Depression Decreases COPD Medication Adherence

Action Points

  • New episodes of depression were strong predictors of poor adherence to maintenance medications used to manage chronic obstructive pulmonary disease (COPD) among older adults, according to a nationally representative sample of patients.
  • Note that among patients with COPD, depression remains one of the most common, yet least recognized and under-treated, comorbidities, with a prevalence of 17% – 44%.

New onset depression was a strong predictor of poor adherence to maintenance medications among a nationally representative sample of older patients with chronic obstructive pulmonary disease.

Average monthly adherence to COPD maintenance medications was low overall among the cohort of more than 30,000 Medicare beneficiaries, peaking at 57% in the month following first prescription fill after a COPD diagnosis and decreasing to 35% within 6 months.

Adjusted regression analysis linked depression to decreased adherence to COPD medications (odds ratio 0.93, 95% CI 0.89-0.98) in the study by researcher Jennifer Albrecht, PhD, of the University of Maryland School of Medicine, Baltimore, and colleagues published online June 24 in the journal Annals of the American Thoracic Society.

“Comorbid depression in COPD resulted in decreased adherence, as did the presence of any other comorbid condition, except asthma, suggesting that multimorbidity decreases adherence, possibly through complex medication regimens or patient prioritization of one comorbid illness over another,” the researchers wrote.

Even though maintenance medications, including inhaled corticosteroids, long-acting β-agonists and long acting anticholinergics reduce exacerbations and improve lung function among COPD patients with moderate to severe disease, adherence to these medications remains low.

Depression is also a common comorbidity among patients with COPD, and it has been associated with poorer adherence to medications in patients with other chronic diseases, such as diabetes, said study co-author Linda Simoni-Wastila, PhD, of the University of Maryland in Baltimore.

“Depression can easily evade clinicians who are focused on FEVs or a broken hip, but it is a serious condition that can affect an individual’s function, both physical and cognitive. Not to mention quality of life,” she said in an email exchange with MedPage Today.

“Individuals with COPD have a risk of depression and it’s imperative that clinicians consider this risk and treat and/or refer their patients for their emotional health in order to adequately manage COPD.”

The newly published analysis included claims data on 31,033 Medicare beneficiaries diagnosed with COPD between 2006 and 2010 who filled at least two prescriptions for a COPD maintenance medication. Close to two-thirds of the sample (65.8%) were female and more than four-fifths (83.2%) were white.

During a 24-month follow up, roughly 20% of the sample received a diagnosis of depression.

“Depressed beneficiaries were more likely to be female (74.4% versus 62.4%, P<0.001), to have more than three comorbid conditions (32.6% vs 22.6%, P<0.001), and to have evidence of a nursing home stay (12.1% vs 4.8%, P<0.001),” the researchers wrote.

Beneficiaries with depression had more severe COPD symptoms in the month of depression diagnosis as evidenced by higher rates of oxygen use (9.7% versus 8.2%, P<0.001).

Among the cohort overall, adherence to COPD maintenance medications dropped dramatically within the first 6 months of use, but the patients with evidence of depression were less likely to remain adherent than patients without depression.

Just 22% of the overall cohort achieved adherence of 80% or more, even though the cohort included only patients with at least two medication fills over a 2-year period following COPD diagnosis. This suggests that even patients who are highly motivated to remain medication adherent have trouble doing so, the researchers noted.

“While our study findings suggest the first six months after COPD diagnosis is a critical time period for medication monitoring, given the chronic and progressive nature of COPD, close attention throughout the disease’s trajectory may be important,” the researchers wrote.

Patients with the highest risk for poor maintenance medication adherence were those with more than three chronic conditions, but this effect was mitigated by increased severity of COPD symptoms, evidence by acute inhaler oxygen use, and COPD-related hospitalizations.

Study limitations cited by the researchers included the reliance on Medicare claims data to identify depression in the cohort, given that depression tends to be underdiagnosed in administrative claims data.

The burden of depression may have also been underestimated, due to the exclusion of patients with dysthymic disorder and depression related to bipolar and schizoaffective disorder from the study.

