Safety of cardiovascular disease drugs approved between 2014 and 2021 in the US: a pharmacovigilance analysis

BACKGROUND

Recently FDA-approved drugs for cardiovascular disease (CVD) require robust post-marketing surveillance. The objective of this study was to assess their safety using a large pharmacovigilance database.

RESEARCH DESIGN AND METHODS

We analyzed adverse event (AE) reports for 17 drugs approved from 2014 to 2021, utilizing the FDA Adverse Event Reporting System (FAERS). Descriptive and disproportionality analyses were conducted by estimating the reporting odds ratio (ROR) and its 95% confidence interval.

RESULTS

Among the 43,664,773 AE reports 97,702 (0.22%) were related to newly approved CVD drugs. No AEs were reported for finerenone and evinacumab. The results from the disproportionality analyses revealed potential risks of acute kidney injury (ROR = 8.24, 95% CI: 6.05-11.22), cardiac failure (ROR = 4.80, 95% CI: 3.82-6.05), and hypotension (ROR = 3.98, 95% CI: 3.44-4.61) among sacubitril/valsartan users. Additionally, ivabradine was found to be associated with tachycardia (ROR = 11.94, 95% CI: 8.35-17.08), abnormal feeling (ROR = 4.40, 95% CI: 2.70-7.18), and dizziness (ROR = 2.56, 95% CI: 1.68-3.90).

CONCLUSIONS

This study identified specific safety concerns related to recently approved CVD drugs. Further research is required to understand the underlying mechanisms and clinical implications of these findings.

COVID-19 knowledge and mental health impact assessment in Haiti

Mental health is a significant public health challenge globally, and one anticipated to increase following the COVID-19 pandemic. In many rural regions of developing nations, little is known about the prevalence of mental health conditions and factors that may help mitigate poor outcomes. This study assessed the impact of the COVID-19 pandemic on mental health and social support for residents of rural Haiti. Data were collected from March to May 2020. The Patient Health Questionnaire subscales for anxiety and depression, and the Perceived Stress Scale were utilized in addition to tailored questions specific to COVID-19 knowledge. Half (51.8%) of the 500 survey respondents reported COVID-19-related anxiety and worrying either daily or across a few days. Half (50.2%) also reported experiencing depression daily or across several days. Most (70.4%) did not have any social support, and 28.0% experienced some stress, with 13.4% indicating high perceived stress. Furthermore, 4.6% had suitable plumbing systems in their homes. The results were immediately actionable, informing the implementation of a mental health counseling program for youth following a loss of social support through school closures. Long-term investments must be made as part of public health responses in rural communities in developing nations, which remain under-studied.

Uptake and Utilization of the COVID-19 Alert App within a University Community in New York

The rapid onset of the COVID-19 pandemic elicited a swift response to control the virus ubiquitous within the United States. Expanded telehealth and health informatics became critical components of the pandemic response. The aim of this study was to assess the utilization of the COVID-19 New York (NY) Alert App and identify the perceived benefits and limitations of the App. A cross-sectional design was employed to collect data by using questionnaires with closed-ended and open-ended questions. The survey was developed and administered during March through April 2021. The study found that the highest rated benefit from using the COVID-19 NY Alert App was receiving alerts about being in close proximity to individuals diagnosed with COVID-19. Results showed that ineffective (insufficient and inappropriate) usage was the highest rated potential challenge for using the App. Study subjects were likely to download this Alert App when they perceived more benefits and less barriers to using the App. Findings from this study can help improve utilization of the App and inform development of similar tele-education tools. The study illuminated considerations for health information applications in scaling-up traditional COVID-19 tracing efforts and may facilitate the design of similar emergency preparedness health technology.

Supplementing branched-chain volatile fatty acids in dual-flow cultures varying in dietary forage and corn oil concentrations. I: Digestibility, microbial protein, and prokaryotic community structure

Branched-chain amino acids are deaminated by amylolytic bacteria to branched-chain volatile fatty acids (BCVFA), which are growth factors for cellulolytic bacteria. Our objective was to determine the dietary conditions that would increase the uptake of BCVFA by rumen bacteria. We hypothesized that increased forage would increase cellulolytic bacterial abundance and incorporation of BCVFA into their structure. Supplemental polyunsaturated fatty acids, supplied via corn oil (CO), should inhibit cellulolytic bacteria growth, but we hypothesized that additional BCVFA would alleviate that inhibition. Further, supplemental BCVFA should increase neutral detergent fiber degradation and efficiency of bacterial protein synthesis more with the high forage and low polyunsaturated fatty acid dietary combination. The study was an incomplete block design with 8 dual-flow continuous cultures used in 4 periods with 8 treatments (n = 4 per treatment) arranged as a 2 × 2 × 2 factorial. The factors were: high forage (HF) or low forage (LF; 67 or 33%), without or with supplemental CO (3% dry matter), and without or with 2.15 mmol/d (which included 5 mg/d of 13C each of BCVFA isovalerate, isobutyrate, and 2-methylbutyrate). The isonitrogenous diets consisted of 33:67 alfalfa:orchardgrass pellet, and was replaced with a concentrate pellet that mainly consisted of ground corn, soybean meal, and soybean hulls for the LF diet. The main effect of supplementing BCVFA increased neutral detergent fiber (NDF) degradability by 7.6%, and CO increased NDF degradability only in LF diets. Supplemental BCVFA increased bacterial N by 1.5 g/kg organic matter truly degraded (6.6%) and 0.05 g/g truly degraded N (6.5%). The relative sequence abundance decreased with LF for Fibrobacter succinogenes, Ruminococcus flavefaciens, and genus Butyrivibrio compared with HF. Recovery of the total 13C dose in bacterial pellets decreased from 144 µg/ mg with HF to 98.9 µg/ mg with LF. Although isotope recovery in bacteria was greater with HF, BCVFA supplementation increased NDF degradability and efficiency of microbial protein synthesis under all dietary conditions. Therefore, supplemental BCVFA has potential to improve feed efficiency in dairy cows even with dietary conditions that might otherwise inhibit cellulolytic bacteria.

Transforming Parkinson's Care in Africa (TraPCAf): protocol for a multimethodology National Institute for Health and Care Research Global Health Research Group project

BACKGROUND

Parkinson's disease (PD) is the second most common neurodegenerative disorder and, according to the Global Burden of Disease estimates in 2015, was the fastest growing neurological disorder globally with respect to associated prevalence, disability, and deaths. Information regarding the awareness, diagnosis, phenotypic characteristics, epidemiology, prevalence, risk factors, treatment, economic impact and lived experiences of people with PD from the African perspective is relatively sparse in contrast to the developed world, and much remains to be learned from, and about, the continent.

