scholarly journals Characterizing Dual Combination Therapy Use in Treatment Escalation of Hypertension: Real-World Evidence from Multinational Cohorts

2021 ◽  
Author(s):  
Yuan Lu ◽  
Jing Li ◽  
Xialin Wang ◽  
Sreemanee Raaj Dorajoo ◽  
Mengling Feng ◽  
...  
Keyword(s):  
Combination Therapy ◽  
South Korea ◽  
Beta Blocker ◽  
Real World ◽  
Antihypertensive Agents ◽  
The United States ◽  
Future Research ◽  
Routine Practice ◽  
Combination Therapies ◽  
History Of

ABSTRACT Background: Over one billion adults have hypertension globally, of whom approximately 70% cannot achieve blood pressure control goal with monotherapy alone. Data are lacking on patterns of dual combination therapies prescribed to patients who escalate from monotherapy in routine practice. Methods: Using eleven electronic health record databases that cover 118 million patients across eight countries/regions, we characterized the initiation of antihypertensive dual combination therapies for patients with hypertension. In each database, we first constructed twelve exposure cohorts of patients who newly initiate dual combination therapy with one of the four most commonly used antihypertensive drug classes (angiotensin-converting enzyme inhibitor [ACEi] or angiotensin receptor blocker [ARB]; calcium channel blocker [CCB]; beta-blocker; and thiazide or thiazide-like diuretic) after escalating from monotherapy with one of the three alternative classes. Using these cohorts, we then described dual combination therapy utilization, stratified by age, gender, history of cardiovascular diseases (CVD), and country. Results: Across data sources, we identified 980,648 patients with hypertension initiating dual combination therapy with antihypertensive agents after escalating from monotherapy: 12,541 from Australia, 6,980 from South Korea, 2,096 from Singapore, 7,008 from China, 16,663 from Taiwan, 103,994 from France, 76,082 from Italy, and 754,137 from the United States (US). Significant variations in treatment utilization existed across countries and patient subgroups. In Australia and Singapore, starting an ACEi/ARB monotherapy followed by a CCB was most common while in South Korea, China and Taiwan, starting a CCB monotherapy followed by an ACEi/ARB was most common. In Italy, France, and the US, sequential use of an ACEi/ARB monotherapy followed by a diuretic was most common. Younger patients were more likely to be prescribed ACEi/ARB followed by either a CCB or a diuretic compared with older patients. Women were more likely to be prescribed diuretics then an ACEi/ARB or a CCB compared with men. Among patients with history of CVD, ACEi/ARB followed by beta-blocker, and beta-blocker followed by ACEi/ARB were more commonly prescribed. Conclusion: This is the largest and most comprehensive study characterizing the real-world utilization of dual combination therapies in treating hypertension. Large variation in the transition between monotherapy and dual combination therapy for hypertension was observed across countries. These results highlight the need for future research to identify which second-line dual combination therapy is most effective in practice.

Fragments of the American Dream: Immigration, Race, and Medical Care in the Segregated South, 1929

Public Voices ◽  
2016 ◽  
Vol 13 (2) ◽  
pp. 1
Author(s):  
John R Phillips
Keyword(s):  
United States ◽  
American Dream ◽  
Black Population ◽  
The United States ◽  
Single Woman ◽  
Future Research ◽  
Legal Doctrine ◽  
Quarter Century ◽  
History Of ◽  
Sunflower County

The cover photograph for this issue of Public Voices was taken sometime in the summer of 1929 (probably June) somewhere in Sunflower County, Mississippi. Very probably the photo was taken in Indianola but, perhaps, it was Ruleville. It is one of three such photos, one of which does have the annotation on the reverse “Ruleville Midwives Club 1929.” The young woman wearing a tie in this and in one of the other photos was Ann Reid Brown, R.N., then a single woman having only arrived in the United States from Scotland a few years before, in 1923. Full disclosure: This commentary on the photo combines professional research interests in public administration and public policy with personal interests—family interests—for that young nurse later married and became the author’s mother. From the scholarly perspective, such photographs have been seen as “instrumental in establishing midwives’ credentials and cultural identity at a key transitional moment in the history of the midwife and of public health” (Keith, Brennan, & Reynolds 2012). There is also deep irony if we see these photographs as being a fragment of the American dream, of a recent immigrant’s hope for and success at achieving that dream; but that fragment of the vision is understood quite differently when we see that she began a hopeful career working with a Black population forcibly segregated by law under the incongruously named “separate but equal” legal doctrine. That doctrine, derived from the United States Supreme Court’s 1896 decision, Plessy v. Ferguson, would remain the foundation for legally enforced segregation throughout the South for another quarter century. The options open to the young, white, immigrant nurse were almost entirely closed off for the population with which she then worked. The remaining parts of this overview are meant to provide the following: (1) some biographical information on the nurse; (2) a description, in so far as we know it, of why she was in Mississippi; and (3) some indication of areas for future research on this and related topics.

