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Background: Risk adjustment for mortality is increasingly important in an era when hospitals and health care systems are being compared with respect to health outcomes and quality. A powerful predictive model has been developed to risk-adjust for 30-day mortality among inpatients, but it is complex and not widely used. Objective: To develop and validate a simpler model, with predictive power similar to more complex models. Research Design: This was a retrospective split-validation study. In a derivation cohort, a predictive model for 30-day mortality was developed using logistic regression with the Charlson comorbidity score, Laboratory-Based Acute Physiology Score, and age as the predictor variables. In the validation cohort, the performance and calibration of the model to predict 30-day mortality was examined. Subjects: All admissions to the medical service of 2 urban university-based teaching hospitals located in Bronx, New York, between July 1, 2002, and April 30, 2008. Measures: All-cause mortality was taken from the social security death registry. Predictor variables were constructed from demographic characteristics, laboratory and billing data extracted from a clinical data repository. Results: The study sample included 147 991 admissions and overall 30-day mortality was 5.4%. The model had excellent discrimination, with a c-statistics of 0.8585 in the derivation cohort and 0.8484 in the validation cohort. The model accurately predicts 30-day mortality in all risk deciles. Conclusions: This simple and powerful predictive model can be used by hospitals and health care systems as a risk-adjustment tool for quality and research purposes. [ABSTRACT FROM AUTHOR]

In observational and retrospective studies, people who use cannabis are more likely than people who do not use cannabis to also use other drugs. People who take medical cannabis are also more likely to report medical and non-medical use of opioid analgesics, stimulants, and tranquilizers. Given that people who take medical cannabis and those who do not are likely to have different underlying morbidity, it is possible that medical cannabis use reduces prescription drug use yet prescription drug use remains relatively high. Studies comparing people who take medical cannabis with people who do not take it cannot draw conclusions about the effect of medical cannabis on drug use. To fully understand the effect of medical cannabis on the use of other drugs, prospective longitudinal studies randomizing individuals to cannabis versus other treatments are urgently needed. [ABSTRACT FROM AUTHOR]

HIV-infected current and former drug users utilize primary care and preventive health services at suboptimal rates, but little is known about how social support networks are associated with health services use. We investigated the relationship between social support networks and the use of specific types of health services by HIV-infected drug users receiving methadone maintenance. We found that persons with greater social support, in particular more social network members or more network members aware of their HIV status, were more likely to use primary care services. In contrast, social support networks were not related to emergency room or inpatient hospital use. Interventions that build social support might improve coordinated and continuous health services utilization by HIV-infected persons in outpatient drug treatment. [Copyright &y& Elsevier]

The article presents a research study concerning the integration of hepatitis C virus (HCV) evaluation services with methadone maintenance treatment (MMT) programs. Research found that injection drug users may receive successful treatment for HCV infection in community-based substance abuse treatment facilities, and the colocation of services effectively reaches socioeconomically-challenged groups.

The article discusses the role of informal caregiving and household factors with regards to microsocial environmental influences on highly active antiretroviral therapy outcomes among active injection drug users (IDUs). It suggests that multinominal regression determined baseline predictors of achieving or maintaining viral suppression. It declares that adherence interventions for IDUs should promote existing informal caregiving and positive medication-taking norms among social networks.

The article discusses the factors associated with antiretroviral therapy adherence and medication errors among HIV-infected injection drug users (IDUs). It suggests that the modifiable factors associated with poor adherence, including depressive symptoms and poor self-efficacy, should be targeted for intervention. It concludes that interventions should include particular efforts to identify medication taking inconsistent with antiretroviral prescriptions.

The article reports on practical and conceptual challenges in measuring antiretroviral adherence. Accurate measurement is significant for targeting and rigorously assessing interventions to enhance adherence and prevent viral resistance. The state of the science of adherence measurement, the advantages and disadvantages of common adherence measurement procedures and directions for improving antiretroviral adherence measurement in clinical care and research are described and discussed.

The article examines the individual-level, interpersonal, and structural factors associated with achieving undetectable plasma viral load among injection drug users receiving recommended highly active antiretroviral therapy (HAART) in the U.S. The subjects used in the study were those currently taking recommended HAART. The results of the study was discussed and suggests that social support in facilitating effective HAART use in the population.

