ABSTRACT
OBJECTIVES: To investigate the factors associated with medication compliance in a multi-ethnic population of patients with systemic lupus erythematosus in an urban community. METHODS: We surveyed patients in our cohort using the standardized measures of the Compliance-Questionnaire-Rheumatology (CQR), the Beliefs about Medications Questionnaire (BMQ), as well as patient self-reported compliance. Demographic and clinical characteristics of compliant and non-compliant patients underwent bivariate analysis. A multivariate analysis was then performed on variables of interest. RESULTS: Of the 94 patients who agreed to participate in the survey, 89 fully completed each questionnaire. Overall, 48% of patients were compliant by CQR. In multivariate analyses, higher education level was associated with non-compliance. Spanish-speaking patients and those with an income of greater than $15,000 per year were more likely to be compliant. CONCLUSIONS: In this urban lupus population, several factors may influence medication compliance. Factors associated with non-compliance are not what have been found in other populations. Further studies looking into specific reasons for certain areas of non-compliance as well as addressing these issues will be important in both treatment and outcomes in lupus patients in implementing appropriate interventions.
ABSTRACT
Drosophila pseudoobscura harbors a rich polymorphism for paracentric inversions on the third chromosome, and the clines in the inversion frequencies across the southwestern United States indicate that strong natural selection operates on them. Isogenic inversion strains were made from isofemale lines collected from four localities, and eight molecular markers were mapped on the third chromosome. Nucleotide diversity was measured for these loci and formed the basis of an evolutionary genomic analysis. The loci were differentiated among inversions. The inversions did not show significant differences among populations, however, likely the result of extensive gene flow among populations. Some loci had significant reductions in nucleotide diversity within inversions compared with interspecies divergence, suggesting that these loci are near inversion breakpoints or are near targets of directional selection. Linkage disequilibrium (LD) levels tended to decrease with distance between loci, indicating that some genetic exchange occurs among gene arrangements despite the presence of inversions. In some cases, however, adjacent genes had low levels of interlocus LD and loosely linked genes had high levels of interlocus LD, suggesting strong epistatic selection. Our results support the hypothesis that the inversions of D. pseudoobscura have emerged as suppressors of recombination to maintain positive epistatic relationships among loci within gene arrangements that developed as the species adapted to a heterogeneous environment.
