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Elderly black Americans use fewer medications than whites and are more likely to skip taking their meds, a new study finds.
It included 100 black and 100 white patients, aged 60 and older, who were interviewed at the start of the study, and again six months and one year later.
Overall, whites used more medications, had more chronic medical conditions and used more physicians. Whites were more likely than blacks to have adequate health literacy skills (58 percent vs. 29 percent) and less likely to be unable to afford medications (12 percent vs. 28 percent).
The most common problems for both whites and blacks were: medication non-adherence (42 percent vs. 68 percent), under treatment (83 percent vs. 87 percent), suboptimal drug use (59 percent vs. 66 percent), and suboptimal dosing (48 percent vs. 56 percent).
The findings support previous research showing that elderly black patients have higher rates of medication non-adherence than whites. But, overall, medication-related problems are prevalent and persist in both races, the researchers said.
“Strategies to better measure the quality of medication use in older adults are needed, and efforts to improve the quality of medication use in older adults must account for potential differences in both the number and types of problems affecting whites and blacks,” concluded Dr. Mary Roth and her colleagues at the University of North Carolina at Chapel Hill.
The study was published online Dec. 11 in the Journal of General Internal Medicine.
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The new swine flu is scary, no doubt about it. But here’s the information you need to better understand the illness and the ways you can protect yourself and your family from infection.
Understanding the Swine Flu Virus
Human influenza, or the “flu,” is a viral infection that usually occurs seasonally and is transmitted between people. The viruses are categorized into two major types, A and B, and subtypes, named H and N. The current swine flu is a new type of influenza A virus, H1N1, which has not previously been seen. This strain is unusual in that it appears to be a cross between strains that infect swine, birds and human beings. While this new strain may yet present some surprises, we know a lot about how influenza is transmitted and how to slow or break that cycle.
The main way that influenza viruses are spread is person to person via the respiratory droplets of coughs and sneezes. The virus is transmitted when these infected droplets land on the mouth or nose of people nearby or when people touch respiratory droplets on another person or an object, and then they touch their mouth or nose or rub their eyes before washing their hands. Swine flu is not spread by eating pork or other food, and pigs pose little risk of viral transmission.
Protecting Yourself and Your Family from Infection
The bottom line of protecting yourself is to practice good hygiene and avoid coming into contact with the virus.
Keep your hands away from your face or wash them first. Stay away from crowds. Avoid contact with sick people if you can. If you can’t, wash your hands often with soap and water. Be sure to use a paper towel to turn off the faucet handles so as not to recontaminate your hands. The same paper towel precautionary measure applies to doorknobs. If you can’t wash your hands, use an alcohol-based hand sanitizer with at least 60 percent alcohol.
Cover your mouth when you cough and sneeze. Teach your family to do the same and to discard used tissues promptly. If no tissues are available, it is better to cough or sneeze into your sleeve than your hand. They should wash their hands immediately, before they contaminate other surfaces with infective secretions.
Keep ill family members away from others at home and stay at home unless medical care is needed. Masks are most effective when worn by infected people to prevent the spread of the virus, so if you are infected and you must go out, wear a mask to reduce the transmission of infected droplets to others. While masks are not effective against small viral particles that may be airborne, and airborne transmission may occur, large infective droplets are probably a major factor and the one that a mask can best protect against. Wear a mask if you are within six feet of an ill person. N-95 masks must fit tightly to work effectively. Don’t worry if you don’t have an N-95 or a fancy surgical mask. The key to prevention is to keep droplets away from your nose, mouth and eyes. You can use a cloth bandana or similar accessory to cover your nose and mouth. Change paper or cloth masks frequently. (In hospitals, N-95 masks are recommended because of higher exposure rates.)
Seek medical care promptly if you become ill with flu-like symptoms-fever, generalized aches, sore throat, cough, runny nose, vomiting, diarrhea and lethargy-especially if you are having trouble breathing. The antiviral medicines Tamiflu and Relenza are quite effective if taken within the first 48 hours of your symptoms’ appearance. If you are exposed to the new 2009H1N1 virus, you might also benefit from prophylactic antivirals to prevent infection, especially if you have underlying health problems. Check with your doctor.
Warning: Do not give aspirin (acetylsalicylic acid) to children or teenagers who have the flu; this can cause the serious and possibly fatal Reye’s syndrome. NSAIDS (nonsteroidal anti-inflamatory drugs) such as ibuprofen (Advil, Motrin), naproxen (Naprosyn, Midol) and acetominophen (Tylenol) are safe to administer for their symptomatic relief.
Remember, staying away from crowds and using good hygiene can help you prevent the contraction of many flu illnesses and give you some measure of reassurance during this flu outbreak.
