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At least 271 records · Page 15Linked to original sources
PubMed2005

The association of consumer cost-sharing and direct-to-consumer advertising with prescription drug use.

BACKGROUND: Previous research on the impact of various cost-sharing strategies on prescription drug use has not considered the impact of direct-to-consumer (DTC) advertising. OBJECTIVE: To explore the association of cost-containment strategies with prescription drug use and to determine if the association is moderated by DTC prescription drug advertising. METHODS: The study population included 288 280 employees and dependents aged 18 to 65 years with employer-sponsored health insurance contributing to the MEDSTAT MarketScan administrative data set. Person-level enrollment and claims data were obtained for beneficiaries enrolled continuously during July 1997 through December 1998. Direct-to-consumer advertising data were obtained from Competitive Media Reporting and linked to the MEDSTAT enrollment files. Localized DTC advertising expenditures for one class of medication were evaluated and matched with prescription claims for eligible MEDSTAT contributors. The association of various types and levels of cost-sharing incentives with incident product use was evaluated, controlling for the level of DTC advertising, health status, and other demographic covariates. RESULTS: The relationship of cost-sharing amounts with drug use was modified by the level of DTC advertising in a geographic market. This relationship was dependent on the type of cost-sharing, distinguishing between co-payments for provider visits and co-payments for prescription drugs. Compared with low-advertising markets, individuals residing in markets with high levels of advertising and paying provider co-payments of $10.00 or more were more likely to use the advertised product. In the same markets, higher prescription drug co-payments were associated with a decreased likelihood of using the advertised product. A similar relationship was not observed for the nonadvertised competitor. CONCLUSIONS: Among insured individuals, response to cost-sharing strategies is moderated by DTC prescription drug advertising. The relative ability of cost-sharing strategies to influence drug use should be interpreted with caution in the presence of DTC advertising.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2026

Elucidating shared genetic signals between type 2 diabetes and three neurodegenerative dementia phenotypes.

Type 2 diabetes (T2D) and dementia frequently co-occur, yet the biological mechanisms underlying this comorbidity remain incompletely understood. Here, we systematically investigate shared genetic signals between T2D and three forms of neurodegenerative dementia (Alzheimer disease, Lewy body dementia, and sporadic frontotemporal dementia) using large-scale genome-wide association studies of clinically diagnosed individuals. We identify five genomic regions harboring shared association signals between T2D and at least one dementia subtype. Among these, the APOE locus was common to all dementia subtypes, whereas the remaining four loci (GBA, CRY2/PEX16/MAPK8IP1, INO80E, and NSF) were each shared exclusively between T2D and one dementia subtype. Integrating multi-omics data across several disease-relevant tissues and orthogonal lines of functional evidence, we prioritize 26 candidate genes through which these shared genetic loci potentially mediate their effect. Pathway enrichment highlights lipid and lipoprotein regulatory biology as a central shared axis. Mendelian randomization analyses using genetically regulated gene expression in relevant tissues indicate pleiotropic mechanisms with divergent phenotypic consequences. Our findings identify shared genetic loci between T2D and neurodegenerative dementia, revealing systemic metabolic-neurodegenerative trade-offs and highlighting key genes that underpin the comorbidity, providing a framework for improved understanding of age-related multi-morbidity.

Alzheimer disease↗
PubMed2001

Risk factors of HIV infection and needle sharing among injecting drug users in Ho Chi Minh City, Vietnam.

