Persistence with statins in primary prevention of cardiovascular disease: findings from a cohort of spanish workers

Introduction and objectives: The aim of this study was to assess patterns of treatment persistence in a cohort of male Spanish workers receiving statin therapy for primary prevention of cardiovascular disease. Methods: This descriptive study was conducted within the framework of the prospective longitudinal Aragon Workers’ Health Study (N = 5400). Incident male statin users were identified based on data collected from the regional government's medication consumption information system. Patterns of treatment persistence with statins prescribed for primary cardiovascular disease prevention were assessed and the relevance of potential predictors explored. Results: Among the 725 new statin users, less than one third remained persistent during the 1 year of follow-up. About 15% of nonpersistent users discontinued statin therapy after dispensation of the first prescription; of these, 42.1% did not recommence treatment within the following year. Factors reducing the likelihood of treatment discontinuation were older age (HR, 0.55; 95%CI, 0.39-0.77) and cotreatment with antihypertensive drugs (HR, 0.68; 95%CI, 0.56-0.82). No association was observed between treatment persistence and cotreatment with antidiabetic or antithrombotic drugs, baseline low-density lipoprotein levels, or total cholesterol levels. However, persistence was influenced by the type of statin first prescribed. Conclusions: Our analysis of a cohort of healthy male workers revealed poor statin persistence. These findings underscore the need for a better understanding of patterns of statin use, especially in apparently healthy individuals, and for the incorporation of patient behavior into prescribing decisions. Abstract Introduction and objectives The aim of this study was to assess patterns of treatment persistence in a cohort of male Spanish workers receiving statin therapy for primary prevention of cardiovascular disease. Methods This descriptive study was conducted within the framework of the prospective longitudinal Aragon Workers’ Health Study (N = 5400). Incident male statin users were identified based on data collected from the regional government's medication consumption information system. Patterns of treatment persistence with statins prescribed for primary cardiovascular disease prevention were assessed and the relevance of potential predictors explored. Results Among the 725 new statin users, less than one third remained persistent during the 1 year of follow-up. About 15% of nonpersistent users discontinued statin therapy after dispensation of the first prescription; of these, 42.1% did not recommence treatment within the following year. Factors reducing the likelihood of treatment discontinuation were older age (HR, 0.55; 95%CI, 0.39-0.77) and cotreatment with antihypertensive drugs (HR, 0.68; 95%CI, 0.56-0.82). No association was observed between treatment persistence and cotreatment with antidiabetic or antithrombotic drugs, baseline low-density lipoprotein levels, or total cholesterol levels. However, persistence was influenced by the type of statin first prescribed. Conclusions Our analysis of a cohort of healthy male workers revealed poor statin persistence. These findings underscore the need for a better understanding of patterns of statin use, especially in apparently healthy individuals, and for the incorporation of patient behavior into prescribing decisions. Resumen: Introducción y objetivos: El objetivo de este estudio es analizar el patrón de persistencia con estatinas en prevención primaria de enfermedad cardiovascular en una cohorte de trabajadores españoles. Métodos: Este estudio descriptivo se llevó a cabo en el marco del estudio prospectivo longitudinal Aragon Workers’ Health Study (n = 5.400). Se identificó a los nuevos usuarios de estatinas varones a partir de datos recogidos en el sistema de información de consumo farmacéutico de Aragón. Se analizaron los patrones de persistencia con estatinas prescritas en prevención primaria cardiovascular, así como los potenciales predictores. Resultados: De los 725 nuevos usuarios de estatinas, menos de un tercio habían persistido durante el año de seguimiento. Alrededor de un 15% de los usuarios no persistentes interrumpieron la terapia con estatinas tras la dispensación de la primera receta y, el 42,1% de ellos no reiniciaron el tratamiento durante el resto del año. La mayor edad (HR = 0,55; IC95%, 0,39-0,77) y el cotratamiento con fármacos antihipertensivos (HR = 0,68; IC95%, 0,56-0,82) redujeron la probabilidad de que se interrumpiera el tratamiento. No se observó asociación entre la persistencia con el tratamiento y la toma concomitante de fármacos antidiabéticos o antitrombóticos, las concentraciones basales de lipoproteínas de baja densidad o las de colesterol total. Sin embargo, la persistencia sí estuvo influida por el tipo de la primera estatina prescrita. Conclusiones: Nuestro análisis en una cohorte de trabajadores varones sanos muestra una baja persistencia con estatinas. Estos resultados reflejan la necesidad de comprender mejor los patrones de utilización de estatinas, especialmente por individuos aparentemente sanos, y de incorporar la conducta del paciente a las decisiones de prescripción. Introducción y objetivos: El objetivo de este estudio es analizar el patrón de persistencia con estatinas en prevención primaria de enfermedad cardiovascular en una cohorte de trabajadores españoles. Métodos: Este estudio descriptivo se llevó a cabo en el marco del estudio prospectivo longitudinal Aragon Workers’ Health Study (n = 5.400). Se identificó a los nuevos usuarios de estatinas varones a partir de datos recogidos en el sistema de información de consumo farmacéutico de Aragón. Se analizaron los patrones de persistencia con estatinas prescritas en prevención primaria cardiovascular, así como los potenciales predictores. Resultados: De los 725 nuevos usuarios de estatinas, menos de un tercio habían persistido durante el año de seguimiento. Alrededor de un 15% de los usuarios no persistentes interrumpieron la terapia con estatinas tras la dispensación de la primera receta y, el 42, 1% de ellos no reiniciaron el tratamiento durante el resto del año. La mayor edad (HR = 0, 55; IC95%, 0, 39-0, 77) y el cotratamiento con fármacos antihipertensivos (HR = 0, 68; IC95%, 0, 56-0, 82) redujeron la probabilidad de que se interrumpiera el tratamiento. No se observó asociación entre la persistencia con el tratamiento y la toma concomitante de fármacos antidiabéticos o antitrombóticos, las concentraciones basales de lipoproteínas de baja densidad o las de colesterol total. Sin embargo, la persistencia sí estuvo influida por el tipo de la primera estatina prescrita. Conclusiones: Nuestro análisis en una cohorte de trabajadores varones sanos muestra una baja persistencia con estatinas. Estos resultados reflejan la necesidad de comprender mejor los patrones de utilización de estatinas, especialmente por individuos aparentemente sanos, y de incorporar la conducta del paciente a las decisiones de prescripción. Introduction and objectives: The aim of this study was to assess patterns of treatment persistence in a cohort of male Spanish workers receiving statin therapy for primary prevention of cardiovascular disease. Methods: This descriptive study was conducted within the framework of the prospective longitudinal Aragon Workers' Health Study (N = 5400). Incident male statin users were identified based on data collected from the regional government's medication consumption information system. Patterns of treatment persistence with statins prescribed for primary cardiovascular disease prevention were assessed and, the relevance of potential predictors explored. Results: Among the 725 new statin users, less than one third remained persistent during the 1 year of follow-up. About 15% of nonpersistent users discontinued statin therapy after dispensation of the first prescription; of these, 42.1% did not recommence treatment within the following year. Factors reducing the likelihood of treatment discontinuation were older age (HR, 0.55; 95%CI, 039-0.77) and cotreatment with antihypertensive drugs (HR, 0.68; 95%CI, 0.56-0.82). No association was observed between treatment persistence and cotreatment with antidiabetic or antithrombotic drugs, baseline low-density lipoprotein levels, or total cholesterol levels. However, persistence was influenced by the type of statin first prescribed. Conclusions: Our analysis of a cohort of healthy male workers revealed poor statin persistence. These findings underscore the need for a better understanding of patterns of statin use, especially in apparently healthy individuals, and for the incorporation of patient behavior into prescribing decisions