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U.S. regulators see benefits to using an AstraZeneca Plc cholesterol drug in a vast new group of patients but will ask outside advisers to probe various safety issues, documents released on Friday said.
AstraZeneca wants permission to promote the Crestor drug, for preventing heart disease in people with normal cholesterol levels but other risk factors based on findings of a large study known as Jupiter.
A Food and Drug Administration reviewer, commenting on a higher number of diabetes cases reported with Crestor patients, said that, at the current time, the benefits seen in the Jupiter trial “outweigh the risk, but further clinical trials are needed to further define this benefit/risk ratio.”
The Jupiter trial “was relatively short in duration” and “therefore the long-term complications are unknown,” the reviewer said.
The reviewer also said the agency felt it was a “chance finding” that gastrointestinal-related deaths were higher in Crestor patients compared with a placebo.
The comments were included in documents the FDA released ahead of a meeting on Tuesday of a panel of outside advisers.
The advisory panel will be asked to comment on the diabetes and gastrointestinal findings before deciding whether to recommend approval for expanded use, according to a November 12 memo. The FDA also will seek input on a higher number of patients who reported a “confusional state” in the Crestor group, the memo said.
Barclays Capital analyst Brian Bourdot said he expects the advisory panel to support wider use of Crestor.
“Overall, the FDA review appears benign, with few safety concerns and little disagreement that Crestor shows a significant benefit” in the expanded group, Bourdot said in a note to clients.
The Jupiter study showed Crestor cut deaths, heart attacks and strokes in middle-aged people with healthy cholesterol, but elevated levels of C-reactive protein, which is associated with heart disease.
The FDA said it would ask the advisory panel to “keep in mind that an estimated 6 million middle-aged and older men and women in the United States” meet the criteria of people in the study.
AstraZeneca said in an analysis also released by the FDA that Crestor’s risks in the Jupiter study were “consistent with the known safety profile.” The company said potential side effects were outweighed by the benefits, including a 44 percent reduction in cardiovascular-related deaths, strokes, heart attacks and other problems.
An expanded label for Crestor would boost sales of the drug in the coming years, but industry analysts say the size of the opportunity is uncertain because of the looming arrival of generic versions of Pfizer Inc’s Lipitor in late 2011.
Gbola Amusa of UBS believes the Jupiter results could expand the overall statin market by 20 percent to 50 percent in volume terms, lifting AstraZeneca’s Crestor sales to some $8 billion in 2012 from $3.6 billion last year.
Others are more cautious, and the consensus forecast for 2012 is $6.75 billion, rising to $6.92 billion in 2013, according to Thomson Pharma.
AstraZeneca’s partner Shionogi & Co Ltd also sells Crestor in Japan and recorded $172 million in revenue from the drug in 2008.
The dramatic reduction in heart attack risk seen in Jupiter already has helped boost prescriptions for Crestor since details were unveiled in November last year.
The FDA will make the final decision on whether to allow AstraZeneca to promote Crestor more widely, but it usually follows panel recommendations.
Crestor is a key driver for AstraZeneca as other drugs go off patent, but its exclusivity through to 2016 is being challenged by generic manufacturers in a case due to go to trial in February 2010. AstraZeneca has requested a summary judgment ahead of the trial to eliminate the most significant issue in the case and is awaiting the judge’s decision.
AstraZeneca shares rose 0.9 percent to $45.77 in afternoon trading on the New York Stock Exchange.
(Reporting by Lisa Richwine and Ben Hirschler; editing by Gerald E. McCormick and Andre Grenon)
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The number of Americans with diabetes will nearly double over the next 25 years, rising from 23.7 million in 2009 to 44.1 million in 2034, according to a study by the University of Chicago.
In the same period, medical costs associated with treating the disease will triple from 113 billion dollars to 336 billion dollars, even without a rise in the incidence of obesity, according to the study published in the December issue of Diabetes Care.
“If we don’t change our diet and exercise habits or find new, more effective and less expensive ways to prevent and treat diabetes, we will find ourselves in a lot of trouble as a population,” said lead author Elbert Huang.
The study said its projections, despite being significantly higher than other recent estimates, may be too conservative because they assume the rate of diabetes and obesity, a risk factor for the disease, will remain stable.
In 1991, scientists projected that the number of Americans with diabetes would reach 11.6 million people in 2030, but some 20 years before that date the figure is already double that.
The study’s authors acknowledge that obesity rates have risen steadily in past years, but predict that they will level out over the next decade and then decline slightly from the current 30 percent level to around 27 percent in 2033.
The US health program Medicare, which provides health care for older Americans, spends some 45 billion dollars a year on diabetes treatment for 8.2 million people.
By 2034, the number of people with diabetes covered by the program is expected to rise to 14.6 million, according to the study, with associated costs rising to 171 billion dollars a year.
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