scholarly journals Patient-Reported Reasons for Not Using Primary Prevention Statin Therapy

2020 ◽  
Vol 9 (10) ◽  
pp. 3337
Author(s):  
Cassandra M. DeWitt ◽  
Robert B. Ponce ◽  
Hayley Bry ◽  
Soma Wali ◽  
Erica Sedlander ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Cardiovascular Health ◽  
Heart Association ◽  
Public Healthcare ◽  
Systematic Testing ◽  
Physician Trust ◽  
Patient Reported ◽  
Barriers To Use ◽  
High Level ◽  
Almost All

Almost half of patients who meet American College of Cardiology/American Heart Association (ACC/AHA) criteria for statin therapy are untreated. We aimed to evaluate patient-reported reasons for not using guideline-recommended statin therapy in a public healthcare system. Achieving this goal is key to addressing gaps in care and reducing preventable cardiovascular morbidity. We surveyed patients who met 2013 ACC/AHA guidelines for statin therapy but were not using statins. The survey probed domains of patient knowledge regarding cardiovascular health and benefits of statins, barriers to use, physician trust, and interest in cardiovascular care. Among 71 patients eligible for guideline-recommended statin therapy but not currently taking statins, 49 (69%) had a high school education or lower, 41 (58%) reported that they were unaware they should be prescribed a statin and 49 (69%) were unaware of the benefits of statins. Almost all patients, 70 (99%), reported caring about their cardiovascular health, 61 (86%) reported that they had a high level of trust in their physician, and 51 (72%) reported a willingness to follow their physician’s advice. Despite interest in cardiovascular health, awareness of benefits of statin therapy was low and knowledge of recommended statin therapy was low. Increasing patients’ awareness of their eligibility through systematic testing and linkage to statin therapy, along with education, may increase statin use among patients recommended for therapy.

DFT Benchmark Study of the O--O Bond Dissociation Energy in Peroxides Validated with High-Level Ab-Initio Calculations

2019 ◽  
Author(s):  
Danilo Carmona ◽  
Pablo Jaque ◽  
Esteban Vöhringer-Martinez
Keyword(s):  
Reference Value ◽  
Basis Set ◽  
Basis Sets ◽  
Mean Deviation ◽  
Bond Dissociation ◽  
Dissociation Energies ◽  
The Mean ◽  
Experimental Values ◽  
High Level ◽  
Almost All

<div><div><div><p>Peroxides play a central role in many chemical and biological pro- cesses such as the Fenton reaction. The relevance of these compounds lies in the low stability of the O–O bond which upon dissociation results in radical species able to initiate various chemical or biological processes. In this work, a set of 64 DFT functional-basis set combinations has been validated in terms of their capability to describe bond dissociation energies (BDE) for the O–O bond in a database of 14 ROOH peroxides for which experimental values ofBDE are available. Moreover, the electronic contributions to the BDE were obtained for four of the peroxides and the anion H2O2− at the CBS limit at CCSD(T) level with Dunning’s basis sets up to triple–ζ quality provid- ing a reference value for the hydrogen peroxide anion as a model. Almost all the functionals considered here yielded mean absolute deviations around 5.0 kcal mol−1. The smallest values were observed for the ωB97 family and the Minnesota M11 functional with a marked basis set dependence. Despite the mean deviation, order relations among BDE experimental values of peroxides were also considered. The ωB97 family was able to reproduce the relations correctly whereas other functionals presented a marked dependence on the chemical nature of the R group. Interestingly, M11 functional did not show a very good agreement with the established order despite its good performance in the mean error. The obtained results support the use of similar validation strategies for proper prediction of BDE or other molecular properties by DF Tmethods in subsequent related studies.</p></div></div></div>

Methyl mercury in the dutch rhine delta

1994 ◽  
Vol 30 (10) ◽  
pp. 213-219 ◽  
Author(s):  
Hendrik Pieters ◽  
Victor Geuke
Keyword(s):  
Suspended Matter ◽  
Methyl Mercury ◽  
Mercury Contamination ◽  
Benthic Organisms ◽  
Considerable Decrease ◽  
Continuous Sedimentation ◽  
Highly Correlated ◽  
High Level ◽  
Almost All