Impact of a basic mathematics course on the performance of college students in algebra subject

A common problem for universities is the lack of knowledge and mathematical skills of new students because this deficiency creates difficulties in their studies throughout their career, which can cause their dropout. The aim of this paper is to describe the impact of a basic mathematics course on the performance of college student in algebra subject. This is a 32-hour course which is developed in 16 sessions in parallel to the algebra classes and is mainly offered to students: a) identified with low performance on mathematics component of national highschool test, and b) remitted by the subject teacher. The main findings are: a) the pass rate for students who attended to more than half of the sessions of the course if 95%, and b) the average grade of the subject tends to increase as with the attendance level to the course of the students. Consequently, these results lead to the conclusion that the course has a positive effect on the students' performance

Factors that promote positive attitudes towards mathematics in higher education students

The purpose of this review article is to explain the importance of understanding attitudes towards teaching and learning mathematics in higher education students. For that, we start from the premise that attitudes are related to performance towards learning mathematics, bearing in mind that what directly influences their success are the feelings of possessing competencies to understand their contents and not the feelings of difficulty towards them. In essence, at first, we describe the different attitudes towards mathematics. Next, we examine how attitudes influence math learning and finally identify the factors that foster positive attitudes toward math. From this, we suggest teaching practices that can be carried out to foster positive attitudes towards mathematics and propose new lines of research in this field

