Participatory Decision Making,Asthma Action Plans,and Use of Asthma Medication: A Population Survey

Use of controller asthma medication and possession of asthma action plans remains suboptimal. Our aim was to investigate the association of the propensity of physicians to involve patients in their care (participatory decision-making style) and their asthma management in a representative population sample of 3015 adults. Current doctor-diagnosed asthma was reported by 393 (13.0%). People who rated their doctors as more participatory were significantly more likely to report more regular use of controller medications and possession of a written asthma action plan, but not less asthma morbidity. Possession of a written action plan was associated with more participatory interactions (OR 2.3; 95% CI 1.1–4.7, for upper tertile scores compared to lowest tertile); more severe symptoms (OR 4.8; 95% CI 1.7–13.0), being female (OR 2.2; 95% CI 1.2–4.3), those with higher education, and residence outside the metropolitan area (OR 2.1; 95% CI 1.1–4.0). Increasing patient participation in their own care is associated with better asthma management, independent of asthma symptoms. Longitudinal studies are needed to examine if increasing participation in decisions can also improve asthma outcomes.     

Effects of Sauna Alone and Postexercise Sauna Baths on Blood Pressure and Hemodynamic Variables in Patients With Untreated Hypertension

J Clin Hypertens (Greenwich). 2012;00:00–00 ©2012 Wiley Periodicals, Inc. The effects of sauna alone vs exercise and sauna on ambulatory blood pressure monitoring and central hemodynamic variables were measured in 16 patients with untreated hypertension assigned to a control period, sauna, or exercise and sauna. Exercise and sauna had positive effects on 24‐hour systolic and mean blood pressure in patients with untreated hypertension. Exercise and sauna and sauna alone reduce total vascular resistance, with positive effects lasting up to 120 minutes after heat exposure.     

Dose-related safety and immunogenicity of a trivalent baculovirus-expressed influenza-virus hemagglutinin vaccine in elderly adults

BACKGROUND: Influenza-virus hemagglutinin (HA) protein expressed in insect cells by recombinant baculovirus is a candidate influenza vaccine. METHODS: In a randomized, double-blind trial conducted in 399 adults > or = 65 years of age, the efficacy of trivalent inactivated influenza vaccine (TIV) licensed for intramuscular injection was compared with that of trivalent baculovirus-expressed HA vaccine administered at doses of 15 microg, 45 microg, or 135 microg of each HA. RESULTS: Compared with TIV, baculovirus-expressed HA vaccine was safe and induced better serum antibody responses to the H3 component when administered at doses of 45 microg or 135 microg of each HA. CONCLUSIONS: Baculovirus-expressed HA is a safe and immunogenic influenza vaccine in elderly adults.     

Impact of coping and socioeconomic factors on quality of life in adults with asthma

OBJECTIVE: The socioeconomic variables of income, race and employment status have been shown to influence health-related quality of life (HRQL) scores in persons with asthma. However, little is known about the impact of other psychological factors or perceptions of economic hardship on HRQL in asthma, despite the known influence these have on general activity levels and emotional perceptions. The aim of the present study was to assess the relationships between psychological and socioeconomic factors and HRQL and on subsequent changes to HRQL over 12 months. METHODOLOGY: Consecutive adult patients with moderate or severe asthma attending outpatient clinics, emergency departments or who were inpatients at two teaching hospitals, completed surveys of clinical status, psychological and socioeconomic variables, and HRQL instruments (SF-36 and Modified Marks Asthma Quality of Life Questionnaire [MAQLQ-M]), at baseline and over 12-months follow-up. RESULTS: Of 343 eligible subjects, survey responses were received from 293 at baseline and 232 at 12-months. Mean age was 42 years (SD 18), 67% were female, 42% had moderate, and 58% severe current asthma clinical status according to the National Asthma Education and Prevention Program guidelines criteria. In random-effects multiple regression models, after adjusting for age, gender, education, income and hospital, significant independent variables associated with each of total MAQLQ-M, SF-36 Physical Component Summary (PCS) and SF-36 Mental Component Summary (MCS) scores were avoidance coping, perceived recent financial difficulties and clinical asthma status. Additional independent associations were, for total MAQLQ-M, patient concerns about costs delaying them from seeking care (overall model r(2) = 0.69); for PCS, active coping (r(2) = 0.69) and for MCS, positive evaluations/satisfaction with illness (r(2) = 0.54). CONCLUSION: Psychological factors, particularly coping styles, need to be taken into account when considering HRQL scores as outcome measures in asthma. Interventions to improve the coping capabilities of individuals with moderate-to-severe asthma may be potentially important areas for improvement of asthma-related HRQL.     

The Role of Academia in Community-Based Pharmaceutical Care

Developing models of pharmaceutical care (PC) for educating students and practitioners represents a fundamental role for schools of pharmacy. Virginia Commonwealth University has sought to facilitate the implementation of PC in the community by hiring faculty to practice in this setting. The mission of the faculty is to implement PC in a community pharmacy practice, to develop clerkship sites for Pharm.D. students, and to evaluate the impact of PC services in the community. Examples of an independent pharmacy model, a grocery chain model, and a retail chain model of care may serve a dual purpose for faculty members, that is, define responsibilities for the academic institution and for the community practice environment.     

Free moment contribution to quiet standing in able-bodied and scoliotic girls

Adolescent idiopathic scoliosis girls are known to display standing imbalance. In addition to a motor deficit problem, the axial torsion of the spine and trunk torsion could reflect an imbalance around the vertical axis. Unlike the excursion of the center of pressure (COP), the forces and moments were rarely addressed to characterize the quiet standing balance. Nonetheless, one dynamical parameter, called free moment (T _V), representing the vertical torque on the feet can reflect the oscillation around the vertical axis associated to the standing imbalance. The objectives of this study were to test if the free moment variability can be utilized to characterize standing balance in a group of able-bodied and non-treated scoliotic girls and to determine if it was associated with that of the COP among each group of subjects tested. Forty-six adolescent girls with half of them presenting an adolescent idiopathic scoliosis were tested during quiet standing balance. Standing balance was assessed with the subjects standing upright and bare feet on a force plate. RMS and range of COP excursions and free moment were calculated.The scoliotic group displayed higher variability in COP excursion by about 24% than the able-bodied girls. Similarly, the T _V RMS (P = 0.00136) and range (P = 0.00197) were statistically higher by about 42% in the scoliotic group. The variability of T _V was associated with that of the COP in both groups. In the medio-lateral direction, the significant correlations between the RMS and range of the free moment and those of the COP were about 0.7 for the able-bodied group and 0.5 for the medio-lateral COP range for the scoliotic group girls. Along the antero-posterior axis, the only statistically significant correlations were observed for the scoliotic group. The free moment variability about the COP measured during quiet standing can be suggestive of an asymmetry control of the trunk around the vertical axis during standing balance. Its variability was more pronounced in scoliotic girls and was associated with the antero-posterior COP variability reflecting both biomechanical and motor control deficits. Free moment calculation could be a supplement insight into the standing balance of scoliotic subjects.