Samples of yellow eel from various locations in the Dutch Rhine area have been analyzed for trend monitoring of mercury since 1977. In the western Rhine delta mercury levels in eels have hardly changed since the seventies, whereas in the eastern part of the Dutch Rhine area a considerable decrease of mercury concentrations in eel has occurred. Because of continuous sedimentation of contaminated suspended matter transported from upstream regions, accumulation rates and concentrations of mercury in eel in the western Rhine delta remained at a relatively high level. Analyses of methyl mercury in biota have been performed to elucidate the role of methyl mercury in the mercury contamination of the Dutch Rhine ecosystem. Low percentages of methyl mercury were observed in zooplankton (3 to 35%). In benthic organisms (mussels) percentages of methyl mercury ranged from 30 to 57%, while in fish species and liver of aquatic top predator birds almost all the mercury was present in the form of methyl mercury (&gt; 80%). During the period 1970-1990 mercury concentrations of suspended matter in the eastern Rhine delta have drastically decreased. These concentrations seemed to be highly correlated with mercury concentrations of eel (R = 0.84). The consequences of this relation are discussed.

Lower perception of pharmacological treatment increases risk of non-adherence to medication

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
CB Graversen ◽  
JB Valentin ◽  
ML Larsen ◽  
S Riahi ◽  
T Holmberg ◽  
...  
Keyword(s):  
Pharmacological Treatment ◽  
Poisson Regression ◽  
Drug Class ◽  
Angiotensin Receptor Blockers ◽  
Adverse Outcomes ◽  
Adherence To Medication ◽  
Increased Risk ◽  
Patient Reported ◽  
High Level

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation Background A large proportion of patients fail to reach optimal adherence to medication following incident ischemic heart disease (IHD) despite amble evidence of the beneficial effect of medication. Non-adherence to medication increases risk of disease-related adverse outcomes but none has explored how perception about pharmacological treatment detail on non-adherence using register-based follow-up data. Purpose To investigate the association between patients’ perception of pharmacological treatment and risk of non-initiation and non-adherence to medication in a population with incident IHD. Methods This cohort study followed 871 patients until 365 days after incident IHD. The study combined patient-reported survey data on perception about pharmacological treatment (categorised by ‘To a high level’, ‘To some level’, and ‘To a lesser level’) with register-based data on reimbursed prescription of cardiovascular medication (antithrombotics, statins, ACE-inhibitors/angiotensin receptor blockers, and β-blockers). Non-initiation was defined as no pick-up of medication in the first 180 days following incident IHD and analysed by Poisson regression. Two different measures evaluated non-adherence in patients initiating treatment: 1) proportion of days covered (PDC) analysed by Poisson regression, and 2) risk of discontinuation analysed by Cox proportional hazard regression. All analyses were adjusted for confounding variables (age, sex, ethnicity, income, educational level, civil status, occupation, charlson comorbidity index, supportive relatives, and individual consultation in medication) identified by directed acyclic graph and obtained from national registers and the survey. Item non-response was handled by multiple imputation and item consistency was evaluated by McDonalds omega. Results Lower perceptions about pharmacological treatment was associated with increased risk of non-initiation and non-adherence to medication irrespectively of drug class and adherence measure in the multiple adjusted analyses (please see figure illustrating results on antithrombotics). A dose-response relationship was observed both at 180- and 365-days of follow-up, but the steepest decline in adherence differed when comparing the two adherence measures (results not shown). Moderate internal consistency was found for the summed measure of perception (McDonalds omega = 0.67). Conclusion Lower perception of pharmacological treatment was associated with subsequent non-initiation and non-adherence to medication, irrespectively of measurement method and drug class. Abstract Figure. Figre: Multiple adjusted analyses

scholarly journals Association of cardiovascular health and epigenetic age acceleration

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Tess D. Pottinger ◽  
Sadiya S. Khan ◽  
Yinan Zheng ◽  
Wei Zhang ◽  
Hilary A. Tindle ◽  
...  
Keyword(s):  
Dna Methylation ◽  
Cardiovascular Health ◽  
Heart Association ◽  
The United States ◽  
Cross Sectional ◽  
Epigenetic Age ◽  
Younger Age ◽  
Cardiovascular Morbidity And Mortality ◽  
Epigenetic Age Acceleration ◽  
Linear Regression Modeling

