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1.
J Natl Med Assoc ; 111(6): 674-681, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31676110

RESUMO

Opioid use disorder (OUD) constitutes a significant public health burden as opioid overdose deaths have continued to rise in the United States. Although treatment modalities are available to manage OUD, some patients experience challenges achieving their OUD management goals. Some of these challenges may be attributable to inherited genetic variations, or polymorphisms, on the genes that code for proteins impacting the pharmacokinetics or pharmacodynamics of medications used in OUD management. Clinical pharmacogenomics testing can elucidate these polymorphisms; however, a lack of real-world evidence for the use of pharmacogenomics in OUD management complicates the implementation process. We conducted a retrospective cohort study of 113 patients undergoing buprenorphine-based OUD management in Northeast Washington D.C. to determine if clinical pharmacogenomics testing for CYP3A4 and CYP3A5 would impact treatment outcomes. Data were collected from the electronic medical record (EMR) from December 30, 2015 to December 31, 2016. Study outcomes were based on presence of withdrawal symptoms, instances of unauthorized substances in urine drug tests (UDTs), and sublingual buprenorphine/naloxone (SBN) dose with standard-of-care (SOC) dosing versus pharmacogenomics (PGx)-based dosing. Pearson correlation tests, Wilcoxon signed rank tests, Wilcoxon rank sum tests, and one-way ANOVA tests were used. Linear and logistic regression analyses were used to assess predictors of withdrawal symptomatology. Kaplan-Meier survival analyses were used to assess time to first withdrawal. Our research suggests that patients with at least one copy of the CYP3A4*1B allele exhibit an accelerated rate of metabolism compared to the wild-type allele CYP3A4*1.

2.
Sr Care Pharm ; 34(9): 604-612, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31601294

RESUMO

OBJECTIVE: The primary objective of this study is to determine factors associated with health literacy and medication adherence in an urban community. DESIGN: A cross-sectional study was conducted to assess factors associated with health literacy and medication adherence. Participants were recruited from October 2012 to April 2013. SETTING: Ambulatory care clinic and senior wellness center. PARTICIPANTS: Participants were eligible if they were older than 18 years of age and had received care at the ambulatory clinic or obtained services at the senior wellness center. INTERVENTIONS: REALM survey and the Morisky 8-Item Medication Adherence Questionnaire. MAIN OUTCOME MEASURES: The two outcomes evaluated in this study were health literacy and medication adherence. RESULTS: A total of 51 participants were enrolled in the study. Twenty-seven (53%) of the participants were noted to be nonadherent to their medications. Twenty (74%) of these participants read below the high school level, and the remaining 7 (26%) read above a high school level. Study findings showed that both education level and comorbidities status were associated with health literacy. Participants who had a below high school education level had greater odds of having a below high school health literacy level (odds ratio [OR] = 7.500, 95% confidence interval [CI] 1.482-37.949). Participants who had two or more comorbidities had greater odds of having a below high school health literacy level (OR = 24.889, 95% CI 2.698-229.610). CONCLUSION: Our study results found associations between both comorbidities and education with health literacy.


Assuntos
Alfabetização em Saúde , Adesão à Medicação , Adolescente , Estudos Transversais , Inquéritos Epidemiológicos , Humanos , Inquéritos e Questionários
3.
Int J Vitam Nutr Res ; 89(1-2): 55-61, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30816823