The researchers concluded that prospective, longitudinal studies are needed to replicate their findings and to “further explore the relationship of these comorbid conditions.”

Funding for this research was provided by the National Institutes of Health.

The researchers declared no relevant conflicts of interest.

last updated 06.24.2016

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Parkinson's Disease: Prevalence Seen as Rising

Action Points

  • The incidence of both the clinical syndrome of parkinsonism and diagnosed Parkinson disease (PD) appears to have increased from 1976 to 2005, particularly in men 70 years and older, according to a population-based study in a single county in Minnesota.
  • Note that these findings contradict several other studies, in different populations, reporting a stable or slightly decreased PD incidence over the years.

The incidence of both parkinsonism and Parkinson disease (PD) appears to have increased from 1976 to 2005, particularly in men 70 years and older, a population-based study in Minnesota indicated.

The overall incidence rates increased significantly over 30 years in men for both parkinsonism (relative risk 1.17 per decade; 95% CI 1.03-1.33) and PD (RR 1.24 per decade; 95% CI 1.08-1.43), Walter A. Rocca, MD, MPH, of the Mayo Clinic, Rochester, Minn., and colleagues reported online in JAMA Neurology, using data on residents of Olmsted County, Minn., collected in a long-running epidemiology project.

For men 70 years or older, incidence rates were the highest for both parkinsonism (RR 1.24 per decade; 95% CI 1.07-1.44) and PD (RR 1.35 per decade; 95% CI 1.10-1.65), the study showed.

In addition, when 10-year birth cohorts were compared, an increased risk of Parkinson disease was observed in both men and women born in the 1920 (1915-1924) cohort. This finding was only significant in men, the researchers noted.

“If these trends are confirmed in other populations, they may be associated with the dramatic changes in smoking behavior during the last 50 years or with other lifestyle or environmental changes,” they said.

These findings contradict several other studies reporting a stable or slightly decreased PD incidence over the years, Rocca and colleagues noted. “Our study provides evidence contrary to two previous U.S. studies and one Canadian study that showed no trend and particularly contrary to three U.K. studies suggesting a possible decline in the occurrence of PD over time. A study using Swiss mortality data suggested a possible birth cohort effect, with higher risk for cohorts born before the 1920s.”

In an accompanying editorial, Honglei Chen, MD, PhD, of the National Institute of Environmental Health Sciences at Research Triangle Park, NC, said that if these results are confirmed in other studies, they could have “important” implications for public health. It has been estimated that the number of people with PD, based on its incidence in 15 countries 10 years ago, will double by 2030, climbing to 9 million, he pointed out.

“If, indeed, PD incidence has been increasing at the rates suggested [by this study] we would have to revise this estimate to an even larger number, presenting an enormous challenge to our health care system. Effective planning for this possibility will therefore be needed.”

The Parkinson’s Disease Foundation (PDF) views all current estimates of the prevalence of the disease “as likely inaccurate” — those in the new Mayo study as well as previous ones, said James Beck, PhD, vice president of scientific affairs. He noted that they have been drawn from samples that fail to reflect the nation’s full geographic and racial/ethnic diversity. The Olmsted County population, for example, is nearly 100% white and un-urbanized.

Beck said that PDF is using a diverse group of datasets to improve the accuracy of these estimates. “The answers will be the impetus to remind government, industry, and science of the urgency to better treat and end this disease.”

On another front, Chen said the Mayo study moves researchers one step closer to closing the gap, albeit indirectly, on a causal link between cigarette smoking and PD incidence. “The increase of PD incidence may follow decrease in cigarette smoking over the past 50 years, a trend that also affects men more than women,” he noted.

The observation that PD incidence was higher for individuals born around the time of the 1918 influenza epidemic also points to the possible role of early-life infections in risk for PD or parkinsonism late in life, he said. “The study attests to the importance of understanding fundamental epidemiology of neurodegenerative diseases and highlights the unique contributions that are possible by well-designed analyses of high-quality, longitudinal electronic medical records,” Chen wrote.

A total of 906 patients with parkinsonism were identified. The median age at onset was 74 years and 501 were male. Of this group, 275 of 464 patients with PD were male with a median age at onset of 73 years.

