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Ito K, Uehara S, Yuasa A, Ushizawa K, Tanabe S, Otaka Y. Gamified exercise for the distal upper extremity in people with post-stroke hemiparesis: feasibility study on subjective perspectives during daily continuous training. Ann Med 2024; 56:2306905. [PMID: 38294958 PMCID: PMC10833108 DOI: 10.1080/07853890.2024.2306905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/13/2024] [Indexed: 02/02/2024] Open
Abstract
INTRODUCTION Dose (number of repetitions) has been suggested as a key element in the effectiveness of rehabilitation exercises to promote motor recovery of the hemiparetic upper limb. However, rehabilitation exercises tend to be monotonous and require significant motivation to continue, making it difficult to increase the exercise dose. To address this issue, gamification technology has been implemented in exercises to promote self-engagement for people with hemiparesis in continuing monotonous repetitive movements. This study aimed to investigate how subjective perspectives, specifically enjoyability, motivation to continue, and expectancy of effectiveness, change through continuous daily exercise using a developed gamified exercise system. MATERIALS AND METHOD Ten people with stroke suffering upper limb dysfunction underwent daily gamified exercise for seven days. The gamified exercise consisted of an electromyography (EMG)-controlled operating system that enabled users to play virtual games using repetitive finger movements. The participants performed conventional self-exercise on the same day as the control exercise, and rated their subjective perspectives on both exercises on a numerical rating scale on each exercise day. RESULTS Ratings for enjoyability and motivation to continue consistently showed significantly higher scores for the gamified exercise than for conventional self-exercise on all exercise days. A similar trend was observed in the ratings for the expectancy of effectiveness. No changes over time were found in any of the ratings throughout the exercise period. CONCLUSIONS Exercise using the developed EMG-controlled gamified system may have the potential to maintain motivation and enjoyment in people with stroke to continue monotonous repetitive finger movements.
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Affiliation(s)
- Kazuki Ito
- Department of Rehabilitation, Fujita Health University Hospital, Aichi, Japan
- Fujita Health University Graduate School of Health Sciences, Aichi, Japan
| | - Shintaro Uehara
- Faculty of Rehabilitation, Fujita Health University School of Health Sciences, Aichi, Japan
| | - Akiko Yuasa
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Aichi, Japan
| | - Kazuki Ushizawa
- Fujita Health University Graduate School of Health Sciences, Aichi, Japan
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Aichi, Japan
| | - Shigeo Tanabe
- Faculty of Rehabilitation, Fujita Health University School of Health Sciences, Aichi, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Aichi, Japan
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Dunn Navarra AM, Gormley M, Liang E, Loughran C, Vorderstrasse A, Garcia DR, Rosenberg MG, Fletcher J, Goldsamt LA. Developing and testing a web-based platform for antiretroviral therapy (ART) adherence support among adolescents and young adults (AYA) living with HIV. PEC Innov 2024; 4:100263. [PMID: 38463238 PMCID: PMC10920727 DOI: 10.1016/j.pecinn.2024.100263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 03/12/2024]
Abstract
Objective Describe the development and testing of a web-based platform for antiretroviral treatment (ART) adherence support among HIV+ adolescents and young adults (AYA) in a randomized controlled trial (RCT). Methods A seven-member multi-disciplinary team operationalized the flat, password protected, web-based platform. Manualized protocols guided the objectives and content for each of the eight web-based sessions. Team members evaluated usability and content validity. Client satisfaction and perceived ease of use was evaluated with the first ten HIV+ AYA participants. Results The web-based platform was developed, evaluated, refined, implemented and pilot tested between September 2020 to April 2022. Usability was rated as high; the evaluation of content validity showed an excellent fit between session content and objectives. HIV+ AYA participants (mean age = 24.2 years) were satisfied with the quality, type, and amount of support/education received, and found the platform easy to use, operate, and navigate. Average time spent per session was 6.5 min. Conclusion Findings support the usability, validity, acceptability, and feasibility of this web-based platform for ART adherence support among HIV+ AYA. Innovation Our research and findings are responsive to research gaps and the need for transparency in the methodological development and testing of web-based control arms for ART adherence support among HIV+ AYA.
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Affiliation(s)
- Ann-Margaret Dunn Navarra
- StonyBrook University, School of Nursing, 101 Nicolls Road, Health Sciences Center, Level 2, StonyBrook, NY 11794, USA
| | - Maurade Gormley
- University of Connecticut, School of Nursing, 231 Glenbrook Road, Storrs, CT 06269, USA
| | - Eva Liang
- New York University, Rory Meyers College of Nursing, 380 Second Avenue, New York, NY 10010, USA
| | - Claire Loughran
- New York University, Rory Meyers College of Nursing, 380 Second Avenue, New York, NY 10010, USA
| | - Allison Vorderstrasse
- University of Massachusetts Amherst, Elaine Marieb College of Nursing, 651 N Pleasant St., Amherst, MA 01003, USA
| | - David R. Garcia
- New York University, Rory Meyers College of Nursing, 433 First Avenue, New York, NY 10010, USA
| | - Michael G. Rosenberg
- Division of Infectious Diseases, Department of Pediatrics, Jacobi Medical Center, Bronx, NY, 10461, USA
| | - Jason Fletcher
- New York University, Rory Meyers College of Nursing, 433 First Avenue, New York, NY 10010, USA
| | - Lloyd A. Goldsamt
- New York University, Rory Meyers College of Nursing, 433 First Avenue, New York, NY 10010, USA
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Zaino ML, Pixley JN, Subramanian VM, Sirdeshmukh D, Feldman SR, Pichardo RO. Monitoring adherence to vulvar lichen sclerosus treatment - a prospective study. J DERMATOL TREAT 2024; 35:2285725. [PMID: 38240095 DOI: 10.1080/09546634.2023.2285725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/15/2023] [Indexed: 01/23/2024]
Abstract
Background: Vulvar lichen sclerosus treatment consists of topical corticosteroids followed by maintenance therapy. Self-reported adherence to topical corticosteroids in vulvar lichen sclerosus is approximately 66-70.4% and adherence to chronic topical medications is poor.Objective: To measure treatment adherence for vulvar lichen sclerosus.Methods: Adults with vulvar lichen sclerosus who were receiving or who were candidates to receive treatment with topical clobetasol propionate 0.05% ointment twice daily received medication tubes equipped with adherence monitors capturing the time and amount of dose dispensed. After 2 months, monitors were returned, and patients were surveyed regarding their adherence.Results: Ten patients participated for a median (range) of 8.5 (7-11) weeks. Eight (80%) and 7 (70%) caps captured medication timing and dosing events, respectively. Median (interquartile range) adherence was 65% (42-77) and median (interquartile range) medication dispensed per use was 0.15 (0.14 - 0.5) grams. Of the 8 patients using active adherence monitors, 2 did not clinically improve; adherence rates and mean quantity dispensed for these two patients were 31% and 0.13 grams, and 9% and 0.74 grams, respectively.Conclusion: Poor adherence to both twice daily application and prescribed medication quantity occurred frequently. Factors related to self-reported non-adherence included perceived greater efficacy, inconvenience, and time-constraints. Patient adherence to recommended treatment and clinical outcomes are areas for improvement in patients with vulvar lichen sclerosus.
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Affiliation(s)
- Mallory L Zaino
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jessica N Pixley
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | | | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Rita O Pichardo
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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bij de Weg JM, de Boer MA, Meijer C, Lugtenburg N, Melles M, de Vries JI, de Groot CJ. The value of a mobile educative Application additional to Standard counselling on aspirin Adherence in Pregnancy: the ASAP study, a randomised controlled trial. PEC Innov 2024; 4:100268. [PMID: 38435238 PMCID: PMC10907203 DOI: 10.1016/j.pecinn.2024.100268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 03/05/2024]
Abstract
Objective To assess the added value of a novel, mobile educative application to standard counselling on aspirin adherence during pregnancy versus standard counselling alone. Methods Participants were randomly assigned for additional use of a mobile educative application or standard counselling alone. Main outcome measures were adherence to aspirin measured by two validated questionnaires: Simplified Medication Adherence Questionnaire (SMAQ), Believes and Behaviour Questionnaire (BBQ), and patients reported tablet intake >90%. Results A total of 174 women with an indication for aspirin during pregnancy were included. The questionnaires were filled in by 126 out of the 174 participants (72.4%). Similar results were found in the app group and the standard counselling groups for both validated questionnaires. Tablet intake >90% was seen in 88.7% and 87.5% (p = 0.834) of the app group and standard counselling group respectively. Subgroup analyses demonstrated a negative effect of BMI and a positive effect of educational level on adherence. Conclusions Our study revealed no added effect of a novel, mobile educative application to standard counselling on aspirin adherence during pregnancy. Tablet intake was equally high in both groups probably explained by our high educated population. Innovation Future studies should focus on tailored counselling on medication to pregnant women's needs including medication reminders, addressing concerns, adequate health literacy and side effects, offering rewards to further stimulate aspirin adherence in pregnancy with optimal outcome for mother and their neonate.
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Affiliation(s)
- Jeske M. bij de Weg
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Marjon A. de Boer
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Cynthia Meijer
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Noëlle Lugtenburg
- Delft University of Technology, Faculty of Industrial Design Engineering, Department of Human-Centered Design, Delft, Netherlands
| | - Marijke Melles
- Delft University of Technology, Faculty of Industrial Design Engineering, Department of Human-Centered Design, Delft, Netherlands
| | - Johanna I.P. de Vries
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Christianne J.M. de Groot
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
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Kwon Y, Lauffenburger JC. Antidepressant discontinuation patterns and characteristics across sociodemographic groups in the United States. J Affect Disord 2024; 355:82-85. [PMID: 38554879 DOI: 10.1016/j.jad.2024.03.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/22/2024] [Accepted: 03/23/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND While antidepressants are frequently used, less is known about contemporary discontinuation patterns, especially across different sociodemographic populations. METHODS Patients 16-84 years initiating antidepressants between 2016 and 2019 within a large US health insurer were identified. The association between patient characteristics and time until antidepressant discontinuation was evaluated using adjusted Cox proportional hazard regression. RESULTS Across 1,365,576 patients, mean time to discontinuation was 168.1 days (SD: 223.6). Men were more likely to discontinue than women (HR: 0.94, 95%CI: 0.94-0.94). Younger patients (16-24 years) were more likely to discontinue than older patients. Patients who were non-White (Asian HR: 1.33, 95%CI: 1.31-1.34; Black HR: 1.27, 95%CI: 1.27-1.28; Hispanic HR: 1.34, 95%:CI 1.34-1.35), with evidence of a substance use disorder (HR: 1.31, 95%CI: 1.27-1.35), or taking tricyclic antidepressants (HR:1.26, 95%CI: 1.25-1.27) were more likely to discontinue. LIMITATIONS Information on reasons for discontinuation was not available, and wide standard deviations for the primary outcome were reported. The results may not be generalized to non-commercially insured beneficiaries. CONCLUSIONS Discontinuation is common within the first 6 months of treatment but varies across populations, highlighting patients who may benefit from potential intervention.
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Affiliation(s)
- Yoojung Kwon
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, United States of America; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, United States of America
| | - Julie C Lauffenburger
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, United States of America.
