Self-care and adherence to medication: a survey in the hypertension outpatient clinic

<p>Abstract</p> <p>Background</p> <p>Self-care practices for patients with hypertension include adherence to medication, use of blood pressure self-monitoring and use of complementary and alternative therapies (CAM) The prevalence of CAM use and blood pressure self-monitoring have not been described in a UK secondary care population of patients with hypertension and their impact on adherence to medication has not been described. Adherence to medication is important for blood pressure control, but poor adherence is common. The study aimed to determine the prevalence of self-care behaviours in patients attending a secondary care hypertension clinic.</p> <p>Methods</p> <p>Cross-sectional questionnaire survey. 196 patients attending a secondary care hypertension clinic in a teaching hospital serving a multiethnic population, Birmingham, UK. Main outcome measures: Prevalence of use of CAM, home monitors, adherence to anti-hypertensive medication.</p> <p>Results</p> <p>CAM use in previous 12 months was reported by 66 (43.1%) respondents. CAM users did not differ statistically from non-CAM users by age, gender, marital status or education. Vitamins, prayer a dietary supplements were the most commonly used CAM. Nine (12.7%) women reported using herbal CAM compared to one man (1.2%), (p = 0.006). Ten (6.7%) respondents reported ever being asked by a doctor about CAM use. Perfect adherence to anti-hypertensive medication was reported by 26 (44.8%) CAM-users and 46 (60.5%) non-CAM users (p = 0.07). Being female and a CAM user was significantly associated with imperfect adherence to anti-hypertensive medication. Older and white British respondents were significantly more likely to report perfect adherence. Blood pressure monitors were used by 67 (43.8%) respondents, which was not associated with gender, CAM use or adherence to medication.</p> <p>Conclusion</p> <p>Hypertensive patients use a variety of self-care methods, including CAM, home blood pressure monitors, and adherence to prescribed medication. This study found the prevalence of CAM use in hypertensive patients was higher than in the UK population. It is important to acknowledge the self-care behaviour of hypertensive patients, in order to assess potential harm, and encourage effective methods of self-care.</p

Global Atmospheric Budget of Acetone: Air‐Sea Exchange and the Contribution to Hydroxyl Radicals

Acetone is one of the most abundant oxygenated volatile organic compounds (VOCs) in the atmosphere. The oceans impose a strong control on atmospheric acetone, yet the oceanic fluxes of acetone remain poorly constrained. In this work, the global budget of acetone is evaluated using two global models: CAM‐chem and GEOS‐Chem. CAM‐chem uses an online air‐sea exchange framework to calculate the bidirectional oceanic acetone fluxes, which is coupled to a data‐oriented machine‐learning approach. The machine‐learning algorithm is trained using a global suite of seawater acetone measurements. GEOS‐Chem uses a fixed surface seawater concentration of acetone to calculate the oceanic fluxes. Both model simulations are compared to airborne observations from a recent global‐scale, multiseasonal campaign, the NASA Atmospheric Tomography Mission (ATom). We find that both CAM‐chem and GEOS‐Chem capture the measured acetone vertical distributions in the remote atmosphere reasonably well. The combined observational and modeling analysis suggests that (i) the ocean strongly regulates the atmospheric budget of acetone. The tropical and subtropical oceans are mostly a net source of acetone, while the high‐latitude oceans are a net sink. (ii) CMIP6 anthropogenic emission inventory may underestimate acetone and/or its precursors in the Northern Hemisphere. (iii) The MEGAN biogenic emissions model may overestimate acetone and/or its precursors, and/or the biogenic oxidation mechanisms may overestimate the acetone yields. (iv) The models consistently overestimate acetone in the upper troposphere‐lower stratosphere over the Southern Ocean in austral winter. (v) Acetone contributes up to 30–40% of hydroxyl radical production in the tropical upper troposphere/lower stratosphere

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

Emission of sunscreen salicylic esters from desert vegetation and their contribution to aerosol formation