Introduction

2017 ◽  
Author(s):  
Travis D. Stimeling
Keyword(s):  
United States ◽  
The United States ◽  
Country Music ◽  
Future Research ◽  
Music Culture ◽  
Rich Variety ◽  
Ethnographic Studies ◽  
Folklore Studies ◽  
History Of ◽  
The Rich

This chapter offers a historiographic survey of country music scholarship from the publication of Bill C. Malone’s “A History of Commercial Country Music in the United States, 1920–1964” (1965) to the leading publications of the today. Very little of substance has been written on country music recorded since the 1970s, especially when compared to the wealth of available literature on early country recording artists. Ethnographic studies of country music and country music culture are rare, and including ethnographic methods in country music studies offers new insights into the rich variety of ways in which people make, consume, and engage with country music as a genre. The chapter traces the influence of folklore studies, sociology, cultural studies, and musicology on the development of country music studies and proposes some directions for future research in the field.

The Interplay of Developing Morality and Gender Attitudes

2020 ◽  
pp. 724-745
Author(s):  
Rebecca S. Bigler ◽  
Lynn S. Liben
Keyword(s):  
Psychological Theory ◽  
The United States ◽  
Gender Nonconformity ◽  
Gender Attitudes ◽  
Future Research ◽  
Policy And Practice ◽  
Ethical Policy ◽  
History Of ◽  
And Gender ◽  
And Behavior

Morality and gender are intersecting realms of human thought and behavior. Reasoning and action at their intersection (e.g., views of women’s rights legislation) carry important consequences for societies, communities, and individual lives. In this chapter, the authors argue that children’s developing views of morality and gender reciprocally shape one another in important and underexplored ways. The chapter begins with a brief history of psychological theory and research at the intersection of morality and gender and suggests reasons for the historical failure to view gender attitudes through moral lenses. The authors then describe reasons for expecting morality to play an important role in shaping children’s developing gender attitudes and, reciprocally, for gender attitudes to play an important role in shaping children’s developing moral values. The authors next illustrate the importance and relevance of these ideas by discussing two topics at the center of contentious debate in the United States concerning ethical policy and practice: treatment of gender nonconformity and gender-segregated schooling. The chapter concludes with suggestions for future research.

Projecting the long-term benefits of single pill combination therapy for patients with hypertension in five countries

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Borghi ◽  
J.G Wang ◽  
A.V Rodionov ◽  
M Rosas ◽  
I.S Sohn ◽  
...  
Keyword(s):  
Combination Therapy ◽  
South Korea ◽  
Health Outcomes ◽  
Clinical Outcomes ◽  
Funding Source ◽  
Combination Therapies ◽  
Private Company ◽  
Treatment Pathways ◽  
Single Pill ◽  
The Impact

