Frequent exposure to green space has been linked to positive health and well-being in varying populations. Yet, there is still limited research exploring the restorative benefits associated with differing types of green space use among students living in the university setting. To address this gap, we explored green space use amongst a population of undergraduate students (n = 207) attending a university with abundant opportunities to access the restorative properties of nature. The purpose of this study was to examine the type and frequency of green space interactions that are most strongly associated with indicators of health and well-being, and investigate student characteristics associated with frequent use of green space. Results revealed that students who frequently engage with green spaces in active ways report higher quality of life, better overall mood, and lower perceived stress. Passive green space interactions were not strongly associated with indicators of health and well-being. Having had daily interactions with green space in childhood was associated with frequent green space use as a university student, and identified barriers to green space use included “not enough time,” and “not aware of opportunities” These results could assist in the tailoring of “green exercise” interventions conducted in the university setting.

Objectives We assessed whether socio-demographic, clinical, health care system, psychosocial, and behavioral factors are differentially associated with low antihypertensive medication adherence scores among older men and women. Design / Setting A cross-sectional analysis using baseline data from the Cohort Study of Medication Adherence in Older Adults (CoSMO, n=2,194). Measurements Low antihypertensive medication adherence was defined as a score <6 on the 8-item Morisky Medication Adherence Scale. Risk factors for low adherence were collected using telephone surveys and administrative databases. Results The prevalence of low medication adherence scores did not differ according to sex (15.0% in women and 13.1% in men p=0.208). In sex-specific multivariable models, having issues with medication cost and practicing fewer lifestyle modifications for blood pressure control were associated with low adherence scores among both men and women. Factors associated with low adherence scores in men but not women included reduced sexual functioning (OR = 2.03; 95% CI: 1.31, 3.16 for men and OR = 1.28; 95% CI: 0.90, 1.82 for women), and BMI ≥25 (OR = 3.23; 95% CI: 1.59, 6.59 for men and 1.23; 95% CI: 0.82, 1.85 for women). Factors associated with low adherence scores in women but not men included dissatisfaction with communication with their healthcare provider (OR = 1.75; 95% CI: 1.16, 2.65 for women and OR =1.16 95% CI: 0.57, 2.34 for men) and depressive symptoms (OR = 2.29; 95% CI: 1.55, 3.38 for women and OR = 0.93; 95% CI: 0.48, 1.80 for men). Conclusion Factors associated with low antihypertensive medication adherence scores differed according to sex. Interventions designed to improve adherence in older adults should be tailored to account for the sex of the target population.

low HRQOL may be an important barrier to achieving high medication adherence.

Background Pharmacy refill adherence assesses medication-filling behaviors whereas self-report adherence assesses medication-taking behaviors. We contrasted the association of pharmacy refill and self-reported antihypertensive medication adherence with cardiovascular disease (CVD) incidence. Methods and Results Adults (n=2075) from the prospective Cohort Study of Medication Adherence among Older Adults (CoSMO) recruited between August 2006 and September 2007 were included. Antihypertensive medication adherence was determined using a pharmacy refill measure, Medication Possession Ratio-MPR (low, medium, high MPR: <0.5, 0.5 to <0.8, ≥0.8, respectively) and a self-reported measure, 8-item Morisky Medication Adherence Scale-MMAS-8 (low, medium, high MMAS-8: <6, 6 to <8, and 8, respectively). Incident CVD events (stroke, myocardial infarction, congestive heart failure, or CVD death) through February 2011 were identified and adjudicated. The prevalence of low, medium and high adherence was 4.5 %, 23.7%, and 71.8% for MPR and 14.0%, 34.3%, and 51.8% for MMAS-8. During a median 3.8 years follow-up, 240 (11.5%) people had a CVD event. After multivariable adjustment and compared to those with high MPR, the hazard ratios (HR) for CVD associated with medium and low MPR were 1.17 (95% confidence interval [CI] 0.87, 1.56) and 1.87 (95% CI: 1.06, 3.30), respectively. Compared to those with high MMAS-8, the HRs (95% CI) for MMAS-8 for medium and low MMAS-8 were 1.04 (0.79–1.38) and 0.89 (0.58–1.35), respectively. Conclusions Pharmacy refill but not self-report antihypertensive medication adherence was associated with incident CVD. The differences in these associations may be due to distinctions in what each adherence measure assesses.

