The impact of racial and ethnic disparities in inhaled corticosteroid adherence on healthcare expenditures in adults with asthma

Purpose: The purpose of this study is to determine racial and ethnic disparities with the adherence to inhaled corticosteroids (ICSs) in adults with persistent asthma, and their association with healthcare expenditures.

Methods: A retrospective, cross-sectional study using the Medical Expenditure Panel Survey (MEPS) 2013–2014 data included patients ≥18 years with persistent asthma. Median medication possession ratio (MPR) was used to dichotomize adherence levels. Multivariate regression analysis was conducted to ascertain the association between adherence and race/ethnicity. Total expenditures and association with adherence were analyzed using a generalized linear model with a log link function and gamma distribution. Unadjusted expenditures were compared after bootstrapping.

Results: The average MPR of ICSs for the sample of 277 patients was 0.34. The average MPR level was 0.33 among whites, 0.37 among African-Americans and 0.35 among other minorities. The average MPR was 0.30 among Hispanics, and 0.35 among non-Hispanics. African-Americans were less likely to be adherent than whites (OR 0.95). Hispanics were less likely to be adherent (OR 0.4; CI 0.206–0.777). Higher adherence was associated with significantly higher total health expenditure than lower adherence ($19,223 vs. $12,840 respectively, p?<?.0001). African-Americans had slightly higher total expenditure compared to whites; however, other minorities had significantly lower health expenditures compared to whites (p?=?.01). Non-Hispanics spent significantly less on healthcare compared to Hispanics (p?=?.04).

Conclusions: Valuable insight into the economic cost of the disparities as they relate to persistent asthma provides further evidence of possible ethnic inequities that warrant addressing.     

Synthesis and Antitubercular Activity of 2‐(substituted phenyl/benzyl‐amino)‐6‐(4‐chlorophenyl)‐5‐(methoxycarbonyl)‐4‐methyl‐3,6‐dihydropyrimidin‐1‐ium Chlorides

A series of 2‐(substituted phenyl/benzyl‐amino)‐6‐(4‐chlorophenyl)‐5‐(methoxycarbonyl)‐4‐methyl‐3,6‐dihydropyrimidin‐1‐ium chlorides 7–13 and 15 was synthesized in their hydrochloride salt form. The title compounds were characterized by FT‐IR, NMR (¹H and ¹³C) and elemental analysis. They were evaluated for their in vitro antitubercular activity against Mycobacterium tuberculosis H37Rv, multidrug resistance tuberculosis and extensively drug resistance tuberculosis by agar diffusion method and tested for the cytotoxic action on peripheral blood mononuclear cells by MTT assay. Among all the tested compounds in the series, compounds 7 and 11 emerged as promising antitubercular agents at 16 μg/mL against multidrug resistance tuberculosis and over 64 μg/mL against extensively drug resistance tuberculosis. The conformational features and supramolecular assembly of the promising compounds 7 and 11 were determined by single crystal X‐ray study.     

The immunology of traumatic brain injury: a prime target for Alzheimer¿s disease prevention

ABSTRACT: A global health problem, traumatic brain injury (TBI) is especially prevalent in young adults members of the military and those involved in full-contact sports. Its pathological hallmark is one or more primary injury foci, followed by a spread to initially normal brain areas via cascades of inflammatory cytokines and chemokines resulting in an amplification of the original tissue injury by microglia, which in many cases can pre-dispose the development of Alzheimer's Disease (AD). The inflammatory based progression of brain injury has been shown to be active in humans for up to 17 years post TBI. Unfortunately, all neuroprotective drug trials have failed, and specific treatments remain less than efficacious. These poor results might be explained by too much of a scientific focus on neurons, without addressing the functions of microglia in the brain; both of which are centers of pro-inflammatory cytokine generation. In order to address this issue, we provide a survey of the TBI-related brain immunological mechanisms which may promote progression to AD. We discuss these microglia-based inflammatory mechanisms involved in the progression of post-trauma brain damage to AD. Flavonoid based strategies to oppose the antigen presenting cell (APC)-like inflammatory phenotype of microglia will also be reviewed. The goal is to provide a rationale for investigations of inflammatory response following TBI which may pose as a pathological link to AD. In the end, a better understanding of neuroinflammation could open therapeutic avenues for abrogation of secondary cell death and behavioral symptoms that may mediate the progression of TBI and AD.     

Arbuscular Mycorrhizal Dependency of Acacia melanoxylon R.Br.

Arbuscular mycorrhizal dependency of Acacia melanoxylon R.Br. was determined under three experimental set up conditions viz, natural soils, coal mine disturbed soils and artificially inoculated conditions. Mycorrhizal dependency of the plant varied significantly with the type of soil and varied between 30 and 62?%. The mycorrhizal dependency of A. melanoxylon in coal mine disturbed soils could be correlated with the degree of disturbance of the soil. The maximum dependency (61?%) was recorded in 7 incline soil. Mycorrhizal dependency indirectly reveals the biomass response varied according to the type of inoculations. Glomus fasciculatum (Gerdemann and Trappe) inoculated seedlings have shown highest dependency followed by Acaulospora foveata (Trappe and Janos) inoculated seedlings. The extent of mycorrhizal dependency has shown a direct correlation with mycorrhizal colonization.     

Study of prevalence of epilepsy in children with type 1 diabetes mellitus

PurposeTo evaluate the prevalence of epilepsy in children (<16 yrs) with type 1 diabetes.MethodsA review of clinical notes and investigations was carried out on all the children with type 1 diabetes who were under follow-up in the Paediatric Diabetes clinic at Alder Hey Children's Hospital in the year 2010.ResultsOf 285 children aged <16 years with type 1 diabetes, six also had epilepsy giving a prevalence of 21/1000. This is approximately six times greater than the prevalence of epilepsy in the general population of children in UK.ConclusionEpilepsy appears to occur more frequently in children with type 1 diabetes than in the general paediatric population.     

