Effect of Monoclonal Antibody Treatment on Clinical Outcomes in Ambulatory Patients With Coronavirus Disease 2019.

We compared rates of emergency department visits or hospitalizations among ambulatory coronavirus disease 2019 (COVID-19) patients treated with monoclonal antibody (mAb) therapy (n = 305) vs untreated patients (n = 6354). Treatment was associated with decreased encounters within 30 days (adjusted odds ratio, 0.23 [95% confidence interval, .

Physician perspectives on de-intensifying diabetes medications.

Guidelines for diabetes care recommend that physicians select individualized glycemic goals based on life expectancy, diabetes duration, comorbidity, and resources/support. When patients have stable hemoglobin A1C (HbA1C) levels, guidelines lack recommendations on when diabetes medications should be de-intensified.To understand physicians' perspectives on de-intensifying diabetes medications in patients with type 2 diabetes.

Perceptions of racism in healthcare among patients with systemic lupus erythematosus: a cross-sectional study.

Background: Racial disparities in the clinical outcomes of systemic lupus erythematosus (SLE) exist. Perceived racial discrimination may contribute to disparities in health.

Objectives: To determine if perceived racism in healthcare differs by race among patients with SLE and to evaluate its contribution to racial disparities in SLE-related outcomes.

Evaluating Primary Care Physician Performance in Diabetes Glucose Control.

This study demonstrates that it is possible to identify primary care physicians (PCPs) who perform better or worse than expected in managing diabetes. Study subjects were 14 033 adult diabetics and their 133 PCPs. Logistic regression was used to predict the odds that a patient would have uncontrolled diabetes (defined as HbA1c ≥8%) based on patient-level characteristics alone.

Racial differences in treatment preferences among lupus patients: a two-site study.

Objectives: To identify the demographic, clinical and psychosocial characteristics associated with racial differences in willingness to receive cyclophosphamide (CYC) or participate in a research clinical trial (RCT) among patients with systemic lupus erythematosus (SLE).

Methods: Data from 163 African-American (AA) and 180 white (WH) SLE patients were evaluated. Structured interviews and chart reviews were conducted to determine treatment preferences in hypothetical situations and identify variables that may affect preferences.

A technology-based quality innovation to identify undiagnosed hypertension among active primary care patients.

Purpose: The goal of this study was to develop a technology-based strategy to identify patients with undiagnosed hypertension in 23 primary care practices and integrate this innovation into a continuous quality improvement initiative in a large, integrated health system.

Methods: In phase 1, we reviewed electronic health records (EHRs) using algorithms designed to identify patients at risk for undiagnosed hypertension. We then invited each at-risk patient to complete an automated office blood pressure (AOBP) protocol.

A study of racial/ethnic differences in treatment preferences among lupus patients.

Objectives: To determine whether there are racial/ethnic differences in the willingness of SLE patients to receive CYC or participate in clinical trials, and whether demographic, psychosocial and clinical characteristics contribute to these differences.

Methods: Data from 120 African-American and 62 white lupus patients were evaluated. Structured telephone interviews were conducted to determine treatment preferences, as well as to study characteristics and beliefs that may affect these preferences.

Serum 2-methoxyestradiol, an estrogen metabolite, is positively associated with serum HDL-C in a population-based sample.

Serum HDL cholesterol (HDL-C) is inversely associated with coronary artery disease, ischemic stroke, and atherosclerosis in men and women. Among postmenopausal women, oral conjugated equine estrogen (CEE) increases serum HDL-C. This is due to activation of hepatic nuclear estrogen receptors, resulting in increased HDL-C expression, as well as modulation of proteins which metabolize HDL-C.

Dietary fiber and serum 16α-hydroxyestrone, an estrogen metabolite associated with lower systolic blood pressure.

Objective: We recently identified an inverse relation between systolic blood pressure (SBP) and serum 16α-hydroxyestrone, a metabolite of 17β-estradiol, in postmenopausal women. Formation of 16α-hydroxyestrone is catalyzed primarily by CYP1A2, a cytochrome P450 enzyme. The objective of this study was to evaluate the relations between known modifiers of CYP1A2 activity and serum 16α-hydroxyestrone in postmenopausal women.