METHODS

Transforming Parkinson's Care in Africa (TraPCAf) is a multi-faceted, mixed-methods, multi-national research grant. The study design includes multiple sub-studies, combining observational (qualitative and quantitative) approaches for the epidemiological, clinical, risk factor and lived experience components, as appropriate, and interventional methods (clinical trial component). The aim of TraPCAf is to describe and gain a better understanding of the current situation of PD in Africa. The countries included in this National Institute for Health and Care Research (NIHR) Global Health Research Group (Egypt, Ethiopia, Ghana, Kenya, Nigeria, South Africa and Tanzania) represent diverse African geographies and genetic profiles, with differing resources, healthcare systems, health and social protection schemes, and policies. The research team is composed of experts in the field with vast experience in PD, jointly led by a UK-based and Africa-based investigator.

DISCUSSION

Despite the increasing prevalence of PD globally, robust data on the disease from Africa are lacking. Existing data point towards the poor awareness of PD and other neurological disorders on the continent and subsequent challenges with stigma, and limited access to affordable services and medication. This multi-site study will be the first of its kind in Africa. The data collected across the proposed sub-studies will provide novel and conclusive insights into the situation of PD. The selected country sites will allow for useful comparisons and make results relevant to other low- and middle-income countries. This grant is timely, as global recognition of PD and the public health challenge it poses builds. The work will contribute to broader initiatives, including the World Health Organization's Intersectoral global action plan on epilepsy and other neurological disorders.

TRIAL REGISTRATION

https://doi.org/10.1186/ISRCTN77014546 .

Feasibility and acceptability of miracle fruit application prior to the consumption of sour-tasting foods as a weight-loss strategy in adults with diabetes or prediabetes: A randomized crossover trial

Miracle fruit (MF) has emerged as a promising option for healthy noncaloric sweeteners due to its sour-to-sweet taste-modifying effects and high antioxidant activity. We aimed to examine the feasibility and acceptability of using MF as a weight-loss strategy for individuals with diabetes or prediabetes. Fifty Korean-American men and women (25 participants each) aged 45-75 years with diabetes or prediabetes were recruited in this study. They participated in a randomized placebo-controlled crossover trial where they took the assigned tablet (either an MF tablet or a placebo-sugar candy) 10 min before consuming food. Using a 9-point hedonic scale, participants assessed the likings of overall, flavor, texture, and aftertaste for green apples, goat cheese, lemonade, pickles, and plain fat-free yogurt before and 10 min after taking the assigned tablet. Additionally, overall liking for meals and calorie intake were assessed during subsequent ad libitum meal sessions. An ANOVA for a crossover design, and independent and paired t-tests were used to compare the outcomes. The results revealed that all postintervention liking values for sour-tasting foods were higher than the respective preintervention liking values for both interventions. However, the MF intervention showed significantly higher pre-post differences in liking for all sour-tasting foods and the overall liking values for breakfast and dinner compared to the placebo intervention (P < 0.001). Furthermore, the MF intervention resulted in a significantly lower calorie intake for each meal than the placebo (P < 0.001). These findings suggest that MF intervention can be considered a viable weight-loss strategy for individuals with diabetes.

Harnessing an Integrated Health Communication (IHC) Framework for Campaigns: A Case of Prescription Drug Decision Making

Drawing on a multiplicity of mass media and health behavior theories, we propose an integrated health communication (IHC) framework to understand and leverage the ways in which mass mediated and interpersonal sources of health information influence the public's health behavior in the context of their prescription drug decisions. Building on the agenda setting theory, two-step flow theory, and the Health Belief Model, we dig into the interrelationships between mass media and interpersonal information sources and information seeking engagement. Employing survey methodology, our framework was tested using a sample of U.S. adults (N = 628). The major results include (a) information gained through interpersonal sources and perceived benefits of the prescription drugs positively and sequentially mediate the association between mass media exposure and intent to seek prescription drug information, (b) interpersonal health information positively moderate the mediation of mass media exposure - perceived benefits - intent to seek prescription drug information, and (c) the inexpert interpersonal information's positive interaction effect with mass media exposure on intent to seek prescription drug information mediated through perceived benefits was greater with high expert interpersonal communication. These results impart valuable theoretical contributions and have the potential to guide integrated health communication (IHC) campaigns.

Interpersonal Communication Influence on Health-Protective Behaviors amid the COVID-19 Crisis

The 2019 novel coronavirus (COVID-19) has posed substantial threats to global public health. Individuals are extensively exposed to interpersonal sources of health information (e.g., family, friends, colleagues, physicians, and pharmacists). Interpersonal connections often encourage people to question or reinforce other sources of health information, which can affect their perceptions and behaviors. This study integrates research on how exposure to interpersonal health communication affects people's risk perception and affective responses to influence health-protective behaviors such as health information seeking and adherence to protective measures. Findings from an online survey of U.S. adults (n = 488) demonstrated that risk perception and affective responses serve as behavioral motivation factors. The influences of cognitive and affective responses were greater to the extent that individuals believed the health-protective behaviors are beneficial. Our study illuminates how people engage in preventive health behaviors to protect themselves in the COVID-19 context and demonstrates the influence of interpersonal social networks in motivating such behaviors. The theoretical and practical implications of these findings are discussed.

Optimistic Bias and Consumer Prescription Drug Decisions: Influences of Direct to Consumer Advertising and Perceived Susceptibility

This study examines how optimistic bias moderates the association of direct-to-consumer prescription drug advertising (DTCA) exposure with consumers' responses to DTCA. We propose and test a model that addresses how exposure to DTCA plays a role in health risk assessment and prescription drug decision engagement. Findings from an online survey of U.S. adults (n = 628) demonstrated that exposure to DTCA is positively associated with consumers' perceived susceptibility and negatively associated with optimistic bias about health risk. The relationship between DTCA exposure and prescription decision engagement was mediated through perceived susceptibility, and this process was moderated by optimistic bias. The study's theoretical implications are discussed along with its consumer and public health implications.

Propionate Attenuates Growth of Oral Streptococci through Enhancing Methionine Biosynthesis

Oral streptococci are considered as an opportunistic pathogen associated with initiation and progression of various oral diseases. However, since the currently-available treatments often accompany adverse effects, alternative strategy is demanded to control streptococci. In the current study, we investigated whether short-chain fatty acids (SCFAs), including sodium acetate (NaA), sodium propionate (NaP), and sodium butyrate (NaB), can inhibit the growth of oral streptococci. Among the tested SCFAs, NaP most potently inhibited the growth of laboratory and clinically isolated strains of Streptococcus gordonii under anaerobic culture conditions. However, the growth inhibitory effect of NaP on six different species of other oral streptococci was different depending on their culture conditions. Metabolic changes such as alteration of methionine biosynthesis can affect bacterial growth. Indeed, NaP enhanced intracellular methionine levels of oral streptococci as well as the mRNA expression level of methionine biosynthesis-related genes. Collectively, these results suggest that NaP has an inhibitory effect on the growth of oral streptococci, which might be due to alteration of methionine biosynthesis. Thus, NaP can be used an effective bacteriostatic agent for the prevention of oral infectious diseases caused by oral streptococci.

