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We examined the effect of 'labels' versus 'descriptions' across four asymptomatic health conditions: pre-diabetes, pre-hypertension, mild hyperlipidaemia, and chronic kidney disease stage 3A, on participants' intentions to pursue further tests. There were four secondary objectives: 1) assessing confidence and satisfaction in their intention to test further; 2) revealing psychological drivers affecting intentions; 3) exploring whether intentions, confidence and satisfaction differ by label vs. description and health condition; and 4) producing a perceptual map of illnesses by label condition. Practitioner validated health-related scenarios were used. Two variants of each condition were developed. Participants were recruited through Qualtrics from Australia, Ireland and Canada and randomly assigned two 'labelled' or two 'descriptive' scenarios. There was no significant difference in intentions to test between label and description conditions (95% CI -0.76 to 0.33 points, p = 0.4). Confidence and satisfaction were both positively associated with intentions: regression coefficient (β) for confidence β = 0.58 points (95% CI 0.49 to 0.68, p < .001) and for satisfaction 0.67 points (95% CI 0.57 to 0.77, p < .001). Predisposition to seek healthcare (β = 0.72; 95% CI 0.47 to 0.98), attributing illness to bad luck (β = -0.16 points; 95% CI -0.3 to -0.02), and concern about the health condition (β = 0.51; 95% CI 0.38 to 0.65) also significantly predicted intentions. Unlike studies investigating symptomatic illnesses, the disease label effect on behavioural intentions was not supported suggesting that reducing demand for medical services for borderline cases cannot be achieved by labelling. The average intention to test score was higher in this sample than previous symptomatic health-related studies and there was a positive relationship between increased intentions and confidence/satisfaction in one's decision. Exploratory insights suggested perceptions of the four labelled asymptomatic illnesses all shifted toward greater levels of dread and concern compared to their respective description condition. ACTRN12618000392268.

The present study was designed to evaluate the independent and interactive effects of a once-a-day yoghurt drink providing 2 g plant sterols/d and capsules providing 2 g fish oil n-3 long-chain (LC) PUFA/d on plasma lipids, apolipoproteins and LDL particle size. Following a 2-week run-in period, 200 mildly hypercholesterolaemic Indian adults aged 35–55 years were randomised into one of four groups of a 2 × 2 factorial, double-blind controlled trial. The 4-week treatments consisted of (1) control yoghurt drink and control capsules, (2) control yoghurt drink and fish oil capsules, (3) plant sterol-enriched yoghurt drink and control capsules, or (4) plant sterol-enriched yoghurt drink and fish oil capsules. Blood was drawn before and after the 4-week intervention. Changes in health status, lifestyle and dietary habits, and daily compliance were recorded. The main effects of plant sterols were a 4·5 % reduction in LDL-cholesterol and a 15 % reduction in TAG without a significant change in HDL-cholesterol. Overall, fish oil n-3 LC-PUFA did not significantly affect cholesterol concentrations but reduced TAG by 15 % and increased HDL-cholesterol by 5·4 %. The combination significantly lowered TAG by 15 % v. control. No significant interaction between plant sterols and n-3 LC-PUFA was observed on plasma cholesterol concentrations. In conclusion, once-a-day intake of 2 g plant sterols/d in a yoghurt drink, 2 g fish oil n-3 LC-PUFA/d in capsules, and their combination had beneficial effects on the lipid profile of mildly hypercholesterolaemic Indian adults. The potent hypotriacylglycerolaemic effect of plant sterols observed in the present study and this population warrants additional investigation.

The aim of the present study was to generate up-to-date normative data for health-related quality of life (QoL) measured with the \"European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30)\" in a random sample of the population in Northern Germany. We conducted a population-based survey of a random sample of 10,000 persons aged 16 years or older. The postal questionnaire included questions regarding lifetime prevalence of common diseases and quality of life. EORTC QLQ-C30 scales were scored according to standard procedures. The results were stratified for age and sex. The questionnaire was completed by 4,684 (47%) of 9,928 eligible persons. Mean age of the participants was 51.7 years (standard deviation: 18.5) and 57% were females. Missing values for the EORTC QLQ-C30 scales and items were sparse (minimum: 0.2%, maximum: 1.5%). Self-reported health related QoL varied by age and sex. Generally, men reported better functioning and fewer symptoms than women. In both sexes function declined and symptoms increased with increasing age. Symptoms most frequently reported were fatigue, pain and insomnia. Compared to the German reference data published in 2001 our participants scored more than 10 points higher on the latter three scales/items. The most frequently reported diseases were hypertension (36%), hyperlipidemia (26%) and arthritis (30%). Lifetime prevalence of depression was 16% in women and 11% in men. Our study participants are representative for the German general population with regard to age, sex and education. Of special interest is the high proportion of participants reporting depression which is also mirrored by high fatigue, pain and insomnia scores. The normative data provided should be used as comparison health-related QoL data when evaluating the QoL in German cancer patients.