A meta-analysis of interventions to reduce loneliness.

Social and demographic trends are placing an increasing number of adults at risk for loneliness, an established risk factor for physical and mental illness. The growing costs of loneliness have led to a number of loneliness reduction interventions. Qualitative reviews have identified four primary intervention strategies: (a) improving social skills, (b) enhancing social support, (c) increasing opportunities for social contact, and (d) addressing maladaptive social cognition.

Loneliness predicts increased blood pressure: 5-year cross-lagged analyses in middle-aged and older adults.

Loneliness is a prevalent social problem with serious physiological and health implications. However, much of the research to date is based on cross-sectional data, including our own earlier finding that loneliness was associated with elevated blood pressure (Hawkley, Masi, Berry & Cacioppo, 2006). In this study, we tested the hypothesis that the effect of loneliness accumulates to produce greater increases in systolic blood pressure (SBP) over a 4-year period than are observed in less lonely individuals.

Serum estrogen metabolites and systolic blood pressure among middle-aged and older women and men.

Background: Hypertension is more common among men at younger ages and among women after age 60, suggesting a possible link between endogenous estrogens and systolic blood pressure (SBP). We tested whether serum 17beta-estradiol (E(2)) or any of its metabolites were associated with SBP among middle-aged and older adults.

Methods: Using a cross-sectional study design, we examined data from a population-based sample of 98 adults living in Cook County, Illinois.

Autonomic tone and C-reactive protein: a prospective population-based study.

Objectives: To examine the cross-sectional and longitudinal relationships between cardiac autonomic tone and serum CRP and to investigate potential causal links between these measures.

Methods: A population-based sample of 188 home-dwelling, middle-aged and older adults (104 women, mean age 59 years) from Cook County, IL, participated in this prospective cohort study. High-frequency heart rate variability (HF) and pre-ejection period (PEP) served as markers of cardiac parasympathetic and sympathetic tone, respectively.

Perceptions of breast cancer treatment among African-American women and men: implications for interventions.

Background: While breast cancer mortality has declined in recent years, the mortality gap between African-American and white women continues to grow. Current strategies to reduce this disparity focus on logistical and information needs, but contextual factors, such as concerns about racism and treatment side effects, may also represent significant barriers to improved outcomes.

Objective: To characterize perceptions of breast cancer treatment among African-American women and men.

From social structural factors to perceptions of relationship quality and loneliness: the Chicago health, aging, and social relations study.

Objective: The objective of this study was to test a conceptual model of loneliness in which social structural factors are posited to operate through proximal factors to influence perceptions of relationship quality and loneliness.

Methods: We used a population-based sample of 225 White, Black, and Hispanic men and women aged 50 through 68 from the Chicago Health, Aging, and Social Relations Study to examine the extent to which associations between sociodemographic factors and loneliness were explained by socioeconomic status, physical health, social roles, stress exposure, and, ultimately, by network size and subjective relationship quality.

Result: Education and income were negatively associated with loneliness and explained racial/ethnic differences in loneliness.

Biomarkers of Psychological Stress in Health Disparities Research.

Psychological stress can contribute to health disparities in populations that are confronted with the recurring stress of everyday life. A number of biomarkers have been shown to be affected by psychological stress. These biomarkers include allostatic load, which is a summary measure of the cumulative biological burden of the repeated attempts to adapt to daily stress.

Interventions to enhance breast cancer screening, diagnosis, and treatment among racial and ethnic minority women.

The authors conduct a systematic review of the literature to identify interventions designed to enhance breast cancer screening, diagnosis, and treatment among minority women. Most trials in this area have focused on breast cancer screening, while relatively few have addressed diagnostic testing or breast cancer treatment. Among patient-targeted screening interventions, those that are culturally tailored or addressed financial or logistical barriers are generally more effective than reminder-based interventions, especially among women with fewer financial resources and those without previous mammography.