Development of machine learning models for the screening of potential HSP90 inhibitors

Heat shock protein 90 (Hsp90) is a molecular chaperone playing a significant role in the folding of client proteins. This cellular protein is linked to the progression of several cancer types, including breast cancer, lung cancer, and gastrointestinal stromal tumors. Several oncogenic kinases are Hsp90 clients and their activity depends on this molecular chaperone. This makes HSP90 a prominent therapeutic target for cancer treatment. Studies have confirmed the inhibition of HSP90 as a striking therapeutic treatment for cancer management. In this study, we have utilized machine learning and different in silico approaches to screen the KCB database to identify the potential HSP90 inhibitors. Further evaluation of these inhibitors on various cancer cell lines showed favorable inhibitory activity. These inhibitors could serve as a basis for future development of effective HSP90 inhibitors.

Economic Evaluation of Pharmacist-Led Digital Health Interventions: A Systematic Review

There has been growing interest in integrating digital technologies in healthcare. The purpose of this study was to systematically review the economic value of pharmacist-led digital interventions. PubMed, Web of Science, and the Cochrane databases were searched to select studies that had conducted economic evaluations of digital interventions by pharmacists for the period from January 2001 to February 2022. Economic evidence from 14 selected studies was synthesized in our analysis. Pharmacists used telephones, computers, web-based interventions, videotapes, smartphones, and multiple technologies for their digital interventions. Prior studies have reported the results of telephone-based interventions to be cost-effective. Alternatively, these interventions were found to be cost-effective when reevaluated with recently cited willingness-to-pay thresholds. In addition, pharmacist-led interventions based on computers, web-based interventions, smartphones, and multiple technologies have been reported to be cost-effective in previous studies. However, videotape-based intervention was found cost-ineffective because there was no significant difference in outcomes between the intervention and the usual care groups. If this intervention had been intensive enough to improve outcomes in the intervention group, favorable cost-effectiveness results could have been obtained. The economic evidence in the previous studies represented short-term economic values. Economic evaluations of the long-term value of digital interventions are warranted in future studies.

Effect of zinc source (zinc sulfate or zinc hydroxychloride) on relative abundance of fecal Treponema spp. in lactating dairy cows

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Cows (n = 24) were fed typical lactating diets that only differed in zinc source inclusion.

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Fecal samples collected from cows were extracted for prokaryotic 16S gene DNA.

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Feeding zinc hydroxychloride decreased the Treponema spp. recovered from fecal samples compared with cows fed zinc sulfate.

Previous research revealed a potential effect of dietary trace mineral source on both ruminal and fecal microbiota. However, the effect of Zn source, specifically, has not previously been considered. Based on reported postruminal solubility, we hypothesized that Zn hydroxychloride would decrease Treponema spp. fecal excretion relative to cows fed Zn sulfate. To test this hypothesis, lactating Holstein cows (n = 24; 685 ± 9 kg of body weight; 159 ± 8 d in milk; parity 3 ± 0.2) were randomly assigned to 1 of 2 dietary treatments: control (75 mg/kg Zn from ZnSO₄) or Zn hydroxychloride (HYD; 75 mg/kg IntelliBond Z; Micronutrients USA LLC). Single fecal grab samples were collected on d 1 before dietary treatments and on d 27 after dietary treatments were applied. Fecal microbial DNA was extracted and sequenced to establish taxonomy using a universal primer for the 16S rRNA gene. Supplementation of HYD decreased the relative abundance of Treponema 2 by 3-fold (14.7% vs. 4.9%). Poor sequencing resolution at the species level limited inference of Treponema spp. toward management or gut health implications of HYD supplementation. However, the inclusion of pathogenic species among Treponema spp. indicates a potential implication of HYD feeding to reduce environmental exposure of the dairy cow to Treponema spp.

Credibility in the time of COVID-19: Cues that audiences look for when assessing information on social media and building confidence in identifying ‘fake news’ about the virus

Navigating the COVID-19 pandemic has included parsing an overwhelming amount of information—much of it online. Many Americans have seen information on social media that they find confusing (Mitchell, Oliphant & Shearer, 2020) and recent research has found that social media use may contribute to greater likelihoods of believing misinformation about the virus and sharing ‘fake news’ about it (Su, 2021; Pennycook et al., 2020). Using a survey of U.S. adults, this research determined which social media platforms Americans rely on most when they search for information about COVID-19: Facebook, YouTube and Twitter. The present study also identified the credibility cues that people look to as they are trying to ascertain the veracity of COVID-19 information they come across on social media and that are predictors of helping them feel more confident in their own ability to identify credible information. Those significant cues—believability, authenticity, trustworthiness, reliability and objectivity—confirm previous research by Appelman and Sundar (2016) and Tandoc et al. (2018b). Educators, public health officials, and journalists are among the professionals who can use these findings to create more effective messages designed to assist people in making better health decisions.

Examining the Theory of Motivated Information Management (TMIM) in the COVID-19 Pandemic

In order to inform understanding of the public's health information management during the COVID-19 pandemic, we applied a modification of TMIM from a serial mediation model to a conditional process model (moderated mediation). In doing so, the current study attempted to refine some of the relational propositions of the original TMIM with a focus on efficacy while addressing the distinction between a mediator and a moderator in a behavioral decision model. Findings from an online survey of U.S. adults (n = 488) demonstrated that anxiety can positively motivate evaluation of information seeking during the COVID-19 pandemic context, a unique context of application for TMIM. Efficacy was found to be qualified as an individual difference variable that moderates the relationships of uncertainty perception and health decision. Our newly proposed conditional process framework of the TMIM opens research directions in health information-seeking and encourages researchers to continuously incorporate updated methodological thought and approach in applying and building communication theory.

Short-chain fatty acids inhibit the biofilm formation of Streptococcus gordonii through negative regulation of competence-stimulating peptide signaling pathway

Streptococcus gordonii, a Gram-positive commensal bacterium, is an opportunistic pathogen closely related to initiation and progression of various oral diseases, such as periodontitis and dental caries. Its biofilm formation is linked with the development of such diseases by enhanced resistance against antimicrobial treatment or host immunity. In the present study, we investigated the effect of short-chain fatty acids (SCFAs) on the biofilm formation of S. gordonii. SCFAs, including sodium acetate (NaA), sodium propionate (NaP), and sodium butyrate (NaB), showed an effective inhibitory activity on the biofilm formation of S. gordonii without reduction in bacterial growth. SCFAs suppressed S. gordonii biofilm formation at early time points whereas SCFAs did not affect its preformed biofilm. A quorum-sensing system mediated by competence-stimulating peptide (CSP) is known to regulate biofilm formation of streptococci. Interestingly, SCFAs substantially decreased mRNA expression of comD and comE, which are CSP-sensor and its response regulator responsible for CSP pathway, respectively. Although S. gordonii biofilm formation was enhanced by exogenous synthetic CSP treatment, such effect was not observed in the presence of SCFAs. Collectively, these results suggest that SCFAs have an anti-biofilm activity on S. gordonii through inhibiting comD and comE expression which results in negative regulation of CSP quorum-sensing system. SCFAs could be an effective anti-biofilm agent against S. gordonii for the prevention of oral diseases.