Cardiovascular diseases are a major cause of death globally. Epidemiological evidence has linked elevated levels of blood cholesterol with the risk of coronary heart disease. However, lipid-lowering agents, despite their importance for primary prevention, are significantly underused in the United States. The objective of this study was to explore associations among socioeconomic factors and the use of antihyperlipidemic agents in 2018 in U.S. patients with hyperlipidemia by applying a theoretical framework. Data from the 2018 Medical Expenditure Panel Survey were used to identify the population of non-institutionalized U.S. civilians diagnosed with hyperlipidemia. This cross sectional study applied the Andersen Behavioral Model to identify patients’ predisposing, enabling, and need factors. Approximately 43 million non-institutionalized adults were diagnosed with hyperlipidemia. With the exception of gender and race, predisposing factors indicated significant differences between patients who used antihyperlipidemic agents and those who did not. The relation between income level and use of antihyperlipidemic agents was significant: X 2 (4, N = 3,781) = 7.09, p <.001. Hispanic patients were found to be less likely to receive treatment (OR: 0.62; 95% CI: 0.43–0.88), as observed using a logistic model, with controls for predisposing, enabling, and need factors. Patients without health insurance were less likely to use lipid-lowering agents (OR: 0.33; 95% CI: 0.14–0.77). The present study offers essential data for prioritizing interventions by health policy makers by identifying barriers in utilizing hyperlipidemia therapy. Non-adherence to treatment may lead to severe consequences and increase the frequency of fatal cardiac events in the near future.

Purpose There are known associations between cardiometabolic risk factors and polypharmacy; however, there is no evidence about how polypharmacy among adults with cardiometabolic risk factors impacts their health-related quality of life (HRQoL). The main objective of this study was to assess the association between polypharmacy and HRQoL among adults with cardiometabolic risk factors living in the USA. Methods Individuals age ≥ 18 years with at least one of the three cardiometabolic risk factors (diabetes, hyperlipidemia, and hypertension) were identified from the Medical Expenditure Panel Survey 2015 data. We defined polypharmacy as use of at least five classes of prescription medications. Physical component summary (PCS) and mental component summary (MCS) were obtained from the 12-item Short-Form Health Survey version 2 to measure HRQoL. We conducted adjusted ordinary least-square regressions to determine the association between polypharmacy and HRQoL. Results We identified 7621 (weighted N  = 80 million) adults with at least one cardiometabolic risk factors of whom 46.9% reported polypharmacy. Polypharmacy was noted in 29.7% of those with hypertension, whereas 82.4% of those with all the three cardiometabolic risk factors had polypharmacy. The unadjusted mean PCS and MCS scores for those with polypharmacy were lower than those without polypharmacy. In the multivariable regressions, we found that adults with polypharmacy had significantly lower PCS scores ( β  = − 4.27, p  < 0.0001) compared to those without polypharmacy, while the MCS scores between those with and without polypharmacy were no longer significantly different. Conclusion Surveillance of use of concurrent prescription medications is warranted so as to improve physical functioning in this vulnerable group.

BACKGROUND Information comparing characteristics of patients who do and do not pick up their prescriptions is sparse, in part because adherence measured using pharmacy claims databases does not include information on patients who never pick up their first prescription, that is, patients with primary non-adherence. Electronic health record medication order entry enhances the potential to identify patients with primary non-adherence, and in organizations with medication order entry and pharmacy information systems, orders can be linked to dispensings to identify primarily non-adherent patients. OBJECTIVE This study aims to use database information from an integrated system to compare patient, prescriber, and payment characteristics of patients with primary non-adherence and patients with ongoing dispensings of newly initiated medications for hypertension, diabetes, and/or hyperlipidemia. DESIGN This is a retrospective observational cohort study. PARTICIPANTS (OR PATIENTS OR SUBJECTS) Participants of this study include patients with a newly initiated order for an antihypertensive, antidiabetic, and/or antihyperlipidemic within an 18-month period. MAIN MEASURES Proportion of patients with primary non-adherence overall and by therapeutic class subgroup. Multivariable logistic regression modeling was used to investigate characteristics associated with primary non-adherence relative to ongoing dispensings. KEY RESULTS The proportion of primarily non-adherent patients varied by therapeutic class, including 7% of patients ordered an antihypertensive, 11% ordered an antidiabetic, 13% ordered an antihyperlipidemic, and 5% ordered medications from more than one of these therapeutic classes within the study period. Characteristics of patients with primary non-adherence varied across therapeutic classes, but these characteristics had poor ability to explain or predict primary non-adherence (models c-statistics = 0.61–0.63). CONCLUSIONS Primary non-adherence varies by therapeutic class. Healthcare delivery systems should pursue linking medication orders with dispensings to identify primarily non-adherent patients. We encourage conduct of research to determine interventions successful at decreasing primary non-adherence, as characteristics available from databases provide little assistance in predicting primary non-adherence.