“These trends were driven primarily by the older age groups,” the researchers said. “The secular trends were not significant for women overall or in age strata. We observed an increased risk for both men and women born in the 1920 cohort (1915-1924). However, this birth cohort effect was significant only for PD and only in men.”

Limitations of the study included a small, all-white sample size without analysis of multiple system atrophy. Changes in clinical practice and diagnostic criteria in the intervening years may also have had an impact on results, the study authors noted.

This study was supported by the National Institute on Aging of the National Institutes of Health and by the Mayo Foundation for Medical Education and Research. No conflicts of interest were disclosed.

last updated 06.22.2016

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memantine, Namenda, Namenda XR

memantine, Namenda, Namenda XR

Pharmacy Author:

Omudhome Ogbru, PharmD

Medical and Pharmacy Editor:

Jay W. Marks, MD

GENERIC NAME: memantine

BRAND NAME: Namenda, Namenda XR



USES: Memantine is used for the treatment of moderate to
severe dementia associated with Alzheimer’s. Dementia can be categorized into
three levels of severity: mild in which patients are alert and sociable, but
forgetfulness begins to interfere with daily living, moderate which often is the
longest stage of the disease with deterioration of intellect, logic, behavior,
and function, and severe, in which there is loss of long-term memory and
language skills. Patients with severe Alzheimer’s may require 24-hour care and
can no longer complete basic self-care tasks including washing, eating, and
using the bathroom.

SIDE EFFECTS: The most common side effects of memantine are:

Memantine may cause a serious skin reaction called Stevens-Johnson syndrome.

Other potential serious side effects include:

Medically Reviewed by a Doctor on 6/20/2016

Report Problems to the Food and Drug Administration

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.

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Delays in Spotting Dementia Can Bring Dangers

News Picture: Delays in Spotting Dementia Can Bring Dangers

Latest Alzheimers News

THURSDAY, June 2, 2016 (HealthDay News) — A delay in diagnosing dementia can put people at risk, a new study suggests.

People who have signs of probable dementia but haven’t yet been formally diagnosed are nearly twice as likely as those who’ve been diagnosed to be performing potentially unsafe activities such as cooking, driving, and managing their medications and finances.

The study included information from more than 7,600 Americans. All were 65 or older.

The findings showed:

  • About 17 percent of people diagnosed with dementia and 28 percent of undiagnosed people were still driving.
  • Twelve percent of diagnosed people and 29 percent of undiagnosed people kept handling their finances.
  • Seventeen percent of diagnosed people and 42 percent of undiagnosed people continued to cook meals for themselves.
  • Nearly 22 percent of diagnosed people and 50 percent of undiagnosed people were still handling their own medications.

However, the study did find that people with dementia symptoms — whether undiagnosed or diagnosed with dementia — were less likely to engage in such activities overall.

“That in itself is good news, though the numbers are still important from a public health and safety standpoint. Either the patients themselves or their family members are self-regulating and doing these activities less frequently as their disease is progressing,” said study leader Dr. Halima Amjad.

Amjad is a fellow at the Johns Hopkins University School of Medicine’s Division of Geriatric Medicine and Gerontology, in Baltimore.

Patients and their families need to be aware of dementia so doctors and loved ones can take measures to protect patients, the researchers said.

“When patients receive a formal dementia diagnosis, their families are typically aware that, at some point, their loved ones will not be able to drive or will need more help with their medicine,” Amjad said in a university news release.

“But when people are undiagnosed, families and friends may ignore or be unaware of functional problems that already exist,” she added.

About 5 million people in the United States have some form of dementia, including Alzheimer’s disease. That number is expected to nearly triple by 2050, the researchers said.

The study findings were published online June 2 in the Journal of the American Geriatrics Society.

— Robert Preidt

Copyright © 2016 HealthDay. All rights reserved.

SOURCE: Johns Hopkins University, news release, June 2, 2016

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Office cake culture is 'danger to health'

Office cake culture is ‘danger to health’

By James Gallagher
Health editor, BBC News website
  • 24 June 2016
  • From the section Health

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Office cakeImage copyright

Having cake at work to celebrate colleagues’ birthdays, engagements or just surviving the week is a danger to health, a senior dentist argues.

