodextrin (Beta-CD), and hydroxy-ethyl-Beta-cyclodextrin (HEBeta-CD). The aim of the study was to increase thesolubility, stability of rifampicin by way of complexation and to evaluate the effect of cyclodextrin on its anti-tubercularactivity. The phase solubility studies showed that it followed Type-AL solubility curve and the slope of the line is lessthan one, indicating 1:1 molar ratio of drug to complexing agent. Cyclodextrin complexes were prepared by kneading(KN) and common solvent (CS) methods. The physical mixtures (PM) were also prepared in the same ratio. In case ofBeta-CD complexes, a 2 fold increase in solubility was observed with CS complex. Formation of complex with side chain4-methyl piperazin-1-ylimino-methyl of rifampicin was confi rmed by FTIR. Formation of complex was confi rmed by DSC,SEM, and powder x-ray diffraction studies. In vitro anti-tubercular activity of rifampicin was found to be enhanced in case of all the complexes indicated by a reduction in MIC of rifampicin to half. Inclusion complexation with Beta-CDand hydroxy ethyl Beta-cyclodextrin improved its physico-chemical properties and in vitro anti-tubercular activity

Development of three layered buccal compact containing metoprolol tartrate by statistical optimization technique.

The objective of this work to evaluate the effect of formulation variables on release properties and bioadhesive strength in development of three layered buccal compact containing highly water-soluble drug metoprolol tartrate (MT) by statistical optimization technique. Formulations were prepared based on rotatable central composite design with peripheral polymer ratio (carbopol 934P: HPMC 4KM) and core polymer ratio (HPMC 4KM: sodium alginate) as two independent formulation variables. The three layered buccal compact comprises a peripheral layer, core layer and backing layer. Four dependent (response) variables were considered: bioadhesion force, percentage MT release at 8 h, T50% (time taken to release 50% of drug) and release exponent (n). The release profile data was subjected to curve fitting analysis for describing the release mechanism of MT from three layered buccal compact. The main effects and interaction terms was quantitatively evaluated by quadratic model. The decrease in MT release was observed with an increase in both the formulation variables and as the carbopol: HPMC ratio increases the bioadhesive strength also increases. The desirability function was used to optimize the response variables, each having a different target and the observed responses were highly agreed with experimental values. The results demonstrate the feasibility of the model in the development of three layered buccal compact containing highly water-soluble drug MT.

Comparison of high-density and low-density lipoprotein cholesterol subclasses and sizes in Asian Indian women with Caucasian women from the Framingham Offspring Study.

BACKGROUND: Asian Indian women have a higher rate of coronary artery disease (CAD) than do other ethnic groups, despite similar conventional risk factors and lipid profiles. Smaller high-density lipoprotein cholesterol (HDL-C) particle size is associated with reduced cardiac protection or even an increased risk of CAD. Exceptional longevity correlates better with larger HDL-C particle sizes. HYPOTHESIS: Higher rates of CAD among Asian Indian women may partly be explained by the differenes in the prevalence of atherogenic HDL-C and low-density lipoprotein cholesterol (LDL-C) sizes and their subclass concentrations among Asian Indian women compared with Caucasian women. METHODS: We measured HDL-C concentrations and sizes by nuclear magnetic resonance spectroscopy in 119 relatively healthy Asian Indian women and compared them with those of 1752 Caucasian women from the Framingham Offspring Study (FOS). RESULTS: Asian Indian women were significantly younger (47.9 +/- 11.2 vs. 51.0 +/- 10.1 years, p = 0.0001), leaner (body mass index 24.0 +/- 4.7 vs. 26.0 +/- 5.6, p = < 0.0002), less likely to be postmenopausal (32 vs. 54%, p = < 0.0001), or smoke (< 1 vs. 20%, p = < 0.0001); nevertheless, prevalence of CAD was higher in Asian Indian women (4.2 vs. 1%, p = 0.0006). Asian Indian women had similar HDL-C (53 +/- 13 vs. 53 +/- 13 mg/dl, p = 0.99), smaller HDL-C particle size (8.9 +/- 0.35 vs. 9.4 +/- 0.44 nm, p = < 0.0001), higher total cholesterol (209 +/- 40 vs. 199 +/- 42 mg/dl, p = 0.01), and similar triglyceride (120 +/- 77 vs. 108 +/- 110 mg/d, p = 0.24) levels. Low-density lipoprotein cholesterol, particle concentrations and sizes, as well as prevalence of pattern B were similar. CONCLUSIONS: Compared with the FOS, Asian Indian women have significantly smaller overall HDL particle size and similar levels of HDL-C, which may reflect impaired, reverse cholesterol transport. Total cholesterol was higher, whereas triglyceride and LDL-C levels were similar. This may partly explain the higher CAD rates in Asian Indian women. Further large scale, prospective, long-term studies are warranted.

Effect of leisure time exercise on high-density lipoprotein cholesterol, its subclasses, and size in Asian Indians.

Asian Indians have a greater prevalence and incidence of coronary artery disease than other ethnic groups, despite similar routine lipid profiles. High-density lipoprotein (HDL) cholesterol, particularly the large subclass, is predominantly associated with coronary artery disease protection. Exercise reduces coronary artery disease risk by improving HDL cholesterol levels. The effect of exercise on HDL cholesterol concentrations, subclasses, and size, measured by nuclear magnetic resonance spectroscopy, was assessed in 388 healthy Asian Indians. Exercise was associated with significantly greater concentrations of total HDL cholesterol, entirely due to significant increases in the cardioprotective large HDL subclass and larger HDL cholesterol particle sizes.