Abstract Background It is well established that single pill combination (SPC) therapies have the potential to improve patient adherence versus multi-pill regimens, thereby improving blood pressure control and clinical outcomes in populations with hypertension. Purpose To develop a microsimulation model, capturing different treatment pathways, to project the impact on clinical outcomes of using single pill combination therapies for the management of hypertension in five countries (Italy, Russia, China, South Korea and Mexico). Methods The model was designed to project health outcomes between 2020 and 2030 for populations with hypertension managed according to four different treatment pathways: current treatment practices [CTP], single drug with dosage titration first then sequential addition of other agents [start low and go slow, SLGS], free choice combination with multiple pills [FCC] and combination therapy in the form of a single pill [SPC]. Model inputs were derived from Global Burden of Disease 2017 dataset, including demographics, health status/risk factors, transition probabilities and treatment attributes/healthcare utilization, and the model incorporated real-world challenges to healthcare delivery such as access to care, SBP measurement error, adherence and therapeutic inertia. Simulated outcomes of mortality, incidence of chronic kidney disease (CKD), stroke and ischemic heart disease (IHD), and disability-adjusted life years (DALYs) due to these conditions were estimated for population of 1,000,000 simulated patients for each treatment pathway and country. Results SPC therapy was projected to improve health outcomes over SLGS, FCC and CTP over 10 years in all five countries. SPC was forecast to reduce mortality by 5.4% (Italy), 4.9% (Russia), 4.5% (China), 2.3% (South Korea) and 3.6% (Mexico) versus CTP and showed greater projected reductions in mortality than SLGS and FCC. DALYs were projected to be reduced with SPC therapy by between 5.7% (Italy) and 2.2% (South Korea) compared with CTP and reductions in the incidence of clinical events were also projected with SPC therapy, with decreases in the range of 11.5% (Italy) to 4.9% (South Korea) versus CTP. Conclusions Ten-year projections of clinical outcomes associated with different anti-hypertensive treatment pathways in five countries indicated that both combination therapies (FCC and SPC) are likely to reduce the disease burden of hypertension compared with conventional management approaches, with SPC showing the greatest overall benefits due to improved adherence. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Sanofi, Gentilly, France

scholarly journals Treatment patterns, healthcare resource utilization, and healthcare costs among patients with pulmonary arterial hypertension in a real-world US database

2018 ◽  
Vol 9 (1) ◽  
pp. 204589401881629 ◽  
Author(s):  
Sean Studer ◽  
Michael Hull ◽  
Janis Pruett ◽  
Eleena Koep ◽  
Yuen Tsang ◽  
...  
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Combination Therapy ◽  
Arterial Hypertension ◽  
Resource Utilization ◽  
Real World ◽  
Healthcare Resource ◽  
Healthcare Resource Utilization ◽  
Treatment Patterns ◽  
Combination Therapies ◽  
Pulmonary Arterial

Several new medications for pulmonary arterial hypertension (PAH) have recently been introduced; however, current real-world data regarding US patients with PAH are limited. We conducted a retrospective administrative claims study to examine PAH treatment patterns and summarize healthcare utilization and costs among patients with newly diagnosed PAH treated in US clinical practice. Patients newly treated for PAH from 1 January 2010 to 31 March 2015 were followed for ≥12 months. Patient characteristics, treatment patterns, healthcare resource utilization, and costs were described. Adherence (proportion of days covered), persistence (months until therapy discontinuation/modification), and the probability of continuing the index regimen were analyzed by index regimen cohort (monotherapy versus combination therapy). Of 1637 eligible patients, 93.8% initiated treatment with monotherapy and 6.2% with combination therapy. The most common index regimen was phosphodiesterase type 5 inhibitor (PDE-5I) monotherapy (70.0% of patients). A total of 581 patients (35.5%) modified their index regimen during the study. Most patients (55.4%) who began combination therapy did so on or within six months of the index date. Endothelin receptor agonists (ERAs) and combination therapies were associated with higher adherence than PDE-5Is and monotherapies, respectively. Healthcare utilization was substantial across the study population, with costs in the combination therapy cohort more than doubling from baseline to follow-up. The majority of patients were treated with monotherapies (most often, PDE-5Is), despite combination therapies and ERAs being associated with higher medication adherence. Index regimen adjustments occurred early and in a substantial proportion of patients, suggesting that inadequate clinical response to monotherapies may not be uncommon.

scholarly journals The Ecology of Antihypertensives in the United States, 1997-2017

2020 ◽  
Author(s):  
Michael E. Johansen ◽  
Joshua D. Niforatos ◽  
Jeremey B. Sussman
Keyword(s):  
United States ◽  
Beta Blocker ◽  
Medical Expenditure Panel Survey ◽  
The United States ◽  
Medical Expenditure ◽  
Future Research ◽  
Channel Blockers ◽  
Converting Enzyme Inhibitors ◽  
Cross Sectional ◽  
Medication Class