OBJECTIVE: We sought to identify risk factors for needle sharing and HIV infection among injecting drug users (IDUs) in Ho Chi Minh City (HCMC), Vietnam. METHODS: Three cross-sectional surveys among IDUs, both on the street (in 11 urban districts) and in the rehabilitation center for IDUs in HCMC, were carried out in April of 1995, 1997, and 1998. Outreach workers interviewed IDUs about socio-demographic characteristics, drug use and sexual practices, and HIV knowledge and perceptions. The IDUs were also tested for seropositivity to HIV. Independent predictors for HIV positivity and needle sharing were determined by univariate and multivariate logistic regression for the study sample within the rehabilitation center in 1997 and for that on the street in 1998. RESULTS: The HIV prevalence in 1998 among IDUs was 44% for those on the street and 38.5% for those in the rehabilitation center. Independent predictors for HIV infection in IDUs were being injected by drug dealers (for the 1997 sample), injecting on the street, and sharing the drug pots (for the 1998 sample). The reported rate of needle sharing was low and decreased significantly from 20% in 1995 to 12% in 1998 for the sample of IDUs at the street. In the multivariate analysis, predictors for needle sharing for both study samples were injecting on the street, injecting at shooting galleries, and having shared needles in the past. Adequate and easy access to sterile needles and syringes, and a supportive environment of behavior change, especially in street and shooting gallery could reduce risks of virus transmission in the Vietnamese IDU community.

Adult↗
PubMed2002

Preferences for patient cost sharing among medicare beneficiaries after HMO plan withdrawals.

OBJECTIVE: To assess Medicare beneficiaries' willingness to cost share in order to minimize disruptions in coverage from HMO plan withdrawals. DESIGN: Cross-sectional survey of Medicare beneficiaries from February 1999 to March 1999. SETTING: Ten U.S. counties with the highest HMO plan withdrawal rates. PATIENTS/PARTICIPANTS: Seven hundred one Medicare beneficiaries for response rate of 69%. MEASUREMENTS AND MAIN RESULTS: Percentage of respondents willing to accept more out-of-pocket costs in order to continue their Medicare HMO coverage. Most respondents (67%) were willing to pay more out-of-pocket costs so that their HMO could have continued Medicare coverage. Those who were white (P =.03), had higher incomes (P =.01), and returned to traditional fee-for-service Medicare (P =.004) were more likely than other respondents to accept increased patient cost sharing. Most beneficiaries preferred Medicare policies requiring HMOs to sign longer-term Health Care Financing Administration (HCFA) contracts (72%) and to offer coverage to beneficiaries regardless of where they lived in a given state (87%). However, respondents' preferences for such policy options were not associated with the amount of cost sharing that respondents were willing to accept. CONCLUSIONS: Most Medicare beneficiaries are willing to accept increased patient cost sharing in order to reduce disruptions in their HMO coverage. Policies intended to reduce HMO plan withdrawals, such as requiring health plans to sign longer-term HCFA contracts, are supported by many Medicare beneficiaries, but these policy preferences were not related to willingness to cost share. In light of an apparent willingness to pay more out-of-pocket medical costs, Medicare beneficiaries in general may accept increased cost sharing in order to retain their HMO coverage.

Age Factors↗
PubMed2007

Injecting equipment sharing and perception of HIV and hepatitis risk among injecting drug users in Budapest.

In central European states, rates of HIV among injection drug users (IDUs) have been low although Hepatitis C (HCV) infection is widespread. The goal of our study was to assess HIV infection, risk perceptions and injecting equipment sharing among IDUs in Budapest, Hungary. Altogether 150 IDUs were interviewed (121 structured interviews between 1999 and 2000 and 29 ethnographic interviews between 2003 and 2004). The majority of them injected heroin (52% and 79%) and many injected amphetamines (51% and 35%). One person tested positive for HIV. Two thirds (68%) shared injecting equipment (syringes, cookers and filters). Some participants said they shared syringes because they were not carrying them for fear of police harassment and that they reused filters as a backup drug supply. In multivariate analysis, sharing of injecting equipment was associated with higher perceived susceptibility to HIV/AIDS, lower self-efficacy for sterile equipment use, higher motivation to comply with peer pressure to use dirty injecting equipment and with having a criminal record. The high levels of injecting risk-behaviors found in this study are a cause for serious concern. Interventions for HIV-prevention need to address not only sharing syringes but also sharing and reusing of other injecting equipment and drug filters.

Adolescent↗
PubMed2001

Trends in HIV seroprevalence and needle sharing among Puerto Rican drug injectors in Puerto Rico and New York: 1992-1999.