Normal response to tibial neurodynamic test in asymptomatic subjects

BACKGROUND: The straight leg raise test (SLR) is one of the most performed physical tests for mechanosensitivity and impairment of the nervous system. According to the anatomy of the tibial nerve, ankle dorsiflexion and eversion movements could be used to perform the tibial neurodynamic test (TNT). To date, no study has documented the normal responses of the TNT. OBJECTIVE: To document normal responses of the TNT in asymptomatic individuals and to investigate influences from sex and leg dominance. METHODS: A cross-sectional study with 44 asymptomatic volunteer subjects, a total of 88 lower limbs, was carried out. The range of motion (ROM), quality, and distribution of sensory responses were recorded. The hip flexion ROM was measured when subjects reported an intensity of their symptoms of 2/10 (P1) and 8/10 (P2). RESULTS: The mean ROM for hip flexion at P1 was 44.22 ± 13.13 and 66.73 ± 14.30 at P2. Hip flexion was significantly greater at P2 than P1 (p 0.05). The descriptor of the quality of sensory responses most often used by participants was stretching (88.6% and 87.5% for P1 and P2, respectively) in the popliteal fossa and posterior calf. CONCLUSIONS: This study describes the sensory responses of asymptomatic subjects resulting from the TNT. Our findings indicate that TNT responses are independent of the influence of sex or leg dominance

A Multi-objective Exploratory Procedure for Regression Model Selection

Variable selection is recognized as one of the most critical steps in statistical modeling. The problems encountered in engineering and social sciences are commonly characterized by over-abundance of explanatory variables, non-linearities and unknown interdependencies between the regressors. An added difficulty is that the analysts may have little or no prior knowledge on the relative importance of the variables. To provide a robust method for model selection, this paper introduces the Multi-objective Genetic Algorithm for Variable Selection (MOGA-VS) that provides the user with an optimal set of regression models for a given data-set. The algorithm considers the regression problem as a two objective task, and explores the Pareto-optimal (best subset) models by preferring those models over the other which have less number of regression coefficients and better goodness of fit. The model exploration can be performed based on in-sample or generalization error minimization. The model selection is proposed to be performed in two steps. First, we generate the frontier of Pareto-optimal regression models by eliminating the dominated models without any user intervention. Second, a decision making process is executed which allows the user to choose the most preferred model using visualisations and simple metrics. The method has been evaluated on a recently published real dataset on Communities and Crime within United States.Comment: in Journal of Computational and Graphical Statistics, Vol. 24, Iss. 1, 201

Sensory function in cluster headache: an observational study comparing the symptomatic and asymptomatic sides

Background: Based on inconsistent sensory alterations demonstrated in cluster headache (CH), the aim of this study was to determine whether patients with CH develop sensory changes in the symptomatic side compared to the asymptomatic side. Methods: Quantitative sensory testing (QST), including pressure pain threshold (PPT), tactile detection threshold (TDT), prick detection threshold (PDT), and two-point detection threshold (2PDT), was evaluated in 16 patients (seven women; age 41.9±6.8 years) with CH. Test sites included the rst, second, and third divisions of the trigeminal nerve, cervical spine, and thenar eminence in the symptomatic and asymptomatic sides. Results: The symptomatic side, compared to the asymptomatic side, presented signi cantly decreased PPT in the rst (P=0.011; 423.81±174.05 kPa vs 480.13±214.99 kPa) and second (P=0.023; 288.88±140.80 kPa vs 326.38±137.33 kPa) divisions of the trigeminal nerve, significantly increased TDT in the first (P=0.002; 2.44±0.40 vs 1.74±0.24) and second (P=0.016; 1.92±0.34 vs 1.67±0.09) divisions, and increased 2PDT in the rst division (P=0.004; 18.13±4.70 mm vs 15.0±4.92 mm) and neck (P=0.007; 45.31±20.65 mm vs 38.44±16.10 mm). Conclusion: These results support the prior evidence suggesting a specific pattern of alteration of sensory function with alterations in the symptomatic side compared to the asymp- tomatic side

Pharmacological Primary Cardiovascular Prevention and Subclinical Atherosclerosis in Men: Evidence from the Aragon Workers' Health Study.

