Health Status of USMS Swimmers Compared With a Representative Sample of the General Population

This study evaluates a group of master swimmers to determine their perceptions of their physical and mental health status. USMS swimmers were surveyed to determine overall perceptions of their physical and mental health. The responses were compared to responses to the same questions included in 2007-2008 National Health and Nutrition Examination Survey (NHANES). Members responding to the USMS survey totaled 1,054 and 5,171 people in the NHANES dataset met inclusion criteria. The USMS sample reported fewer physically and mentally unhealthy days and fewer inactive days due to health. Over 95% of USMS respondents indicated excellent to good health compared to 75.4% of the NHANES sample. People engaged in physical activity, especially regular swimming, have higher odds of having better health status

Relationship Between Symptoms and Health‐Related Quality of Life in Patients Treated for Hypertension

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90331/1/phco.24.4.344.33177.pd

Metformin use and asthma outcomes among patients with concurrent asthma and diabetes

Background and objectiveMetformin is a firstâ line treatment for patients with diabetes. Recent animal studies indicated that metformin can reduce airway inflammation. However, it remains unclear whether the use of metformin can help patients maintain asthma control. The purpose of this study was to evaluate the association between the use of metformin and asthmaâ related outcomes, which include asthmaâ related hospitalization, asthmaâ related emergency room visits and asthma exacerbation, among patients with concurrent asthma and diabetes.MethodsWe conducted an 11â year (2001â 2011) retrospective cohort study using the Taiwan National Health Insurance Research Database. Patients with concurrent asthma and diabetes were included. The date of the first observed prescription of metformin was defined as the index date. For each metformin user, two matched metformin nonâ users of the same age and gender were randomly selected. Patients were followed for 3â years to measure the occurrence of asthmaâ related outcomes. Multivariable logistic regression models were used to assess the association between metformin use and asthmaâ related outcomes.ResultsOf 1332 patients with concurrent asthma and diabetes, 444 (33.3%) were metformin users. Compared with nonâ users, metformin users had a lower risk of asthmaâ related hospitalization (ORâ =â 0.21, 95% CI: 0.07â 0.63) and asthma exacerbation (ORâ =â 0.39, 95% CI: 0.19â 0.79).ConclusionThe risk of asthmaâ related outcomes was lower for metformin users than nonâ users. Healthâ care providers should consider metformin as a treatment strategy for patients with concurrent asthma and diabetes.Metformin is commonly used for diabetic patients and has recently been found to reduce airway inflammation in animal studies. We evaluated the association between metformin use and asthma exacerbation among patients with concurrent asthma and diabetes and found that the risk of exacerbation was lower among metformin users than nonâ users.See Editorial, page 1144Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134202/1/resp12818_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134202/2/resp12818.pd

The Addition of the Charlson Comorbidity Index to the GRACE Risk Prediction Index Improves Prediction of Outcomes in Acute Coronary Syndrome

Patients with cardiovascular disease have increased risk of poor outcomes when coexisting illnesses are present. Clinicians, administrators, and health services researchers utilize risk adjustment indices to stratify patients for various outcomes. The GRACE Risk Prediction Index (GRPI) was developed to risk stratify patients who experienced an acute coronary syndrome (ACS) event. GRPI does not account for the presence of comorbid conditions. The objective of this study was to compare the ability of the GRPI and the Charlson Comorbidity Index (CCI), used independently or combined, to predict mortality or secondary coronary events in patients admitted for ACS. Data were obtained from an academic health system's ACS registry. Outcomes included inpatient and 6-month postdischarge mortality and occurrence of secondary cardiovascular events or revascularization procedures. Logistic regression derived C statistics for CCI, GRPI, and CCI-GRPI predictive models for each outcome. Likelihood ratio tests determined the contribution of CCI when added to GRPI models. Complete data were available for 1202 patients. The GRPI model had the greatest C statistic when predicting inpatient mortality (0.73); the GRPI-CCI combined model C statistic was 0.81 when predicting death during the follow-up period; and C statistics for all 3 models were similar in predicting secondary events (0.57?0.60). The likelihood ratio analysis demonstrated that adding CCI to GRPI models was beneficial primarily for predicting secondary events. CCI is a useful addition to GRPI when predicting future cardiac-related events or mortality after an ACS event. It is an acceptable alternative to the GRPI model if data to construct GRPI are not available. (Population Health Management 2014;17:54?59)Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140179/1/pop.2012.0117.pd

Association between Anticholinergic Medication Use and Risk of Dementia among Patients with Parkinson’s Disease