Interpersonal Communication Influence on Health-Protective Behaviors Amid the COVID-19 Crisis

Drawing on a multiplicity of mass media and health behavior theories, we propose an integrated health communication (IHC) framework to understand and leverage the ways in which mass mediated and interpersonal sources of health information influence the public's health behavior in the context of their prescription drug decisions. Building on the agenda setting theory, two-step flow theory, and the Health Belief Model, we dig into the interrelationships between mass media and interpersonal information sources and information seeking engagement. Employing survey methodology, our framework was tested using a sample of U.S. adults (N=628). The major results include (a) information gained through interpersonal sources and perceived benefits of the prescription drugs positively and sequentially mediate the association between mass media exposure and intent to seek prescription drug information, (b) interpersonal health information positively moderate the mediation of mass media exposure-perceived benefits-intent to seek prescription drug information, and (c) the inexpert interpersonal information's positive interaction effect with mass media exposure on intent to seek prescription drug information mediated through perceived benefits was greater with high expert interpersonal communication. These results impart valuable theoretical contributions and have the potential to guide integrated health communication (IHC) campaigns.

Conditions stimulating neutral detergent fiber degradation by dosing branched-chain volatile fatty acids. III: Relation with solid passage rate and pH on prokaryotic fatty acid profile and community in continuous culture

Our objectives were to evaluate potential interactions in culture conditions that influence how exogenously dosed branched-chain VFA (BCVFA) would be recovered as elongated fatty acids (FA) or would affect bacterial populations. A 2 × 2 × 2 factorial arrangement of treatments evaluated 3 factors: (1) without versus with BCVFA (0 vs. 2 mmol/d each of isobutyrate, isovalerate, and 2-methylbutyrate; each dose was partially substituted with ¹³C-enriched tracers before and during the collection period); (2) high versus low pH (ranging diurnally from 6.3 to 6.8 vs. 5.7 to 6.2); and (3) low versus high particulate-phase passage rate (k_p; 2.5 vs. 5.0%/h) in continuous cultures administered a 50:50 forage:concentrate diet twice daily. Samples of effluent were collected and composited before harvesting bacteria from which FA and DNA were extracted. Profiles and enrichments of FA in bacteria were evaluated by gas chromatography and isotope-ratio mass spectrometry. The ¹³C enrichment in bacterial FA was calculated as percentage recovery of dosed ¹³C-labeled BCVFA. Dosing BCVFA increased the even-chain iso-FA, preventing the reduced concentration at higher k_p and potentially as a physiological response to decreased pH. However, decreasing pH decreased recovery of ¹³C in these even-chain FA, suggesting greater reliance on isobutyrate produced from degradation of dietary valine. The iso-FA were decreased, whereas anteiso-FA and 16:0 increased with decreasing pH. Thus, 2-methylbutyrate still appeared to be important as a precursor for anteiso-FA to counter the increased rigidity of bacterial membranes that had more saturated straight-chain FA when pH decreased. Provision of BCVFA stimulated the relative sequence abundance of Fibrobacter and Treponema, both of which require isobutyrate and 2-methylbutyrate. Numerous bacterial community members were shifted by low pH, including increased Prevotella and genera within the phylum Proteobacteria, at the expense of members within phylum Firmicutes. Because of relatively few interactions with pH and k_p, supplementation of BCVFA can stimulate neutral detergent fiber degradability via key fibrolytic bacteria across a range of conditions. Decreasing pH shifted bacterial populations and their FA composition, suggesting that further research is needed to distinguish pH from dietary changes.

Screening of inhibitors against SARS-CoV-2 spike protein and their capability to block the viral entry mechanism: A viroinformatics study

SARS-CoV-2, previously named 2019 novel coronavirus (2019-nCoV), has been associated with the global pandemic of acute respiratory distress syndrome. First reported in December 2019 in the Wuhan province of China, this new RNA virus has several folds higher transmission among humans than its other family member (SARS-CoV and MERS-CoV). The SARS-CoV-2 spike receptor-binding domain (RBD) is the region mediating the binding of the virus to host cells via Angiotensin-converting enzyme 2 (ACE2), a critical step of viral. Here in this study, we have utilized in silico approach for the virtual screening of antiviral library extracted from the Asinex database against the Receptor binding domain (RBD) of the S1 subunit of the SARS-CoV-2 spike glycoprotein. Further, the molecules were ranked based on their binding affinity against RBD, and the top 15 molecules were selected. The affinity of these selected molecules to interrupt the ACE2-Spike interaction was also studied. It was found that the chosen molecules were demonstrating excellent binding affinity against spike protein, and these molecules were also very effectively interrupting the ACE2-RBD interaction. Furthermore, molecular dynamics (MD) simulation studies were utilized to investigate the top 3 selected molecules' stability in the ACE2-RBD complexes. To the best of our knowledge, this is the first study where molecules' inhibitory potential against the Receptor binding domain (RBD) of the S1 subunit of the SARS-CoV-2 spike glycoprotein and their inhibitory potential against the ACE2-Spike has been studied. We believe that these compounds can be further tested as a potential therapeutic option against COVID-19.

Suppressed Degradation and Enhanced Performance of CsPbI3 Perovskite Quantum Dot Solar Cells via Engineering of Electron Transport Layers

CsPbI₃ perovskite quantum dots (CsPbI₃-PQDs) have recently come into focus as a light-harvesting material that can act as a platform through which to combine the material advantages of both perovskites and QDs. However, the low cubic-phase stability of CsPbI₃-PQDs in ambient conditions has been recognized as a factor that inhibits device stability. TiO₂ nanoparticles are the most regularly used materials as an electron transport layer (ETL) in CsPbI₃-PQD photovoltaics; however, we found that TiO₂ can facilitate the cubic-phase degradation of CsPbI₃-PQDs due to its vigorous photocatalytic activity. To address these issues, we have developed chloride-passivated SnO₂ QDs (Cl@SnO₂ QDs), which have low photocatalytic activity and few surface traps, to suppress the cubic-phase degradation of CsPbI₃-PQDs. Given these advantages, the CsPbI₃-PQD solar cells based on Cl@SnO₂ ETLs show significantly improved device operational stability (under conditions of 50% relative humidity and 1-sun illumination), compared to those based on TiO₂ ETLs. In addition, the Cl@SnO₂-based devices showed improved open circuit voltage and photocurrent density, resulting in enhanced power conversion efficiency (PCE) up to 14.5% compared to that of TiO₂-based control devices (PCE of 13.8%).

Content Analysis of 2012-2019 FDA Warning Letters and Notices of Violations using the Economic, Clinical, and Humanistic Outcomes (ECHO) Model

Objective:

The study purpose was to critically review FDA-issued warning letters (WLs) and notice of violation (NOV) letters against drug companies’ from 2012-2019 for economic, clinical, and humanistic (ECHO) claims made in pharmaceutical promotional materials. Specific objectives were to assess the, (1) number of WLs and NOV issued; (2) frequency of WLs and NOV by therapeutic areas; (3) type of communication media cited in WLs or NOV; (4) intended audience for the claims in promotional materials for which the WLs and NOV were issued; and (5) number of WLs and NOV for ECHO claims.

