Depressive symptoms and self-reported adherence to medical recommendations to prevent cardiovascular disease: NHANES 2005-2010.

UNLABELLED: This study's aim was to examine the relationships between depressive symptom severity and adherence to medication and lifestyle recommendations intended to prevent cardiovascular disease (CVD) in a large, diverse sample of men and women representative of the U.S. POPULATION: Participants were adults from the National Health and Nutrition Examination Survey (NHANES) 2005-2010 with a self-reported history of hypertension and/or hypercholesterolemia, but no CVD. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms, and the Blood Pressure and Cholesterol interview was used to assess self-reported adherence to five medical recommendations: take antihypertensive medication (n = 3313), eat fewer high fat/cholesterol foods (n = 2924), control/lose weight (n = 2177), increase physical activity (n = 2540), and take cholesterol medication (n = 2266). Logistic regression models (adjusted for demographics, diabetes, body mass index, smoking, and alcohol intake) revealed that a 1-SD increase in PHQ-9 score was associated with a 14% lower odds of adherence to the control/lose weight recommendation (OR = 0.86, 95% CI: 0.75-0.98, p = .02) and a 25% lower odds of adherence to the increase physical activity recommendation (OR = 0.75, 95% CI: 0.65-0.86, p < .001). PHQ-9 score, however, was not related to the odds of adherence to the take antihypertensive medication (p = .21), eat fewer high fat/cholesterol foods (p = .40), or take cholesterol medication (p = .90) recommendations. Our findings suggest that poor adherence to provider recommendations to control/lose weight and to increase physical activity may partially explain the excess risk of CVD among depressed persons.

Phlebotomist interpersonal skill predicts a reduction in reactions among volunteer blood donors.

BACKGROUND: Adverse reactions in response to blood donation negatively affect the likelihood of donor return. In this study, the interpersonal skill of phlebotomists was examined as a potential predictor of both donor reactions and returns for future donation. STUDY DESIGN AND METHODS: Participants were 82 phlebotomists who completed the Social Skills Inventory, a global measure of interpersonal skill. Scores on this measure were used to predict the likelihood of donor reaction (rated by phlebotomists) and return for future donation in two samples of volunteer blood donors associated with these phlebotomists. Use of two samples permitted examination of phlebotomist interpersonal skill as a predictor of donor reactions and returns both before and after the phlebotomists were aware of the interpersonal skills assessment. RESULTS: Results of multilevel logistic regression analyses demonstrated that a one-standard-deviation increase in Social Skills Inventory score was associated with a significant reduction in the likelihood of donor reaction in the first sample (odds ratio [OR], 0.86; 95% confidence interval [CI], 0.76-0.96) and with a marginally significant reduction in the likelihood of donor reaction in the second sample (OR, 0.90; 95% CI, 0.79-1.02). Social Skills Inventory scores were not related to returns for future donation in either sample. CONCLUSIONS: This study provides the first empirical evidence that phlebotomist interpersonal skill predicts the experience of reactions among volunteer blood donors. A focus on the interpersonal skill of phlebotomists may therefore provide an additional avenue for improving donors' physical well-being and satisfaction, thereby enhancing donor retention.

Prescription of amiodarone through a computerized template that includes both decision support and executive functions improves the monitoring for toxicities.

The antiarrhythmic drug amiodarone causes severe side effects that warrant active monitoring. In a given patient, monitoring for amiodarone toxicities involves checking past results of five laboratory/imaging tests and reordering four of these tests every 6 to 12 month, a process that is both complex and time-consuming. We hypothesized that a software tool that automated the retrieval and ordering of these tests in a context-sensitive manner would improve the completeness of surveillance for drug toxicities.