Determinants of racial/ethnic differences in blood pressure management among hypertensive patients

Background

Prior literature has shown that racial/ethnic minorities with hypertension may receive less aggressive treatment for their high blood pressure. However, to date there are few data available regarding the confounders of racial/ethnic disparities in the intensity of hypertension treatment.

Methods

We reviewed the medical records of 1,205 patients who had a minimum of two hypertension-related outpatient visits to 12 general internal medicine clinics during 7/1/01-6/30/02. Using logistic regression, we determined the odds of having therapy intensified by patient race/ethnicity after adjustment for clinical characteristics.

Results

Blacks (81.9%) and Whites (80.3%) were more likely than Latinos (71.5%) to have therapy intensified (P = 0.03). After adjustment for racial differences in the number of outpatient visits and presence of diabetes, there were no racial differences in rates of intensification.

Conclusion

We found that racial/ethnic differences in therapy intensification were largely accounted for by differences in frequency of clinic visits and in the prevalence of diabetes. Given the higher rates of diabetes and hypertension related mortality among Hispanics in the U.S., future interventions to reduce disparities in cardiovascular outcomes should increase physician awareness of the need to intensify drug therapy more agressively in patients without waiting for multiple clinic visits, and should remind providers to treat hypertension more aggressively among diabetic patients.     

Treatment of rheumatoid arthritis in the Medicare Current Beneficiary Survey

Introduction

Numerous studies across different health systems have documented that many patients with rheumatoid arthritis (RA) do not receive disease-modifying anti-rheumatic drugs (DMARDs). Relatively little is known about correlates of DMARD use and whether there are socioeconomic and demographic disparities. We examined DMARD use during 2001 to 2006 in the Medicare Current Beneficiary Survey (MCBS), a longitudinal US survey of randomly selected Medicare beneficiaries.

Methods

Participants in MCBS with RA were included in the analyses, and DMARD use was based on an in-home assessment of all medications. Variables included as potential correlates of DMARD use in weighted regression models included race/ethnicity, insurance, income, education, rheumatology visit, region, age, gender, comorbidity index, and calendar year.

Results

The cohort consisted of 509 MCBS participants with a diagnosis code for RA. Their median age was 70 years, 72% were female, and 24% saw a rheumatologist. Rates of DMARD use ranged from 37% among those <75 years of age to 25% of those age 75 to 84 and 4% of those age 85 and older. The multivariable adjusted predictors of DMARD use include: visit with a rheumatologist in the prior year (odds ratio, OR, 7.74, 95% CI, 5.37, 11.1) and older patient age (compared with <75 years, ages 75 to 84, OR 0.58, 95% CI 0.37, 0.92, and 85 and over, OR 0.09, 95% CI 0.02, 0.31). In those without a rheumatology visit, lower income and older age were associated with a significantly reduced probability of DMARD use; no association of DMARD use with income or age was observed for subjects seen by rheumatologists. Race and ethnicity were not significantly associated with receipt of DMARDs.

Conclusions

Among individuals not seeing rheumatologists, lower income and older age were associated with a reduced probability of DMARD use.     

云南含笑天然居群的表型多样性分析

为揭示云南含笑天然居群表型变异程度和变异规律,以云南昆明地区天然分布的云南含笑为研究对象,调查了6个居群180个单株的14个表型性状,采用巢式方差分析、变异系数、相关分析、Shannon-Weaver多样性指数分析和聚类分析等方法,分析了居群间和居群内表型多样性.结果表明:(1)云南含笑表型性状在居群间和居群内存在极其丰富的多样性,14个表型性状平均表型分化系数(24.38％)小于居群内变异(75.62％),居群内变异是表型变异的主要来源;14个表型性状的变异系数(CV)在16.20％～60.11％之间,表明云南含笑居群内表型性状离散程度较高.(2)对云南含笑各居群的Shannon-Weaver指数分析表明,云南含笑各居群具有丰富的多样性,总体表型多样性指数为1.772.(3)利用居群间欧氏距离进行的UPGMA聚类分析结果表明,云南含笑6个天然居群可以聚为3类,而且表型性状并没有严格依地理距离而聚类.     

Hospitalization after Cataract Surgery in a Nationwide Managed-Care Population

Purpose

Little is known regarding the extent by which patients undergoing outpatient cataract surgery are at risk for postoperative hospitalization. We sought to determine the percentage of patients undergoing cataract surgery who were subsequently hospitalized, the patient characteristics associated with postoperative hospitalization, and the reasons for hospitalization.