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de Jongh CA, Bikker FJ, de Vries TJ, Werner A, Gibbs S, Krom BP. Porphyromonas gingivalis interaction with Candida albicans allows for aerobic escape, virulence and adherence. Biofilm 2024; 7:100172. [PMID: 38226024 PMCID: PMC10788424 DOI: 10.1016/j.bioflm.2023.100172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/12/2023] [Accepted: 12/12/2023] [Indexed: 01/17/2024] Open
Abstract
In the oral cavity Candida albicans interacts with many oral bacteria, including Porphyromonas gingivalis, both physically and metabolically. The aim of this in vitro study was to characterize these interactions and study their effects on the survival of P. gingivalis. First, metabolic interactions were evaluated by counting the colony forming units (CFU) after co-culturing. The results indicated that the anaerobic bacterium P. gingivalis survives under aerobic conditions when co-cultured with C. albicans. This is due to the oxygen consumption by C. albicans as determined by a reduction in survival upon the addition of Antimycin A. By measuring the protease activity, it was found that the presence of C. albicans induced gingipain activity by P. gingivalis, which is an important virulence factor. Adherence of P. gingivalis to hyphae of C. albicans was observed with a dynamic flow system. Using various C. albicans mutants, it was shown that the mechanism of adhesion was mediated by the cell wall adhesins, members of the agglutinin-like sequence (Als) family: Als3 and Als1. Furthermore, the two microorganisms could be co-cultured into forming a biofilm in which P. gingivalis can survive under aerobic culturing conditions, which was imaged using scanning electron microscopy. This study has further elucidated mechanisms of interaction, virulence acquisition and survival of P. gingivalis when co-cultured with C. albicans. Such survival could be essential for the pathogenicity of P. gingivalis in the oxygen-rich niches of the oral cavity. This study has emphasized the importance of interaction between different microbes in promoting survival, virulence and attachment of pathogens, which could be essential in facilitating penetration into the environment of the host.
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Affiliation(s)
- Caroline A. de Jongh
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Floris J. Bikker
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Teun J. de Vries
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Arie Werner
- Department of Dental Materials Science, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Susan Gibbs
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Bastiaan P. Krom
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Gosling J, Simmonds-Buckley M, Kellett S, Duffy D, Olenkiewicz-Martyniszyn K. Development and initial evaluation of a treatment integrity measure for low-intensity group psychoeducational interventions. Behav Cogn Psychother 2024; 52:317-330. [PMID: 38014558 DOI: 10.1017/s1352465823000528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND Despite the importance of assessing the quality with which low-intensity (LI) group psychoeducational interventions are delivered, no measure of treatment integrity (TI) has been developed. AIMS To develop a psychometrically robust TI measure for LI psychoeducational group interventions. METHOD This study had two phases. Firstly, the group psychoeducation treatment integrity measure-expert rater (GPTIM-ER) and a detailed scoring manual were developed. This was piloted by n=5 expert raters rating the same LI group session; n=6 expert raters then assessed content validity. Secondly, 10 group psychoeducational sessions drawn from routine practice were then rated by n=8 expert raters using the GPTIM-ER; n=9 patients also rated the quality of the group sessions using a sister version (i.e. GPTIM-P) and clinical and service outcome data were drawn from the LI groups assessed. RESULTS The GPTIM-ER had excellent internal reliability, good test-retest reliability, but poor inter-rater reliability. The GPTIM-ER had excellent content validity, construct validity, formed a single factor scale and had reasonable predictive validity. CONCLUSIONS The GPTIM-ER has promising, but not complete, psychometric properties. The low inter-rater reliability scores between expert raters are the main ongoing concern and so further development and testing is required in future well-constructed studies.
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Affiliation(s)
- Jonah Gosling
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Melanie Simmonds-Buckley
- Department of Psychology, University of Sheffield, Sheffield, UK
- Rotherham Doncaster and South Humber NHS Foundation Trust, UK
| | - Stephen Kellett
- Department of Psychology, University of Sheffield, Sheffield, UK
- Rotherham Doncaster and South Humber NHS Foundation Trust, UK
| | - Daniel Duffy
- Sheffield Health and Social Care NHS Foundation Trust, UK
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Koko JAB, Mohamed OSA, Koko BAB, Musa OAY. The ABCDE approach: Evaluation of adherence in a low-income country. Injury 2024; 55:111268. [PMID: 38097486 DOI: 10.1016/j.injury.2023.111268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/23/2023] [Accepted: 12/01/2023] [Indexed: 04/19/2024]
Abstract
BACKGROUND Early recognition and initial treatment of trauma patients prevents deterioration and buys time for making a definitive diagnosis. The "Airway, Breathing, Circulation, Disability and Exposure" (ABCDE) approach should be used whenever an injury is suspected. It provides quick identification and management of life-threatening problems. Still, there is limited knowledge regarding adherence to the ABCDE approach. This research aims to assess the adherence of the trauma team members to the ABCDE approach in the management of major trauma patients and the factors affecting it. METHOD The study is a cross-sectional hospital-based study conducted in the trauma and resuscitation rooms of major governmental hospitals in Khartoum in the period from Jan.30, 2022, to Mar.29, 2022. It was done among the medical staff dealing with major trauma cases. Data were collected by observation using a modified standardized checklist for assessing the ABCDE approach and via a self-administered questionnaire for identifying the factors affecting adherence. Total coverage of all major trauma cases resuscitation (n = 50) was done. Also, a sample size of 158 medical staff was covered for the questionnaire. The data was analyzed in Statistical Package for the Social Science (SPSS) V.23. RESULTS The mean percentage of adherence to the ABCDE approach was 37.9 % (SD 15.44). When the ABCDE sequence was not followed, the ACB was the commonest sequence. Also, adherence had no significant relation with any patient or staff-related factor. The main present obstacles to adherence to the ABCDE approach were overcrowding in the room and unprepared facilities. While the major present facilitator was the clinical experience. CONCLUSION The adherence rate was low, but initiation of the ABCDE approach was rapid. The factors participating in low adherence rates were usually facility or population-based factors. We recommend further studies, further training and embedment of guidelines, and the provision of larger trauma rooms with adequate supplies.
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Affiliation(s)
- Julia Adam Bashir Koko
- Faculty of Medicine, University of Medical Sciences and Technology (UMST), Khartoum, Sudan.
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Jitrapat H, Sivaipram I, Piumsomboon A, Suttiruengwong S, Xu J, Vo TLT, Li D. Ingestion and adherence of microplastics by estuarine mysid shrimp. Mar Environ Res 2024; 197:106455. [PMID: 38507983 DOI: 10.1016/j.marenvres.2024.106455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/31/2024] [Accepted: 03/14/2024] [Indexed: 03/22/2024]
Abstract
Microplastics have been reported to be present in zooplankton, yet questions persist regarding their fate and dynamics within biota. We selected the commercial mysid shrimp, Mesopodopsis orientalis, as the focal zooplankton for this study due to their crucial role in our study area, the Inner Gulf of Thailand in January 2022. We investigated the presence of microplastics in mysid bodies and fecal pellets, examining both attached microplastics on external body parts and those ingested. In addition, we conducted microplastic feeding experiments, exposing mysids to various treatments of microplastics. The results of the field investigation indicate that mysids exhibited an average of 0.12 ± 0.03 microplastic items/mysid from whole-body samples. The shape, type, and color of microplastics found in mysids were similar to those present in seawater, with blue PET microfibers being the most prevalent. Our observations on live mysids revealed that microplastics were acquired through ingestion and adherence to appendages and exoskeletons. Microplastics were observed in mysid's fecal pellets at 0.09 ± 0.03 items/mysid, while microplastics adhering to the mysid's body and appendages were observed at 0.10 ± 0.04 items/mysid. The sizes of microplastics extracted from preserved mysids ranged from 58 μm to 4669 μm, with median of 507 μm. The laboratory experiments revealed that the presence of microalgae enhanced microplastic ingestion in mysids; microplastics incubated with a cyanobacterium, Oscillatoria sp., and diatom Navicula sp. significantly increased the number of microplastic particles ingested by mysids. This study showed that microplastics can be more ingested in mysids, especially when food items are present. Microplastic fate in these animals may involve expulsion into the environment or adherence, potentially facilitating their transfer up the marine food web.
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Affiliation(s)
- Hattaya Jitrapat
- State Key Laboratory of Estuarine and Coastal Research, East China Normal University, Shanghai, 200062, China; Hainan Institute, East China Normal University, Sanya, 572025, China; Plastic Marine Debris Research Center, East China Normal University, Shanghai, 200241, China; Regional Training and Research Center on Plastic Marine Debris and Microplastics, IOC-UNESCO, Shanghai, 200241, China
| | - Itchika Sivaipram
- Department of Marine Science, Faculty of Science, Chulalongkorn University, Bangkok, 10330, Thailand.
| | - Ajcharaporn Piumsomboon
- Department of Marine Science, Faculty of Science, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Supakij Suttiruengwong
- Department of Materials Science and Engineering, Faculty of Engineering and Industrial Technology, Silpakorn University, Nakhon Pathom, 73000, Thailand
| | - Jiayi Xu
- State Key Laboratory of Estuarine and Coastal Research, East China Normal University, Shanghai, 200062, China; Hainan Institute, East China Normal University, Sanya, 572025, China; Plastic Marine Debris Research Center, East China Normal University, Shanghai, 200241, China; Regional Training and Research Center on Plastic Marine Debris and Microplastics, IOC-UNESCO, Shanghai, 200241, China.
| | - Tuan Linh Tran Vo
- State Key Laboratory of Estuarine and Coastal Research, East China Normal University, Shanghai, 200062, China; Hainan Institute, East China Normal University, Sanya, 572025, China; Plastic Marine Debris Research Center, East China Normal University, Shanghai, 200241, China; Regional Training and Research Center on Plastic Marine Debris and Microplastics, IOC-UNESCO, Shanghai, 200241, China; Institute of Oceanography, Viet Nam Academy of Science and Technology (VAST), 1 Cau Da Street, Nha Trang, Khanh Hoa, 650000, Viet Nam
| | - Daoji Li
- State Key Laboratory of Estuarine and Coastal Research, East China Normal University, Shanghai, 200062, China; Hainan Institute, East China Normal University, Sanya, 572025, China; Plastic Marine Debris Research Center, East China Normal University, Shanghai, 200241, China; Regional Training and Research Center on Plastic Marine Debris and Microplastics, IOC-UNESCO, Shanghai, 200241, China.
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Shani M. Free spirit. Patient Educ Couns 2024; 122:108159. [PMID: 38295668 DOI: 10.1016/j.pec.2024.108159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 12/23/2023] [Accepted: 01/16/2024] [Indexed: 02/25/2024]
Affiliation(s)
- Michal Shani
- Family Medicine Department, School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Family Medicine Central District, Clalit Health Service, Rehovot, Israel.
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Fentie AM, Huluka SA, Gebremariam GT, Gebretekle GB, Abebe E, Fenta TG. Impact of pharmacist-led interventions on medication-related problems among patients treated for cancer: A systematic review and meta-analysis of randomized control trials. Res Social Adm Pharm 2024; 20:487-497. [PMID: 38368123 DOI: 10.1016/j.sapharm.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 01/31/2024] [Accepted: 02/13/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Medication-related problems (MRPs) continue to impose a voluminous health impact, particularly among patients on anti-cancer therapy, due to the nature and complexity of the care. Pharmacists have a pivotal role in ensuring the safe, effective, and rational use of medicines in this group of patients. OBJECTIVES To examine the impact of pharmacist-led interventions in resolving MRPs among patients treated for cancer. METHODS This systematic review and meta-analysis was conducted and reported following the PRISMA protocol and registered in PROSPERO (Registration number: CRD42022311535). Four database searches, PubMed, EMBASE, Cochrane, and International Pharmaceuticals Abstracts, were systematically searched from August 2022 to January 2023. Only randomized control trials (RCTs) were included. The Cochrane risk of bias assessment tool was used to check the quality of the included studies. The outcome measures were overall MRPs, adherence, medication errors, and adverse drug events (ADEs). Data for meta-analysis were analyzed used using STATA version 17 and standardized mean difference effect sizes were calculated for continuous outcomes and odds ratio for categorical outcomes. RESULTS Out of the 90 studies screened for eligibility, 20 RCT studies were included for the systematic review and 15 for the meta-analysis. Close to two-thirds of the studies were from Europe (n = 7) and Asia (n = 6). A combination of educational and behavioral intervention strategies were used for a period ranged from 8 days to 12 months. The pharmacist-led intervention improved adherence to treatment by 4.79 times (AOR = 4.79; 95%CI = 2.64, 8.68; p-value<0.0001), reduced the occurrence of ADEs by 1.28 (SMD = -1.28; 95%CI = -0.04-2.52; p-value = 0.04) and decreased the overall MRPs by 0.53 (SMD = -0.53; 95%CI = -0.79, -0.28; p-value<0.0001) compared to control groups. CONCLUSION This study found out that pharmacist-led interventions can significantly lower MRPs among patients treated for cancer. Hence, a global concerted effort has to be made to integrate pharmacists in a multidisciplinary direct cancer care.