Methods:

The quantitative content analysis approach was employed to review WLs and NOVs, obtained from the FDA website, from January 2012-December 2019. A data abstraction form was created based on the published literature on this topic and assessment of the content of WLs and NOVs for 2010. This form was pilot tested on letters issued in 2011. The researchers discussed any unclear question or information presented in the letters. The letters were reviewed three researchers. If there was disagreement between the reviewers, either a fourth reviewer arbitrated on the disagreement or the letter(s) were discussed by the researchers to determine a final classification. ICD-10 codes were used for therapeutic categories in the data collected form. Descriptive statistics, Kappa statistics for interrater reliability, and Cochrane-Armitage test were performed using IBM SPSS Statistics version 24.0

Results:

A total of 102 letters were analyzed. Of these, 19 (19%) were WLs and 83 (81%) were NOVs. Majority of these letters were issued to manufacturers of therapeutic agents for diseases of the nervous system (n=15; 14.7%) and neoplasms (n=15; 14.7%). The most commonly cited media for violation was online website (n=29; 27.1%). Out of the 153 violations in 102 letters, 92 (60.1%) were clinical; 13 (8.5%) humanistic; 2 (1.3%) were economic; and 46 (30%) were categorized as ‘Others’.

Conclusion:

The study found misleading claims of the clinical effectiveness and risk information included in the promotional materials targeted to consumers as well as healthcare providers. Promoting reliable, evidence-based information is important for the health of the public as inadequate information could lead to irrational decision making both on consumer as well as on prescriber side.

Effects of diet fermentability and supplementation of 2-hydroxy-4-(methylthio)-butanoic acid and isoacids on milk fat depression: 2. Ruminal fermentation, fatty acid, and bacterial community structure

The experiment was conducted to understand ruminal effects of diet modification during moderate milk fat depression (MFD) and ruminal effects of 2-hydroxy-4-(methylthio)-butanoic acid (HMTBa) and isoacids on alleviating MFD. Five ruminally cannulated cows were used in a 5 × 5 Latin square design with the following 5 dietary treatments (dry matter basis): a high-forage and low-starch control diet with 1.5% safflower oil (HF-C); a low-forage and high-starch control diet with 1.5% safflower oil (LF-C); the LF-C diet supplemented with HMTBa (0.11%; 28 g/d; LF-HMTBa); the LF-C diet supplemented with isoacids [(IA) 0.24%; 60 g/d; LF-IA]; and the LF-C diet supplemented with HMTBa and IA (LF-COMB). The experiment consisted of 5 periods with 21 d per period (14-d diet adaptation and 7-d sampling). Ruminal samples were collected to determine fermentation characteristics (0, 1, 3, and 6 h after feeding), long-chain fatty acid (FA) profile (6 h after feeding), and bacterial community structure by analyzing 16S gene amplicon sequences (3 h after feeding). Data were analyzed using the MIXED procedure of SAS (SAS Institute Inc., Cary, NC) in a Latin square design. Preplanned comparisons between HF-C and LF-C were conducted, and the main effects of HMTBa and IA and their interaction within the LF diets were examined. The LF-C diet decreased ruminal pH and the ratio of acetate to propionate, with no major changes detected in ruminal FA profile compared with HF-C. The α-diversity for LF-C was lower compared with HF-C, and β-diversity also differed between LF-C and HF-C. The relative abundance of bacterial phyla and genera associated indirectly with fiber degradation was influenced by LF-C versus HF-C. As the main effect of HMTBa within the LF diets, HMTBa increased the ratio of acetate to propionate and butyrate molar proportion. Ruminal saturated FA were increased and unsaturated FA concentration were decreased by HMTBa, with minimal changes detected in ruminal bacterial diversity and community. As the main effect of IA, IA supplementation increased ruminal concentration of all branched-chain volatile FA and valerate and increased the percentage of trans-10 C18 isomers in total FA. In addition, α-diversity and the number of functional features were increased for IA. Changes in the abundances of bacterial phyla and genera were minimal for IA. Interactions between HMTBa and IA were observed for ruminal variables and some bacterial taxa abundances. In conclusion, increasing diet fermentability (LF-C vs. HF-C) influenced rumen fermentation and bacterial community structure without major changes in FA profile. Supplementation of HMTBa increased biohydrogenation capacity, and supplemental IA increased bacterial diversity, possibly alleviating MFD. The combination of HMTBa and IA had no associative effects in the rumen and need further studies to understand the interactive mechanism.

Effect of Treatment with the PD-1/PD-L1 Inhibitors on Key Health Outcomes of Cancer Patients

BACKGROUND

Recent studies have shown that treatment with the programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitor class could significantly improve survival outcomes in several oncology indications. However, there is some clinical uncertainty.

OBJECTIVE

This study aimed to obtain high-level estimates of the impact of treatment with PD-1/PD-L1 inhibitor class to oncology treatment on key health outcomes in real-world situations and to inform public health policy decisions about cancer care after reducing uncertainties around new immuno-oncology therapy options in South Korea.

METHODS

A model was developed to estimate the impact of PD-1/PD-L1 inhibitors on outcomes in situations wherein both anti-PD-1/PD-L1s and standard of care (SOC) were available versus SOC only. A partitioned survival model was utilized to estimate the impact of introducing anti-PD-1/PD-L1s on outcomes, including life-years gained, quality-adjusted life-years gained, progression-free survival-years obtained, and grade 3 or higher adverse events avoided for six indications over 5 years. An exponential distribution was fitted to the survival function of the SOC based on visual inspection. Outcomes associated with anti-PD-1/PD-L1s were estimated using a piecewise modeling approach with Kaplan-Meier analysis followed by best-fitting survival analysis. The incident number of patients and market share of anti-PD-1/PD-L1s during 2020-2024 were projected using published literature and Korean market survey data. Sensitivity analyses were performed to test the uncertainty of input parameters.

RESULTS

During the next 5-year period (2020-2024), introducing the anti-PD-1/PD-L1 class led to a gain of 22,001 life-years (+ 31%), 19,073 quality-adjusted life-years (+ 38%), and 22,893 progression-free survival-years (+ 82%); it also avoided 3610 adverse events (- 11%) compared with SOC alone. Most adverse events associated with anti-PD-1/PD-L1s were attributed to combination therapy with cytotoxic chemotherapy (91%). In a scenario wherein the time to reimbursement of the anti-PD-1/PD-L1s was accelerated by 1 year, the life-years gained increased by 14% compared with the base-case scenario.

CONCLUSIONS

Anti-PD-1/PD-L1 therapy is expected to provide marked survival benefits for patients with cancer. This study demonstrated the potentially beneficial health impacts of utilizing the anti-PD-1/PD-L1 class at the population level. The findings could inform health policy decision makers about cancer care and ultimately enhance population health through rapid access to innovative cancer drugs.