Methods

We identified all beneficiaries of a large U.S. managed care network age ≥40 years old who underwent ≥1 cataract surgery from 2001–2011. All enrollees who required inpatient hospitalization within 7, 14, 30, and 90 days following initial cataract surgery and the reasons for hospitalization were determined. Logistic regression was performed to assess factors that significantly impacted the odds of requiring postoperative hospitalization.

Results

Among the 64,981 patients who underwent cataract surgery, rates of hospitalization within 7, 14, 30, and 90 days were 0.3%, 0.5%, 1.3% and 4.2%, respectively. Among the 10,674 patients who had no major preexisting medical comorbidities, 0.1% were hospitalized within 7 days. The odds of hospitalization increased by 35% (OR = 1.35 [CI, 1.23–1.48]) with the presence of each additional comorbidity and by 14% with each additional hospitalization in the 3 years prior to cataract surgery (OR = 1.14 [CI, 1.10–1,18]). Those who were hospitalized in the 30 days prior to cataract surgery had 524% increased odds of being hospitalized within 7 days after cataract surgery (OR = 6.24, [CI, 3.37–11.57]) compared to those with no record of preoperative hospitalization. Postoperative hospitalizations were most commonly due to cardiovascular conditions, comprising over 25% of primary diagnoses associated with hospitalization.

Conclusions

The risk of hospitalization after cataract surgery is low, and is very low among those with no major preexisting medical comorbidities. Opportunities may exist to limit comprehensive preoperative evaluation and testing to those who have serious pre-existing medical comorbidities.     

桂东不同林龄马尾松人工林的生物量及其分配特征

根据5a、15a、21a、32a、60a生的5个不同林龄的15块1 000m2样地(3次重复)调查资料,利用21株不同年龄和径阶的马尾松样木数据,建立以胸径(D)为单变量的生物量回归方程.采用样木回归分析法(乔木层)和样方收获法(灌木层、草本层、地上凋落物)获取不同林龄马尾松人工林的生物量,并分析了其组成、分配特征及不同林龄生物量的变化趋势.结果表明:(1)林分的总生物量随林龄而增加,5a、15a、21a、32a和60a生马尾松人工林生物量分别为15.03、125.93、183.51、191.53、405.31 Mg/hm2,其中活体植物占75.01％～94.19％,地上凋落物占0.86％～24.99％.(2)层次分配方面乔木层占绝对优势,占90.20％～98.35％,且随林龄的增加而增大,其次为地上凋落物,占0.86％～24.99％;草本层和灌木层生物量较小,分别占0.47％～34.85％和0.32％～27.00％,均随林龄的增加呈递减趋势.(3)乔木层器官分配以干所占比例最高,占49.93％～83.10％,且随林龄而增加;根相对比较稳定,占6.97％～12.82％;枝、叶分别占11.75％～14.83％、1.33％～23.65％,均随林龄增大而下降.灌木层器官分配除幼龄林为根＞枝＞叶,其余的均呈枝＞根＞叶的趋势.草本层中龄林和近熟林生物量地下＞地上,其他林龄生物量地上＞地下.(4)各林龄凋落物生物量在3.48～6.68Mg/hm2,规律性不强.(5)马尾松人工林乔木层各器官及林分生物量具有良好的优化增长模型,其32a生林分生物量高于同林龄的楠木人工林,低于热带雨林,是一种速生丰产、固碳潜力大的优良造林树种.     

The Wavelet-Based Cluster Analysis for Temporal Gene Expression Data

A variety of high-throughput methods have made it possible to generate detailed temporal expression data for a single gene or large numbers of genes. Common methods for analysis of these large data sets can be problematic. One challenge is the comparison of temporal expression data obtained from different growth conditions where the patterns of expression may be shifted in time. We propose the use of wavelet analysis to transform the data obtained under different growth conditions to permit comparison of expression patterns from experiments that have time shifts or delays. We demonstrate this approach using detailed temporal data for a single bacterial gene obtained under 72 different growth conditions. This general strategy can be applied in the analysis of data sets of thousands of genes under different conditions.[1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29]     

红毛菜丝状体核分裂研究

选择具异型世代交替的福建人工栽培的红毛菜为研究材料,对红毛菜丝状体世代的丝状藻丝及孢子囊枝等阶段进行了较系统的核分裂观察研究,探讨红毛菜核分裂特征.结果显示:红毛菜营养藻丝和孢子囊枝细胞均为二倍体细胞,2n=8,其核分裂显示为有丝分裂的过程;同时,丝状体阶段细胞核分裂至前期末均会出现同源染色体配对现象,显示有丝分裂同源染色体配对行为是红毛菜丝状体核分裂的一个重要特征.