Abstract Background Cardiovascular health (CVH) has been defined by the American Heart Association (AHA) as the presence of the “Life’s Simple 7” ideal lifestyle and clinical factors. CVH is known to predict longevity and freedom from cardiovascular disease, the leading cause of death for women in the United States. DNA methylation markers of aging have been aggregated into a composite epigenetic age score, which is associated with cardiovascular morbidity and mortality. However, it is unknown whether poor CVH is associated with acceleration of aging as measured by DNA methylation markers in epigenetic age. Methods and results We performed a cross-sectional analysis of racially/ethnically diverse post-menopausal women enrolled in the Women’s Health Initiative cohort recruited between 1993 and 1998. Epigenetic age acceleration (EAA) was calculated using DNA methylation data on a subset of participants and the published Horvath and Hannum methods for intrinsic and extrinsic EAA. CVH was calculated using the AHA measures of CVH contributing to a 7-point score. We examined the association between CVH score and EAA using linear regression modeling adjusting for self-reported race/ethnicity and education. Among the 2,170 participants analyzed, 50% were white and mean age was 64 (7 SD) years. Higher or more favorable CVH scores were associated with lower extrinsic EAA (~ 6 months younger age per 1 point higher CVH score, p < 0.0001), and lower intrinsic EAA (3 months younger age per 1 point higher CVH score, p < 0.028). Conclusions These cross-sectional observations suggest a possible mechanism by which ideal CVH is associated with greater longevity.

scholarly journals 77 Routine outpatients visits during SARS-CoV2 global pandemic

2020 ◽  
Vol 22 (Supplement_N) ◽  
pp. N135-N137
Author(s):  
Teresa Fedele ◽  
Silvia Orefice ◽  
Ludovica Fiorillo ◽  
Vittoria Cuomo ◽  
Valentina Capone ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Lifestyle Changes ◽  
Panic Attacks ◽  
Office Visits ◽  
Current Crisis ◽  
Outpatient Visits ◽  
Global Pandemic ◽  
Patient Reported ◽  
Almost All ◽  
New Onset

Abstract Aims The inability to carry office visits was collateral damage caused by the Coronavirus (COVID-19) pandemic. Tele-health is a relatively new, and yet fundamental amid the current crisis, resource to bridge the gap between phisicians and patients. Methods and results We report our experience with telemedicine and describe the major events occured in our patients. 121 consecutive adult patients with arterial hypertension (F/M: 56/65; mean age: 66.8 years) were enrolled. 33 patients (27%) had also diabetes, 94 (78%) were also affected from dyslipidemia and 11 (9%) had CAD. They all referred to our ambulatory of hypertension, in most of case for several years. Given the impossibility to continue routine outpatient visits during lockdown, they were all phone called by three residents in order to detect their state of health or any events they could have experienced over this period. They were all asked about their own blood pressure values, the occurrence of new symptoms and of new-onset both cardiovascular and non cardiovascular events. We also followed a self-made preset form. 31 of them (26%) experienced cardiovascular symptoms/events during this period: 11 had hypertensive peaks, in one case associated with nausea and vomiting while 2 of them had hypotensive episodes; 10 had typical angina and/or dyspnoea while 4 had atypical angina; 6 had palpitations; 1 of them developed new onset atrial fibrillation resolved with pharmacologic cardioversion during hospitalization; 1 had syncope; 1 patient reported new onset peripheral oedema; 2 patients died during lockdown for non cardiovascular causes. 17 of them also developed non cardiovascular symptoms, 7 of whom were severe anxiety and/or panic attacks. Almost all patients had important lifestyle changes, in 15 cases (12.3%) associated with weight increase. Conclusion The impossibility to access to routine outpatient visits during lockdown due to global pandemic of SARS-CoV2, has brought out the risk of underestimating consequences of chronic disease, in absence of appropriate Follow-up. Nevertheless, the two deaths we report were not related to cardiovascular disease. The risk is that both the missing of cardiovascular control visit and the extension of the waiting list, could provoke serious complications in patients suffering from chronic cardiovascular disease.

Development and Evaluation of a Prediabetes Decision Aid in Primary Care: Examining Patient-Reported Outcomes by Language Preference and Educational Attainment

2021 ◽  
Vol 47 (3) ◽  
pp. 216-227
Author(s):  
Keerthi Bandi ◽  
Maria C. Vargas ◽  
Azucena Lopez ◽  
Kenzie A. Cameron ◽  
Ronald T. Ackermann ◽  
...  
Keyword(s):  
Educational Attainment ◽  
Decision Aid ◽  
Patient Reported Outcomes ◽  
Office Visit ◽  
Decisional Conflict ◽  
Language Preference ◽  
Intention To Adopt ◽  
Patient Reported ◽  
Evidence Based Treatments ◽  
Almost All