Neighborhood economic disadvantage, violent crime, group density, and pregnancy outcomes in a diverse, urban population.

Prior research has established associations between pregnancy outcomes and specific neighborhood characteristics, including economic disadvantage, violent crime, and racial/ethnic segregation. Recently, associations have also been found between various health outcomes and group density, the degree to which an individual is a racial or ethnic majority in his or her local community. The objective of this study was to determine the extent to which census tract economic disadvantage, violent crime rate, and group density are associated with pregnancy outcomes among White, Black, and Hispanic infants in a large metropolitan setting.

Respiratory sinus arrhythmia and diseases of aging: obesity, diabetes mellitus, and hypertension.

Associations between respiratory sinus arrhythmia (RSA) and several chronic diseases, including obesity, diabetes mellitus, and hypertension, have been documented in recent years. Although most evidence suggests reduced RSA is the result of chronic disease rather than the cause, some studies have documented reduced RSA among at-risk individuals prior to disease onset. These results raise the possibility that decreased vagal tone may play a role in the pathogenesis of certain chronic diseases.

Racial and ethnic disparities in breast cancer mortality: are we doing enough to address the root causes?

Breast cancer is the most common noncutaneous malignancy and the second most lethal form of cancer among women in the United States. Mortality from breast cancer has declined since the late 1980s, but this decline has been steeper among white women compared with black women. As a result, the black:white mortality rate ratio has increased over the last two decades.

Loneliness is a unique predictor of age-related differences in systolic blood pressure.

A population-based sample of Caucasians, African Americans, and Latino Americans, 50-68 years of age (M = 57.5), from Cook County, Illinois (N = 229), was tested to examine how loneliness and co-occurring psychosocial factors (depressive symptoms, perceived stress, social support, and hostility) were related to indices of cardiovascular and endocrine functioning. Extending prior research, the authors found that loneliness was associated with elevated systolic blood pressure (SBP) and age-related increases in SBP, net of demographic variables, health behavior variables, and the remaining psychosocial factors.

Estrogen metabolites and systolic blood pressure in a population-based sample of postmenopausal women.

Context: Lower systolic blood pressure (SBP) and lower rates of coronary heart disease among premenopausal women compared with similarly aged men and postmenopausal women suggest that female sex hormones may confer cardiovascular protection. 2-Hydroxyestradiol, a product of 17beta-estradiol oxidative metabolism, inhibits the proliferation of vascular smooth muscle cells in vitro. The other major product of 17beta-estradiol oxidative metabolism, 16alpha-hydroxyestradiol, does not demonstrate similar inhibitory effects.

Racial and ethnic disparities in breast cancer: a multilevel perspective.

Although the etiology of racial and ethnic disparities in breast cancer is complex, the studies reviewed here suggest many possible culprits. In the authors' model, outcomes at the cellular level reflect not only genetic constitution and the hormonal milieu but also the interactions of predictors at multiple levels. At the societal level, important predictors include toxin and hormone exposure, access to care, quality of care, and social support.

The effects of racial density and income incongruity on pregnancy outcomes.

This study shows that living in a better area reduces the risk of adverse pregnancy outcomes but, among African-American women, living in an area in which they are in a racial minority may increase the risk. Using the 1991 cohort of single infants born to African-American women in Chicago, we measured census tract socioeconomic status and defined women as having "positive income incongruity" if they lived in wealthier tracts than the average African-American woman of comparable education and marital status. We examined whether or not the effect of positive income incongruity differed according to whether or not African-American women lived in predominantly black, or mixed tracts.

Gender and ethnic differences in urinary stress hormones: the population-based Chicago Health, Aging, and Social Relations Study.

Gender and ethnic disparities in cardiovascular disease and mortality have spurred interest in the epidemiology of stress hormone production. Greater disease burden among men and blacks raises the possibility of gender and ethnic differences in stress hormone production. The purpose of this study was to determine whether urinary stress hormones were higher among men and blacks in a population-based sample.