Biogenic volatile organic compounds (BVOC) produced by plants are known to have an important role in atmospheric chemistry. However, our knowledge of the range of BVOCs produced by different plant processes is still expanding, and there remain poorly understood categories of BVOCs. In this study, emissions of a novel class of BVOC emissions were investigated in a desert region. Our study considered 8 species of common desert plants: blackbrush (Coleogyne ramosissima), desert willow (Chilopsis linearis), mesquite (Prosopis glandulosa), mondel pine (Pinus eldarica), pinyon pine (Pinus monophylla), cottonwood (Populus deltoides), saguaro cactus (Carnegiea gigantea) and yucca (Yucca baccata). The measurements focused on BVOCs with relatively high molecular weight (&gt;C15) and/or an oxygenated functional group. Significantly high emission rates of two salicylic esters were found for blackbrush, desert willow and mesquite with emission rates of 3. 1, 1.0 and 4.8μgC dwg-1 h-1, respectively (dwg; dry weight of the leaves in gram). The salicylic esters were identified as 2-ethylhexenyl salicylate (2-EHS) and 3,3,5-trimethylcyclohexenyl salicylate (homosalate) and are known as effective ultraviolet (UV) absorbers. We propose that the plants derive a protective benefit against UV radiation from the salicylic esters and that the emission process is driven by the physical evaporation of the salicylic esters due to the high ambient temperatures. In addition, the salicylic esters are predicted to be an effective precursor of secondary organic aerosol (SOA) because they probably produce oxidation products that can condense onto the aerosol phase. We estimated the contribution of the sunscreen esters themselves and their oxidation products on the SOA formation for the Las Vegas area using a BVOC emission model. The contribution was estimated to reach 50% of the biogenic terpenoid emission in the landscapes dominated by desert willow and mesquite and 13% in the Las Vegas area. The contributions to biogenic SOA are likely to be higher due to the potentially high SOA yields of these compounds. © Author(s) 2008

Emission of sunscreen salicylic esters from desert vegetation and their contribution to aerosol formation

Biogenic volatile organic compounds (BVOC) produced by plants are known to have an important role in atmospheric chemistry. However, our knowledge of the range of BVOCs produced by different plant processes is still expanding, and there remain poorly understood categories of BVOCs. In this study, emissions of a novel class of BVOC emissions were investigated in a desert region. Our study considered 8 species of common desert plants: blackbrush (Coleogyne ramosissima), desert willow (Chilopsis linearis), mesquite (Prosopis glandulosa), mondel pine (Pinus eldarica), pinyon pine (Pinus monophylla), cottonwood (Populus deltoides), saguaro cactus (Carnegiea gigantea) and yucca (Yucca baccata). The measurements focused on BVOCs with relatively high molecular weight (&gt;C15) and/or an oxygenated functional group. Significantly high emission rates of two salicylic esters were found for blackbrush, desert willow and mesquite with emission rates of 3. 1, 1.0 and 4.8μgC dwg-1 h-1, respectively (dwg; dry weight of the leaves in gram). The salicylic esters were identified as 2-ethylhexenyl salicylate (2-EHS) and 3,3,5-trimethylcyclohexenyl salicylate (homosalate) and are known as effective ultraviolet (UV) absorbers. We propose that the plants derive a protective benefit against UV radiation from the salicylic esters and that the emission process is driven by the physical evaporation of the salicylic esters due to the high ambient temperatures. In addition, the salicylic esters are predicted to be an effective precursor of secondary organic aerosol (SOA) because they probably produce oxidation products that can condense onto the aerosol phase. We estimated the contribution of the sunscreen esters themselves and their oxidation products on the SOA formation for the Las Vegas area using a BVOC emission model. The contribution was estimated to reach 50% of the biogenic terpenoid emission in the landscapes dominated by desert willow and mesquite and 13% in the Las Vegas area. The contributions to biogenic SOA are likely to be higher due to the potentially high SOA yields of these compounds. © Author(s) 2008

Airborne flux measurements of methane and volatile organic compounds over the haynesville and marcellus shale gas production regions

Emissions of methane (CH4) and volatile organic compounds (VOCs) from oil and gas production may have large impacts on air quality and climate change. Methane and VOCs were measured over the Haynesville and Marcellus shale gas plays on board the National Center for Atmospheric Research C-130 and NOAA WP-3D research aircraft in June–July of 2013. We used an eddy covariance technique to measure in situ fluxes of CH4 and benzene from both C-130 flights with high-resolution data (10 Hz) and WP-3D flights with low-resolution data (1 Hz). Correlation (R = 0.65) between CH4 and benzene fluxes was observed when flying over shale gas operations, and the enhancement ratio of fluxes was consistent with the corresponding concentration observations. Fluxes calculated by the eddy covariance method show agreement with a mass balance approach within their combined uncertainties. In general, CH4 fluxes in the shale gas regions follow a lognormal distribution, with some deviations for relatively large fluxes (&gt;10 μgm-2 s-1). Statistical analysis of the fluxes shows that a small number of facilities (i.e., ~10%) are responsible for up to ~40% of the total CH4 emissions in the two regions. We show that the airborne eddy covariance method can also be applied in some circumstances when meteorological conditions do not favor application of the mass balance method. We suggest that the airborne eddy covariance method is a reliable alternative and complementary analysis method to estimate emissions from oil and gas extraction