AbstractBackgroundAntihypertensives are the most used medication type in the United States, yet there remains uncertainty about the use of different antihypertensives. We sought to characterize use of antihypertensives by and within medication class(es) between 1997-2017.MethodsA repeated cross-sectional study of 493,596 adult individuals using the 1997-2017 Medical Expenditure Panel Survey (MEPS). The Orange Book and published research were used for adjunctive information. The primary outcome was the estimated use by and within anti-hypertensive medication class(es).ResultsThe proportion of individuals taking any antihypertensive during a year increased from 1997 to the early 2010’s and then remained stable. The proportion of the population taking 2 or more medications declined from 2015-2017. The proportion of adults using angiotensin II receptor-blockers (ARBs) and dihydropyridine calcium channel-blockers (CCBs) increased during the study period, while angiotensin-converting enzyme inhibitors (ACE-Is) increased until 2010 after which rates remained stable. Beta-blocker use was similar to ACE-Is with an earlier decline starting in 2012. Thiazide diuretic use increased from 1997-2007, leveled off until 2014, and declined from 2015-2017. Non-dihydropyridine CCBs use declined throughout the study. ACE-Is, ARBs, CCBs, thiazide diuretics, and loop diuretics all had one dominant in-class medication. There was a clear increase in the use of losartan within ARBs, lisinopril within ACE-Is, and amlodipine within CCBs following generic conversion. Furosemide and hydrochlorothiazide started with and maintained a dominant position in their classes. Metoprolol use increased throughout the study and became the dominant beta-blocker, while atenolol peaked around 2005 and then declined thereafter.ConclusionsAntihypertensive classes appear to have a propensity to equilibrate to an individual medication, despite a lack of outcomes based research to compare medications within a class. Future research could focus on comparative effectiveness for within-class medications early in the life cycle of therapeutics that are probable to have wide spread use.

scholarly journals Migraine Headache : An Overview

2010 ◽  
Vol 23 (1) ◽  
pp. 114-119
Author(s):  
ASM Hasan ◽  
Iftekhar Mahmood ◽  
MR Islam ◽  
MSI Khan ◽  
SM Ali ◽  
...  
Keyword(s):  
Migraine Headache ◽  
Botulinum Toxin Type A ◽  
Antihypertensive Agents ◽  
Opioid Analgesics ◽  
The Elderly ◽  
Botulinum Toxin Type ◽  
The United States ◽  
Treatment Modalities ◽  
Migraine Treatment ◽  
History Of

The history of headache can be traced almost to the beginning of the history of humankind. Among the many causes of it, migraine headache is a debilitating disorder affecting millions of people in the United States and worldwide. The diagnosis of migraine can significantly affect quality of life, health care costs and daily productivity. Hundreds of trials and many guidelines have documented various approaches to migraine management, whether via acute treatment or chronic migraine prophylaxis. Acute or abortive migraine management encompasses specific and nonspecific migraine therapeutics including non-opioid and opioid analgesics, triptans and ergotamines. Prophylactic migraine management data span the pharmacological spectrum from antiepileptic and antihypertensive agents to botulinum toxin type A. Special considerations for migraine management also must be applied in various populations including children, pregnant women and the elderly. Although hundreds of clinical trials are available regarding migraine treatment modalities, this review serves as an introduction to current accepted therapeutics for migraine treatment and an overview of pharmacological prophylaxis in the modern management of migraine. TAJ 2010; 23(1): 114-119

From Ink to Web and Beyond

2017 ◽  
Author(s):  
Heather McKee Hurwitz
Keyword(s):  
Social Media ◽  
Digital Media ◽  
Women Activists ◽  
The United States ◽  
Future Research ◽  
Women's Activism ◽  
Media Activism ◽  
Mainstream Media ◽  
History Of ◽  
Feminist Movements

Mainstream media ignores the breadth and diversity of women’s activism and often features sexist, racist, and sexualized portrayals of women. Also, women hold disproportionately fewer jobs in media industries than men. Despite these challenges, women activists protest gender inequality and advocate a variety of other goals using traditional and new social media. This chapter examines the history of women’s media activism in the United States from women activists’ use of mainstream and alternative newspapers, magazines, radio, and television, to how activists adopted Internet technologies and new digital media strategies starting in the 1990s, to how contemporary feminists protest with Facebook and hashtag activism today. I argue that women activists’ use of new social media may necessitate significant shifts in how we research continuity and diversity in women’s and feminist movements, and how we conceptualize resources, micromobilization, and leadership in social movements broadly. I conclude with several suggestions for future research.

