Predictors of Medication Adherence in an Urban Latino Community with Healthcare Disparities

Ethnic disparities exist when comparing glycemic control: Latino patients have suboptimal glycemic control as compared to non-Latino whites. A key factor to achieving optimal diabetes management and control is medication adherence. We conducted a nested, cross-sectional retrospective study of data (n?=?61) collected from a larger parallel, randomized, longitudinal study conducted at an urban primary care practice examining a culturally tailored community-based peer counselor intervention. Baseline demographic and medication utilization covariates were evaluated for eligibility into the multivariate logistic regression to predict medication adherence. Significant correlates of medication adherence were physician or healthcare team support (OR 12.79, 95% CI 1.04, 157.21), and increasing numbers of medications taken (OR 1.24, 95% CI 1.04, 1.48). Receipt of government benefits was associated with medication non-adherence (OR 0.06, 95% CI 0.01, 0.51). Modifiable factors such as the number of medications and the patient-healthcare team relationship appear to play a role in medication adherence.     

Daily self-monitoring of body weight, step count, fruit/vegetable intake, and water consumption: a feasible and effective long-term weight loss maintenance approach

Maintenance of weight loss remains a challenge for most individuals. Thus, practical and effective weight-loss maintenance (WTLM) strategies are needed. A two-group 12-month WTLM intervention trial was conducted from June 2007 to February 2010 to determine the feasibility and effectiveness of a WTLM intervention for older adults using daily self-monitoring of body weight, step count, fruit/vegetable (F/V) intake, and water consumption. Forty weight-reduced individuals (mean weight lost=6.7±0.6 kg; body mass index [calculated as kg/m2] 29.2±1.1), age 63±1 years, who had previously participated in a 12-week randomized controlled weight-loss intervention trial, were instructed to record daily body weight, step count, and F/V intake (WEV [defined as weight, exercise, and F/V]). Experimental group (WEV+) participants were also instructed to consume 16 fl oz of water before each main meal (ie, three times daily), and to record daily water intake. Outcome measures included weight change, diet/physical activity behaviors, theoretical constructs related to health behaviors, and other clinical measures. Statistical analyses included growth curve analyses and repeated measures analysis of variance. Over 12 months, there was a linear decrease in weight (β=-0.32, P<0.001) and a quadratic trend (β=0.02, P<0.01) over time, but no group difference (β=-0.23, P=0.08). Analysis of the 365 days of self-reported body weight for each participant determined that weight loss was greater over the study period in the WEV+ group than in the WEV group, corresponding to weight changes of -0.67 kg and 1.00 kg, respectively, and an 87% greater weight loss (β=-0.01, P<0.01). Overall compliance to daily tracking was 76%±5%. Daily self-monitoring of weight, physical activity, and F/V consumption is a feasible and effective approach for maintaining weight loss for 12 months, and daily self-monitoring of increased water consumption may provide additional WTLM benefits.     

Oral Cancer in India: An Epidemiologic and Clinical Review

Oral cancer is one of the most fatal health problems faced by the mankind today. In India, because of cultural, ethnic, geographic factors and the popularity of addictive habits, the frequency of oral cancer is high. It ranks number one in terms of incidence among men and third among women. Several factors like tobacco and tobacco related products, alcohol, genetic predisposition and hormonal factors are suspected as possible causative factors. Hence the study was designed to determine the prevalence of Oral Cancer in patients who attended the outpatient department, at Bharati Vidyapeeth Deemed University Dental College Sangli India during a period of 24 months in 2009–2010. Further various modes of tobacco and alcohol consuming habit were assessed along with the site of occurrence of oral cancer. About 35,122 subjects belonging to a semi-urban district of Sangli in Western Maharashtra (India) were screened. Tobacco and alcohol consumption was the common habit among the study population. Out of these about 112 cases showed Oral Cancer. The prevalence of Oral Cancer was 1.12%. Statistical analysis was done using the SPSS software 11. The findings in the present study reveal a high prevalence of Oral Cancer and a rampant misuse of variety of addictive substances in the community. Close follow up and systematic evaluation is required in this population. Education about ill effects of tobacco and alcohol consumption is necessary at a broader scale. There is an urgent need for awareness programs involving the community health workers, dentists and allied medical professionals.     

First chemical feature-based pharmacophore modeling of potent retinoidal retinoic acid metabolism blocking agents (RAMBAs): identification of novel RAMBA scaffolds

The first three-dimensional (3D) pharmacophore model was developed for potent retinoidal retinoic acid metabolism blocking agents (RAMBAs) with IC(50) values ranging from 0.0009 to 5.84nM. The seven common chemical features in these RAMBAs as deduced by the Catalyst/HipHop program include five hydrophobic groups (hydrophobes), and two hydrogen bond acceptors. Using the pharmacophore model as a 3D search query against NCI and Maybridge conformational Catalyst formatted databases; we retrieved several compounds with different structures (scaffolds) as hits. Twenty-one retrieved hits were tested for RAMBA activity at 100nM concentration. The most potent of these compounds, NCI10308597 and HTS01914 showed inhibitory potencies less (54.7% and 53.2%, respectively, at 100nM) than those of our best previously reported RAMBAs VN/12-1 and VN/14-1 (90% and 86%, respectively, at 100nM). Docking studies using a CYP26A1 homology model revealed that our most potent RAMBAs showed similar binding to the one observed for a series of RAMBAs reported previously by others. Our data shows the potential of our pharmacophore model in identifying structurally diverse and potent RAMBAs. Further refinement of the model and searches of other robust databases is currently in progress with a view to identifying and optimizing new leads.     