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Affiliation(s)
- Atalay Mulu Fentie
- Addis Ababa University, College of Health Sciences, School of Pharmacy, Department of Pharmacology and Clinical Pharmacy, Ethiopia.
| | - Solomon Assefa Huluka
- Addis Ababa University, College of Health Sciences, School of Pharmacy, Department of Pharmacology and Clinical Pharmacy, Ethiopia
| | - Girma Tekle Gebremariam
- Addis Ababa University, College of Health Sciences, School of Pharmacy, Department of Pharmacology and Clinical Pharmacy, Ethiopia
| | | | - Ephrem Abebe
- Purdue University, College of Pharmacy, West Lafayette, IN, USA; Indiana University, School of Medicine, Indianapolis, IN, USA
| | - Teferi Gedif Fenta
- Addis Ababa University, College of Health Sciences, School of Pharmacy, Department of Social Pharmacy and Pharmaceutics, Ethiopia
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12
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Heo M, Norton BL, Pericot-Valverde I, Mehta SH, Tsui JI, Taylor LE, Lum PJ, Feinberg J, Kim AY, Arnsten JH, Sprecht-Walsh S, Page K, Murray-Krezan C, Anderson J, Litwin AH. Optimal hepatitis C treatment adherence patterns and sustained virologic response among people who inject drugs: The HERO study. J Hepatol 2024; 80:702-713. [PMID: 38242324 DOI: 10.1016/j.jhep.2023.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 11/27/2023] [Accepted: 12/20/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND & AIMS Direct-acting antivirals (DAAs) are highly effective for treating HCV infection even among people who inject drugs (PWID). Yet, little is known about patients' adherence patterns and their association with sustained virologic response (SVR) rates. We aimed to summarize various adherence patterns and determine their associations with SVR. METHODS Electronic blister packs were used to measure daily adherence to once-a-day sofosbuvir/velpatasvir during the 12-week treatment period among active PWIDs. Blister pack data were available for 496 participants who initiated DAAs for whom SVR status was known. Adherence was summarized in multiple patterns, such as total adherent days, consecutive missed days, and early discontinuations. Thresholds for adherence patterns associated with >90% SVR rates were also determined. RESULTS The overall SVR rate was 92.7%, with a median adherence rate of 75%. All adherence patterns indicating greater adherence were significantly associated with achieving SVR. Participant groups with ≥50% (>42/84) adherent days or <26 consecutive missed days achieved an SVR rate of >90%. Greater total adherent days during 9-12 weeks and no early discontinuation were significantly associated with higher SVR rates only in those with <50% adherence. Participants with first month discontinuation and ≥2 weeks of treatment interruption had low SVR rates, 25% and 85%, respectively. However, greater adherent days were significantly associated with SVR (adjusted odds ratio 1.10; 95% CI 1.04-1.16; p <0.001) even among participants with ≥14 consecutive missed days. CONCLUSIONS High SVR rates can be achieved in the PWID population despite suboptimal adherence. Encouraging patients to take as much medication as possible, with <2 weeks consecutive missed days and without early discontinuation, was found to be important for achieving SVR. IMPACT AND IMPLICATIONS People who inject drugs can be cured of HCV in >90% of cases, even with relatively low adherence to direct-acting antivirals, but early discontinuations and long treatment interruptions can significantly reduce the likelihood of achieving cure. Clinicians should encourage people who inject drugs who are living with HCV to adhere daily to direct-acting antivirals as consistently as possible, but if any days are interrupted, to continue and complete treatment. These results from the HERO study are important for patients living with HCV, clinicians, experts writing clinical guidelines, and payers. CLINICAL TRIAL NUMBER NCT02824640.
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Affiliation(s)
- Moonseong Heo
- Department of Public Health Sciences, Clemson University, Clemson, SC 29605, USA.
| | - Brianna L Norton
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 3330 Kossuth Avenue Bronx, NY 10467, USA
| | - Irene Pericot-Valverde
- Department of Psychology, College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, SC 29634, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6546, Baltimore, MD 21205, USA
| | - Judith I Tsui
- Department of Medicine, University of Washington, 325 9th Ave., Seattle, WA 98104, USA
| | - Lynn E Taylor
- Department of Pharmacy, University of Rhode Island, Avedesian Hall, 7 Greenhouse Rd, Kingston, RI 02881, USA
| | - Paula J Lum
- Division of HIV, Infectious Disease and Global Medicine, University of California, San Francisco and San Francisco General Hospital, 2540 23rd Street, San Francisco, CA 94110, USA
| | - Judith Feinberg
- Department of Behavioral Medicine and Psychiatry, and Department of Medicine, Section of Infectious Diseases, West Virginia University School of Medicine, 930 Chestnut Ridge Road, Morgantown, WV 26505, USA
| | - Arthur Y Kim
- Division of Infectious Diseases, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St., Boston, MA 02114, USA
| | - Julia H Arnsten
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 3330 Kossuth Avenue Bronx, NY 10467, USA
| | | | - Kimberly Page
- Department of Internal Medicine, University of New Mexico Health Sciences Center, University of New Mexico MSC 10 5550, Albuquerque, NM 87131, USA
| | - Cristina Murray-Krezan
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, 200 Meyran Avenue, Suite 300, Pittsburgh, PA 15213, USA
| | - Jessica Anderson
- Department of Internal Medicine, University of New Mexico Health Sciences Center, University of New Mexico MSC 10 5550, Albuquerque, NM 87131, USA
| | - Alain H Litwin
- School of Health Research, Clemson University, Clemson, SC 29605, USA; Department of Medicine, University of South Carolina School of Medicine, 876 W Faris Rd, Greenville, SC 29605, USA; Department of Medicine, Prisma Health, Greenville, SC 29605, USA.
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13
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Laurora I, Henrie B, Guillard H, Bradford R, Sober S, Glasier A. Evaluation of adherence to a daily progestin-only pill in a simulated over-the-counter setting. Contraception 2024; 133:110388. [PMID: 38431261 DOI: 10.1016/j.contraception.2024.110388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE The Adherence with Continuous Dose Oral Contraceptive: Evaluation of Self-Selection and Use (ACCESS) study assessed whether consumers can adhere to the regimen for a progestin-only pill (norgestrel 0.075 mg) in an over-the-counter (OTC) setting. STUDY DESIGN An actual use study in a simulated OTC environment assessed adherence to directions to take norgestrel 0.075 mg every day at the same time in 883 participants for up to 24 weeks. RESULTS Eighty-five percent (747/883) of participants reported ≥85% adherence to taking norgestrel 0.075 mg every day and reported taking their dose within three hours of their scheduled dosing time on 96% of days. When accounting for use of a condom for 48 hours if a pill was missed, participants reported correctly following the label's directed use for 97% of doses overall, with 95% of participants following label directions for ≥85% of doses. The main limitations were related to finding a balance between intensely collecting data to ensure accurate assessment of adherence and leaving users to behave as they would in a real OTC situation without healthcare practitioner intervention. We observed that some participants reported taking more doses than they could have based on the supply of medication given to them. To fully examine the situation, and the impact on the conclusions, additional post hoc sensitivity analyses were performed, and showed remarkably consistent results. CONCLUSIONS Consumers were highly adherent to taking norgestrel 0.075 mg when using only the information provided by the proposed OTC label. IMPLICATIONS Adherence to a daily oral contraceptive pill was high when obtained OTC. This suggests that effectiveness of an OTC pill is likely to be like that of a prescribed pill and easier access to this effective contraceptive should allow more opportunity to prevent pregnancy.
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Affiliation(s)
- Irene Laurora
- HRA Pharma, A Perrigo Company, Global Women's Health, Chatillion, France.
| | | | - Hélène Guillard
- HRA Pharma, A Perrigo Company, Global Women's Health, Chatillion, France
| | | | - Stephanie Sober
- HRA Pharma, A Perrigo Company, Global Women's Health, Chatillion, France
| | - Anna Glasier
- Department of Obstetrics and Gynaecology, University of Edinburgh, Queen's Medical Research Institute, Scotland
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Liao J, Wen Y, Yin Y, Qin Y, Zhang G. Factors Impacting One-year Follow-up Visit Adherence after Bariatric Surgery in West China: A Mixed Methods Study. Obes Surg 2024:10.1007/s11695-024-07227-z. [PMID: 38619773 DOI: 10.1007/s11695-024-07227-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 04/16/2024]
Abstract
PURPOSE Quality follow-up (FU) is crucial after bariatric surgery. However, poor adherence after surgery is prevalent. This research aimed to explore the factors related to FU adherence after bariatric surgery in West China. MATERIALS AND METHODS This study used a sequential explanatory mixed-methods research design. Participants (n = 177) were identified from the West China Hospital. Demographic information, disease profile, treatment information, and post-surgery FU information were obtained from the bariatric surgery database of the Division of Gastrointestinal Surgery of the West China Hospital. The survey data were analyzed using logistic regression. Semi-structured interviews with participants (n = 10) who had low adherence were conducted. The recording was transcribed verbatim and entered into qualitative data analysis software. Qualitative data were analyzed using a content analysis approach. RESULTS Multiple logistic regression revealed that living in Chengdu (OR, 2.308), being employed (OR, 2.532), non-smoking (OR, 2.805), and having less than five years of obesity (OR, 2.480) were positive predictors of FU adherence within one year. Semi-structured interviews suggested that factors related to adherence to FU were lack of motivation, lack of opportunity, insufficient ability, and beliefs regarding consequences. CONCLUSION Factors impacting one-year FU visit adherence after bariatric surgery include not only demographic and disease-related factors but also social and family factors. These results will provide evidence to support healthcare professionals in developing personalized postoperative FU management strategies.
