The Association between Trust in Health Care Providers and Medication Adherence among Black Women with Hypertension

Background: Black women have the highest prevalence of hypertension in the world. Reasons for this disparity are poorly understood. The historical legacy of medical maltreatment of Blacks in the U.S. provides some insight into distrust in the medical profession, refusal of treatment, and poor adherence to treatment regimens. Methods: Black women (N = 80) who were prescribed antihypertensive medications were recruited from urban communities in North Carolina. Study participants completed the Trust in Physician and Hill-Bone Compliance to High Blood Pressure Therapy questionnaires. An exact discrete-event model was used to examine the relationship between trust and medication adherence. Results: Mean age of study participants was 48 ± 9.2 years. The majority of participants (67%) were actively employed and 30% had incomes at or below the federal poverty level. Increasing levels of trust in the health care provider was independently associated with greater medication adherence (PTrend = 0.015). Conclusion: Black women with hypertension who trusted their health care providers were more likely to be adherent with their prescribed antihypertensive medications than those who did not trust their health care providers. Findings suggest that trusting relationships between Black women and health care providers are important to decreasing disparate rates of hypertension

Religious/Spiritual Coping in Older African American Women

The purpose of this study was to identify religious/spiritual coping behaviors of African American women with hypertension (HTN) and explore how religious/spiritual coping influences adherence to high blood pressure (HBP) therapy in older African American women. A mixed-method research design guided this study. Twenty African American women with primary HTN were enrolled in this study using a mixed methods concurrent triangulation design. Data collection included physiologic, descriptive, and sociodemographic data. Adherence was measured using the Hill-Bone Compliance to High Blood Pressure Therapy scale (Kim, Hill, Bone, & Levine, 2000), and religious/spiritual coping was evaluated with the Brief Religious/Spiritual Coping scale. Qualitative data were obtained by audiotaped interviews using a semi-structured interview guide. Descriptive, physiologic data and data from questionnaires were analyzed. Five themes emerged. (a) Feelings of dizziness, lightheadedness, and feeling sick; (b) Belief in God or a Supreme Being, (c) Prayer as the primary coping mechanism, (d) Adherence conceptualized as obedience to God’s will, and (e) Need for healthcare providers to pray and provide more health information. This study provided insight into the influence of religious/spiritual coping behaviors on adherence to HTN treatment in older African American women with HTN in a rural medically underserved area. Nurses and other healthcare providers are in a key position to influence positive health outcomes in rural settings with limited resources using culturally appropriate strategies

Could Ovarian Cancer Prediction Models Improve the Triage of Symptomatic Women in Primary Care? A Modelling Study Using Routinely Collected Data.

CA125 is widely used as an initial investigation in women presenting with symptoms of possible ovarian cancer. We sought to develop CA125-based diagnostic prediction models and to explore potential implications of implementing model-based thresholds for further investigation in primary care. This retrospective cohort study used routinely collected primary care and cancer registry data from symptomatic, CA125-tested women in England (2011-2014). A total of 29,962 women were included, of whom 279 were diagnosed with ovarian cancer. Logistic regression was used to develop two models to estimate ovarian cancer probability: Model 1 consisted of age and CA125 level; Model 2 incorporated further risk factors. Model discrimination (AUC) was evaluated using 10-fold cross-validation. The sensitivity and specificity of various model risk thresholds (≥1% to ≥3%) were compared with that of the current CA125 cut-off (≥35 U/mL). Model 1 exhibited excellent discrimination (AUC: 0.94) on cross-validation. The inclusion of additional variables (Model 2) did not improve performance. At a risk threshold of ≥1%, Model 1 exhibited greater sensitivity (86.4% vs. 78.5%) but lower specificity (89.1% vs. 94.5%) than CA125 (≥35 U/mL). Applying the ≥1% model threshold to the cohort in place of the current CA125 cut-off, 1 in every 74 additional women identified had ovarian cancer. Following external validation, Model 1 could be used as part of a 'risk-based triage' system in which women at high risk of undiagnosed ovarian cancer are selected for urgent specialist investigation, while women at 'low risk but not no risk' are offered non-urgent investigation or interval CA125 re-testing. Such an approach has the potential to expedite ovarian cancer diagnosis, but further research is needed to evaluate the clinical impact and health-economic implications.Cancer Research UK [C8640/A23385] National Institute for Health Research (NIHR) School for Primary Care Research (FR17 424