Psoriatic arthritis (PsA) is an inflammatory arthritis associated with irreversible joint damage in a subset of individuals. There is a need to screen early for this condition to prevent damage. To meet this need, we have developed the psoriatic arthritis screening and evaluation (PASE) questionnaire. The 15-item PASE questionnaire was administered to 190 individuals with either psoriasis or PsA. The PASE questionnaire was readministered to a subset of individuals with PsA in order to assess test–retest reliability and sensitivity-to-change. Receiver operator curves were constructed to optimize sensitivity and specificity for the diagnosis of PsA. Of the 190 participating in the study, 19.5% (37/191) participants were diagnosed with PsA. PASE total scores ranged from 15 to 74 (possible range, 15–75). The PsA group had a median Total score of 51 (25th and 75th percentile 44 and 57), and non-PsA group had a median total score of 34 (25th and 75th percentile 21 and 49) (p < 0.001). A PASE total score of 44 was able to distinguish PsA from non-PsA participants with 76% sensitivity and 76% specificity. Furthermore, 13 of the 15 items demonstrated significant test–retest reliability as assessed by Pearson correlation coefficient (r ≥ 0.5). PASE was sensitive-to-change with therapy; PASE scores were significantly lower for PsA individuals after systemic therapy (p < 0.034). The PASE questionnaire is a valid and reliable tool to screen for active PsA among individuals with psoriasis. PASE scores may be used as a marker of therapeutic response.

Background Little is known about the associations between depressive symptoms, social support and antihypertensive medication adherence in older adults. Purpose We evaluated the cross-sectional and longitudinal associations between depressive symptoms, social support and antihypertensive medication adherence in a large cohort of older adults. Methods A cohort of 2,180 older adults with hypertension was administered questionnaires, which included the Center for Epidemiologic Studies-Depression Scale, the Medical Outcomes Study Social Support Index, and the hypertension-specific Morisky Medication Adherence Scale at baseline and 1 year later. Results Overall, 14.1% of participants had low medication adherence, 13.0% had depressive symptoms, and 33.9% had low social support. After multivariable adjustment, the odds ratios that participants with depressive symptoms and low social support would have low medication adherence were 1.96 (95% confidence interval (CI) 1.43, 2.70) and 1.27 (95% CI 0.98, 1.65), respectively, at baseline and 1.87 (95% CI 1.32, 2.66) and 1.30 (95% CI 0.98, 1.72), respectively, at 1 year follow-up. Conclusion Depressive symptoms may be an important modifiable barrier to antihypertensive medication adherence in older adults

This pilot study suggests that the PST can distinguish individuals with psoriasis from individuals without psoriasis in an English-speaking population being seen at an outpatient dermatology clinic. Furthermore, the PST may be used to identify psoriasis phenotypes. Although the PST may be limited by spectrum bias in this pilot study, we believe it remains a reliable tool to collect information on psoriasis in remote populations.

Objectives-Secondary analysis of clinical trial data suggests visit-to-visit variability (VVV) of blood pressure is strongly associated with the incidence of cardiovascular disease. Measurement of blood pressure in usual practice settings may be subject to substantial error, calling into question the value of VVV in real-world settings.Methods-We analyzed data on adults ≥ 65 years of age with diagnosed hypertension who were taking antihypertensive medication from the Cohort Study of Medication Adherence among Older Adults (n=772 with 14 or more blood pressure measurements). All blood pressure measurements, taken as part of routine out-patient care over a median of 2.8 years, were abstracted from patients' medical charts.Results-Using each participant's first 7 systolic blood pressure (SBP) measurements, the mean intra-individual standard deviation was 13.5 mmHg. The intra-class correlation coefficient for the standard deviation based on the first 7 and second 7 SBP measurements was 0.28 (95% CI: 0.20 -0.34). Individuals in the highest quintile of standard deviation of SBP based on their first 7 measurements were more likely to be in the highest quintile of VVV using their second 7 measurements (observed/expected ratio = 1.71, 95% CI: 1.29 -2.22). Results were similar for other metrics of VVV. The intra-class correlation coefficient was lower for diastolic blood pressure (DBP) than SBP.Address correspondence and reprint requests to: Paul Muntner, Department of Epidemiology, University of Alabama at Birmingham, 1665 University Boulevard, Suite 230J, Birmingham, AL 35294, Phone: (205) Fax: (205) Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptConclusions-These data suggest VVV of SBP measured in a real-world setting is not random. Future studies are needed to assess the prognostic value of VVV of SBP assessed in routine clinical practice. KeywordsBlood pressure; variability; reproducibility; health services research Several recent studies have reported a strong and graded association between visit to visit variability (VVV) of blood pressure and the incidence of coronary heart disease, stroke, and all-cause mortality [1,2]. These associations were present after adjustment for several potential confounders, including mean blood pressure level. Furthermore, VVV has been demonstrated to be reproducible, suggesting it may have value as a predictor of cardiovascular disease risk [3]. While these data may have profound implications for the treatment of hypertension, they were derived from large randomized controlled trials and observational cohort studies wherein blood pressure measurements were performed as part of a research protocol at set time periods following standardized procedures.The use of electronic medical records provides an opportunity to make VVV of blood pressure available for use in routine clinical practice. However, blood pressure measurement in the office setting is often criticized for having systematic and random error [4,5]. The degree to which VVV of blood press...