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Affiliation(s)
- Jing Liao
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Yue Wen
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China.
| | - Yiqiong Yin
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Yi Qin
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Guixiang Zhang
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China
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Makonokaya L, Maida A, Kalitera LU, Wang A, Kapanda L, Kayira D, Bottoman M, Nkhoma H, Dunga S, Joaki Z, Chamanga R, Nkanaunena K, Hrapcak S, Nyirenda R, Chiwandira B, Maulidi M, Woelk G, Machekano R, Maphosa T. Early Effects of Scaling Up Dolutegravir-Based ARV Regimens Among Children Living with HIV in Malawi. AIDS Behav 2024:10.1007/s10461-024-04312-3. [PMID: 38615099 DOI: 10.1007/s10461-024-04312-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/15/2024]
Abstract
Viral suppression (VS) in children has remained suboptimal compared to that in adults. We evaluated the impact of transitioning children weighing < 20 kg to a pediatric formulation of dolutegravir (pDTG) on VS in Malawi. We analyzed routine retrospective program data from electronic medical record systems pooled across 169 healthcare facilities in Malawi supported by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF). We included children who weighed < 20 kg and received antiretroviral therapy (ART) between July 2021-June 2022. Using descriptive statistics, we summarized demographic and clinical characteristics, ART regimens, ART adherence, and VS. We used logistic regression to identify factors associated with post-transition VS. A total of 2468 Children Living with HIV (CLHIV) were included, 55.3% of whom were < 60 months old. Most (83.8%) had initiated on non-DTG-based ART; 71.0% of these had a viral load (VL) test result before transitioning to pDTG, and 62.5% had VS. Nearly all (99.9%) CLHIV transitioned to pDTG-based regimens. Six months after the transition, 52.7% had good ART adherence, and 38.6% had routine VL testing results; 81.7% achieved VS. Post-transition VS was associated with good adherence and pre-transition VS: adjusted odds ratios of 2.79 (95% CI 1.65-4.71), p < 0.001 and 5.32 (95% CI 3.23-9.48), p < 0.001, respectively. After transitioning to pDTG, VS was achieved in most children tested within the first 6 months. However, adherence remained suboptimal post-transition and VL testing at 6 months was limited. Interventions to improve VL testing and enhance ART adherence are still needed in CLHIV on pDTG-based regimens.
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Affiliation(s)
| | - Alice Maida
- U. S. Centers for Disease Control and Prevention, Division of Global HIV and TB, Lilongwe, Malawi
| | | | - Alice Wang
- U. S. Centers for Disease Control and Prevention, Division of Global HIV and TB, Lilongwe, Malawi
| | - Lester Kapanda
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi
| | - Dumbani Kayira
- U. S. Centers for Disease Control and Prevention, Division of Global HIV and TB, Lilongwe, Malawi
| | | | - Harrid Nkhoma
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi
| | - Shalom Dunga
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi
| | - Zuze Joaki
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi
| | - Rachel Chamanga
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi
| | - Kondwani Nkanaunena
- U. S. Centers for Disease Control and Prevention, Division of Global HIV and TB, Lilongwe, Malawi
| | - Susan Hrapcak
- U. S. Centers for Disease Control and Prevention, Atlanta, USA
| | - Rose Nyirenda
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi
| | - Brown Chiwandira
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi
| | - Martin Maulidi
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi
| | - Godfrey Woelk
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA
| | | | - Thulani Maphosa
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi
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Attal S, Kemner J, Alvir J, Barth S, Schuessler S. Tafamidis 61 mg Patient Characteristics and Persistency? A Retrospective Analysis of German Statutory Health Insurance Data (IQVIA™ LRx). Cardiol Ther 2024:10.1007/s40119-024-00365-6. [PMID: 38615093 DOI: 10.1007/s40119-024-00365-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/18/2024] [Indexed: 04/15/2024] Open
Abstract
INTRODUCTION Tafamidis is the first drug approved by the European Commission for the treatment of wild-type or hereditary transthyretin amyloid cardiomyopathy (ATTR-CM) in adults to reduce cardiovascular mortality and cardiovascular-related hospitalization. Real-world treatment patterns of tafamidis 61 mg in Germany are not well studied in patients with ATTR-CM. METHODS This was a non-interventional, retrospective, observational cohort study of adult patients in Germany based on the IQVIA pharmacy claims database (IQVIA™ LRx). Patients included in the analysis were statutory insured and received at least one prescription of tafamidis 61 mg between March 1, 2020 and August 31, 2022. Treatment adherence was analyzed using the modified medical possession ratio (mMPR) and proportion of days covered (PDC). RESULTS Overall, 1565 adult patients received at least one tafamidis prescription in the study period. Their mean age was 78.3 years, 82.4% were male, and 23.2% were treated by a cardiologist. Persistency rates for patients treated with tafamidis 61 mg were high: 78.0% for 12 months and 65.1% for 24 months after treatment initiation. Patients also had high adherence rate on filling their prescriptions on time: 94.6% and 90.5% of patients had adherence rates of at least 80%, measured by mMPR and PDC, respectively. CONCLUSIONS In the IQVIA™ LRx database, patients prescribed tafamidis 61 mg in Germany displayed high adherence and persistency rates, which suggest good drug tolerability and ease of use.
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Affiliation(s)
- Sepideh Attal
- Pfizer PIO, 23-25 Avenue du Dr Lannelongue, 75668, Paris Cedex 14, France.
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17
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Meyer JD, Perkins SL, Gidley JM, Kuzniar JM, Phillips LA, Lansing JL, Wade NG, Herring MP, Lefferts WK. Feasibility and preliminary efficacy of a theory-informed resistance exercise training single-arm intervention for major depression. Psychol Sport Exerc 2024; 73:102642. [PMID: 38615899 DOI: 10.1016/j.psychsport.2024.102642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/27/2024] [Accepted: 04/05/2024] [Indexed: 04/16/2024]
Abstract
Many adults with major depressive disorder (MDD) do not receive effective treatment. The potential benefits of resistance exercise training (RET) are understudied and may be mechanistically related to cerebral blood flow changes. PURPOSE To assess feasibility, acceptability, and preliminary efficacy of a 16-week, theory-informed RET trial for the treatment of MDD and explore changes in cerebral blood flow. METHODS Ten adults with DSM-5-diagnosed MDD were enrolled in a single-arm, 16-week, twice-weekly, whole-body RET intervention, consistent with US and WHO Physical Activity resistance exercise guidelines. To build intrinsic motivation and develop exercise-preparatory habits, motivators and commitment were discussed weekly. Screening, enrollment, and intervention attendance and compliance rates documented feasibility. At baseline and weeks 8, 16, and 26, current MDD diagnosis, clinician-rated, and self-reported symptom severity were evaluated along with cerebral blood flow which was assessed as middle cerebral artery (MCA) mean blood velocity, conductance, and pulsatility. RESULTS Nine participants completed the intervention. Strong feasibility and acceptability (98 % adherence, 93 % compliance, and 90 % retention) were found. MDD remission was reached by 8/9 participants at week 16 and persisted through week 26. There were large decreases in clinician-rated and self-reported symptoms at each assessment (Hedges' g = 0.84-2.13). There were small-to-moderate increases in MCA velocity (g = 0.32-0.57) and conductance (g = 0.20-0.76) across time, with minimal changes in pulsatility (all g < 0.21). CONCLUSIONS Preliminary results suggest RET for MDD treatment is feasible and plausibly efficacious, finding large antidepressant effects. A sufficiently powered randomized controlled trial to assess RET's efficacy for treating MDD via potential cerebrovascular mechanisms is warranted.
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Affiliation(s)
- Jacob D Meyer
- Iowa State University, 534 Wallace Rd., Ames, IA, 50014, USA.
| | - Seana L Perkins
- Iowa State University, 534 Wallace Rd., Ames, IA, 50014, USA
| | - John M Gidley
- Iowa State University, 534 Wallace Rd., Ames, IA, 50014, USA
| | | | | | - Jeni L Lansing
- Iowa State University, 534 Wallace Rd., Ames, IA, 50014, USA
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Liu Y, Xian Y, Liu X, Cheng Z, Wei S, Wang J, Chen J, Li C, Ma J, Yang J, Liu F, Yu M, Chen Z, Cui Z. Significant insights from a National survey in China: PrEP awareness, willingness, uptake, and adherence among YMSM students. BMC Public Health 2024; 24:1009. [PMID: 38605341 PMCID: PMC11010336 DOI: 10.1186/s12889-024-18512-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 04/03/2024] [Indexed: 04/13/2024] Open
Abstract
INTRODUCTION Few studies focused on the Pre-Exposure Prophylaxis (PrEP) -related aspects, and the applicability of prior evidence to young men who have sex with men (YMSM) students was unknown. This study aimed to assess the awareness, willingness, uptake, and adherence (AWUA) to PrEP among YMSM students in China and to explore the associated factors with these stages. METHODS A cross-sectional survey with a sizable sample of 1151 was conducted among YMSM students aged 16 and above, who self-identified as men who have sex with men(MSM) and resided in mainland China between October 20 and December 20, 2021. The chi-square test and Fisher's exact test were used for univariate analysis, followed by multivariable logistic regression analysis of influencing factors at all levels. RESULTS According to the cascade analysis approach, 88.71% of the participants were aware of PrEP, among which 66.7% expressed willingness to use it. Among those who were willing to use PrEP, only 13.80% took it, and of those who took it, 44.68% adhered to it. The students taking PrEP were those with higher education (OR = 4.239, 95% CI: 1.334-13.467), residence in pilot cities (OR = 2.791, 95% CI: 1.498-5.198), residence in high-risk areas (OR = 5.082, 95% CI: 2.224-11.612), engagement in multi-person sexual behavior (OR = 2.186, 95% CI: 1.236-3.867), and substance use (OR = 1.908, 95% CI: 1.167-3.118). Furtherly, students with higher adherence to PrEP were likely to have receptive sexual behaviors (OR = 8.702, 95% CI: 2.070-36.592), absence of substance use (OR = 4.468, 95% CI: 1.371-14.561), and uptake of PrEP through daily oral route. (OR = 7.065, 95% CI: 1.699-29.371). CONCLUSION YMSM students exhibit distinct patterns of "high awareness, low willingness, low uptake, and low adherence" to PrEP. Strategies for reduction in the acquisition of HIV prioritizing the current features of utilizing PrEP were urgently warranted.
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Affiliation(s)
- Yuanyuan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Yidan Xian
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Xuan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Zhaoyu Cheng
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Siyue Wei
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Jianping Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Jiageng Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Changping Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Jun Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Jie Yang
- "Shenlan" Public Health Counseling Service Center, Tianjin, China
| | - Fengli Liu
- "Shenlan" Public Health Counseling Service Center, Tianjin, China
| | - Maohe Yu
- STD & AIDS Control and Prevention Section, Tianjin Center for Disease Control and Prevention, Tianjin, China
- Tianjin Key Laboratory of Pathogenic Microbiology of Infectious Disease, Tianjin Centers for Disease Control and Prevention, Tianjin, 300011, China
| | - Zhongdan Chen
- HIV/Hepatitis/STI/TB, World Health Organization Representative Office in China, 401 Dongwai Diplomatic Building 23, DongzhimenwaiDajie, Chaoyang District, Beijing, 100600, China
| | - Zhuang Cui
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, China.
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.
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Okamura K, Shimada H, Imazato K, Sako H, Udo A, Taniguchi K, Morisaki S, Imamura I, Urata H, Arima H, Miura SI. Impact of renal denervation on quality of life how does renal denervation contribute to improving hypertension treatment affected by poor medication adherence? Hypertens Res 2024:10.1038/s41440-024-01679-7. [PMID: 38605140 DOI: 10.1038/s41440-024-01679-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/13/2024]
Abstract
The US Food and Drug Administration has approved renal denervation (RDN) as a new treatment option for hypertension (HT) because it not only has antihypertensive effects but also improves the quality of blood pressure (BP) reduction. RDN is expected to be increasingly used in clinical practice in the future. This review summarizes the impact of RDN on quality of life (QOL). Although the treatment of HT aims to improve life prognosis, the use of antihypertensive agents can impair QOL because of adverse effects and lifestyle changes associated with long-term medication use. Consequently, poor adherence to antihypertensive agents is a common problem and may be the most important issue affecting patient QOL. In RDN trials in patients taking antihypertensive agents, approximately 40% of patients had poor adherence to the drugs. Poor adherence is often the cause of resistant hypertension. Therefore, RDN should be well suited to treating HT and improving QOL. Studies have shown that approximately 30% of HT patients prefer RDN to drug treatment. Patients who prefer RDN are typically male and younger and have high BP, poor adherence, and a history of adverse effects of antihypertensive agents. We hope that RDN will improve not only life prognosis but also QOL in HT patients because of its benefits for adherence. Furthermore, we expect that in the future, RDN will be used in other sympathetic nervous system-related diseases, such as heart failure, atrial fibrillation, and sleep apnea syndrome.