Formulación y evaluación de comprimidos sublinguales con sulfato de terbutalina: estudios de optimización e in vivo / Formulation and evaluation of a sublingual tablet containing terbutaline sulphate: optimisation and in vivo studies

La finalidad de este trabajo de investigación es la formulación de un comprimido sublingual de sulfato de terbutalina de acción rápida y mejorar la biodisponibilidad y el cumplimiento de las pautas por parte del paciente. Para la preparación de los gránulos se utilizó una técnica de granulación húmeda. Se prepararon formulaciones basadas en el diseño factorial con variables de formulación 3 32: : la cantidad de celulosa microcristalina (MCC) (X 1) y la crospovidona como componente bioadhesivo (X 2). Como variables de respuesta se evaluaron la resistencia al aplastamiento, la friabilidad y el tiempo de desintegración (DT). Los principales efectos y términos de interacción se evaluaron cuantitativamente mediante un modelo cuadrático. Los resultados revelaron que la cantidad de MCC y crospovidona afectaban significativamente a las variables de respuesta. La formulación optimizada de comprimidos contiene 31,5 mg de MCC y 4,5 mg de crospovidona, se desintegra en un período corto con un índice DT de 30,2 + 5,5 seg. y tiene una resistencia al aplastamiento suficiente y una friabilidad aceptable. Las concen- concentraciones traciones plasmáticas de terbutalina se obtuvieron a los 5 minutos. Los resultados indican que la crospovidona, un componente bioadhesivo, impide tragar la terbutalina, sin afectar a su liberación y absorción. En conclusión, la formulación del comprimido sublingual se puede extrapolar a otros fármacos en los que se desee una absorción rápida

The objective of this research was to formulate a sublingual tablet formulation of terbutaline for rapid action, and to improve both bioavailability and patient compliance to therapy. A wet granulation technique was adapted to prepare the granules. Granule formulations were prepared using an adapted wet granulation technique based on a 3 32 full factorial design. The formulation variables were expressed as follows; quantity of microcrystalline cellulose (MCC), (X 1 ), and bioadhesive component crospovidone, (X 2 ), while crushing strength, friability and disintegration time (DT) were determined as response variables. The main effects and interaction terms were quantitatively evaluated using a quadratic model. The results obtained showed that the quantity of MCC and crospovidone significantly affect response variables. An optimised tablet formulation, containing 31.5 mg of MCC and 4.5 mg of crospovidone, provides a short DT of 30.2 + 5.5 sec with sufficient crushing strength and acceptable friability, while DT for serum concentrations of terbutaline were obtained within 5 min. The results indicate that the inclusion of crospovidone, a bioadhesive component, in sublingual tablet formulations, makes the swallowing of tablets unnecessary, because the release and absorption of the terbutaline in such formulations is acceptably effective. In conclusion, the developed sublingual tablet formulations is of interest, because it can be extrapolated to other drugs, where rapid absorption is desirable

Comparison of levels of large and small high-density lipoprotein cholesterol in Asian Indian men compared with Caucasian men in the Framingham Offspring Study.

Asian Indians have a higher incidence of coronary artery disease (CAD) than do other ethnic groups, despite similar standard risk factors and lipid profiles. The large subclass of high-density lipoprotein (HDL) cholesterol is predominantly associated with protection against coronary artery disease. We compared various lipoprotein concentrations and sizes in 211 healthy Asian Indian men with those in 1,684 Caucasian men from the Framingham Offspring Study as measured by nuclear magnetic resonance spectroscopy. Concentrations of HDL cholesterol were similar in the 2 groups, but concentrations of large HDL cholesterol were lower and concentrations of small HDL cholesterol were significantly higher in Asian Indian than in Caucasian men. HDL particle size was smaller in Asian Indians. Levels of low-density lipoprotein cholesterol, low-density lipoprotein particle size, and prevalence of pattern B were similar in the 2 groups.

Race, ethnicity, and sociocultural characteristics predict noncompliance with lipid-lowering medications.

BACKGROUND: Sociocultural factors that predict noncompliance with lipid-lowering medications are not well understood. METHODS: Interviews and medical record review were conducted for 510 patients treated with lipid-lowering medications. Compliance with lipid-lowering medications was measured by patients' self-assessment of medication-taking practices. RESULTS: Adjusted for age and sex, there was a higher frequency of noncompliance among Black and Hispanic subjects. Adjusted for age, sex, and race/ethnicity, noncompliance was associated with medication side effects, feelings of sadness or depression, fair or poor health status, primary use of a language other than English, single or divorced status, fewer and less frequent contact with friends, children in the household, and lower education. Independent predictors of noncompliance in multivariate models were side effects (OR = 3.9, P < 0.01), sadness or depression (OR = 1.9, P = 0.05), Black (OR = 3.7, P < 0.01, vs. White), Hispanic (OR = 6.3, P < 0.01, vs. White), single or divorced (OR = 2.1, P < 0.01), children in the household (OR = 1.5 per child, P < 0.01), and lack of health insurance (OR = 2.4, P = 0.05). CONCLUSIONS: Unmarried status, feelings of sadness or depression, lack of insurance, and children in the household were independently associated with poorer compliance with lipid-lowering medications in this urban population. Nonetheless, higher noncompliance among minority patients persisted independently of these and other specific social, cultural, and economic factors.