Psychometric Testing of the Self-Care of Hypertension Inventory

Background: Hypertension (HTN) is a global public health issue. Self-care is an essential component of HTN treatment, but no instruments are available with which to measure self-care of HTN. Objectives: The purpose of this study is to test the psychometric properties of the Self-care of Hypertension Inventory (SC-HI). Methods: Using the Self-care of Chronic Illness theory, we developed a 24-item measure of maintenance, monitoring, and management appropriate for persons with chronic HTN, tested it for content validity, and then tested it in a convenience sample of 193 adults. Exploratory factor analysis was used to identify measure structure. Cronbach\u27s α and factor determinacy scores and were used to assess reliability. Validity was tested with the Medical Outcomes Study General Adherence Scale and the Decision Making Competency Inventory. Results: Seventy percent of the sample was female; mean age was 56.4 ± 13 years; mean duration of HTN was 11 ± 9 years. Removal of 1 item on alcohol consumption resulted in a unidimensional self-care maintenance factor with acceptable structure and internal consistency (α = .83). A multidimensional self-care management factor included “consultative” and “autonomous” factors (factor determinacy score = 0.75). A unidimensional confidence factor captured confidence in and persistence with each aspect of self-care (α = .83). All the self-care dimensions in the final 23-item instrument were associated with treatment adherence and several with decision making. Conclusion: These findings support the conceptual basis of self-care in patients with HTN as a process of maintenance, monitoring, and management. The SC-HI confidence scale is promising as a measure of self-efficacy in self-care

Issues influencing medication adherence in Black women with hypertension

The purposes of this study were to: (a) describe the differences in adherent and nonadherent Black women who have hypertension (HTN), (b) examine issues that influence medication adherence, and (c) explore the relationship of reactant behaviors and medication adherence. Cox‘s interaction model of client health behavior was used to guide this study. Client singularity background variables: demographic characteristics (age and education), social influence (religion), previous health care experience (family history of HTN, comorbidities, number of medications, blood pressure [BP], and body mass index), and environmental resources (income and type of health coverage) along with client singularity dynamic variables: intrinsic motivation (reactance), cognitive appraisal (HTN knowledge, self-care of HTN, trust in health care provider, and coping), and affective response (perceived racism and depression) were examined to determine their influence on the health outcome, medication adherence. A cross-sectional, correlational non-experimental study was conducted with a convenience sample of 80 Black women who were taking antihypertensive prescription medications for blood pressure control. Over half of the participants (56%) were single, divorced, or widowed. Ages ranged from 19 to 60 with a mean age of 47.8 (SD ± 9.2). Almost one-third 30% (n=24) of the participants reported household incomes levels at or below the federal poverty level. The majority of the sample was employed (67%), physically inactive (90%), overweight/obese (88%), and had a history of smoking (54%). The study results did not show a difference between those who adhere to antihypertensive medications and those who do not. Also, there was no relationship between reactant behaviors and medication adherence. However, in the optimal predictive model, those aged 40-49 were less likely to be adherent to their antihypertensive medications. In contrast, those who took 5 to 7 medications were more likely to be adherent. Trust in the health care provider was highly associated with adherence to the medication treatment regimen. These results are congruent with the expectation that trust in the health care provider promotes better medication adherence. Future research should continue to identify factors that influence adherence to the treatment regimen among Black women with HTN and develop interventions that facilitate their ability to better manage their HTN and thus, maintain BP control

The diagnostic performance of CA125 for the detection of ovarian and non-ovarian cancer in primary care: a population-based cohort study