RESUMO

Optimal serum vitamin D levels are reported to be associated with many health benefits; however, few studies have determined predictive factors using national level data. An assessment of predictive factors for vitamin D inadequacy was conducted using National Health and Nutrition Examination Survey (NHANES) 2001-2006 data. Using the study sample including adults aged 40 years or more, data analysis was performed using the weighted multivariate logistic regression statistical procedure. The prevalence of vitamin D inadequacy (serum vitamin D <20 ng/ml) was 37.3%. Non-Hispanic Blacks were 6.4 times more likely to demonstrate vitamin D inadequacy compared to non-Hispanic Whites (ORadj=6.351; 95% CI 5.338, 7.555; p<0.0001). Also, female gender was a significant predictor of vitamin D inadequacy (ORadj=1.499; 95% CI 1.315, 1.708; p<0.0001) in multivariate models. Subjects who reported not taking vitamin D supplements in the past 30 days were more than twice as likely to be vitamin D inadequate compared with those who had taken dietary supplements containing vitamin D (ORadj=2.225; 95% CI 1.903, 2.601; p<0.0001). In conclusion, the strongest predictor of vitamin D inadequacy was non-Hispanic Black ethnicity. Other potential predictors included smoking, non-use of vitamin D supplements, abnormal BMI, collecting samples in winter, female gender, perception of own health condition as not excellent, lack of health care, and older age. More focused interventions targeting groups of United States residents with vitamin D inadequacy are needed.


Assuntos
Deficiência de Vitamina D , Vitamina D , Vitaminas/metabolismo , Adulto , Idoso , Suplementos Nutricionais , Feminino , Humanos , Inquéritos Nutricionais , Estados Unidos , Vitaminas/química
4.
Artigo em Inglês | MEDLINE | ID: mdl-30262740

RESUMO

There are persistent disparities with regard to receipt of herpes zoster vaccine among elderly blacks, but no data is available regarding the public health or economic impact of these disparities. A decision tree was constructed with multiple Markov nodes in order to estimate the preventable cases of herpes zoster occurring among elderly blacks due to disparities in receipt of herpes zoster vaccine and to quantify the economic costs associated with these disparities. The model was constructed to examine the number of herpes zoster cases occurring among elderly blacks from the age of 60 to 84 over a 20 year period and also calculated costs due to herpes zoster complications and lost productivity. Achievement of health equity would prevent over 34,500 cases of herpes zoster from occurring in the future and avert over $180 million in lost productivity and treatment costs as a result of these cases of herpes zoster. These results help to show that thousands of cases of herpes zoster could be prevented if blacks were vaccinated at the same frequency as whites and help to show the benefit of implementing viable strategies to achieving this goal.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Análise Custo-Benefício , Disparidades nos Níveis de Saúde , Vacina contra Herpes Zoster/economia , Saúde Pública/economia , Saúde Pública/estatística & dados numéricos , Vacinação/economia , Idoso , Idoso de 80 Anos ou mais , Feminino , Equidade em Saúde , Herpes Zoster/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos , Vacinação/estatística & dados numéricos
5.
Clin Med Insights Pediatr ; 12: 1179556518784300, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30046262

RESUMO

Objectives: Broad-spectrum antibiotics are frequently prescribed for children with upper respiratory tract infections (URI). Excessive use of broad-spectrum antibiotics leads to the emergence of resistant bacteria. This study aimed to identify factors associated with prescribing broad-spectrum antibiotics among children younger than 18 years presenting with URI in outpatient settings. Methods: We conducted a cross-sectional analysis of the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey-Outpatient Departments (NHAMCS-OPD) between 2006 and 2010. Descriptive statistics of visits from children with URI were estimated. Simple and multiple logistic regression analyses were used to identify socio-demographic and clinical characteristics associated with broad-spectrum antibiotic prescribing. We also completed a stratified analysis by age (⩽2 vs >2). Results: A total of 4013 outpatient visits for children with URI from both NAMCS and NHAMCS-0PD data were examined. Broad-spectrum antibiotics were prescribed in 39% of the visits, accounting for an estimated 6.8 million visits annually. Multivariable analysis showed that visits in the South region (odds ratio [OR] = 2.38; 95% confidence interval [CI]: 1.38-4.10) compared with the West region and visits with diagnoses of acute sinusitis (OR = 2.77; 95% CI: 1.65-4.63) and acute otitis media (OR = 1.90; 95% CI: 1.32-2.74) compared with those with acute pharyngitis were associated with greater odds of broad-spectrum antibiotic prescribing. Conclusions: The prescribing of broad-spectrum antibiotics is common for children with URI in ambulatory care settings. Diagnosis and management of URI remain a critical area for awareness campaigns promoting judicious use of antibiotics.