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Affiliation(s)
- Keisuke Okamura
- Department of Cardiology and Cardiovascular Center, Imamura Hospital, Tosu, Saga, Japan.
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Fukuoka, Japan.
| | - Hideaki Shimada
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Keisuke Imazato
- Department of Cardiology and Cardiovascular Center, Imamura Hospital, Tosu, Saga, Japan
| | - Hideto Sako
- Department of Cardiology and Cardiovascular Center, Imamura Hospital, Tosu, Saga, Japan
| | - Akihiro Udo
- Department of Cardiology and Cardiovascular Center, Imamura Hospital, Tosu, Saga, Japan
| | - Kenichiro Taniguchi
- Department of Cardiology and Cardiovascular Center, Imamura Hospital, Tosu, Saga, Japan
| | - Shogo Morisaki
- Department of Cardiology and Cardiovascular Center, Imamura Hospital, Tosu, Saga, Japan
| | - Ichiro Imamura
- Department of Cardiology and Cardiovascular Center, Imamura Hospital, Tosu, Saga, Japan
| | - Hidenori Urata
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Fukuoka, Japan
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20
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Zhang Y, Zhang L. Current challenges with adherence to pharmacotherapy in allergic rhinitis. Expert Opin Pharmacother 2024:1-4. [PMID: 38602452 DOI: 10.1080/14656566.2024.2336082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/25/2024] [Indexed: 04/12/2024]
Affiliation(s)
- Yuan Zhang
- Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Luo Zhang
- Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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21
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Nowojewski A, Bark E, Shih VH, Dearden R. Patient adherence and response time in electronic patient-reported outcomes: insights from three longitudinal clinical trials. Qual Life Res 2024:10.1007/s11136-024-03644-w. [PMID: 38598132 DOI: 10.1007/s11136-024-03644-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE Patient-reported outcome measures (PROMs) are used to collect data on disease symptoms in support of clinical trial endpoints. Clinical studies can last a year or more, and the patients' adherence and response time to daily at-home questionnaires may vary significantly over time. The aim of this study was to understand patterns and changes in patients' completion of daily PROMs during longitudinal clinical studies. METHODS Data were collected from 1342 patients randomized into three respiratory clinical trials (NCT03401229, NCT03347279, and NCT03406078). PROMs were completed by patients using electronic handheld devices that collected the starting and completion times. A Bayesian generalized linear mixed-effects model was used to identify unbiased coefficients associated with PROM adherence and response time using patient, site, and calendar features as covariates. RESULTS Adherence decreased over time after randomization, and the rate of decrease was higher in younger patients. The 14-day pre-randomization adherence was correlated with adherence throughout the study. Patients were also more adherent during working days compared to non-working days. Oldest patients took twice as long to complete PROMs throughout the study; however, the response time for all patients decreased during the first month of the study regardless of age. Response time increased 7 days before and after the date of a scheduled clinic visit and when a patient-reported higher symptom burden. CONCLUSION Detailed analyses of adherence and response time for daily PROMs in clinical trials can provide significant insights about trends of patient behavior in longitudinal clinical studies with high baseline adherence.
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Affiliation(s)
- Andrzej Nowojewski
- Imaging & Data Analytics, Clinical Pharmacology & Safety Sciences, AstraZeneca, R&D BioPharmaceuticals, Cambridge, UK.
| | - Erik Bark
- BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
| | - Vivian H Shih
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, USA
| | - Richard Dearden
- Imaging & Data Analytics, Clinical Pharmacology & Safety Sciences, AstraZeneca, R&D BioPharmaceuticals, Cambridge, UK
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22
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McLaughlin MM, Gleber CD, Wang H, Halterman JS, Lande MB. Medication fill duration in pediatric hypertension: adherence, blood pressure control, and disparities. Pediatr Nephrol 2024:10.1007/s00467-024-06363-z. [PMID: 38597974 DOI: 10.1007/s00467-024-06363-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Medication nonadherence is a barrier to hypertension control. The Centers for Disease Control and Prevention recommends prescribing 90-day fills for maintenance medications yet antihypertensives are often dispensed as 30-day fills. Our objectives were to examine how often patients receive 30-day supplies of medication despite prescriptions for longer duration and to examine the effect of medication fill duration on adherence and hypertension control. METHODS We conducted a retrospective cohort study of pediatric patients with hypertension over a 3-year period. For each patient, days prescribed per fill were compared to days dispensed per fill using pharmacy reports and insurance claim data. Proportion of Days Covered (PDC) was calculated to estimate adherence. Hypertension control was determined by provider assessment of control and blood pressure measurement at the final visit. RESULTS Final cohort included 449 patients. A total of 70% had at least one prescription for ≥ 90 days but only 37% had at least one dispense for ≥ 90 days. There was no difference in the likelihood of being prescribed a 90-day fill by insurance type (public vs. private); however, patients with public insurance were less likely to be dispensed a 90-day fill (OR = 0.068, p < 0.001). Patients who received 90-day fills had better adherence (median PDC 77.5% vs. 58.1%, p < 0.001) and were more likely to have hypertension control based on provider assessment. CONCLUSIONS Longer fill duration is associated with improved adherence and hypertension control. Patients with public insurance are markedly less likely to be dispensed 90-day fills, a modifiable barrier to improving adherence.
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Affiliation(s)
- Meghan M McLaughlin
- Department of Pediatrics, University of Rochester Medical Center, Pediatric Nephrology, 601 Elmwood Ave, Box 777, Rochester, NY, 14642, USA.
| | - Conrad D Gleber
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Hongyue Wang
- Department of Biostatistics, University of Rochester Medical Center, Rochester, NY, USA
| | - Jill S Halterman
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Marc B Lande
- Department of Pediatrics, University of Rochester Medical Center, Pediatric Nephrology, 601 Elmwood Ave, Box 777, Rochester, NY, 14642, USA
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23
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Rousseau A, McGrath E, Benjamins L, Cockern S, Meade J, Houston K, Breaux M, Secord E. Off-label use of long-acting injectable antiretroviral therapy: A Single Center Retrospective Review of Youth Living with HIV with detectable HIV RNA starting Injectable Therapy. J Pediatric Infect Dis Soc 2024:piae033. [PMID: 38591356 DOI: 10.1093/jpids/piae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Indexed: 04/10/2024]
Abstract
Nineteen youth living with HIV (YLWH) opted for injectable cabotegravir and rilpivirine without oral lead in and without achieving an undetectable HIV viral load (VL) for the 3 months prior to initiation. All achieved undetectable status within 3 months (3 injections) and maintained an undetectable status through 6-12 months of therapy.
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Affiliation(s)
- Alison Rousseau
- Wayne State University School of Medicine (WSUSOM), Detroit MI, USA
| | - Eric McGrath
- Professor of Pediatrics, WSUSOM Division of Pediatric Infectious Disease, Detroit, MI, USA
| | - Laura Benjamins
- Professor of Pediatrics, WSUSOM, Division of Adolescent Medicine, Detroit, MI, USA
| | - Salome Cockern
- Assistant Professor of Pediatrics, WSUSOM, Detroit, MI, USA
| | - Jill Meade
- Assistant Professor of Pediatrics, WSUSOM, Detroit, MI, USA
| | | | | | - Elizabeth Secord
- Professor of Pediatrics, WSUSOM, Division Chief for Allergy and Immunology, Detroit Michigan, USA
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24
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Woolpert KM, Schmidt JA, Ahern TP, Hjorth CF, Farkas DK, Ejlertsen B, Collin LJ, Lash TL, Cronin-Fenton DP. Clinical factors associated with patterns of endocrine therapy adherence in premenopausal breast cancer patients. Breast Cancer Res 2024; 26:59. [PMID: 38589932 PMCID: PMC11003111 DOI: 10.1186/s13058-024-01819-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/02/2024] [Indexed: 04/10/2024] Open
Abstract
INTRODUCTION Patients with hormone receptor positive breast cancer are recommended at least five years of adjuvant endocrine therapy, but adherence to this treatment is often suboptimal. We investigated longitudinal trends in adjuvant endocrine therapy (AET) adherence among premenopausal breast cancer patients and identified clinical characteristics, including baseline comorbidities and non-cancer chronic medication use, associated with AET adherence. METHODS We included stage I-III premenopausal breast cancer patients diagnosed during 2002-2011 and registered in the Danish Breast Cancer Group clinical database who initiated AET. We used group-based trajectory modeling to describe AET adherence patterns. We also linked patients to Danish population-based registries and fit multinomial logistic models to compute odds ratios (ORs) and 95% confidence intervals (95% CIs) associating clinical characteristics with AET adherence patterns. RESULTS We identified three adherence patterns among 4,353 women-high adherers (57%), slow decliners (36%), and rapid decliners (6.9%). Women with stage I disease (vs. stage II; OR: 1.9, 95% CI 1.5, 2.5), without chemotherapy (vs. chemotherapy; OR: 4.3, 95% CI 3.0, 6.1), with prevalent comorbid disease (Charlson Comorbidity Index score ≥ 1 vs. 0; OR: 1.6, 95% CI 1.1, 2.3), and with a history of chronic non-cancer medication use (vs. none; OR: 1.3, 95% CI 1.0, 1.8) were more likely to be rapid decliners compared with high adherers. CONCLUSIONS Women with stage I cancer, no chemotherapy, higher comorbidity burden, and history of chronic non-cancer medication use were less likely to adhere to AET. Taking steps to promote adherence in these groups of women may reduce their risk of recurrence.
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Affiliation(s)
- Kirsten M Woolpert
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
| | - Julie A Schmidt
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Thomas P Ahern
- Department of Surgery, The Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Cathrine F Hjorth
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Dóra K Farkas
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Bent Ejlertsen
- On behalf of the Danish Breast Cancer Group, Rigshospitalet, Copenhagen, Denmark
- Department of Oncology, Department of Clinical Medicine, University of Copenhagen and Rigshospitalet, Copenhagen, Denmark
| | - Lindsay J Collin
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Deirdre P Cronin-Fenton
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
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25
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Kelly NK, Rosso MT, Rainer C, Claude K, Muessig KE, Hightow-Weidman L. Discordance Between HIV Risk Perception, Sexual Behavior, and Pre-exposure Prophylaxis Adherence Among Young Sexual and Gender Minorities in the United States. J Adolesc Health 2024:S1054-139X(24)00120-4. [PMID: 38583158 DOI: 10.1016/j.jadohealth.2024.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/07/2024] [Accepted: 02/16/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE In the United States, youth experience suboptimal HIV pre-exposure prophylaxis (PrEP) adherence. One common idea posits that this is due to their developing decision-making skills. However, quantitative evidence of this assumption is limited. We therefore examined whether individual decision-making factors, such as HIV risk perception and sexual behavior, predicted PrEP adherence in a national trial of young sexual and gender minorities (YSGMs). METHODS In 2019-2021, the Adolescent Medicine Trials Network for HIV Interventions 142 study enrolled 225 PrEP users (ages 16-24) throughout the country. Regression models estimated the associations between HIV risk perception (using a modified Perceived HIV Risk Scale), sexual behavior (condomless anal sex in ≤ 3 months), and self-reported oral PrEP adherence (≥4 pills in the past week) at the same time point (baseline) and longitudinally (3 months). RESULTS Baseline risk perception (risk ratio [RR]: 0.92, 95% confidence interval [CI]: 0.82, 1.04) and condomless anal sex (RR: 1.10, 95% CI: 0.97, 1.25) were not associated with PrEP adherence at the same time point and did not predict 3-month adherence (RR: 0.97, 95% CI: 0.85, 1.11; RR: 1.05, 95% CI: 0.93, 1.19, respectively). Baseline risk perception was not associated with condomless anal sex at either time point (baseline RR: 1.16, 95% CI: 0.94, 1.43; 3-month RR: 1.07, 95% CI: 0.90, 1.28). DISCUSSION In this national trial of YSGM, HIV risk perception and condomless anal sex did not predict PrEP adherence. Targeting individual-level perceptions and behaviors will likely insufficiently address youth's suboptimal PrEP use. Future research should identify YSGM-specific adherence drivers and train providers to recognize such motivations.