Prof Nigel Hunt, from the Faculty of Dental Surgery, at the Royal College of Surgeons, says “cake culture” is fuelling obesity and dental problems.

At the organisation’s annual dinner for dentists, he will say workplace temptation stops people losing weight.

And staff should be rewarded with fruit, nuts or cheese instead.

Sugar rush

In the speech, he will say: “Managers want to reward staff for their efforts, colleagues want to celebrate special occasions, and workers want to bring back a gift from their holidays.

“But for many people the workplace is now the primary site of their sugar intake and is contributing to the current obesity epidemic and poor oral health.”

He will say nearly 65,000 adults every year need hospital treatment for tooth decay.

Prof Hunt will say: “Cake culture also poses difficulties for those who are trying their hardest to lose weight or become healthier – how many of us have begun such diets only to cave in to the temptation of the doughnuts, cookies or the triple chocolate biscuits?”

Fruit platter

While he does not believe office cake should be banned, he will say it should be purchased in smaller quantities and consumed only with lunch.

Dentists recommend cutting down on sugary or starchy foods between meals as they give bacteria fuel to produce acids that decay teeth.

At the dinner, which is being rounded off with mint panna cotta, British strawberries and chocolate soil, Prof Hunt will say: “Ideally office workers should consider other alternatives altogether like fruit platters, nuts, or cheese.

“Responsible employers should take a lead and avoid such snacks in meetings.”

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Testicle removal surgeon Marwan Farouk struck off

Testicle removal surgeon Marwan Farouk struck off

  • 24 June 2016
  • From the section Beds, Herts & Bucks

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BMI Chiltern Hospital in Great MissendenImage copyright

Image caption

Dr Marwan Farouk disposed of the testicle in a medical waste bin at BMI Chiltern Hospital

A surgeon who tried to cover up the fact he had cut off a man’s testicle in error has been struck off.

The organ was removed at the private BMI Chiltern Hospital in Buckinghamshire in April 2014.

The Medical Practitioners Tribunal Service (MPTS) heard Dr Marwan Farouk, who had been supposed to remove a cyst, disposed of the testicle and did not tell the patient it had been removed.

The MPTS ruling said Dr Farouk had been misleading or dishonest.

‘Chuck it’

In a case brought by the General Medical Council (GMC), the tribunal heard Dr Farouk was meant to repair a hernia and remove a cyst on the epididymis, which is attached to the testicle, at the hospital in Great Missenden.

However, he removed the patient’s entire right testicle.

For more Buckinghamshire stories, visit the BBC Local Live page

A theatre nurse told the tribunal she had been told to “chuck it”, or words to that effect, although it was the doctor who actually disposed of the testicle in a medical waste bin.

After the operation, Dr Farouk failed to tell the patient it had been removed and instead told the man “he had a small right testicle, but it won’t give you any problems”, or words to that effect.

Dr Farouk admitted to the hearing he had removed the testicle and failed to ensure it was sent to the histology department for testing.

The tribunal did not believe Dr Farouk’s evidence that he had not recognised the specimen to be a testicle and that was why he had not recorded any tissue being removed.

‘Deliberate acts’

The ruling said: “As an experienced surgeon, even on a cursory examination, you must have recognised the specimen for what it was.

“This was a series of deliberate acts designed by you to cover up the fact you had made an error.”

The tribunal found it was not proven that Dr Farouk had operated outside his area of expertise or that he failed to tell the patient’s GP that the entire testicle had been removed.

The ruling concluded that the surgeon’s misconduct meant his fitness to practise was impaired. He has 28 days to appeal.

A BMI spokesman said: “Dr Farouk’s practising privileges at the Chiltern Hospital were removed following the incident and our own investigation.

“We will apply any lessons learned from the hearing.”

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Flint children's blood lead levels rose in water crisis: U.S. officials

A sign is seen next to a water dispenser at North Western High School in Flint, Michigan, May 4, 2016. REUTERS/Carlos Barria
A sign is seen next to a water dispenser at North Western High School in Flint, Michigan, May 4, 2016.