Purpose The purpose of this study was to examine the development and preliminary effectiveness of a novel Prediabetes Decision Aid on adoption of intensive lifestyle interventions (ILIs) and metformin. Little research has focused on increasing uptake of these evidence-based treatments, especially among non-English speakers and those with low educational attainment. Methods Investigators developed an English and Spanish decision aid displaying information about type 2 diabetes (T2DM) risk and treatments to prevent T2DM and prompting patients to identify next steps for management. This pilot study was a single-arm, pretest-posttest trial of 40 adult patients with prediabetes, obesity, and ≥1 office visit within the prior 12 months. Participants reviewed this tool briefly with a study team member, and data were collected on 3 coprimary outcomes: knowledge about T2DM risk, decisional conflict, and intention to adopt treatment. Exploratory outcomes included subsequent documentation of prediabetes in chart notes and adoption of ILIs or metformin. Results Almost all participants were women, with nearly half expressing Spanish language preference and low educational attainment. A nonsignificant increase in knowledge was observed across all subgroups. Decisional conflict was significantly reduced from pretest to posttest and was similar between subgroups defined by language preference and educational attainment. While intention to adopt ILIs increased across all subgroups, this change was only significant among Spanish speakers and participants with low educational attainment. At 6 months, 17 participants had subsequent provider documentation of prediabetes, and 12 adopted ILIs or metformin. Conclusions The decision aid improved patient-reported outcomes and promoted treatment adoption in a diverse patient sample.

scholarly journals The Problems and Needs of Patients Diagnosed with Cancer and Their Caregivers

2020 ◽  
Vol 18 (1) ◽  
pp. 87
Author(s):  
Anna Lewandowska ◽  
Grzegorz Rudzki ◽  
Tomasz Lewandowski ◽  
Sławomir Rudzki
Keyword(s):  
Cancer Patients ◽  
Medical Information ◽  
Unmet Needs ◽  
Public Healthcare ◽  
Literature Analysis ◽  
The Public ◽  
The Mean ◽  
High Level ◽  
Patients Experience

(1) Background: As the literature analysis shows, cancer patients experience a variety of different needs. Each patient reacts differently to the hardships of the illness. Assessment of needs allows providing more effective support, relevant to every person’s individual experience, and is necessary for setting priorities for resource allocation, for planning and conducting holistic care, i.e., care designed to improve a patient’s quality of life in a significant way. (2) Patients and Methods: A population survey was conducted between 2018 and 2020. Cancer patients, as well as their caregivers, received an invitation to take part in the research, so their problems and needs could be assessed. (3) Results: The study involved 800 patients, 78% women and 22% men. 66% of the subjects were village residents, while 34%—city residents. The mean age of patients was 62 years, SD = 11.8. The patients received proper treatment within the public healthcare. The surveyed group of caregivers was 88% women and 12% men, 36% village residents and 64% city residents. Subjects were averagely 57 years old, SD 7.8. At the time of diagnosis, the subjects most often felt anxiety, despair, depression, feelings of helplessness (46%, 95% CI: 40–48). During illness and treatment, the subjects most often felt fatigued (79%, 95% CI: 70–80). Analysis of needs showed that 93% (95% CI: 89–97) of patients experienced a certain level of need for help in one or more aspects. (4) Conclusions: Patients diagnosed with cancer have a high level of unmet needs, especially in terms of psychological support and medical information. Their caregivers also experience needs and concerns regarding the disease. Caregivers should be made aware of the health consequences of cancer and consider appropriate supportive care for their loved ones.

scholarly journals When a Ciliate Meets a Flagellate: A Rare Case of Colpoda spp. and Colpodella spp. Isolated from the Urine of a Human Patient. Case Report and Brief Review of Literature

Biology ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 476
Author(s):  
Vlad S. Neculicioiu ◽  
Ioana A. Colosi ◽  
Dan A. Toc ◽  
Andrei Lesan ◽  
Carmen Costache
Keyword(s):  
Respiratory Insufficiency ◽  
Combined Treatment ◽  
Primary Care Clinic ◽  
Clinical Signs ◽  
Heart Association ◽  
Chronic Obstructive ◽  
Human Patient ◽  
Care Clinic ◽  
Morphological Criteria ◽  
Patient Reported

An often-overlooked side of the population aging process and the steady rise of non-communicable diseases reflects the emergence of novel infectious pathogens on the background of an altered host immune response. The aim of this article was to present the first record of a ciliate and flagellate protozoa recovered from the urine of an elderly patient and to review the existing medical literature involving these parasites. A 70-year-old female patient was admitted for breathing difficulties on the basis of an acute exacerbation of COPD (Chronic obstructive pulmonary disease) with respiratory insufficiency. The patient reported a long history of multiple comorbidities including COPD Gold II, chronic respiratory insufficiency, chronic heart failure NYHA III (New York Heart Association Functional Classification), type 2 diabetes and morbid obesity. During routine examinations, we ascertained the presence of two unusual protozoa, a ciliate and a flagellate, in the patient’s urine samples, identified on morphological criteria to be most likely Colpoda spp. and Colpodella spp., with similarities to C. steinii and C. gonderi. The presence of these parasites was not associated with any clinical signs of urinary disease. Following a combined treatment with ceftriaxone and metronidazole, we observed the disappearance of these pathogens upon discharge from the primary care clinic. This study highlights the importance of including unusual pathogens in the differential diagnosis of cases which involve immunosuppression.