Hyperlipidaemia and cognitive dysfunction (CD) are the two public health concerns. Though hyperlipidaemia has been comprehensively studied in respect to CVD, its role on CD needs to be explored. Hence, we evaluated hyperlipidaemia as a risk factor for CD and the efficacy of EPA (20 : 5n-3) + DHA (22 : 6n-3) and zerumbone (Z) in modulating CD under hyperlipidaemic conditions. Male Wistar rats (Rattus norvegicus) were fed control, high-fat (HF), high-fat + fish oil (HF + F), high-fat + zerumbone (HF+Z) and high-fat + fish oil + zerumbone (HF+F+Z) containing diets. After a 30 d feeding trial, memory parameters (Morris water maze, elevated plus maze (transfer latency) and T-maze (spontaneous alteration)) and locomotor skills (open field test and rotarod test) were assessed. Hyperlipidaemia significantly (P < 0·05) reduced memory and motor coordination skills compared with control. However, the administration of EPA + DHA and zerumbone significantly (P < 0·05) restored the hyperlipidaemia-induced loss of memory and motor coordination skills. Collectively, our data imply that hyperlipidaemia causes CD by decreasing memory and motor coordination skills, and administration of EPA + DHA and zerumbone prevents hyperlipidaemia-induced CD. The augmented effect of EPA + DHA, together with zerumbone, discloses a promising strategy for lowering the severity of CD in hyperlipidaemic conditions.

Background. The cross-sectional study is aimed at investigating the relationship between cortisol, testosterone, and metabolic characteristics among male schizophrenics. Methods. 174 patients were grouped based on their risk of metabolic syndrome (MetS) into the non-MetS, high-risk-MetS (HR-MetS), or MetS groups. Metabolic indices (body mass index (BMI), mean arterial pressure (MAP), cholesterol, triglyceride, and fasting blood glucose (FBG)) were associated with cortisol and testosterone levels using correlation analysis. Multiple linear regression analysis was used to associate the correlations between the WHO Quality of Life–BREF (WHOQOL–BREF) score and the five metabolic indices. Results. The WHOQOL–BREF score for the non-MetS group significantly differed from the scores of the HR-MetS and MetS groups. The triglyceride level was positively correlated with the cortisol level, while all five metabolic indices were negatively correlated with testosterone level. Stepwise regression analysis produced a model predicting WHOQOL–BREF scores with four variables including MAP, intelligence quotient (IQ), FBG, and age. The correlation analysis then showed that there was a weak linear correlation between the testosterone level and all five metabolic indices. Conclusions. Among the five metabolic indices, the risks of hypertension and hyperglycemia are correlated with the quality of life in male schizophrenics rather than those of obesity or hyperlipidemia.

RESEARCH DISIGN AND METHODS- The Diabetes Outreach Van Enhancement (DOVE) study was a controlled trial of a multifaceted intervention directed at health care providers to improve the quality of care for rural patients with type 2 diabetes in northern Alberta, Canada. The intervention consisted of an educational outreach (\"academic detailing\") service, whereby specialist physicians promoted aggressive cardiovascular risk reduction for diabetes to primary care physicians.

Objective The prevalence of obesity and associated cardiometabolic risk factors such as diabetes, hyperlipidemia and hypertension is increasing significantly for all demographic groups. Research design and methods The 2000 and 2002 Medical Expenditure Panel Survey (MEPS), a nationally representative survey of the U.S. population, was used to estimate the marginal impact of obesity on health function, perception, and preferences for individuals with diabetes, hyperlipidemia, and hypertension using multivariate regression methods controlling for age, sex, race, ethnicity, education, income, insurance, smoking status, comorbidity, and proxy response. Three different instruments were used: SF-12 physical component scale (PCS-12) and mental component scale (MCS-12); EQ-5D index and visual analogue scale (VAS). Censored least absolute deviation was used for the EQ-5D and VAS (due to censoring) and ordinary least squares (OLS) was used for the PCS-12 and MCS-12. Results After controlling for sociodemographic characteristics, diabetes, hyperlipidemia, and hypertension were associated with significantly lower scores compared to normal weight individuals without the condition for all four instruments. Obesity significantly exacerbated this association. Controlling for comorbidity attenuated the negative association of obesity and cardiometabolic risk factors on instrument scores. In addition, scores decreased for increasing weight and number of risk factors. Conclusions Obesity significantly exacerbates the deleterious association between diabetes, hyperlipidemia, and hypertension, and health function, health perception, and preference-based scores in the United States.