This study assessed trends in HIV seroprevalence and needle-sharing behaviors among Puerto Rican injection drug users (IDUs) in Puerto Rico and New York. Data from two studies of IDUs conducted from 1992 through 1995 and 1998 through 1999 in Bayamón, Puerto Rico, and East Harlem, New York, were examined to assess trends over this period. Separate analyses were conducted for IDUs who were current crack smokers. Significant decreasing trends in seroprevalence were found among IDUs in the New York and Puerto Rico samples (p <.001). Significant decreasing trends in receptive and distributive needle sharing were found in the New York sample, and a significant decline in receptive sharing was found in the Puerto Rico sample. Overall, higher levels of needle-sharing behaviors were reported in Puerto Rico compared with New York. Decreasing trends in needle sharing and seroprevalence in both communities are an encouraging finding. Ongoing epidemiologic studies to monitor the epidemic and continued prevention efforts to help maintain or further these declines are needed, particularly to address the higher rates of needle sharing in Puerto Rico.

Adolescent↗
PubMed2006

An outbreak of hepatitis B virus infection among methamphetamine injectors: the role of sharing injection drug equipment.

AIM: To identify risk factors for acute hepatitis B virus (HBV) infection among Wyoming methamphetamine injectors. DESIGN: A case-control study conducted in the setting of an outbreak. SETTING: A county in central Wyoming, United States. PARTICIPANTS: Cases were identified through surveillance and contact tracing and were defined as Natrona County, Wyoming, residents who were either symptomatic or confirmed serologically to be acutely infected with HBV during January-August, 2003. Controls were susceptible to HBV infection. All participants identified themselves as methamphetamine injectors. MEASUREMENTS: Participants were administered a survey that inquired about risk factors for HBV infection, including drug use practices and sexual behaviors. Controls were also tested serologically for acute HBV infection. FINDINGS: Among the 18 case-patients and 49 controls who participated in the study, sharing water used to prepare injections and/or rinse syringes was associated with HBV infection (94% of case-participants versus 44% of controls; OR = 21.9, 95% CI: 2.7, 177.8), as was sharing cotton filters (89% of case-participants versus 52% of controls; OR = 7.4, 95% CI: 1.5, 35.6); sharing syringes was not statistically associated. In logistic regression models adjusted for age, sex, and interview site, sharing rinse water and sharing cotton remained statistically associated. CONCLUSIONS: Methamphetamine use has become increasingly prevalent in the United States. Our findings highlight the need for awareness of risks associated with injection drug use and sharing behaviors. Enhanced hepatitis B vaccination programs and educational campaigns that target methamphetamine injectors specifically, including those living in rural areas, should be developed and implemented.

Adult↗
PubMed2003

Cost sharing for substance abuse and mental health services in managed care plans.

Recent initiatives to improve private insurance coverage for substance abuse and mental health in the United States have mostly focused on equalizing coverage limits to those found in general medical care. Federal law does not address cost sharing (copayments and coinsurance), which may also deter needed care or impose significant financial burdens on enrollees. This article reports on cost sharing requirements for outpatient care in a nationally representative sample of managed care plans in 1999. Levels of cost sharing are substantial, with around 40 percent of products requiring copayments of $20 or more and another 15 percent requiring coinsurance of 50 percent. Cost sharing for outpatient substance abuse treatment is very similar to that for mental health. Compared to general medical care, at least 30 percent of products impose higher cost sharing for substance abuse and mental health treatment. Future parity initiatives should be examined for how they address differences in cost sharing as well as limits.

Cost Sharing↗
PubMed1994

Sharing injecting equipment and sexual behavior in ambulatory intravenous drug users: a national survey (Spain).

This article examines the relationship between sharing and sexual behavior in a nationwide sample of 1,074 intravenous drug users (IVDUs) in ambulatory treatment in Spain. Of our sample, 31.9% shared or had shared injecting equipment. Sharing was associated with sex-less frequent in males--and yielded an inverse relationship with age, years of education, and age at first intravenous drug use. Sharers, especially women, engaged more frequently in sex in exchange for money. A small proportion (6.3%) of male IVDUs had bisexual or homosexual relations. Condoms were always used by 18.4% of males and 15.9% of females. The sharing of injecting equipment was not generally associated with a particular type of penetrative sexual encounter, although condom use was less frequent among IVDUs who shared injecting equipment. The limitations of the present study are discussed.