scholarly journals Liquid Biopsy and Other Non-Invasive Diagnostic Measures in PCNSL

Cancers ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 2665
Author(s):  
Alexander Baraniskin ◽  
Roland Schroers
Keyword(s):  
Central Nervous System Lymphoma ◽  
Circulating Tumor Dna ◽  
Mri Findings ◽  
Diagnostic Measures ◽  
Non Hodgkin Lymphoma ◽  
Specificity And Sensitivity ◽  
Demyelinating Lesions ◽  
Granulomatous Diseases ◽  
High Level ◽  
Almost All

Primary central nervous system lymphoma is a rare but highly aggressive form of non-Hodgkin lymphoma that remains confined to the CNS neuroaxis. The diagnosis of PCNSL requires a high level of suspicion as clinical presentation varies depending on the involved CNS areas. Neurological symptoms and MRI findings may mimic gliomas, demyelinating lesions, or infectious and granulomatous diseases. Almost all PCNSL patients undergo invasive surgical procedures for definite diagnosis. Stereotactic biopsy is still the gold standard in achieving a diagnostic accuracy of 73–97%. Both the potential procedural morbidity and mortality, as well as the time to definite histopathologic diagnosis resulting in delays of treatment initiation, have to be considered. On the contrary, minimally invasive procedures, such as MRI, CSF cytology, and flow cytometry, still have limited value due to inferior specificity and sensitivity. Hence, novel diagnostic approaches, including mutation analyses (MYD88) in circulating tumor DNA (ctDNA) and the determination of microRNAs (miR-21, miR-19b, and miR-92) as well as cytokine levels (IL10 and IL6) in blood, cerebrospinal fluid (CSF), and vitreous fluid (VRF), move into the focus of investigation to facilitate the diagnosis of PCNSL. In this review, we outline the most promising approaches that are currently under clinical consideration.

scholarly journals Multiple-Locus Sequence Typing Analysis of Bacillus cereus and Bacillus thuringiensis Reveals Separate Clustering and a Distinct Population Structure of Psychrotrophic Strains

2006 ◽  
Vol 72 (2) ◽  
pp. 1569-1578 ◽  
Author(s):  
Alexei Sorokin ◽  
Benjamin Candelon ◽  
Kévin Guilloux ◽  
Nathalie Galleron ◽  
Natalia Wackerow-Kouzova ◽  
...  
Keyword(s):  
Bacillus Thuringiensis ◽  
Bacillus Cereus ◽  
Individual Gene ◽  
Mild Winter ◽  
Systematic Testing ◽  
Bacillus Weihenstephanensis ◽  
Paris Area ◽  
Population Structures ◽  
Multiple Strains ◽  
Almost All

ABSTRACT We used multilocus sequence typing (MLST) to characterize phylogenetic relationships for a collection of Bacillus cereus group strains isolated from forest soil in the Paris area during a mild winter. This collection contains multiple strains isolated from the same soil sample and strains isolated from samples from different sites. We characterized 115 strains of this collection and 19 other strains based on the sequences of the clpC, dinB, gdpD, panC, purF, and yhfL loci. The number of alleles ranged from 36 to 53, and a total of 93 allelic profiles or sequence types were distinguished. We identified three major strain clusters—C, T, and W—based on the comparison of individual gene sequences or concatenated sequences. Some less representative clusters and subclusters were also distinguished. Analysis of the MLST data using the concept of clonal complexes led to the identification of two, five, and three such groups in clusters C, T, and W, respectively. Some of the forest isolates were closely related to independently isolated psychrotrophic strains. Systematic testing of the strains of this collection showed that almost all the strains that were able to grow at a low temperature (6°C) belonged to cluster W. Most of these strains, including three independently isolated strains, belong to two clonal complexes and are therefore very closely related genetically. These clonal complexes represent strains corresponding to the previously identified species Bacillus weihenstephanensis. Most of the other strains of our collection, including some from the W cluster, are not psychrotrophic. B. weihenstephanensis (cluster W) strains appear to comprise an effectively sexual population, whereas Bacillus thuringiensis (cluster T) and B. cereus (cluster C) have clonal population structures.

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