Assessing high‐intensity focused ultrasound treatment of prostate cancer with hyperpolarized 13C dual‐agent imaging of metabolism and perfusion

The goal of the study was to establish early hyperpolarized (HP) ¹³C MRI metabolic and perfusion changes that predict effective high‐intensity focused ultrasound (HIFU) ablation and lead to improved adjuvant treatment of partially treated regions. To accomplish this a combined HP dual‐agent (¹³C pyruvate and ¹³C urea) ¹³C MRI/multiparametric ¹H MRI approach was used to measure prostate cancer metabolism and perfusion 3–4 h, 1 d, and 5 d after exposure to ablative and sub‐lethal doses of HIFU within adenocarcinoma of mouse prostate tumors using a focused ultrasound applicator designed for murine studies. Pathologic and immunohistochemical analysis of the ablated tumor demonstrated fragmented, non‐viable cells and vasculature consistent with coagulative necrosis, and a mixture of destroyed tissue and highly proliferative, poorly differentiated tumor cells in tumor tissues exposed to sub‐lethal heat doses in the ablative margin. In ablated regions, the intensity of HP ¹³C lactate or HP ¹³C urea and dynamic contrast‐enhanced (DCE) MRI area under the curve images were reduced to the level of background noise by 3–4 h after treatment with no recovery by the 5 d time point in either case. In the tissues that received sub‐lethal heat dose, there was a significant 60% ± 12.4% drop in HP ¹³C lactate production and a significant 30 ± 13.7% drop in urea perfusion 3–4 h after treatment, followed by recovery to baseline by 5 d after treatment. DCE MRI K^trans showed a similar trend to HP ¹³C urea, demonstrating a complete loss of perfusion with no recovery in the ablated region, while having a 40%–50% decrease 3–4 h after treatment followed by recovery to baseline values by 5 d in the margin region. The utility of the HP ¹³C MR measures of perfusion and metabolism in optimizing focal HIFU, either alone or in combination with adjuvant therapy, deserves further testing in future studies.     

Consumer credit as a novel marker for economic burden and health after cancer in a diverse population of breast cancer survivors in the USA

Background

Consumer credit may reflect financial hardship that patients face due to cancer treatment, which in turn may impact ability to manage health after cancer; however, credit’s relationship to economic burden and health after cancer has not been evaluated.

Methods

From May to September 2015, 123 women with a history of breast cancer residing in Pennsylvania or New Jersey completed a cross-sectional survey of demographics, socioeconomic position, comorbidities, SF-12 self-rated health, economic burden since cancer diagnosis, psychosocial stress, and self-reported (poor to excellent) credit quality. Ordinal logistic regression evaluated credit’s contribution to economic burden and self-rated health.

Results

Mean respondent age was 64 years. Mean year from diagnosis was 11.5. Forty percent of respondents were Black or Other and 60% were White. Twenty-four percent self-reported poor credit, and 76% reported good to excellent credit quality. In adjusted models, changing income, using savings, borrowing money, and being unable to purchase a health need since cancer were associated with poorer credit. Better credit was associated with 7.72 ([1.22, 14.20], p =?0.02) higher physical health t-score, and a ??2.00 ([??3.92, ??0.09], p =?0.04) point change in psychosocial stress.

Conclusions

This exploratory analysis establishes the premise for consumer credit as a marker of economic burden and health for breast cancer survivors. Future work should validate these findings in larger samples and for other health conditions.

Implications for Cancer Survivors

Stabilizing and monitoring consumer credit may be a potential intervention point for mitigating economic burden after breast cancer.

     

Epidemiology and postoperative outcomes of atypical femoral fractures in older adults: A systematic review

Objective

To review the literature on epidemiology and postoperative outcomes particularly surgical, functional and quality of life of atypical femoral fractures (AFFs) in the older population (aged ≥65 years) using the first and second American Society of Bone Mineral Research (ASBMR) Task Force consensus definition.

Methods

Electronic search for articles on AFFs and bisphosphonates published in English was performed. Eligible studies were reviewed systematically in relation to (a) the epidemiology of AFFs in older people and (b) postoperative outcomes of AFFs.

Results

Twenty-three studies on AFFs were included: 14 on epidemiology and 11 on treatment outcomes (two articles reported on both aspects). The epidemiological studies showed that the incidence of AFFs is low (3.0-9.8 per 100,000 person-years) but relative risk increased with longer duration of bisphosphonates use, especially after more than three years. Most cases of AFFs occurred in older people aged 65 years and above. However, in six studies, the mean age of patients with bisphosphonate-related AFFs is younger than those with typical proximal femoral fractures (mean age range of 66–75 years versus 75-89 years respectively). Varying postoperative and functional outcomes have been reported but differences in study population, management approaches and endpoints may account for these variations. For incomplete AFFs, prophylactic surgical intervention is potentially beneficial.

Conclusion

The benefits of bisphosphonates in reducing osteoporotic fractures still outweigh the risk of AFFs in view of its low absolute risk, when the ASBMR Task Force criteria for this type of fracture were applied. The risk of AFFs in different age groups is not well defined but tends to affect the younger patients more (aged <65 years) as compared to the older population (aged ≥65 years). Evidence supporting different types of treatment in AFFs such as intramedullary or extramedullary surgical devices and the use of teriparatide, a parathyroid hormone analogue, is not yet well established.