Enhanced biofilm formation of Streptococcus gordonii with lipoprotein deficiency

Streptococcus gordonii is a commensal Gram-positive bacterium that acts as an opportunistic pathogen that can cause apical periodontitis, endocarditis, and pneumonia. Biofilm formation of bacteria is important for the initiation and progression of such diseases. Although lipoproteins play key roles in physiological functions, the role of lipoproteins of S. gordonii in its biofilm formation has not been clearly understood. In this study, we investigated the role of lipoproteins of S. gordonii in the bacterial biofilm formation using its lipoprotein-deficient strain (Δlgt). The S. gordonii Δlgt exhibited increased biofilm formation on the human dentin slices or on the polystyrene surfaces compared to the wild-type strain, while its growth rate did not differ from that of the wild-type. In addition, the S. gordonii Δlgt strain exhibited the enhanced LuxS mRNA expression and AI-2 production, which is known to be a positive regulator of biofilm formation, compared to the wild-type. Concordantly, the augmented biofilm formation of S. gordonii Δlgt was attenuated by an AI-2 inhibitor, D-ribose. In addition, lipoproteins from purified S. gordonii inhibited the biofilm formation of S. gordonii wild-type and Δlgt. Taken together, these results suggest that lipoprotein-deficient S. gordonii form biofilms more effectively than the wild-type strain, which might be related to the AI-2 quorum-sensing system.

Health care use and expenditures attributable to cancer: A population-based study

BACKGROUND

As more people are living with cancer due to increases in cancer survival, it is important to understand cancer burden. Studies have examined cancer-related costs using data more than a decade ago.

OBJECTIVE

To update the economic burden and uniquely provide health care service use attributable to cancer using a nationally representative sample of the U.S.

POPULATION

METHODS

Data were obtained from the 2008-2015 Medical Expenditure Panel Survey (MEPS). Individuals with cancer were matched to those without cancer in terms of demographics and comorbidities based on a propensity score (PS). For outcomes of health care use, a (zero-inflated) negative binomial model was employed. To analyze the outcomes of health care spending, a generalized linear model with a log link function and gamma distributed errors (or a two-part model) was used.

RESULTS

Compared to the PS-matched noncancer controls, individuals with cancer received 1.05, 1.08, and 1.76 times more frequent annual emergency department (ED) visit care, hospitalization care, and hospital outpatient visit care, respectively. Additionally, people with cancer received prescriptions and office-based visit care about 5 times and 20 times more frequently. An average annual total health care spending among those with cancer was about $4100 higher. Average annual expenses on hospitalizations, office-based visits, hospital outpatient visits, and prescriptions among those with cancer were also about $1,400, $1,400, $700, and $300 higher. However, there was no significant difference in expenses on ED visit and out-of-pocket expenses on prescriptions between people with cancer and noncancer controls.

CONCLUSIONS

Individuals with cancer used all types of health care services more frequently than noncancer controls. Accordingly, expenditures on various types of health care services among those with cancer were higher.

Optimistic bias and preventive behavioral engagement in the context of COVID-19

Background

The coronavirus (COVID-19) pandemic presents a global crisis. To remain safe, individuals must take preventive measures. Health behavior theories suggest that perceived risk is a key determinant of engagement in preventive behavior. People often underestimate their risk for disease compared with similar others’, a phenomenon known as optimistic bias (OB).

Objective

This study aimed to explore how OB affected individuals' engagement in COVID-19 preventive behavior/intentions. Based on health behavior theories, this study considered risk perception and risk response as mediators of the relationship between OB and individuals’ preventive health behaviors and intentions.

Methods

This study used a cross-sectional survey design. Online survey platforms were used to recruit U.S. adults. A total of 293 valid responses were included in the analyses. Multivariate regression analyses were conducted to determine the relationship of OB to the respondents’ health information seeking intention and related behavioral outcomes.

Results

Results from the first regression model showed that OB was negatively related to risk perception. In other words, optimistically biased respondents perceived their risk of COVID-19 to be low. The second model demonstrated that perceived risk was related positively to affective responses to risk (e.g., worry and fear). That is, the lower their perceived risk of COVID-19, the less likely respondents were to feel anxiety and fear about this disease. Models 3 and 4 revealed positive relationships between risk response and respondents’ intentions and behaviors. Finally, the results supported a fully mediated pathway: OB → risk perception → risk response → information seeking intention and behavioral outcomes.

Conclusions

The study findings suggest that by decreasing their perceived risk and subsequent responses, optimistic bias can undermine individuals’ motivation to take precautions. To reduce this bias, the actual risk of COVID-19 should be reinforced.

Consumer Engagement with Prescription Medicine Decisions: Influences of Health Beliefs and Health Communication Sources

Consumers' prescription drug decisions are affected by a number of structural, psychological, and health communication source variables. To provide a theoretically sound and comprehensive prescription medication decision engagement framework, this study integrated Andersen's Health Service Use Model to address contextual and structural factors, the Health Belief Model (HBM) to examine psychological factors, and extant research on the influence of various health communication sources to explain the prescription drug decision engagement mechanisms of health information-seeking intention, prescription drug-seeking intent, and prescription-seeking behavior. Employing survey methodology, the framework was tested using a sample of U.S. adult consumers (N = 370). Results demonstrated the utility of the integrated model for explaining consumers' participation in their prescription decisions. Specifically, consumers' assessment of target health behaviors and the use of various health communication sources significantly improved the explanatory power of the decision engagement model beyond structural factors. The results impart valuable theoretical contributions and have the potential to guide public health interventions related to consumers' prescription drug decisions.

P10.02 Differentiating microglia and tumour associated macrophages in high grade glioma

BACKGROUND

Glioblastoma multiforme (GBM) is the most common primary brain tumour that affects adults. This aggressive tumour is invariably fatal, carrying a rapid progression and a dismal median survival period of only 15 months despite multimodal treatment approaches. Central to GBM pathogenesis is the immunosuppressive profile of these tumours. The two cell types that are highly abundant in these tumours and play critical roles in the immunosuppressive niche are the brain’s resident microglia and their peripheral counterparts - tumour associated macrophages (TAMs). Despite microglia and TAMs being ontogenetically distinct, these cells have largely been grouped together in research owing to the previous lack of cell-specific markers. Recent evidence has suggested that although TAMs may hold a predominantly pro-tumoral role, microglia may adopt a more anti-tumoral phenotype. Therefore, the differentiation of these two cell types is critical in elucidating the potentially characteristic roles of these two cell types in GBM pathogenesis.

MATERIAL AND METHODS

Tissue sections from resected low- and high-grade glioma tumours, along with epilepsy tissue (control), were used for immunohistochemistry (IHC) staining of macrophage pan-makers (Iba1, CD45, PU.1) and microglial-specific markers (TMEM119, P2RY12). Marker co-localisation was then used to differentiate microglia from TAMs. We further investigated a wider subset of cell-specific markers using multicolour flow cytometry and immunocytochemical staining of isolated cells from patient tissue samples.

RESULTS

Immunofluorescent staining of glioma and epilepsy tissue revealed two clear populations of cells; one population displayed long processes and co-labelling for both pan- and microglial-specific markers, whilst the other population displayed an amoeboid phenotype with only pan-maker staining. Preliminary analysis comparing microglia/TAM populations in low-grade, high-grade and epilepsy tissue suggests a clear difference in the proportions of these cells.

