Favorable Ratings of Providers\u27 Communication Behaviors Among U.S. Women with Depression: A Population-based Study Applying the Behavioral Model of Health Services Use

Background Little is known about the relationships between sociodemographic characteristics and ratings of provider communication behavior among women with depression in the United States. This study uses the Andersen Behavioral Model to examine the relationships among predisposing, enabling, and need factors and ratings of perceived patient–provider communication in women with depression. Methods The sample consisted of women with depression who visited any provider in the previous 12 months in the 2002–2008 Medical Expenditure Panel Survey (n = 3,179; weighted n = 4,707,255). Multivariate logistic regression was used to examine the independent contribution of predisposing, enabling, and need factors on providers\u27 communication behavior measures. Findings Black (non-Hispanic) women were more likely to report that providers always listened carefully (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.01–1.94), explained so they understood (OR, 1.53; 95% CI, 1.10–2.11), and showed respect for what they had to say (OR, 1.39; 95% CI, 1.01–1.92). Women participating in the paid workforce and those without a usual source of care were at increased risk for less favorable experiences. Conclusions Participation in the paid workforce and lack of a usual source of care were associated with an increased likelihood of less optimal communication experiences. Implications for Practice and/or Policy Ensuring that women with depression have reliable access to a continuous source of care and expanding the availability of nonemergent, after-hours care may be instrumental for improving patient–provider communication in this population

The Impact of Patient–Provider Communication and Language Spoken on Adequacy of Depression Treatment for U.S. Women

Many women with depression are untreated or undertreated for their condition. The quality of patient–provider communication may impact the receipt of depression treatment. We examine the relationship between patient–provider communication and receipt of adequate treatment for depression among women. The study sample consisted of women with depression who visited a provider in the previous 12 months in the 2002–2008 Medical Expenditure Panel Survey (N = 3,179). Multivariate regression was used to examine the independent contribution of sociodemographic characteristics, health care factors, patient–provider communication, and respondent language on depression treatment status (none, some, adequate). We found that more than one-third of women with depression in the United States did not receive adequate treatment. Women reporting that providers usually or always listened carefully were more likely to receive adequate treatment (OR = 1.59; 95% CI = 1.10−2.30 and OR = 1.55; 95% CI = 1.07−2.23, respectively). Non-English-speaking women were 50% less likely to receive adequate treatment (OR = 0.49; 95% CI = 0.30−0.80). Having a usual source of care was associated with an increased likelihood of receiving some and adequate treatment (OR = 1.84; 95% CI = 1.24−2.73 and OR = 2.22; 95% CI = 1.61−3.05, respectively). Effective provider listening behaviors may help increase the number of U.S. women with depression who receive adequate treatment. Efforts to improve language access for limited English-proficient women are likely critical for improving treatment outcomes in this population. Additionally, ensuring that women with depression have consistent access to health care services is important for obtaining adequate depression care

Small Drusen and Age-Related Macular Degeneration: The Beaver Dam Eye Study

We tested the hypothesis that large areas of small hard drusen (diameter \u3c63 μm) and intermediate drusen (diameter 63-124 μm) are associated with the incidence of age-related macular degeneration (AMD). Eyes of 3344 older adults with at least 2 consecutive visits spaced 5 years apart over a 20-year period were included. A 6-level severity scale including no drusen, 4 levels of increasing area (from minimal (\u3c2596 μm2) to large (\u3e9086 μm2)) of only small hard drusen, and intermediate drusen was used. The 5-year incidence of AMD was 3% in eyes at the start of the interval with no, minimal, small, and moderate areas of only small drusen and 5% and 25% for eyes with large area of only small drusen and intermediate drusen, respectively. Compared to eyes with a moderate area of small drusen, the odds ratio (OR) of developing AMD in eyes with a large area of only small drusen was 1.8 (p \u3c 0.001). Compared to eyes with large area of only small drusen, eyes with intermediate drusen had an OR of 5.5 (p \u3c 0.001) of developing AMD. Our results are consistent with our hypothesis that large areas of only small drusen are associated with the incidence of AMD

Links between Climate, Malaria, and Wetlands in the Amazon Basin

Climate changes are altering patterns of temperature and precipitation, potentially affecting regions of malaria transmission. We show that areas of the Amazon Basin with few wetlands show a variable relationship between precipitation and malaria, while areas with extensive wetlands show a negative relationship with malaria incidence

Esophageal Clearance Patterns in Normal Older Adults as Documented with Videofluoroscopic Esophagram

Normal esophageal bolus transport in asymptomatic healthy older adults has not been well defined, potentially leading to ambiguity in differentiating esophageal swallowing patterns of dysphagic and healthy individuals. This pilot study of 24 young (45–64 years) and old (65+years) men and women was designed to assess radiographic esophageal bolus movement patterns in healthy adults using videofluoroscopic recording. Healthy, asymptomatic adults underwent videofluoroscopic esophagram to evaluate for the presence of ineffective esophageal clearance, namely, intraesophageal stasis and intraesophageal reflux. Intraesophageal stasis and intraesophageal reflux were visualized radiographically in these normal subjects. Intraesophageal stasis occurred significantly more frequently with semisolid (96%) compared with liquid (16%) barium, suggesting that a variety of barium consistencies, as opposed to only the traditional fluids, would better define the spectrum of esophageal transport. Intraesophageal reflux was observed more frequently in older males than in their younger counterparts. The rates of intraesophageal stasis and intraesophageal reflux were potentially high given that successive bolus presentations were spaced 10 seconds apart. These findings suggest a need for a more comprehensive definition regarding the range of normal esophageal bolus transport to (a) prevent misdiagnosis of dysphagia and (b) to enhance generalization to functional eating, which involves solid foods in addition to liquids

Inhaled corticosteroid use is associated with increased circulating tregulatory cells in children with asthma

BACKGROUND: T regulatory (Treg) cells are important in balancing immune responses and dysregulation of Treg cells has been implicated in the pathogenesis of multiple disease states including asthma. In this study, our primary aim was to determine Treg cell frequency in the peripheral blood of children with and without asthma. The secondary aim was to explore the association between Treg cell frequency with allergen sensitization, disease severity and medication use. METHODS: Peripheral blood mononuclear cells from healthy control subjects (N = 93) and asthmatic children of varying disease severity (N = 66) were characterized by multi-parameter flow cytometry. RESULTS: Our findings demonstrate that children with asthma had a significantly increased frequency of Treg cells compared to children without asthma. Using a multivariate model, increased Treg cell frequency in children with asthma was most directly associated with inhaled corticosteroid use, and not asthma severity, allergic sensitization, or atopic status of the asthma. CONCLUSION: We conclude that low dose, local airway administration of corticosteroids is sufficient to impact the frequency of Treg cells in the peripheral blood. These data highlight the importance of considering medication exposure when studying Treg cells and suggest inhaled corticosteroid use in asthmatics may improve disease control through increased Treg cell frequency