Real-world outcomes in patients (pts) with metastatic urothelial carcinoma (mUC) who received first- or second-line immunotherapies (IO) in the United States (US).

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 457-457
Author(s):  
Marley Boyd ◽  
Srinivas Annavarapu ◽  
Gurjyot K. Doshi ◽  
Kentaro Imai ◽  
Eric Sbar ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Real World ◽  
Performance Status ◽  
The United States ◽  
Future Research ◽  
Second Line ◽  
Ecog Performance Status ◽  
Using Data ◽  
Line Of Therapy

457 Background: Benefit of IO (PD1 and PD-L1 inhibitors) for mUC was observed in clinical trials but real-world evidence for benefit and clinical outcomes is limited. Methods: This was a retrospective study of adult pts with mUC who initiated IO regardless of PD-L1 expression in the first- (1L cohort) or second-line (2L cohort) setting between 5/1/2016-1/31/2019 in the US Oncology Network (USON), a network of community oncology practices. Descriptive and Kaplan-Meier analyses to evaluate baseline characteristics, treatment patterns and clinical outcomes were conducted using data from USON’s electronic heath record. Results: Among 393 pts in the 1L cohort, median (range) age at IO initiation was 77 (42, 90+), 74% were male, 69% were White, and 19.1% and 4.1% had ECOG performance status (PS) 2 and 3/4, respectively. Among the 366 pts in the 2L cohort, median (range) age at IO initiation was 70 (29, 90+), 74% were male, 71% were White, and 19.7% and 1.4% had ECOG PS 2 and 3, respectively. Median (range) follow-up durations from IO initiation were 4.2 (0, 34.1; 1L cohort) and 4.1 (0, 31.3; 2L cohort) months (mo), during which time 43.1% (1L cohort) and 44.4% (2L cohort) of pts died. Median overall survival (OS) from IO initiation (95% confidence interval [CI]) was 10.6 (9.7, 13.2) mo for the 1L cohort and 9.4 (7.1, 11.5) mo for the 2L cohort; 1-year survival probabilities (95% CI) were 46.6% (40.1%, 52.8%; 1L cohort) and 43.4% (36.8%, 49.8%; 2L cohort). By the end of the follow-up, 48.1% of 1L pts and 47.8% of 2L pts were alive and did not advance to next line of therapy, and 13.5% of 1L and 13.4% of 2L cohort pts advanced to the next line of therapy. Median (95% CI) treatment durations were 2.6 (2.1, 2.9) and 2.8 (2.2, 3.5) mo for the 1L and 2L cohorts, respectively; 6-mo ongoing treatment probabilities (95% CI) were 26.6% (22.2%, 31.2%; 1L cohort) and 31.4% (26.4%, 36.4%; 2L cohort). Conclusions: OS of pts in the real world receiving 1L and 2L IO appears consistent with clinical trial results, although survival follow-up is limited. A minority of pts received post-IO therapy. Future research should examine influence of pt characteristics and PD-L1 expression on treatment choice and outcomes.

Trans Pornography

2020 ◽  
Vol 7 (2) ◽  
pp. 152-171 ◽  
Author(s):  
Sophie Pezzutto ◽  
Lynn Comella
Keyword(s):  
United States ◽  
Political Economy ◽  
The United States ◽  
Economic Organization ◽  
Future Research ◽  
The Political ◽  
Transgender Studies ◽  
Economic Forces ◽  
History Of ◽  
Industry Trends

Abstract This article introduces the field of trans pornography studies and makes a case for why studying it matters. We locate trans pornography within the broader field of porn studies, while also pointing to its importance to transgender studies. We map the history of trans pornography and examine the wider social, political, and economic forces contributing to the transformation of trans porn into a genre of mainstream straight porn. We discuss the economic organization of the trans porn industry and current industry trends, including geographical shifts in production and the rise of alternative production platforms. We address areas of future research and the need for more scholarship on the political economy of the trans porn industry, audiences and consumers, transmasculine representation in pornography, and research that focuses on trans porn production outside the United States.

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