The objective of this study is to describe the profile of primary preventive treatment for cardiovascular disease in adult males and to analyze the association between treatment profile and subclinical atherosclerosis. We selected male workers who had undergone ultrasound imaging and had no previous history of cardiovascular disease (n = 2138). Data on the consumption of primary cardiovascular drugs from the previous year were obtained. We performed bivariate analyses to compare patient characteristics according to cardiovascular treatment and the presence of subclinical atherosclerosis, and logistic regression models to explore the association between these two variables. Among participants with no personal history of cardiovascular disease, subclinical atherosclerosis was present in 77.7% and 31.2% had received some form of preventive treatment. Of those who received no preventive treatment, 73.6% had subclinical atherosclerosis. Cardiovascular preventive treatment was associated only with CACS > 0 (odds ratio (OR), 1.37; 95% confidence interval (95% CI), 1.06-1.78). Statin treatment was associated with a greater risk of any type of subclinical atherosclerosis (OR, 1.73) and with CACS > 0 (OR, 1.72). Subclinical atherosclerosis existed in almost 75% of men who had no personal history of cardiovascular disease and had not received preventive treatment for cardiovascular disease

Expression of divIB of Bacillus subtilis during vegetative growth

Expression of the division initiation gene, divIB, of Bacillus subtilis vegetative growth was examined. lacZ fusion studies and transcription start point mapping have established that a sigma A promoter proximal to divIB is utilized in vivo. The -10 region of this promoter, which is located 93 bp upstream of the start codon, has been defined precisely by site-directed mutagenesis that destroys the promoter. Examination of transcripts by Northern (RNA) blotting has shown that there are at least two transcripts for divIB. The established proximal promoter was found to give rise to a very minor transcript which could not be convincingly demonstrated in wild-type cells but which became apparent upon insertion of a plasmid into the chromosome just upstream of this promoter. The major transcript for divIB originated from a site several kb upstream of the gene and is probably the same as the long polycistronic message also traversing the murD-spoVE-murG genes that was identified previously by others (A.D. Henriques, H. de Lencastre, and P.J. Piggot, Biochimie 74:735-748, 1992). Transcription from the proximal promoter alone, in an upstream-deletion mutant strain, provided sufficient DivIB for normal growth and division as well as sporulation

Immediate Effects of Upper Cervical Translatoric Mobilization on Cervical Mobility and Pressure Pain Threshold in Patients With Cervicogenic Headache: A Randomized Controlled Trial

Objective The purpose of this study was to evaluate the immediate effects of upper cervical translatoric spinal mobilization (UC-TSM) on cervical mobility and pressure pain threshold in subjects with cervicogenic headache (CEH). Methods Eighty-two volunteers (41.54 ± 15.29 years, 20 male and 62 female) with CEH participated in the study and were randomly divided into the control and treatment groups. The treatment group received UC-TSM and the control group remained in the same position for the same time as the UC-TSM group, but received no treatment. Cervical mobility (active cervical mobility and flexion-rotation test), pressure pain thresholds over upper trapezius muscles, C2-3 zygapophyseal joints and suboccipital muscles, and current headache intensity (visual analog scale) were measured before and immediately after the intervention by 2 blinded investigators. Results After the intervention, UC-TSM group exhibited significant increases in total cervical mobility (P =.002, d = 0.16) and the flexion–rotation test (P .05). Nevertheless, there was a significantly lower intensity of headache in the UC-TSM group (P =.039, d = 0.57). Conclusions Upper cervical translatoric spinal mobilization intervention increased upper, and exhibited a tendency to improve general, cervical range of motion and induce immediate headache relief in subjects with CEH

Field Scale Variability of Nitrogen and δ15N in Soil and Plants

Understanding the factors that influence soil and plant nitrogen (N) spatial variability may improve our ability to develop management systems that maximize productivity and minimize environmental hazards. The objective of this study was to determine the field (65 ha) scale spatial variability of N and δ15N in soil and corn (Zea mays). Soil, grain, and stover samples were collected from grids that ranged in size from 30 by 30 m to 60 by 60 m. Plant samples, collected following physiological maturity in 1995, were analyzed for total N and δ15N. Soil samples, collected prior to planting in the spring of 1995 and 1996, were analyzed for inorganic‐N, total N, and δ15N. All parameters showed strong spatial relationships. In an undrained portion of the field containing somewhat poorly and poorly drained soils there was a net loss of 95 kg N ha‐1, while in an adjacent area that was tile drained there was a net gain of 98 kg N ha‐1. Denitrification and N mineralization most likely were responsible for losses and gains, respectively. Differences between the N balances of these areas (193 kg N ha‐1) provide a relative measure of the impact of tile drainage on plant N availability and greenhouse gas production in a wet year