Reuters/Carlos Barria

Federal health officials on Friday confirmed that the blood lead levels of children in Flint, Michigan, rose after the city switched to the Flint River as the source of its drinking water, exposing residents to dangerously high contamination.

Flint, with a population of about 100,000, was under control of a state-appointed emergency manager in 2014 when it switched its water source to the river from Detroit’s municipal system to save money. The city switched back in October.

The river water was more corrosive than the Detroit system’s and caused more lead to leach from aging pipes.

Lead can be toxic, and children are especially vulnerable. The crisis has prompted lawsuits by parents who say their children have shown dangerously high levels of lead in their blood.

U.S. Centers for Disease Control and Prevention officials said on Friday that they found that the percentage of young children with elevated blood lead levels was significantly higher when the water source was the Flint River.

“This crisis was entirely preventable, and a startling reminder of the critical need to eliminate all sources of lead from our children’s environment,” Patrick Breysse, director of the agency’s National Center for Environmental Health, said in a statement.

When the water source was switched back to the Detroit system, the agency said, the percentage of children under 6 years old with elevated blood lead returned to levels seen before the switch.

The agency urged residents to use filters on their faucets to get water for drinking, cooking and brushing teeth. It said regular tap water could be used for bathing and showering because lead is not absorbed into the skin, but young children should not be allowed to drink bath water.

The U.S. Environmental Protection Agency said on Thursday that properly filtered water in Flint was safe to drink. City officials, however, said bottled water was still needed since not every home can use the filters.

(Reporting by Ben Klayman; Editing by Lisa Von Ahn)

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Arizona says it has run out of drugs for executions

The execution chamber at the Arizona State Prison Complex- Florence - HU9 is shown in the screen grab from a video provided by the Arizona Department of Corrections March 4, 2015.  REUTERS/Arizona Department of Corrections/Handout
The execution chamber at the Arizona State Prison Complex- Florence – HU9 is shown in the screen grab from a video provided by the Arizona Department of Corrections March 4, 2015.

Reuters/Arizona Department of Corrections/Handout

Arizona has run out of execution drugs, including a sedative implicated in botched lethal injections, according to a filing on Friday in a court case challenging the U.S. state’s execution methods.

The Arizona Department of Corrections’ supply of midazolam, a sedative, expired on May 31 and it has not been able to replace it, state lawyers said in the filing in Phoenix’s U.S. District Court.

“What is more, the Department’s source of midazolam has vanished under pressure from death penalty opponents,” the court document said.

The lawsuit was filed on behalf of seven death-row inmates who allege that Arizona’s use of midazolam and two other drugs violate the U.S. Constitution’s ban on cruel and unusual punishment.

Since midazolam was at the heart of the lawsuit, the filing asked the judge hearing the case, Neil Wake, to decide whether the suit was moot.

The document said the Department of Corrections also lacked the execution drugs pentobarbital and sodium thiopental.

Arizona has not carried out an execution since the July 2014 execution of Joseph Wood. He was administered 14 times the allowed doses of midazolam and a narcotic, hydromorphone, and took almost two hours to die.

Midazolam, a relative of Valium, has also been cited in a troubled 2014 execution in Oklahoma. It was at the center of a U.S. Supreme Court decision last year where the court upheld its use in Oklahoma.

After the high court’s ruling, Arizona switched to a three-step protocol of midazolam, a paralytic drug and potassium chloride, which stops the heart.

The protocol was the same as that decided in the Supreme Court case, and state lawyers have argued that midazolam thus was acceptable for use in Arizona.

But Wake has ruled that Supreme Court decisions in the Oklahoma case and another involving midazolam were based only on the facts specific to them.

Drug company Pfizer Inc (PFE.N) said last month it had banned the sale of execution drugs, including midazolam. The move cut off the last major U.S. source for drugs in the deadly mixes.

The number of inmates executed in the United State has plummeted since the 1990s, with 14 executions so far this year, according to the Death Penalty Information Center.

(Reporting by Ian Simpson in Washington; Editing by Mary Milliken)

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