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Affiliation(s)
- Nicole K Kelly
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Matthew T Rosso
- Institute on Digital Health and Innovation, Florida State University, College of Nursing, Tallahassee, Florida
| | - Crissi Rainer
- Institute on Digital Health and Innovation, Florida State University, College of Nursing, Tallahassee, Florida
| | - Kristina Claude
- Institute on Digital Health and Innovation, Florida State University, College of Nursing, Tallahassee, Florida
| | - Kathryn E Muessig
- Institute on Digital Health and Innovation, Florida State University, College of Nursing, Tallahassee, Florida
| | - Lisa Hightow-Weidman
- Institute on Digital Health and Innovation, Florida State University, College of Nursing, Tallahassee, Florida
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26
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Agnew S, Crawford M, MacPherson I, Shiramizu V, Fleming L. The impact of symptom clusters on endocrine therapy adherence in patients with breast cancer. Breast 2024; 75:103731. [PMID: 38599048 PMCID: PMC11017041 DOI: 10.1016/j.breast.2024.103731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND When taken as prescribed, endocrine therapy is effective in reducing risk of recurrence and mortality in the treatment of patients with breast cancer. However, treatment side effects can act as a barrier to medication adherence. Existing research has not identified any specific side effects as consistent predictors of nonadherence. Our aim was to explore the influence of symptom clusters on self-reported adherence in patients with breast cancer. METHODS A cross-sectional online survey was conducted, including patients with breast cancer currently or previously prescribed endocrine therapy (N = 1051). This included measures of self-reported endocrine therapy adherence and common symptoms among this population (insomnia, depression, anxiety, fatigue, musculoskeletal, and vasomotor symptoms). RESULTS Unintentional nonadherence was higher than intentional nonadherence (50.8 % vs 31.01 %). The most troublesome symptom was insomnia (73.83 % displayed probable insomnia disorder). K-means cluster analysis identified 2 symptom clusters: overall High symptoms, and overall Low symptoms. Participants in the Low symptoms cluster were significantly more likely to be classed as adherent based on unintentional and intentional items. CONCLUSIONS Nonadherence was high in the current sample, and significantly more likely in participants reporting overall severe symptoms. Clinicians should be aware of the scale of common side effects and facilitate open conversation about potential barriers to adherence. Follow-up care should include assessment of common symptoms and signpost patients to appropriate support or treatment when required. Future research should explore potential for a central symptom to act as a target for intervention, to relieve overall side effect burden and facilitate better medication adherence.
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Affiliation(s)
- Sommer Agnew
- University of Strathclyde, 16 Richmond St, Glasgow, G1 1XQ, Scotland, UK.
| | - Megan Crawford
- University of Strathclyde, 16 Richmond St, Glasgow, G1 1XQ, Scotland, UK.
| | | | - Victor Shiramizu
- University of Strathclyde, 16 Richmond St, Glasgow, G1 1XQ, Scotland, UK.
| | - Leanne Fleming
- University of Strathclyde, 16 Richmond St, Glasgow, G1 1XQ, Scotland, UK.
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27
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Creese M, Hale G, Benny T, Bush A, Holger DJ, Bahamonde J, Maravent S, Steinberg JG, Brook M, Metzner M, Singh-Franco D, Riskin JW, Pansuria M. Assessing Confidence and Competence of Student Pharmacists in a Virtual Medication Adherence Training Program. Am J Pharm Educ 2024:100699. [PMID: 38582309 DOI: 10.1016/j.ajpe.2024.100699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 02/13/2024] [Accepted: 04/02/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE To assess the impact of a virtual medication adherence training (VMAT) program on students' perceived confidence and perceived competency in delivering medication adherence services via telehealth. METHODS This pilot pre-/post-observational study consisted of two subsequent sections: 1) four asynchronous self-study modules via Canvas (Instructure, Inc.) learning management system, and 2) two live application-based sessions involving virtual and telephonic standardized patients. A pre-/post-survey was given to first-, second-, and third-year Doctor of Pharmacy students to assess perceived confidence and perceived competence. Participants completed a five-question multiple-choice quiz before and after each module to assess knowledge. RESULTS Students' overall perceived confidence and perceived competency significantly increased upon completing VMAT. Knowledge in each module assessment also significantly improved. During assessment of performance throughout the live sessions, most participants lost points when resolving issues within the interaction, addressing the need for patient follow-up, and assessing patient knowledge of medication adherence. CONCLUSION This novel VMAT suggests that this or similar programs would be beneficial to improve pharmacy students' perceived confidence, perceived competence, and knowledge in delivering virtual medication adherence services in the telehealth setting. The incorporation of such training within the didactic curriculum of doctoral pharmacy programs should be considered to improve patient care skills for future medication experts.
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Affiliation(s)
- Mekaliah Creese
- Nova Southeastern University Barry and Judy Silverman College of Pharmacy.
| | - Genevieve Hale
- Nova Southeastern University Barry and Judy Silverman College of Pharmacy.
| | - Tina Benny
- Nova Southeastern University Barry and Judy Silverman College of Pharmacy.
| | - Andrea Bush
- Nova Southeastern University Barry and Judy Silverman College of Pharmacy.
| | - Dana J Holger
- Nova Southeastern University Barry and Judy Silverman College of Pharmacy.
| | - Jennifer Bahamonde
- Nova Southeastern University Barry and Judy Silverman College of Pharmacy.
| | - Stacey Maravent
- Nova Southeastern University Barry and Judy Silverman College of Pharmacy.
| | | | - Meredith Brook
- Nova Southeastern University Barry and Judy Silverman College of Pharmacy.
| | - Miriam Metzner
- Nova Southeastern University Barry and Judy Silverman College of Pharmacy.
| | | | | | - Mamta Pansuria
- Nova Southeastern University Barry and Judy Silverman College of Pharmacy.
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28
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McGill JB, Hirsch IB, Parkin CG, Aleppo G, Levy CJ, Gavin JR. The Current and Future Role of Insulin Therapy in the Management of Type 2 Diabetes: A Narrative Review. Diabetes Ther 2024:10.1007/s13300-024-01569-8. [PMID: 38573469 DOI: 10.1007/s13300-024-01569-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/14/2024] [Indexed: 04/05/2024] Open
Abstract
Early initiation of intensive insulin therapy has been demonstrated to be effective in controlling glycemia and possibly preserving beta-cell function. Innovations in insulin formulations and delivery systems continue. However, we have seen an acceleration in the development of new classes of diabetes medications for individuals with type 2 diabetes and obesity, such as, for example, glucagon-like peptide-1 receptor agonists (GLP-1 RAs). These formulations have been shown to confer significant benefits in achieving good glycemic control with reduced hypoglycemia risk, weight loss, and cardiorenal protection. Therefore, it is reasonable to question whether there is still a role for insulin therapy in the management of type 2 diabetes. However, there are clear limitations inherent to GLP-1 RA therapy, including high rates of suboptimal adherence and treatment discontinuation due to high cost and side effects, which diminish long-term efficacy, and supply issues. In addition, newer formulations have shown improvements in convenience and tolerability, and have been shown to be even more effective when used in conjunction with basal insulin. In this narrative review, we discuss current evidence that supports GLP-1 RA use in combination with insulin therapy and the potential pitfalls of reliance on GLP-1 RAs as a substitute for insulin therapy.
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Affiliation(s)
- Janet B McGill
- Division of Endocrinology, Metabolism and Lipid Research, School of Medicine, Washington University in St. Louis, 660 S. Euclid, Campus Box 8127, St. Louis, MO, 63110, USA
| | - Irl B Hirsch
- UW Medicine Diabetes Institute, University of Washington School of Medicine, 750 Republican Street, Building F, Seattle, WA, 98109, USA
| | - Christopher G Parkin
- CGParkin Communications, Inc., 2675 Windmill Pkwy, Ste. 2721, Henderson, NV, 89074, USA.
| | - Grazia Aleppo
- Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine Northwestern University, 675 N St Clair St Galter Pavilion, Ste 14-100, Chicago, IL, 60611, USA
| | - Carol J Levy
- Division of Endocrinology, Diabetes, and Metabolism, Mount Sinai Diabetes Center and T1D Clinical Research, Icahn School of Medicine at Mount Sinai, 5 E 98th St, New York, NY, 10029, USA
| | - James R Gavin
- Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA, 30322, USA
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29
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Treier AK, Hautmann C, Dose C, Nordmann L, Katzmann J, Pinior J, Scholz KK, Döpfner M. Process Mechanisms in Behavioral Versus Nondirective Guided Self-help for Parents of Children with Externalizing Behavior. Child Psychiatry Hum Dev 2024; 55:453-466. [PMID: 36064990 PMCID: PMC9444695 DOI: 10.1007/s10578-022-01400-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 11/03/2022]
Abstract
The study examined potential mediating effects of therapist behaviors in the per-protocol sample (n = 108) of a randomized controlled trial comparing a behavioral and a nondirective guided self-help intervention for parents of children with externalizing disorders (4-11 years). Additionally, from an exploratory perspective, we analyzed a sequential model with parental adherence as second mediator following therapist behavior. Outcomes were child symptom severity of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder rated by blinded clinicians, and parent-rated child functional impairment. We found a significant indirect effect on the reduction of ADHD and functional impairment through emotion- and relationship-focused therapist behavior in the nondirective intervention. Additionally, we found limited support for an extended sequential mediation effect through therapist behavior and parental adherence in the models for these outcomes. The study proposes potential mediating mechanisms unique to the nondirective intervention and complements previous findings on mediator processes in favor of the behavioral group. Trial registration ClinicalTrials.gov NCT01350986.
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Affiliation(s)
- Anne-Katrin Treier
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany.
- School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Medical Faculty, University of Cologne, Cologne, Germany.
| | - Christopher Hautmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
- School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Medical Faculty, University of Cologne, Cologne, Germany
| | - Christina Dose
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
- School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Medical Faculty, University of Cologne, Cologne, Germany
| | - Lisa Nordmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
| | - Josepha Katzmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
| | - Julia Pinior
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
| | - Kristin Katharina Scholz
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
| | - Manfred Döpfner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
- School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Medical Faculty, University of Cologne, Cologne, Germany
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Permana DA, Susanah S, Adrizain R, Rahayuningsih SE, Dhamayanti M, Rakhmilla LE. Factors Related to the Quality of Life in Children with Transfusion-Dependent Thalassemia. Pediatr Hematol Oncol 2024; 41:179-197. [PMID: 38424668 DOI: 10.1080/08880018.2023.2286962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/07/2023] [Indexed: 03/02/2024]
Abstract
Objective: Increased survival rate of patients with Transfusion-dependent Thalassemia (TDT) should be in line with their good quality of life (QoL). The study aimed to analyze the relationship between sociodemographic factors and clinical characteristics with the QoL of children with TDT. Methods: A cross-sectional study was conducted at Hasan Sadikin General Hospital from December 2022 to February 2023. A total of 158 eligible subjects aged 5-18 years with TDT were included in the analysis. QoL assessment was performed using child self-report and parent-proxy report questionnaires, along with physical examination findings. Bivariate and multivariate analyses were conducted to analyze the data. Results: A total of 158 subjects who met the research criteria were included in the analysis. Of 58.9% of children with TDT had a low adherence rate to iron chelating therapy (ICT). School function had the lowest score in QoL based on child-self report and parent proxy. Gender (p<0,05) and adherence to ICT (p<0,05) were significantly associated with lower quality of life. Conclusion: Female and adherence to ICT were predictors of children with TDT's QoL.