Adult↗
PubMed1994

Edinburgh drug users: are they injecting and sharing less?

OBJECTIVE: To describe epidemiological trends in injecting and equipment sharing among a sample drawn from a drug-using population with a high rate of HIV infection. DESIGN: A structured interview was administered prior to treatment to cross-sectional samples of drug users over the period 1988-1991. Reports of injecting, sharing and HIV infection were compared annually. SETTING: Lothian Health Board's Community Drug Problems Service is a secondary level service offering harm reduction and treatment of dependency. PARTICIPANTS: A total of 734 consecutively referred drug users resident in Edinburgh. Re-referrals in the same calendar year were excluded. MEASURES: History of injecting and sharing, recent injecting and sharing, HIV testing history, drugs used in previous month and substitute prescription status. RESULTS: Large reductions in the frequency of injecting were found over the 4 years even among those who were not receiving oral substitutes. More participants in latter years were receiving prescriptions combining opioids and benzodiazepines. Fewer of those interviewed latterly had ever shared injecting equipment. Among recent injectors just as many share equipment as previously. HIV prevalence did not vary significantly over the period. An HIV prevalence of 19% was reported among recent injectors. CONCLUSIONS: Edinburgh's drug users are engaging in far safer drug-taking behaviour than previously. Levels of HIV in this population suggest that the epidemic is being contained. A small number persist in high risk drug-related activities. Further investigation of the characteristics of these individuals and the need to develop novel methods of influencing their behaviour are recommended.

Adult↗
PubMed2000

Juvenile rheumatoid arthritis: linkage to HLA demonstrated by allele sharing in affected sibpairs.

OBJECTIVE: To test for linkage between the HLA region and juvenile rheumatoid arthritis (JRA), with stratification by onset and course types, in a cohort of affected sibling pairs (ASPs). METHODS: Eighty pairs of siblings with JRA who were registered with the Research Registry for JRA ASPs (sponsored by the National Institute of Arthritis and Musculoskeletal and Skin Diseases) were typed for HLA-DR. The observed ratio of sharing of none, one, or both parental DR alleles was compared against the expected ratio of 1:2:1 by goodness-of-fit chi-square tests. A group of 265 unrelated control subjects served as a comparison population for HLA-DR allele frequencies among patients, by Fisher's exact test. RESULTS: Overall, there was excess sharing of 2 DR alleles among ASPs with JRA. The observed ratio of sharing 0, 1, or 2 DR alleles was 8:40:32, instead of the expected ratio of 20:40:20 (P < 0.001). When stratified by JRA onset type, excess allele sharing was demonstrated among ASPs who were concordant for onset type (P = 0.002). This was true for both pauciarticular and polyarticular onset. When stratified by disease course, excess allele sharing was also demonstrated among ASPs who were concordant for disease course (P < 0.001). This was true for both the pauciarticular and the polyarticular course. Among the 32 ASPs who shared two DR alleles, 5 pairs had both DR8 and DR11, which was significantly more frequent (P < 0.0001) than the incidence in the control group (n = 0). CONCLUSION: This study of an independent cohort of multiplex families confirms the previously reported linkage between pauciarticular JRA and the HLA-DR region that was identified using a different analytic method in a cohort of simplex families. Additionally, this study establishes evidence for linkage between polyarticular JRA and the HLA-DR region.

Alleles↗
PubMed2002

Approaches to sharing occupational safety and health information on a global scale.