Prevalence of coronary heart disease and risk factors in an urban Indian population: Jaipur Heart Watch-2

BACKGROUND: The prevalence of risk factors for coronary heart disease has been inadequately studied in India. A repeat cross-sectional survey was carried out to evaluate the changes in the major coronary risk factors in the urban population of Jaipur previously studied in the early 1990s. METHODS AND RESULTS: Randomly selected adults > or =20 years of age were studied using stratified sampling. The target study sample was 1800 with a population proportionate gender distribution (males 960, females 840). Coronary risk factors, anthropometric variables, blood pressure, ECG, fasting blood glucose and lipids were evaluated. A total of 1123 subjects (62.4%) (males 550, females 573) were examined. Fasting blood samples were available in 523 males and 559 females. Overall coronary heart diesase prevalence, diagnosed by history or ECG changes, was found in 34 males (6.18%) and 58 females (10.12%). Risk factor prevalence showed that smoking/tobacco use was present in 201 males (36.5%) and 67 females (11.7%). Physical inactivity, either work-related or leisure time, was seen in 157 males (28.5%) and 130 females (22.7%). Hypertension (> or =140 and/or 90 mmHg) was present in 200 males (36.4%) and 215 females (37.5%). Diabetes diagnosed by history or fasting glucose > or =126 mg/dl was found in 72 males (13.1%) and 65 females (11.3%). Obesity, body mass index > or =27 kg/m2 was present in 135 males (24.5%) and 173 females (30.2%), while truncal obesity (waist:hip >0.9 males, >0.8 females) was found in 316 males (57.4%) and 392 females (68.4%). The most common dyslipidemia in both males and females was low HDL-cholesterol (<40 mg/dl: males 54.9%, females 54.2%). High total cholesterol levels of > or =200 mg/dl (males 37.4%, females 4.1%), high LDL-cholesterol levels of > or =130 mg/dl (males 37.0%, females 45.8%) and high levels of triglycerides > or = 150 mg/dl (males 32.3%, females 28.6%) were also seen in a significant number. Hypertension, obesity, truncal obesity, diabetes and dyslipidemias increased significantly with age in both males and females (Mantel-Haenzel chi2 for trend, p<0.05). CONCLUSIONS: There is a high prevalence of standard coronary risk factors--smoking, physical inactivity, hypertension, hypercholesterolemia, diabetes and obesity--as well as factors peculiar to south Asians--truncal obesity, low HDL-cholesterol and high triglycerides--in this urban Indian population. As compared to a previous study in the early 1900s in a similar population, there is a significant increase in the number of people with obesity, diabetes and dyslipidemias.     

Rotary endodontics in primary teeth – A review

Endodontic treatment in primary teeth can be challenging and time consuming, especially during canal preparation, which is considered one of the most important steps in root canal therapy. The conventional instrumentation technique for primary teeth remains the “gold-standard” over hand instrumentation, which makes procedures much more time consuming and adversely affects both clinicians and patients. Recently nickel–titanium (Ni–Ti) rotary files have been developed for use in pediatric endodontics. Using rotary instruments for primary tooth pulpectomies is cost effective and results in fills that are consistently uniform and predictable. This article reviews the use of nickel–titanium rotary files as root canal instrumentation in primary teeth. The pulpectomy technique is described here according to different authors and the advantages and disadvantages of using rotary files are discussed.     

Effectiveness of plain radiography in diagnosing hollow viscus perforation: study of 1,723 patients of perforation peritonitis

Gastrointestinal perforations remain the most common cause of surgical pneumoperitoneum since time immemorial. The aim of this study was to find out the effectiveness of plain radiography in diagnosing hollow viscous perforation. A prospective analysis of a total of 1,723 patients of perforation peritonitis between January 2009 and June 2011, confirmed by exploratory laparotomy, was worked out in the study. All these patients had undergone either an upright chest or erect abdominal or both radiographs before undergoing operative procedure. Pneumoperitoneum was evaluated, and the findings were compared with that of exploratory laparotomy. Out of the 1,723 patients of documented perforation on intraoperative finding, 1,537 patients showed pneumoperitoneum on preoperative plain radiography. The overall positivity rate of plain radiography in detecting pneumoperitoneum was 89.20%. The positivity rate was highest for stomach and duodenal perforation (94.19%) and the least for appendicular perforation (7.69%) with highly significant difference (p value, <0.001). In developing world, where there is limited availability of resources and overburden of patients, imposing a limitation in adapting advanced radiological technique as a first line of investigation, plain radiography may be considered as a valuable screening tool in detecting pneumoperitoneum with high positivity rate.     

Why did I start dialysis? A qualitative study on views and expectations from an elderly cohort of patients with end-stage renal failure starting haemodialysis in the United Kingdom

Background  

It is now common for elderly patients with end-stage kidney disease to be offered treatment by dialysis. However, what these patients expect from dialysis is not known. Therefore, the purpose of this study was to elucidate the expectations of elderly patients starting dialysis and to investigate whether their views change after 6 months on this treatment.