6.
J Epidemiol Glob Health ; 7(2): 119-122, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28215491

RESUMO

Baby Boomers (BBs) are responsible for three-quarters of hepatitis C virus (HCV) infections in the United States; however, HCV testing is distinctly underused by them. A cross-sectional study was conducted to assess the prevalence of HCV testing and to evaluate predictors of HCV testing intention among African-American BBs. The study was guided by the Health Belief Model and theory of reasoned action frameworks. Of the 137 participants included in the study, 44.8% had at least a college education; 13.9% received prior to 1992 blood transfusion. Findings related to HCV testing showed that 32.1% of the participants intended to test for HCV within 6months and 43.8% had received a previous HCV test. Significant predictors of HCV testing intention within 6months included having a blood transfusion prior to 1992 [odds ratio (OR)=8.25, 95% confidence interval (CI): 2.02-33.61], perceptions of benefits (OR=1.57, 95% CI: 1.13-2.18), severity (OR=1.39, 95% CI: 1.17-1.65), and subjective norms (OR=1.42, 95% CI: 1.12-1.79). These predictors of HCV testing intention can be used to develop future HCV testing initiatives for African-American BBs.


Assuntos
Afro-Americanos/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Hepatite C/diagnóstico , Intenção , Crescimento Demográfico , Adulto , Idoso , Estudos Transversais , District of Columbia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
7.
Addict Behav Rep ; 6: 8-14, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29450233

RESUMO

Introduction: Opioid use disorder (OUD) is characterized by a problematic pattern of opioid use leading to clinically-significant impairment or distress. Opioid agonist treatment is an integral component of OUD management, and buprenorphine is often utilized in OUD management due to strong clinical evidence for efficacy. However, interindividual genetic differences in buprenorphine metabolism may result in variable treatment response, leaving some patients undertreated and at increased risk for relapse. Clinical pharmacogenomics studies the effect that inherited genetic variations have on drug response. Our objective is to demonstrate the impact of pharmacogenetic testing on OUD management outcomes. Methods: We analyzed a patient who reported discomfort at daily buprenorphine dose of 24 mg, which was a mandated daily maximum by the pharmacy benefits manager. Regular urine screenings were conducted to detect the presence of unauthorized substances, and pharmacogenetic testing was used to determine the appropriate dose of buprenorphine for OUD management. Results: At the 24 mg buprenorphine daily dose, the patient had multiple relapses with unauthorized substances. Pharmacogenetic testing revealed that the patient exhibited a cytochrome P450 3A4 ultrarapid metabolizer phenotype, which necessitated a higher than recommended daily dose of buprenorphine (32 mg) for adequate OUD management. The patient exhibited a reduction in the number of relapses on the pharmacogenetic-based dose recommendation compared to standard dosing. Conclusion: Pharmacogenomic testing as clinical decision support helped to individualize OUD management. Collaboration by key stakeholders is essential to establishing pharmacogenetic testing as standard of care in OUD management.

8.
J Infect Public Health ; 9(4): 436-42, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26706773

RESUMO

BACKGROUND: Baby boomers (people born between 1945 and 1965) are responsible for three-quarters of Hepatitis C (HCV) infections in the US; however, HCV testing is distinctly underused by them. AIM: To assess the status, predictors, and correlates of HCV knowledge among African-American baby boomers (AABBs) in Washington, DC. METHODS: A cross-sectional survey among persons aged 46-69 was conducted using audio computer-assisted self-interviewing (ACASI). Data on HCV knowledge, socio-demographics, prior history of HCV testing, health-related characteristics, HCV vulnerability and HCV treatment perceptions were collected. Descriptive statistics was used to describe the study population. Pearson correlations were used to examine linear associations between HCV knowledge and Health Belief Model constructs related to HCV. Linear regression analysis was conducted to assess the predictors of knowledge. RESULTS: Out of the 137 participants, about sixty percent (60.6%) were females, mean age 59±6.40; 44.8% had at least a college education. The average knowledge score was low (48.7%). HCV knowledge was significantly correlated with constructs of perceived severity and perceived benefits. Age (ß=-0.10; p=0.003), and level of education (ß=0.93, p=0.027) were significant predictors. CONCLUSIONS: Overall, respondents have a low level of knowledge. The lower level of education and older age were significant predictors of inadequate HCV knowledge. Thus, HCV education among these people may be a vital component in reducing the gaps in HCV knowledge.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Hepatite C/psicologia , Afro-Americanos , Idoso , Estudos Transversais , District of Columbia , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade
9.
J Womens Health (Larchmt) ; 19(5): 847-54, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20459329