BACKGROUND: The global burden of occupational morbidity and mortality is staggering. Information sharing has been identified as a major way of reducing this burden. Past and current approaches to such sharing and application are worth examining in order to guide future efforts. METHODS: Recent literature from international agencies and others was examined to identify examples of information sharing and to determine the status of such sharing and related issues. Literature was included from the areas of surveillance, priority setting, research, dissemination, and risk management. RESULTS: Examples of global information sharing were identified and lessons were drawn from the issues attendant to them. CONCLUSIONS: Results indicate that a broad range of efforts actively promote the global distribution of occupational safety and health information. To advance global approaches to the sharing of occupational and safety and health information, it is critical to improve the opportunity and capacity to access information. Important objectives in achieving this goal are developing coherent and transparent information policies, conducting research on dissemination, adaptation, and utilization of information, and overcoming barriers to information and training.

Global Health↗
PubMed1994

"Homozygosity" for the HLA-DR shared epitope contributes the highest risk for rheumatoid arthritis concordance in identical twins.

OBJECTIVE: To assess the contribution of HLA-DRB1 alleles in determining rheumatoid arthritis (RA) concordance in monozygotic twins. METHODS: Ninety-one monozygotic twins pairs in which at least 1 twin was affected were typed for HLA-DRB1 using both serologic methods and polymerase chain reaction amplification with sequence-specific oligonucleotide hybridization. The role of DR4 and of the shared epitope in disease concordance was investigated. Relative risks (RR) with 95% confidence intervals were determined. RESULTS: Increased concordance for RA was observed in both DR4 positive and shared epitope positive pairs (RR 3.4 and 3.7, respectively). A 5-fold risk for RA concordance was seen in twins who were "homozygous" for the shared epitope, compared with those negative for the shared epitope. CONCLUSION: In the absence of the shared epitope, RA concordance in monozygotic twins is rare. In contrast, "homozygosity" for the shared epitope is the most important factor in determining RA concordance.

Arthritis, Rheumatoid↗
PubMed2000

Territory tenure in song sparrows is related to song sharing with neighbours, but not to repertoire size.

Song repertoires may be a product of sexual selection and several studies have reported correlations of repertoire size and reproductive success in male songbirds. This hypothesis and the reported correlations, however, are not sufficient to explain the observation that most species have small song repertoire sizes (usually fewer than 10, often fewer than five song types). We examined a second important aspect of a male's song repertoire, the extent to which he shares songs with his neighbours. Song sharing has not been measured in previous studies and it may be partially confounded with repertoire size. We hypothesized that in song sparrows, Melospiza melodia, song sharing rather than repertoire size per se is crucial for male territorial success. Our longitudinal study of 45 song sparrows followed from their first year on territory showed that the number of songs a bird shares with his neighbourhood group is a better predictor of lifetime territory tenure than is his repertoire size. We also found that song sharing increases with repertoire size up to but not beyond eight to nine song types, which are the most common repertoire sizes in the population (range in our sample 5-13). This partial confound of song sharing and repertoire size may account for some earlier findings of territory tenure-repertoire size correlations in this species and other species having small- or medium-sized repertoires. Copyright 2000 The Association for the Study of Animal Behaviour.

Journal Article↗
PubMed2002

All-or-none bottleneck versus capacity sharing accounts of the psychological refractory period phenomenon.

The goal of the present experiment was to test the predictions of Central Bottleneck and Central Capacity Sharing models. According to the Central Bottleneck model, dual task interference, as observed in the PRP paradigm, is caused by an all-or-none bottleneck in information processing. The Central Capacity Sharing model postulates that dual task interference is caused by a capacity limited process that can allocate capacity in a graded fashion. The Central Bottleneck model predicts no change in RT1 with decreasing SOA, whereas the Central Capacity Sharing model predicts that RT1 will increase with decreasing SOA and that the slope of the RT1 SOA effect will depend upon the difficulty of task 2. Subjects were required to perform a tone pitch judgement and shape-matching task in rapid succession. Task order was randomized and the SOA between the first and second stimulus varied from 50 to 1250 ms. Results from this experiment favour the Central Capacity Sharing model. The results were then run through simulations of both the Central Bottleneck and Central Capacity Sharing models. Results from the simulations also favoured the Central Capacity Sharing model. As the difficulty of the second task increased, more capacity was allocated to it, confirming the prediction that as task 2 difficulty increases, the RT1 SOA slope increases. The proportion of capacity allocated to the first task varied from.78 to.91 indicating that capacity can be allocated in a graded fashion.