Background The serum biomarker Cancer Antigen 125 (CA125) is widely used as an investigation for possible ovarian cancer in symptomatic women presenting to primary care. However, its diagnostic performance in this setting is unknown. We evaluated the performance of CA125 in primary care for the detection of ovarian and non-ovarian cancers. Methods and findings We studied women in the UK Clinical Practice Research Datalink with a CA125 test performed between 1 May 2011 – 31 December 2014. Ovarian and non-ovarian cancers diagnosed in the year following CA125 testing were identified from the cancer registry. Women were categorised by age: <50 years and ≥50 years. Conventional measures of test diagnostic accuracy, including sensitivity, specificity and positive predictive value, were calculated for the standard CA125 cut-off (≥35 U/ml). The probability of a woman having cancer at each CA125 level between 1-1000 U/ml was estimated using logistic regression. Cancer probability was also estimated on the basis of CA125 level and age in years using logistic regression. We identified CA125 levels equating to a 3% estimated cancer probability: the ‘risk threshold’ at which the UK National Institute for Health and Care Excellence advocates urgent specialist cancer investigation. 50,780 women underwent CA125 testing; 456 (0.9%) were diagnosed with ovarian cancer and 1321 (2.6%) with non-ovarian cancer. 3.4% of women <50 years and 15.2% of women ≥50 years with CA125 levels ≥35 U/ml, had ovarian cancer. 20.4% of women ≥50 years with a CA125 level ≥35 U/ml, who did not have ovarian cancer, were diagnosed with a non-ovarian cancer. A CA125 value of 53 U/ml equated to a 3% probability of ovarian cancer overall. This varied by age, with a value of 104 U/ml in 40-year-old women and 32 U/ml in 70-year-old women, equating to a 3% probability. The main limitations of our study were that we were unable to determine why CA125 tests were performed and that our findings are based solely on UK primary care data, so caution is need in extrapolating them to other healthcare settings. Conclusions CA125 is a useful test for ovarian cancer detection in primary care, particularly in women ≥50 years old. Clinicians should also consider non-ovarian cancers in women with high CA125 levels, especially if ovarian cancer has been excluded, in order to prevent diagnostic delay. Our results enable clinicians and patients to determine the estimated probability of ovarian cancer and all cancers at any CA125 level and age, which can be used to guide individual decisions on the need for further investigation or referral.National Institute of Health Research (NIHR) School of Primary Care Research [FR17 424]. Cancer Research UK [C8640/A23385]

Identifying opportunities for timely diagnosis of bladder and renal cancer via abnormal blood tests: a longitudinal linked data study.

BACKGROUND: Understanding pre-diagnostic test use could reveal diagnostic windows where more timely evaluation for cancer may be indicated. AIM: To examine pre-diagnostic patterns of results of abnormal blood tests in patients with bladder and renal cancer. DESIGN AND SETTING: A retrospective cohort study using primary care and cancer registry data on patients with bladder and renal cancer who were diagnosed between April 2012 and December 2015 in England. METHOD: The rates of patients with a first abnormal result in the year before cancer diagnosis, for 'generic' (full blood count components, inflammatory markers, and calcium) and 'organ-specific' blood tests (creatinine and liver function test components) that may lead to subsequent detection of incidental cancers, were examined. Poisson regression was used to detect the month during which the cohort's rate of each abnormal test started to increase from baseline. The proportion of patients with a test found in the first half of the diagnostic window was examined, as these 'early' tests might represent opportunities where further evaluation could be initiated. RESULTS: Data from 4533 patients with bladder and renal cancer were analysed. The monthly rate of patients with a first abnormal test increased towards the time of cancer diagnosis. Abnormalities of both generic (for example, high inflammatory markers) and organ-specific tests (for example, high creatinine) started to increase from 6-8 months pre-diagnosis, with 25%-40% of these patients having an abnormal test in the 'early half' of the diagnostic window. CONCLUSION: Population-level signals of bladder and renal cancer can be observed in abnormalities in commonly performed primary care blood tests up to 8 months before diagnosis, indicating the potential for earlier diagnosis in some patients