RESUMO

AIM: To describe long-term prescribing patterns of osteoporosis therapy before and after the Women's Health Initiative (WHI) publication. METHODS: We conducted a time-series analysis from 1997 to 2005 using nationally representative data based on office-based physician and hospital ambulatory clinic visits. Bivariate and multivariable analyses were conducted using chi-square tests and logistic regression, respectively, and trends in the prevalence of osteoporosis therapies were evaluated per 6-month (semiannual) intervals. Linear regression and graphic techniques were used to determine statistical differences in the prevalence trends between the two periods. RESULTS: Overall prevalence of therapeutic or preventive osteoporosis therapy was similar between the WHI periods. However, a significant decrease in estrogen therapy and increases in bisphosphonates, calcium/vitamin D were observed in the period after the WHI publication (p < 0.05). Multiple logistic regression analysis showed older age and white race were associated with a higher likelihood of antiosteoporosis medication (AOM) prescription, and Medicaid insurance type was associated with a lower likelihood of an AOM prescription. Excluding calcium/vitamin D, nonestrogen therapy was more likely to be prescribed in the after-WHI period (office-based physician clinic: [adjusted OR, aOR] 2.49 [2.04-4.04]; hospital-based clinic: aOR 2.42 [1.67-7.50]) Nonestrogen therapy was more prevalent in visits made by older women, women of white race, women with contraindicated conditions for estrogen therapy, and women from the Northeast region. CONCLUSIONS: After the WHI publication, the overall prevalence of osteoporosis therapy did not change; however, a shift from estrogen to nonestrogen therapy was observed after the WHI publication. Black women were less likely to receive nonestrogen antiosteoporosis therapy in hospital-based clinics.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Osteoporose/tratamento farmacológico , Padrões de Prática Médica , Saúde da Mulher , Adulto , Terapia de Reposição de Estrogênios/estatística & dados numéricos , Terapia de Reposição de Estrogênios/tendências , Feminino , Humanos , Modelos Lineares , Pessoa de Meia-Idade , Serviços de Saúde da Mulher , Adulto Jovem
10.
Pharmacoepidemiol Drug Saf ; 19(1): 90-8, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20035528

RESUMO

PURPOSE: To examine the rate of lipid testing among children from a large US medical insurance claims database, describe the characteristics of pediatric dyslipidemia, and assess the sensitivity of the International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes for identifying dyslipidemic children. METHODS: This retrospective cohort study used the claims data from the Integrated Healthcare Information Services (IHCIS), for the years 2003-2006. Two study cohorts consisted of children with laboratory-defined and diagnosis/treatment-defined dyslipidemia, respectively. They were compared to age- and gender-matched children without dyslipidemia, with respect to co-morbidities during the 6-month prior to and 12-month after the first dyslipidemic laboratory value or diagnosis/treatment. RESULTS: Seven per cent of the children who had laboratory values available in the database had a cholesterol test during the study period. Only 15% of laboratory-defined children (n = 23,475) had a dyslipidemia diagnosis. Cholesterol-modifying medications were rarely prescribed. Substantially more laboratory-defined children than their comparators were obese (8 times), had diabetes mellitus (10 times), or had hypertension (5 times). These co-morbidities were even higher among diagnosis/treatment-defined children. CONCLUSIONS: The rate of lipid testing among children was low. The ICD-9-CM diagnostic codes showed low sensitivity against laboratory definitions. Though only a small proportion of dyslipidemic children were diagnosed or treated with a medication, co-morbidities associated with dyslipidemia were common.