Analysis of Variance↗
PubMed2001

Mapping of a susceptibility gene for multiple sclerosis to the 51 kb interval between G511525 and D6S1666 using a new method of haplotype sharing analysis.

Multiple sclerosis (MS) is a complex disease that is partly genetic in origin. Although an association of MS with specific human leukocyte antigen (HLA) types has been known for almost 30 years, the nature of this relationship has remained unclear. Furthermore, genetic resolution sufficient to implicate a specific gene in the HLA region has not been achieved. Many loci in the HLA region have been found to be significantly associated with MS, which is largely explained by the extended haplotype sharing and varying marker informativity of the region. We have determined 248 haplotypes of MS patients from the population of the northern Netherlands and 226 haplotypes of their relatives as controls using a set of 22 microsatellite markers covering the HLA region. The data were analyzed using standard association methods and a new statistical method, haplotype sharing statistics (HSS). Haplotype sharing statistics determines the extent of haplotype sharing for all pairs of haplotypes of patients and of controls and calculates the difference in mean haplotype sharing between patients and controls. Haplotype sharing was found to be significantly greater among patients than among controls in a region of 1.1 Mb between markers G511525 and TNFalpha. The involvement of this region is also supported by association analysis and the transmission/disequilibrium test (TDT). Within this region, HSS, which is largely independent of association and TDT, indicated the interval of 51 kb between G511525 and D6S1666 as that most likely to contain a susceptibility gene for MS. As DQB1 is the sole gene known in this interval at present, the results of our analysis suggest that this gene plays a role in the pathogenesis of MS.

Cluster Analysis↗
PubMed2002

Sharing of a single picture archiving and communications system among disparate institutions: barriers to success.

There has been a great deal of interest in sharing picture archiving and communications system (PACS) technology. Much of the discussion to this point has involved macro business/technical issues, such as cost for service, bandwidth, and storage technologies. In our own effort to share the Maine Medical Center PACS with other providers, we have found that the micro issues are just as important, including trust, cooperation, persistence, and dedication to fundamental change. It is not impossible to share a PACS, but a number of barriers must be overcome if the overall effort is to be successful. In this paper we present our experience with shared PACS technology by describing the impediments to sharing PACS among disparate institutions; explaining our early attempts to integrate "outside" images into our institutional PACS and the impediments that led to the failure of those early attempts; and suggesting a semi-quantitative means for calculating Likelihood of Success, based on lessons learned thus far. We also describe a new, multilevel effort at sharing our PACS, hoping to stimulate discussion of the barriers to success and to solicit input from PACS vendors and from fellow SCAR members.

Computer Communication Networks↗
PubMed2005

Surrogate data--a secure way to share corporate data.

The privacy of chemical structure is of paramount importance for the industrial sector, in particular for the pharmaceutical industry. At the same time, companies handle large amounts of physico-chemical and biological data that could be shared in order to improve our molecular understanding of pharmacokinetic and toxicological properties, which could lead to improved predictivity and shorten the development time for drugs, in particular in the early phases of drug discovery. The current study provides some theoretical limits on the information required to produce reverse engineering of molecules from generated descriptors and demonstrates that the information content of molecules can be as low as less than one bit per atom. Thus theoretically just one descriptor can be used to completely disclose the molecular structure. Instead of sharing descriptors, we propose to share surrogate data. The sharing of surrogate data is nothing else but sharing of reliably predicted molecules. The use of surrogate data can provide the same information as the original set. We consider the practical application of this idea to predict lipophilicity of chemical compounds and we demonstrate that surrogate and real (original) data provides similar prediction ability. Thus, our proposed strategy makes it possible not only to share descriptors, but also complete collections of surrogate molecules without the danger of disclosing the underlying molecular structures.

Chemical Engineering↗