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151324/1/phar2305.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151324/2/phar2305_am.pd

Cross-Sectional Survey of Perceived Barriers Among Community Pharmacists Who Do Not Immunize, in Wayne County, Michigan

Introduction: The goal of the study was to identify perceived barriers to implementation of vaccination services encountered by independent and small-chain community pharmacies in an urban setting. Methods: Pharmacists in independent and small-chain pharmacies located in 29 Michigan ZIP codes were visited and asked to complete a 5- to 10-min semi-structured interview. Results: A total of 93 independent and 12 small-chain pharmacies participated (n = 105; 61%). The pharmacies filled an average of 700 prescriptions each week with 1.1 pharmacist full-time equivalents and 57 h of technician time. The most common services that participating pharmacies provided were dispensing outpatient medication (99%), medication therapy management (MTM, 65.7%), disease management or coaching (54.3%), point-of-care testing (34.3%), and dispensing medications to inpatient facilities (16.2%). Only seven pharmacies (6.7%) administered vaccinations. When pharmacists were asked to identify what it would take to start to administer vaccines, the most common responses were increased demand from patients (37.1%), adequate time (19%), appropriate space (17.1%), appropriate amount of staff (14.3%), change in attitudes or beliefs of the owner or pharmacists at that pharmacy (13.3%), increased profit related to vaccines (11.4%), and increased awareness among patients about the importance of vaccines (11.4%). The majority of pharmacies (65.3%) reported that only one factor would need to change to start to administer vaccines. Conclusion: Independent and small-chain community pharmacies in an urban, primarily low-income area identified several barriers that have prevented implementation of vaccination services. However, the majority of pharmacies reported that only one factor would need to change in order to begin to administer vaccines. Interventional efforts necessary to address commonly cited barriers may include providing education to pharmacists about the need for community pharmacy-based immunization programs in addition to services provided by physician offices, as well as the importance of proactively providing immunization-related recommendations to patients

State oversight of polypharmacy and psychotropic medication use among individuals with intellectual and developmental disabilities: a three state case study

Adults with intellectual and developmental disabilities (IDD) are prescribed more medications than the general population, placing them at significantly higher risk for issues due to taking multiple medications (polypharmacy). There are currently no clear national standards for the administration of medications given this risk. The following policy analysis explores state policies related to prescription medication oversight. This analysis pays particular attention to the use of medications that alter one’s mental state (psychotropics) among people with IDD who receive home and community-based services (HCBS) in the United States. The article outlines current efforts implemented to reduce medication-related risks for people with IDD in three states and explores the similarities and differences across strategies. This policy analysis aims to initiate conversation and encourage further consideration and deliberation necessary to move toward clear and concrete guidelines for the oversight of medication regimens

Effect Of Pregnancy And Lactation On Lipoprotein And Cholesterol Metabolism In The Rat

Origins of hyperlipidemia and cholestasis that occur during pregnancy were investigated by examining expression of key elements related to plasma and hepatic cholesterol metabolism during pregnancy, lactation, and post-lactation in the rat model. Among major findings were: during pregnancy, the activities of hepatic 3-hydroxy-3-methylglutaryl coenzyme A reductase, acyl coenzyme A:cholesterol acyltransferase, acyl coenzyme A:diacylglycerol acyltransferase, cholesterol 7 alpha-hydroxylase, cholesterol ester hydrolases, low density lipoprotein receptors, LRP, and mdr2 were significantly lower or similar to non-pregnant controls while SR-B1 was elevated. Once lactation began, reductase, cholesterol acyltransferase, 7 alpha-hydroxylase activities, low density lipoprotein receptors, and mdr2 increased while SR-B1 decreased. In later stages of lactation most hepatic elements returned to near control levels. Plasma cholesterol levels were higher than control at birth and during lactation with increase in LDL-size particles. By 24 h post-lactation, plasma triglycerides were 3.7-fold higher while cholesterol remained unchanged. Very large lipoproteins were present while LDL-size particles were now absent. Hepatic cholesterol acyltransferase had decreased to 27% of control while diacylglycerol acyltransferase increased 3-fold and low density lipoprotein receptors doubled. Most elements were normalized 3 weeks after weaning except for LRP and low density lipoprotein receptors which were elevated. These studies provide an integrated picture of expression of key elements of hepatic and plasma cholesterol metabolism during pregnancy and lactation and advance understanding of hyperlipidemia and cholestasis during these states

Work‐Related Outcomes After a Myocardial Infarction

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90385/1/phco.24.16.1515.50946.pd