CONCLUSION

Our work complements RNA-Seq studies, showing that TMEM119 and P2RY12, alongside other markers, can indeed identify two distinct myeloid cell populations within glioma tissue. This provides a strong basis for further study where we aim to elucidate the respective roles of microglia and TAMs within tumours. Ultimately, this may hold the potential for differential targeting of these cells using immunotherapies.

Validation of a nomogram to predict the risk of cancer in patients with intraductal papillary mucinous neoplasm and main duct dilatation of 10 mm or less

BACKGROUND

Intraductal papillary mucinous neoplasm (IPMN) is premalignant pancreatic lesion. International guidelines offer limited predictors of individual risk. A nomogram to predict individual IPMN malignancy risk was released, with good diagnostic performance based on a large cohort of Asian patients with IPMN. The present study validated a nomogram to predict malignancy risk and invasiveness of IPMN using both Eastern and Western cohorts.

METHODS

Clinicopathological and radiological data from patients who underwent pancreatic resection for IPMN at four centres each in Eastern and Western countries were collected. After excluding patients with missing data for at least one malignancy predictor in the nomogram (main pancreatic duct diameter, cyst size, presence of mural nodule, serum carcinoembryonic antigen and carbohydrate antigen (CA) 19-9 levels, and age).

RESULTS

In total, data from 393 patients who fit the criteria were analysed, of whom 265 were from Eastern and 128 from Western institutions. Although mean age, sex, log value of serum CA19-9 level, tumour location, main duct diameter, cyst size and presence of mural nodule differed between the Korean/Japanese, Eastern and Western cohorts, rates of malignancy and invasive cancer did not differ significantly. Areas under the receiver operating characteristic (ROC) curve values for the nomogram predicting malignancy were 0·745 for Eastern, 0·856 for Western and 0·776 for combined cohorts; respective values for the nomogram predicting invasiveness were 0·736, 0·891 and 0·788.

CONCLUSIONS

External validation of the nomogram showed good performance in predicting cancer in both Eastern and Western patients with IPMN lesions.

Impacts of the Regional Greenhouse Gas Initiative (RGGI) on infant mortality: a quasi-experimental study in the USA, 2003-2014

OBJECTIVES

The Regional Greenhouse Gas Initiative (RGGI) is the first mandatory market-based regulatory programme to limit regional carbon dioxide (CO₂) emissions in the USA. Empirical evidence has shown that high concentrations of ambient air pollutants such as CO₂ have been positively associated with an increased risk of morbidity (eg, respiratory conditions including asthma and lung cancer) and premature mortality. The purpose of this study was to examine the impacts of RGGI on death rates in infancy.

DESIGN

A quasi-experimental difference-in-differences design.

SETTING AND PARTICIPANTS

We estimated the impacts of RGGI on infant mortality from 2003 through 2014 in the USA (6 years before and after RGGI implementation). Our analytic models included state- and year-fixed effects in addition to a number of covariates.

OUTCOME MEASURES

Death rates in infancy: neonatal mortality rates (NMRs), deaths under 28 days as well as infant mortality rates (IMRs), deaths under 1 year.

RESULTS

Implementation of RGGI was associated with significant decreases in overall NMRs (a reduction of 0.41/1000 live births) and male NMRs (a reduction of 0.43/1000 live births). However, RGGI did not have a significant effect on female NMRs. Similarly, overall IMRs and male IMRs decreased significantly by 0.37/1000 live births and 0.61/1000 live births, respectively, after implementation of RGGI while female IMRs were not significantly affected by RGGI.

CONCLUSIONS

RGGI was associated with decreases in overall infant mortality and boy mortality through reducing air pollutant concentrations. Of note, the impact of this environmental policy on infant girls was much smaller.

Acute and Chronic Effects of Cocaine on Cardiovascular Health

Cardiac complications resulting from cocaine use have been extensively studied because of the complicated pathophysiological mechanisms. This study aims to review the underlying cellular and molecular mechanisms of acute and chronic effects of cocaine on the cardiovascular system with a specific focus on human studies. Studies have consistently reported the acute effects of cocaine on the heart (e.g., electrocardiographic abnormalities, acute hypertension, arrhythmia, and acute myocardial infarction) through multifactorial mechanisms. However, variable results have been reported for the chronic effects of cocaine. Some studies found no association of cocaine use with coronary artery disease (CAD), while others reported its association with subclinical coronary atherosclerosis. These inconsistent findings might be due to the heterogeneity of study subjects with regard to cardiac risk. After cocaine use, populations at high risk for CAD experienced coronary atherosclerosis whereas those at low risk did not experience CAD, suggesting that the chronic effects of cocaine were more likely to be prominent among individuals with higher CAD risk. Studies also suggested that risky behaviors and cardiovascular risks may affect the association between cocaine use and mortality. Our study findings highlight the need for education regarding the deleterious effects of cocaine, and access to interventions for cocaine abusers.

Is Antibiotic Prophylaxis Cost-effective for Dental Patients Following Total Knee Arthroplasty?

Introduction:

Routine antibiotic prophylaxis (AP) to prevent prosthetic joint infection remains controversial. The lack of prophylaxis guideline consensus from the American Academy of Orthopaedic Surgeons (AAOS) and the American Dental Association (ADA) contributes to clinician confusion.

Objectives:

This cost-effectiveness decision model informs the AP debate and guideline development by comparing the benefits, harms, and costs of alternative prophylaxis strategies.

Methods:

A Markov state-transition model was developed comparing lifetime health outcomes and costs of alternative AP strategies for dental patients aged 65 y with a history of total knee arthroplasty (TKA). Based on our interpretation of AP recommendations from the AAOS and ADA, incremental cost-effectiveness ratios were calculated to compare the following strategies: no AP, AP for the first 2 y after a TKA, and lifetime AP.

Results:

The no-AP strategy had the lowest average lifetime costs ($17,119) and quality-adjusted life years (11.2151). Compared with a no-prophylaxis strategy, the 2-y AP strategy had incremental costs of $56 and 0.0006 QALYs gained and was cost-effective (incremental cost-effectiveness ratio = $95,100) when a willingness-to-pay threshold of $100,000 per quality-adjusted life year was used. Based on the results of 1-way sensitivity analysis, the no-AP strategy was cost-effective when we modestly increased base case amoxicillin adverse event estimates that were substantially lower than estimates reported in previous models. When plausible combinations of important model parameters were varied, model results suggested that there may be clinical scenarios when AP may be appropriate for some medically at-risk patient populations.

Conclusion:

The results of cost-effectiveness decision modeling generally support questioning routine AP for dental patients with TKA. Sensitivity analyses suggest that prophylaxis may be cost-effective for patient populations with a higher medical risk of infection. This finding is consistent with the recommendations of the 2015 ADA practice guideline and the appropriate use criteria jointly developed by the AAOS and the ADA.

Knowledge Transfer Statement:

The results of this decision modeling research support the contention that routine AP before invasive dental procedures to prevent prosthetic joint infection may not be cost-effective for patients without medical conditions, potentially conferring a higher infection risk. Model sensitivity analyses suggest that there may be clinical situations when medically at-risk patients benefit from AP.