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Affiliation(s)
- Dea Aprilianti Permana
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Susi Susanah
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Riyadi Adrizain
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Sri Endah Rahayuningsih
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Meita Dhamayanti
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Lulu Eva Rakhmilla
- Department of Epidemiology and Biostatistic, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
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Mahoney J, Vertigan A, Hew M, Oates J. Exploring Factors Impacting Engagement in Speech Pathology Intervention for Inducible Laryngeal Obstruction. J Voice 2024:S0892-1997(24)00079-1. [PMID: 38565469 DOI: 10.1016/j.jvoice.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 04/04/2024]
Abstract
AIM Speech pathology is the first-line treatment for inducible laryngeal obstruction (ILO) and involves behavioral techniques to address symptoms and modify maladaptive laryngeal postures. Benefit from speech pathology is reliant on patients engaging in treatment sessions, regular home practice, and generalizing techniques to everyday activities. There is limited research exploring engagement in speech pathology treatment for ILO, particularly from the patient perspective. This study aimed to explore the experiences of living with ILO and how this experience may impact the way patients engage in speech pathology treatment. STUDY DESIGN Qualitative study. METHODS Semistructured interviews were completed with seven participants exploring their experiences living with ILO, their diagnostic process and their experiences with speech pathology treatment. Data were analyzed using reflexive thematic analysis to determine shared meanings across participants and themes were developed. FINDINGS Three major themes were identified - Life with ILO, Challenges of Speech Pathology Treatment, and What Matters to Me. Patients' reports of living with ILO and interacting with speech pathology suggested that these experiences impacted their readiness to start treatment and persist through the challenges of the treatment. Engagement appeared to be positively associated with significant ILO symptom burden and life impact, confidence in the diagnostic process, recommendation for speech pathology treatment, a tailored intervention by a patient-perceived expert in the field and working in a partnership with the speech pathologist to develop a sense of agency. Patients indicated their engagement was negatively influenced by competing time demands, social embarrassment when using symptom relief techniques and laryngeal exercises, and a low ILO symptom burden and life impact. CONCLUSION The reasons behind engagement in speech pathology treatment for ILO appear to be a complex interaction between previous experiences of living with ILO including the diagnostic process and the experience of speech pathology treatment. A patient-centered approach to therapy may help to maximize engagement by exploring readiness and expectations for treatment. The greater understanding of the patient experience provided through this study may allow speech pathologists to devise meaningful ways to maximize engagement in treatment for people with ILO.
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Affiliation(s)
- Janine Mahoney
- Speech Pathology, La Trobe University, Melbourne, Victoria, Australia; Speech Pathology Department, The Alfred, Melbourne, Victoria, Australia.
| | - Anne Vertigan
- Speech Pathology, John Hunter Hospital, Newcastle, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia; Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Mark Hew
- Allergy, Asthma and Clinical Immunology Service, The Alfred, Melbourne, Victoria, Australia; Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jennifer Oates
- Speech Pathology, La Trobe University, Melbourne, Victoria, Australia
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Alt A, Luomajoki H, Roese K, Luedtke K. How do non-specific back pain patients think about their adherence to physiotherapy, and what strategies do physiotherapists use to facilitate adherence? A focus group interview study. J Man Manip Ther 2024; 32:150-158. [PMID: 37725067 PMCID: PMC10956927 DOI: 10.1080/10669817.2023.2258699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/09/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Long-term effectiveness of physiotherapy (PT) for low back pain (LBP) depends on the adherence of patients. Objectives: (1) Identify aspects associated with the adherence of patients with LBP to physiotherapy, and (2) identify factors to facilitate adherence of patients with LBP to PT. METHOD Focus group interviews were conducted with 10 patients with LBP (n = 10, 5 women) and 11 physiotherapists (5 women) from Germany and Switzerland, treating patients with LBP. Data analysis was based on structured content analysis. Deductive and inductive categories were identified and coded. RESULTS Patients with LBP requested more and effective home programs, long-term rehabilitation management, and individualized therapy to achieve a higher level of adherence. Physiotherapists requested more time for patient education. Communication, quality of the therapist-patient relationship, and individualized therapy were identified as essential factors by both representatives. CONCLUSION Patients and physiotherapists identified aspects contributing to adherence. These may guide the development of multidimensional measurement tools for adherence. In addition, this information can be used to develop PT approaches to facilitate the level of adherence.
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Affiliation(s)
- A Alt
- Department of Physiotherapy, Universität zu Lübeck, Institute of Health Sciences, Lübeck, Germany
| | - H Luomajoki
- Institute of physiotherapy, Zürich University of applied Sciences ZHAW, Winterthur, Switzerland
| | - K Roese
- Department of Occupational Therapy, Universität zu Lübeck, Institute of Health Sciences, Lübeck, Germany
| | - K Luedtke
- Department of Physiotherapy, Universität zu Lübeck, Institute of Health Sciences, Lübeck, Germany
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Haider I, Pond GR, Cameron R, Aljama M, Kouroukis TC, Wong K, Fiala MA, Wildes TM, Mian H. A structured oral chemotherapy teaching tool to improve adherence in adults with multiple myeloma: A pilot randomized controlled trial. J Geriatr Oncol 2024; 15:101735. [PMID: 38460399 DOI: 10.1016/j.jgo.2024.101735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 02/09/2024] [Accepted: 02/19/2024] [Indexed: 03/11/2024]
Abstract
INTRODUCTION Many of the newer treatments for adults with newly-diagnosed and relapsed multiple myeloma (MM) are orally administered. Adherence is a challenge, and little is known about strategies to optimize adherence. MATERIALS AND METHODS Forty-seven patients initiating orally-administered anti-myeloma therapy were enrolled and randomized in a pilot study to receive either standard of care teaching or the Multinational Association of Supportive Care in Cancer Oral agent Teaching Tool (MOATT), a structured teaching tool. Adherence was measured electronically with a Medication Event Monitoring System (MEMS) cap. Optimal adherence was defined as an adherence rate of ≥90% over the six months study duration. Patients completed surveys regarding cancer therapy satisfaction and self-efficacy for medication management at one month and six months following the initiation of treatment in both arms. RESULTS The mean adherence of patients over six months was 86.9%; 43.9% of the cohort were classified as non-adherent using the 90% threshold of adherence. Mean adherence was similar among standard of care teaching (87.9%) versus the MOATT intervention tool (85.6%) as was cancer therapy satisfaction and self-efficacy for medication management. DISCUSSION In our pilot, the MOATT tool was not found to be feasible or acceptable. There were no preliminary differences noted between standard of care teaching versus the structured MOATT teaching tool with regards to overall adherence rates, cancer therapy satisfaction, or self-efficacy in medication management. Overall adherence rates were suboptimal in our study. Future research should work to identify aspects of educational interventions which are effective, and investigate different strategies which can be used to supplement patient education and potentially optimize medication adherence in patients with MM.
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Affiliation(s)
- Imran Haider
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gregory R Pond
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Ruthanne Cameron
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Mohammed Aljama
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Tom C Kouroukis
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Kirk Wong
- Cancer Centre Pharmacy, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Mark A Fiala
- Division of Oncology, Washington University School of Medicine, St Louis, USA
| | - Tanya M Wildes
- Department of Medicine, University of Nebraska Medical Center/ Nebraska Medicine, USA
| | - Hira Mian
- Department of Oncology, McMaster University, Hamilton, ON, Canada.
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Abbad-Gomez D, Domingo L, Comas M, Santiá P, Jansana A, Poblador B, Sanz T, Del Cura I, Ibañez B, Padilla M, Redondo M, Castells X, Sala M. Effect of comorbidity and multimorbidity on adherence to follow-up recommendations among long-term breast cancer survivors. Maturitas 2024; 182:107918. [PMID: 38280353 DOI: 10.1016/j.maturitas.2024.107918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/22/2023] [Accepted: 01/14/2024] [Indexed: 01/29/2024]
Abstract
OBJECTIVES To study the impact of comorbidities, multimorbidity, and multimorbidity clusters on adherence to recommended follow-up guidelines among long-term breast cancer survivors. STUDY DESIGN Retrospective cohort study based on 2078 women diagnosed with breast cancer from 2000 to 2006 and followed up from 2012 to 2016. MAIN OUTCOME MEASURES Adherence to breast cancer follow-up recommendations (annual medical visit and imaging) was determined. Comorbidities were classified as acute/chronic. Multimorbidity was defined as the presence of two or more chronic comorbidities aside from breast cancer. Five multimorbidity clusters were considered. Multivariate logistic regression models were fitted to determine the relationship between adherence to recommendations and the presence of comorbidities and multimorbidity, considering both sociodemographic and clinical characteristics. RESULTS Overall adherence to recommendations was 79.5 %. Adherence was lower among long-term breast cancer survivors with no comorbidities (75.8 %). Among multimorbidity clusters, adherence was highest in the anxiety and fractures cluster (84.3 %) and was lowest in the musculoskeletal and cardiovascular cluster (76.4 %). In adjusted multivariate models, multimorbidity was associated with higher levels of adherence (OR = 1.52 95 %CI 1.16-1.99), and adherence was highest in the metabolic and degenerative cluster (OR = 2.2 95 %CI 1.4-3.5). CONCLUSION Adherence to follow-up recommendations was higher among long-term breast cancer survivors with multimorbidity than among those without. Adherence also differed by multimorbidity cluster. These results suggest suboptimal adherence to the current follow-up recommendations in certain groups, suggesting the need to adapt clinical practice guidelines to reflect patients' comorbidities and different characteristics.