Background: Patient self-report is a practical method for measuring adherence, but little is known about its optimal use., Objectives: To examine the retest reliability and predictive validity of 3 different types of self-report adherence measures among patients with common chronic illnesses., Research Design: Correlation and regression analyses of data from an ongoing randomized controlled trial., Subjects: Patients (N = 415) aged >or=40 years recruited from a primary care network with arthritis, asthma, chronic lung disease, congestive heart failure, depression, and/or diabetes mellitus, plus impairment in >or=1 basic activity and/or a score of >or=4 on the 10-item Center for Epidemiologic Studies Depression Scale., Measures: : Self-report adherence (administered variously at baseline, 2, 4, and 6 weeks, and 6 months): number of pills taken/number of pills prescribed (PT/PP), using 1-7 days recall, and global reports of medication adherence and overall adherence tendencies. Six-month functional outcomes: Health Assessment Questionnaire (HAQ) and Short Form-36 (SF-36)., Results: Correlation coefficients among contemporaneously administered 1-7 days PT/PP measures were >or=0.78. Correlations among PT/PP measures and global adherence measures, and among PT/PP measures at 2 and 4 weeks, ranged from 0.11 to 0.54. PT/PP measures using >or=3-4 days recall significantly predicted adjusted 6-month HAQ but not SF-36 score., Conclusions: Self-report PT/PP and general medication adherence measures tap different behavioral constructs. Self-reported PT/PP at a given point in time is not necessarily representative of medication adherence over time. Among chronically ill patients, 3-4 days recall of PT/PP yield adherence estimates, which are practically as reliable and valid as longer intervals and which predict functional outcomes.

Background: Osteopenia has been described in HIV-infected persons, but most studies have not focused on aging men, have not included an HIV-negative comparison group with similar risks to those of the HIV-infected men, or lacked data on fracture rates., Methods: We analyzed bone mineral density (BMD) and incident fractures in 559 men who were >or= 49 years old with or at-risk for HIV, including 328 with and 231 without HIV infection., Results: Median age was 55 years, 56% were black and 89% had used illicit drugs. In unadjusted analysis, BMD was lower in HIV-infected compared with HIV-uninfected men at the femoral neck (0.97 +/- 0.14 versus 1.00 +/- 0.15 g/cm; P < 0.05) and lumbar spine (1.17 +/- 0.20 versus 1.20 +/- 0.21 g/cm; P = 0.06); both differences were significant (P < 0.05) after adjusting for age, weight, race, testosterone level, and prednisone and illicit drug use. Non-black race and body weight were independently associated with BMD at both measurement sites and methadone therapy was independently associated with spine BMD. Among HIV-infected men, 87% had taken antiretrovirals and 74% had taken protease inhibitors, but their use was not associated with BMD. Among men who had at least one subsequent study visit (94%), incident fracture rates per 100 person-years differed among men with normal BMD, osteopenia and osteoporosis (1.4 versus 3.6 versus 6.5; P < 0.01). A 38% increase in fracture rate among HIV-infected men was not statistically significant., Conclusions: HIV infection is independently associated with modestly reduced BMD in aging men, and decreased BMD is associated with increased fracture risk.

Objectives: To examine the relationship between antiretroviral adherence and viral load, and to determine the predictors of adherence over time in HIV-infected women., Design: Prospective observational study., Methods: One-hundred sixty-one HIV-infected women who were taking antiretroviral therapy for a median of 3.0 years were recruited from the HIV Epidemiology Research Study, a multicenter cohort study of HIV infection in women. Antiretroviral adherence (percent of doses taken as prescribed) was measured over a 6-month period using MEMS caps. At baseline and follow-up, CD4 lymphocyte count and viral load were measured, and a standardized interview was administered to elicit medication history and drug use behaviors. To examine changes in adherence over time, the mean adherence to all antiretroviral agents was calculated for each monitored month., Results: Adherence varied significantly over time (P < 0.001), ranging from a mean of 64% in month 1 to 45% in month 6. Nearly one-fourth of the participants had a 10% or greater decrease in adherence between consecutive months. Virologic failure occurred in 17% of women with adherence of > or = 88%, 28% of those with 45-87% adherence, 43% of those with 13-44% adherence, and 71% of those with < or = 12% adherence. In multivariate analysis, factors predicting lower adherence included active drug use, alcohol use, more frequent antiretroviral dosing, shorter duration of antiretroviral use, younger age, and lower initial CD4 lymphocyte count., Conclusions: Antiretroviral adherence is not stable over time. Interventions aimed at monitoring and improving long-term adherence in women are urgently needed.