Health care utilization and expenditures among adults with rheumatoid arthritis using specialty pharmaceuticals

BACKGROUND

Despite the rising popularity of using specialty medications for patients with rheumatoid arthritis (RA), little is known about the use or spending on medical services among these patients.

OBJECTIVE

The objective of this study was to investigate health care utilization and expenditures among patients with RA using specialty medications compared with those using non-specialty (i.e., traditional) medications.

METHODS

This was a retrospective cohort study using Medical Expenditure Panel Survey data from 2009 through 2015. Health care use and expenditures were examined using a (zero-truncated or zero-inflated) negative binomial model and a generalized linear model with a log link function and gamma distribution (or a two-part model).

RESULTS

Compared to patients with RA who were traditional medication users (TMUs), those categorized as specialty medication users (SMUs) were prescribed about 24% fewer medications (incidence rate ratio [IRR] = 0.76, 95% CI = 0.66-0.89) and received fewer office-based visits (IRR = 0.84, 95% CI = 0.70-0.99). Although SMUs' spending on emergency department visits was lower, their spending on total health care was $14,570 higher than that of TMUs. Compared with TMUs, users of both specialty and traditional medications (BMUs) had fewer emergency department visits (IRR = 0.57, 95% CI = 0.39-0.81) with less spending on emergency service use. Overall, BMUs' total health care spending was $5720 higher than TMUs' total spending.

CONCLUSIONS

There were some differences in health care use and expenditures for treating RA between patients using specialty medications and those using traditional medications. Total health care spending was higher for SMUs/BMUs despite their less frequent use of some types of medical services and lower spending on emergency department visits, because of the high cost of specialty medications for RA. The high costs of specialty medications implies the importance of the efficient use of these medications.

Characteristics of patients using specialty medications

BACKGROUND

Specialty medications include innovative drugs and biologic agents requiring special handling and close monitoring. Although specialty medications have been widely used for various chronic conditions, increased use of these medications has contributed a growing share of total health care expenditures.

OBJECTIVE

The aim of this study was to examine patient characteristics related to specialty medication use.

METHODS

Using Medical Expenditure Panel Survey (MEPS) data from 2000 through 2013, this study identified U.S. adults using specialty medications. Andersen's Health Services Utilization model was used to identify potential factors related to specialty medication use. Associations between the variables identified by Andersen's model and specialty medication use were analyzed using logistic multilevel modelling. Sampling weights were considered and standard errors were adjusted to account for the complex survey design.

RESULTS

A fully adjusted model suggested that older adults, individuals with prescription drug insurance, or those using mail order services were more likely to use specialty medications regardless of whether they used traditional medications concurrently. Behaviors of using specialty medications were positively associated with married and active working status and negatively associated with middle or high income and having a usual source of care (visiting a doctor's office, clinic, or health center when sick) when comparing individuals using traditional medications and those using specialty medications. In addition, when comparing individuals using traditional medications with those using both specialty medications and traditional medications, behaviors of using specialty medications were positively associated with female gender, worse health state, and more comorbidities.

CONCLUSION

This study identified characteristics of patients using specialty medications. Some sociodemographic, economic, and clinical factors were related to specialty medication use among U.S. adults.

The Effect of Medicare Part D on Prescription Drug Spending and Health Care Use: 6 Years of Follow-up, 2007-2012

BACKGROUND

Previous studies have shown that Medicare Part D was associated with a reduction in out-of-pocket expenditures for Medicare beneficiaries during the early years of its implementation (2006 and 2007). However, a question remains regarding the effect of Part D on out-of-pocket expenditures in the longer term.

OBJECTIVE

To evaluate the effects of Part D on prescription drug expenditures and certain health care use for a longer time period using a large, nationally representative sample of Medicare beneficiaries.

METHODS

Using Medical Expenditure Panel Survey (MEPS) data from 2000 through 2005 (pre-Part D period) and from 2007 through 2012 (Part D era), this study identified a cohort of elderly Medicare beneficiaries (treatment group) and a near-elderly non-Medicare population (control group). A difference-in-differences analysis was conducted to estimate the effect of Part D on prescription medication use and expenditures and outpatient visits. Propensity score weights and sampling weights were applied to obtain unbiased effect estimates accounting for complex survey designs.

RESULTS

A total of 26,585 elderly Medicare beneficiaries and 20,688 near-elderly non-Medicare beneficiaries were identified. The introduction of Part D was associated with an adjusted average reduction of $105 in annual out-of-pocket spending on prescription drugs during the post-Part D period (2007 through 2012). The reduction in annual out-of-pocket spending ranged from $49 to $152 during the post-Part D period. No significant increase was found in total prescription expenditures or prescription medication use following the introduction of Part D nor were there significant changes in outpatient visits.

CONCLUSIONS

A continued reduction of Part D out-of-pocket drug expenditures was found each year from 2007 to 2012.

DISCLOSURES

No funding has been received to conduct this study or prepare this manuscript. The authors have no conflicts of interest to declare. Study concept and design were primarily contributed by Park with assistance from Jung. Both authors contributed equally to data analysis and interpretation. The manuscript was written primarily by Park, with assistance from Jung, and revised primarily by Jung.

Telephone-adapted Mindfulness-based Stress Reduction (tMBSR) for patients awaiting kidney transplantation

BACKGROUND

Patients with progressive kidney disease experience increasing physiologic and psychosocial stressors and declining health-related quality of life (HRQOL).

METHODS

We conducted a randomized, active-controlled, open-label trial to test whether a Mindfulness-based Stress Reduction (MBSR) program delivered in a novel workshop-teleconference format would reduce symptoms and improve HRQOL in patients awaiting kidney transplantation. Sixty-three transplant candidates were randomized to one of two arms: i) telephone-adapted MBSR (tMBSR, an 8-week program of meditation and yoga); or ii) a telephone-based support group (tSupport). Participants completed self-report questionnaires at baseline, post-intervention, and after 6-months. Anxiety, measured by the State-Trait Anxiety Inventory (STAI) post-intervention served as the primary outcome. Secondary outcomes included: depression, sleep quality, pain, fatigue, and HRQOL assessed by SF-12 Physical and Mental Component Summaries (PCS, MCS).

RESULTS

55 patients (age 54±12yrs) attended their assigned program (tMBSR, n=27; tSupport, n=28). 49% of patients had elevated anxiety at baseline. Changes in anxiety were small and did not differ by treatment group post-intervention or at follow-up. However, tMBSR significantly improved mental HRQOL at follow-up: +6.2 points on the MCS - twice the minimum clinically important difference (95% CI: 1.66 to 10.8, P=0.01). A large percentage of tMBSR participants (≥90%) practiced mindfulness and reported it helpful for stress management.

CONCLUSIONS

Neither mindfulness training nor a support group resulted in clinically meaningful reductions in anxiety. In contrast, finding that tMBSR was more effective than tSupport for bolstering mental HRQOL during the wait for a kidney transplant is encouraging and warrants further investigation. ClinicalTrials.govNCT01254214.