Assuntos
Colesterol/sangue , Dislipidemias/sangue , Dislipidemias/classificação , Revisão da Utilização de Seguros , Classificação Internacional de Doenças/normas , Adolescente , Criança , Bases de Dados Factuais , Dislipidemias/diagnóstico , Feminino , Humanos , Estudos Longitudinais , Masculino , Pediatria , Estudos Retrospectivos , Sensibilidade e Especificidade
11.
Pharmacoepidemiol Drug Saf ; 15(8): 537-45, 2006 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16700083

RESUMO

PURPOSE: To describe patterns of medication use during pregnancy in ambulatory care settings according to the U.S. Food and Drug Administration (FDA) pregnancy risk classification. METHODS: A cross-sectional study of two national ambulatory care surveys, sampling all office visits made by pregnant women in 1999 and 2000, was conducted. Using the FDA pregnancy risk classification, patterns of medication use and predictive factors for FDA pregnancy risk D or X (D/X) medications were evaluated. RESULTS: In 1999 and 2000, about half of all pregnant visits had one or more medications. Among the total visits, FDA Class A was the majority (private = 65.7%; hospital = 79.5%; p < 0.05) followed by Class C (private = 26.5%; hospital = 36.4%; p < 0.05). Class D/X medications accounted for 6.4% and 2.9% of visits in private and hospital, respectively (p < 0.05). Medications with unknown pregnancy categories were predominant in the private setting (12.0% and 3.9%; p < 0.05). Age, insurance type, region, physician specialty, and number of medications were associated with a category D/X prescription. Among hospital visits, those from the West region and with private insurance were more likely to receive category D/X prescriptions. Number of medications was strongly associated with high-risk drugs in both settings. CONCLUSIONS: This study shows considerable medication use among pregnant women. The prevalence of visits with FDA pregnancy category D/X drugs was moderate, but still indicates exposure to high-risk medications.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Gravidez/estatística & dados numéricos , Adulto , Prescrições de Medicamentos/classificação , Prescrições de Medicamentos/estatística & dados numéricos , Tratamento Farmacológico/classificação , Tratamento Farmacológico/estatística & dados numéricos , Feminino , Humanos , Ambulatório Hospitalar/estatística & dados numéricos , Estados Unidos , United States Food and Drug Administration
12.
J Natl Med Assoc ; 98(3): 430-5, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16573310

RESUMO

PURPOSES: To assess patterns of dementia/Alzheimer's disease (AD) management and to investigate predictive factors of cholinesterase inhibitor prescriptions. METHODOLOGY: A cross-sectional study was conducted using a national survey among the elderly aged >60 from 2000 to 2002. Visit characteristics and cholinesterase inhibitor prescriptions associated with dementia/AD status were evaluated. MAIN FINDINGS: A total of 25,561 visit records were identified. Of the total visits, only 0.6% had dementia/AD records. Most of the dementia/AD visits were made by women (60.6%) and white patients (93.5%). Of the dementia/AD visits, about half (46.5%) were prescribed with one or more cholinesterase inhibitors. Donepezil was the most prevalent agent (68.0%) followed by rivastigmine (26.0%). Logistic regression analyses indicated that the physician's specialty was a strong predictor for cholinesterase inhibitor prescription; psychiatrists [odds ratio (OR)=5.5; p<0.01] and neurologists (OR=2.6; p<0.03) were more likely to prescribe cholinesterase inhibitor than other physicians. Other characteristics including race did not show significant association. CONCLUSIONS: The study findings suggest that physicians who specialized in psychiatry and neurology predominantly provided ambulatory care services for dementia patients. More efforts should be given to detect and to treat dementia patients with cognitive-enhancing agents after the formal diagnosis in the ambulatory care setting.


Assuntos
Assistência Ambulatorial , Inibidores da Colinesterase/uso terapêutico , Demência/tratamento farmacológico , Prescrições de Medicamentos/estatística & dados numéricos , Idoso , Demência/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/estatística & dados numéricos , Estados Unidos/epidemiologia
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