Factors Associated with Myocardial Infarction Reoccurrence

BACKGROUND: As recurrent myocardial infarctions (MIR) constitute almost a third of the annual MIs, identifying traditional and novel variables related to MIR is important. OBJECTIVE: The aim of this study was to examine modifiable cardiac risks, adiposity, symptoms associated with inflammation (fatigue, depression, sleep) and inflammatory cytokines and MIR by sex and race. METHODS: Using a cross sectional descriptive design, we recruited a convenience sample of adults (N =156) discharged with first MI or had MIR in the last 3 to 7 years. Surveys measured demographics, cardiac risk factors, depression, sleep, and fatigue. Anthropometric measures and cytokines TNFα, IL-6, and hsCRP were obtained. A maximum likelihood regression was calculated to predict MIR. RESULTS: The sample included 57% men and 30% Black participants, and the mean age was 65 years (SD = 12). The hsCRP was the only cytokine related to symptoms: fatigue (r= .309, p < .001) and depression (r = .255, p = .002). An MIR was not associated with race despite White participants reporting better sleep (t = −3.25 (146), p = .002), lower BMI (t = −3.49 (154), p = .001), and fewer modifiable risk factors (t = −2.05 (152), p = .04). An MIR was associated with being male, higher hsCRP and TNFα levels (p < .001), and higher inflammatory symptoms of fatigue (p = .04), depression (p = .01) and poor sleep (p < .001). CONCLUSION: Further examination of biomarkers to understand the mechanisms associated with inflammatory symptoms of fatigue, depression, and poor sleep and MIR is needed

Could Ovarian Cancer Prediction Models Improve the Triage of Symptomatic Women in Primary Care? A Modelling Study Using Routinely Collected Data

From MDPI via Jisc Publications RouterHistory: accepted 2021-06-06, pub-electronic 2021-06-09Publication status: PublishedFunder: Cancer Research UK; Grant(s): C8640/A23385Funder: NIHR School for Primary Care Research; Grant(s): FR17 424CA125 is widely used as an initial investigation in women presenting with symptoms of possible ovarian cancer. We sought to develop CA125-based diagnostic prediction models and to explore potential implications of implementing model-based thresholds for further investigation in primary care. This retrospective cohort study used routinely collected primary care and cancer registry data from symptomatic, CA125-tested women in England (2011–2014). A total of 29,962 women were included, of whom 279 were diagnosed with ovarian cancer. Logistic regression was used to develop two models to estimate ovarian cancer probability: Model 1 consisted of age and CA125 level; Model 2 incorporated further risk factors. Model discrimination (AUC) was evaluated using 10-fold cross-validation. The sensitivity and specificity of various model risk thresholds (≥1% to ≥3%) were compared with that of the current CA125 cut-off (≥35 U/mL). Model 1 exhibited excellent discrimination (AUC: 0.94) on cross-validation. The inclusion of additional variables (Model 2) did not improve performance. At a risk threshold of ≥1%, Model 1 exhibited greater sensitivity (86.4% vs. 78.5%) but lower specificity (89.1% vs. 94.5%) than CA125 (≥35 U/mL). Applying the ≥1% model threshold to the cohort in place of the current CA125 cut-off, 1 in every 74 additional women identified had ovarian cancer. Following external validation, Model 1 could be used as part of a ‘risk-based triage’ system in which women at high risk of undiagnosed ovarian cancer are selected for urgent specialist investigation, while women at ‘low risk but not no risk’ are offered non-urgent investigation or interval CA125 re-testing. Such an approach has the potential to expedite ovarian cancer diagnosis, but further research is needed to evaluate the clinical impact and health–economic implications

Identifying Ovarian Cancer in Symptomatic Women: A Systematic Review of Clinical Tools

In the absence of effective ovarian cancer screening programs, most women are diagnosed following the onset of symptoms. Symptom-based tools, including symptom checklists and risk prediction models, have been developed to aid detection. The aim of this systematic review was to identify and compare the diagnostic performance of these tools. We searched MEDLINE, EMBASE and Cochrane CENTRAL, without language restriction, for relevant studies published between 1 January 2000 and 3 March 2020. We identified 1625 unique records and included 16 studies, evaluating 21 distinct tools in a range of settings. Fourteen tools included only symptoms; seven also included risk factors or blood tests. Four tools were externally validated—the Goff Symptom Index (sensitivity: 56.9−83.3%; specificity: 48.3−98.9%), a modified Goff Symptom Index (sensitivity: 71.6%; specificity: 88.5%), the Society of Gynaecologic Oncologists consensus criteria (sensitivity: 65.3−71.5%; specificity: 82.9−93.9%) and the QCancer Ovarian model (10% risk threshold—sensitivity: 64.1%; specificity: 90.1%). Study heterogeneity precluded meta-analysis. Given the moderate accuracy of several tools on external validation, they could be of use in helping to select women for ovarian cancer investigations. However, further research is needed to assess the impact of these tools on the timely detection of ovarian cancer and on patient survival