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Affiliation(s)
- David Abbad-Gomez
- Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain; PhD Program in Biomedicine, Universitat Pompeu Fabra, Barcelona, Spain; Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain
| | - Laia Domingo
- Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain; Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain.
| | - Mercè Comas
- Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain; Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain
| | - Paula Santiá
- Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain
| | - Anna Jansana
- Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain; Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain; Nutrition and Metabolism Branch, International Agency for Research On Cancer (IARC-WHO), 25 Avenue Tony Garnier, Lyon, France
| | - Beatriz Poblador
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain; EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
| | - Teresa Sanz
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain; Madrid Health Service, Primary Care Research Unit, Madrid, Spain
| | - Isabel Del Cura
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain; Madrid Health Service, Primary Care Research Unit, Madrid, Spain
| | - Berta Ibañez
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain; Navarrabiomed, HUN, UPNA, IdISNA. Pamplona, Spain
| | - Maria Padilla
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain; Research Unit, Costa del Sol Hospital, University of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Marbella, Spain
| | - Maximino Redondo
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain; Research Unit, Costa del Sol Hospital, University of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Marbella, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain; Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain; Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Maria Sala
- Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain; Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain
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Ledwidge M, Ryan F, Seoighe A, Santos-Martinez MJ, Ryan C, Gilmer JGF. Management of iron deficiency in women of childbearing age with oral iron intolerance: a prospective, randomised, controlled trial of three doses of an iron-whey-protein formulation : Prospective RandomisEd study of women of Childbearing age with gastroInteStinal Intolerance to Oral iroN (PRECISION). Int J Clin Pharm 2024; 46:390-400. [PMID: 38147281 PMCID: PMC10960882 DOI: 10.1007/s11096-023-01640-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 08/17/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Nutritional deficit and oral iron gastrointestinal intolerance may be a common cause of iron deficiency, which can be managed by pharmacists. AIM To understand the prevalence of iron deficiency in women of childbearing age with a self-reported history of intolerance to oral iron and the tolerability of three doses of an iron-whey-protein formulation in the care of these women. METHOD Ferritin and haemoglobin levels were documented in women of childbearing age with oral iron gastrointestinal intolerance. In those with iron deficiency (ferritin < 30 µg/L), adherence, gastrointestinal tolerability, ferritin, transferrin saturation and haemoglobin levels were compared between their prior oral iron product and iron-whey-protein microspheres randomised to three doses (14 mg daily, 25 mg daily and 50 mg daily) for 12 weeks. RESULTS Most screened women had low iron stores (128 (62.7%); ferritin < 30 µg/L), 65 (31.9%) had moderate to severe iron deficiency (ferritin < 12 µg/L) and 33 (16.2%) had iron deficiency anaemia (ferritin < 30 µg/L, haemoglobin < 12 g/dL). Amongst the 59 women who participated in the prospective clinical study of iron-whey-protein microspheres over 12 weeks, 48 (81.4%) were classified as adherent/persistent and fewer instances of gastrointestinal intolerance were reported (0.59 ± 0.91) when compared to 12 (20.3%) and (4.0 ± 2.2) respectively while taking the prior oral iron (Fisher's Exact and T-test respectively, both p < 0.001). There was no difference in adherence or tolerability of different iron-whey-protein formulation doses. Ferritin, haemoglobin and energy levels increased significantly over 12 weeks. CONCLUSION Undiagnosed iron deficiency is common in women of childbearing age with a history of intolerance to oral iron and iron-whey-protein microspheres can improve adherence, GI tolerability, iron stores, haemoglobin and energy levels in these women. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov identifier (registration includes full trial protocol): NCT04778072.
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Affiliation(s)
- Mark Ledwidge
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland.
- Solvotrin Therapeutics, Little Island, Cork, Ireland.
- School of Medicine, University College Dublin, Dublin, Ireland.
| | - Fiona Ryan
- Solvotrin Therapeutics, Little Island, Cork, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Anna Seoighe
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - Maria Jose Santos-Martinez
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Cristin Ryan
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - J G F Gilmer
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
- Solvotrin Therapeutics, Little Island, Cork, Ireland
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Kasetti P, Husain NF, Skinner TC, Asimakopoulou K, Steier J, Sathyapala SA. Personality traits and pre-treatment beliefs and cognitions predicting patient adherence to continuous positive airway pressure: A systematic review. Sleep Med Rev 2024; 74:101910. [PMID: 38471433 DOI: 10.1016/j.smrv.2024.101910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 01/09/2024] [Accepted: 02/12/2024] [Indexed: 03/14/2024]
Abstract
Adherence to Continuous Positive Airway Pressure (CPAP) for obstructive sleep apnoea (OSA) can be improved by behavioural interventions which modify patients' beliefs and cognitions about OSA, CPAP, and themselves. We have conducted the first systematic review of the literature on beliefs and cognitions held before starting treatment, and personality (which influences the former) that predict the decision to purchase or start CPAP, or CPAP adherence one month or more after CPAP initiation. A systematic search and screen of articles identified 21 eligible publications from an initial 1317. Quality assessment performed using an adapted Newcastle-Ottawa Scale demonstrated that 13 (62%) studies were poor quality and only seven (33%) were high quality. Eighteen factors, such as self-efficacy (confidence) in using CPAP and value placed on health predicted CPAP adherence; however, for only six (33%), utility as an intervention target is known, from calculation of individual predictive power. Studies did not use new behavioural frameworks effective at explaining adherence behaviours, nor did they interview patients to collect in-depth data on barriers and facilitators of CPAP use. Future studies cannot have these limitations if high quality evidence is to be generated for intervention development, which is currently sparse as highlighted by this review.
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Affiliation(s)
- P Kasetti
- Imperial College London, London, United Kingdom
| | - N F Husain
- Thames Valley Deanery, Oxford, United Kingdom
| | - T C Skinner
- La Trobe University, Melbourne, Australia; Copenhagen University, Denmark
| | | | - J Steier
- King's College London, London, United Kingdom; Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - S A Sathyapala
- Imperial College London, London, United Kingdom; Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom.
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Ramos-Dávila EM, Ruiz-Lozano RE, Gutierrez-Juarez K, Rusque-Lavalle CM, Garza-Villarreal PA, Nacif-Lopéz F, Macias-Rodriguez Y. Knowledge and compliance with contact lens care: A population-based study at a referral center in Northeast Mexico. Cont Lens Anterior Eye 2024; 47:102126. [PMID: 38342733 DOI: 10.1016/j.clae.2024.102126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 12/28/2023] [Accepted: 02/05/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE Despite the increasing prevalence of contact lens (CL) wear, knowledge and compliance with proper care remain suboptimal. This study aims to assess the level of knowledge and compliance with lens care practices in patients attending a third-level institution in Northeast Mexico. METHODS A cross-sectional study using a self-administered online survey was conducted. Patients at the Instituto Tecnolgico de Monterrey were invited to participate. The questionnaire consisted of three sections: demographic data and CL information, CL practices, and CL care knowledge. Participants responding correctly to 6/7 questions from the second and third sections were classified as having good compliance and good knowledge, respectively. Predictive factors for good compliance and knowledge were calculated using a logistic regression model. RESULTS A total of 287 users participated in the study. The median age was 25 (14-78) years with a female (n = 221, 77 %) predominance. Good knowledge was observed in 215 (74.9 %), whereas only 42 (14.6 %) presented good compliance. Failing to replace CL as prescribed (n = 199, 69.3 %) and sleeping with the devices (n = 198, 69 %) were the most frequent practices causing non-compliance. Whereas prohibition of swimming with CL was the least known practice (n = 74, 25 %). Users with recent (≤5 years) wearing experience were more likely to present good knowledge (OR 2.19, p = 0.014) and compliance (OR 3.15, p < 00.01). No statistical correlation was established between knowledge and compliance. CONCLUSION Non-compliance and lack of knowledge of proper CL care were prevalent among in this population. Long-term CL users were at higher risk of non-compliance and lack of knowledge. Moreover, knowledge was not related to compliance; therefore, different strategies must be implemented to reduce CL misconduct.
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Affiliation(s)
| | - Raul E Ruiz-Lozano
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico
| | | | | | | | - Fredy Nacif-Lopéz
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico
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Wongso LV, Rahadi A, Sukmaningrum E, Handayani M, Wisaksana R. Acceptability of a pilot motivational interviewing intervention at public health facilities to improve the HIV treatment cascade among people who inject drugs in Indonesia. Harm Reduct J 2024; 21:73. [PMID: 38561793 PMCID: PMC10985935 DOI: 10.1186/s12954-024-00989-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND HIV-positive people who inject drugs (PWID) experience challenges in initiating and adhering to antiretroviral treatment (ART). Counselling using motivational interviewing (MI) techniques may help them formulate individualised strategies, and execute actions to address these challenges collaboratively with their providers. We evaluated the acceptability of MI from a pilot implementation at three public health facilities in Indonesia. METHODS Adapting the acceptability constructs developed by Sekhon (2017) we assessed the acceptability to HIV-positive PWID clients (n = 12) and providers (n = 10) in four synthesised constructs: motivation (attributes that inspire engagement); cost consideration (sacrifices made to engage in MI); learned understanding (mechanism of action); and outcomes (ability to effect change with engagement). We included all providers and clients who completed ≥ 2 MI encounters. Qualitative analysis with an interpretive paradigm was used to extract and categorise themes by these constructs. RESULTS In motivation, clients valued the open communication style of MI, while providers appreciated its novelty in offering coherent structure with clear boundaries. In cost consideration, both groups faced a challenge in meeting MI encounters due to access or engagement in other health care areas. In learned understanding, clients understood that MI worked to identify problematic areas of life amenable to change to support long-term ART, with reconciliation in family life being the most targeted change. By contrast, providers preferred targeting tangible health outcomes to such behavioural proxies. In outcomes, clients were confident in their ability to develop behaviours to sustain ART uptakes, whereas providers doubted the outcome of MI on younger PWID or those with severe dependence. CONCLUSIONS There is broad acceptability of MI in motivating engagement for both actors. Relative to providers, clients were more acceptable in its mechanism and had greater confidence to perform behaviours conducive to ART engagement. Design innovations to improve the acceptability of MI for both actors are needed.
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Affiliation(s)
- Lydia V Wongso
- University Center of Excellence - AIDS Research Center, Health Policy and Social Innovation, Atma Jaya Catholic University of Indonesia, DKI Jakarta, 12930, Indonesia
| | - Arie Rahadi
- University Center of Excellence - AIDS Research Center, Health Policy and Social Innovation, Atma Jaya Catholic University of Indonesia, DKI Jakarta, 12930, Indonesia.
| | - Evi Sukmaningrum
- University Center of Excellence - AIDS Research Center, Health Policy and Social Innovation, Atma Jaya Catholic University of Indonesia, DKI Jakarta, 12930, Indonesia
- Faculty of Psychology, Atma Jaya Catholic University of Indonesia, DKI Jakarta, 12930, Indonesia
| | - Miasari Handayani
- Research Center for Care and Control of Infectious Diseases, Universitas Padjadjaran, Bandung, 40161, Indonesia
| | - Rudi Wisaksana
- Research Center for Care and Control of Infectious Diseases, Universitas Padjadjaran, Bandung, 40161, Indonesia
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Cordeiro MF, Denis P, Astarita C, Belsey J, Rivas M, García-Feijoo J. Prevalence of comorbidities with the potential to increase the risk of non adherence to topical ocular hypotensive medication in patients with open-angle glaucoma. Curr Med Res Opin 2024; 40:647-655. [PMID: 38410906 DOI: 10.1080/03007995.2024.2322048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/19/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE To evaluate the prevalence of comorbidities that may limit or prevent adherence to topical ocular hypotensive therapy in patients with open-angle glaucoma (OAG). METHODS The UK Clinical Practice Research Datalink (CPRD) database of primary and secondary care and prescription records was analyzed to identify patients with a first (index) diagnosis of OAG during 2016-2020. The primary care records of these patients were screened for diagnostic terms linked to prespecified (qualifying) comorbidities considered to have the potential to impact patients' ability to instill eye drops. The prevalence of each of 10 categories of qualifying comorbidity recorded within the period from 5 years before to 2 years after the index OAG diagnosis was analyzed. RESULTS A total of 100,968 patients with OAG were included in the analysis. Among the patients in the OAG cohort, 13,962 (13.8%) were aged 40-54 years, 32,145 (31.8%) were aged 55-69 years, 42,042 (41.6%) were aged 70-84 years, and 12,819 (12.7%) were aged 85+ years. Within the OAG population, 82.7%, 14.6%, and 2.7% of patients had no category, one category, and two or more categories of qualifying comorbidity, respectively. Qualifying comorbidities were most common in older patients. The most prevalent qualifying comorbidities were categorized as degenerative, traumatic, or pathological central nervous system disorder disrupting cognitive function (5.2%), movement disorder (4.4%), and low vision (4.1%). The prevalence of arthropathies and injuries affecting upper limbs (including arthritis in the hands) was 2.4%. CONCLUSIONS The presence of comorbidities should be considered when determining whether eye drops are suitable treatment for glaucoma. Neurodegenerative disease affecting cognition and memory, motor disease, and low vision are common comorbidities that may impact adherence to eye drops, and affected patients may benefit from non-drop treatment modalities.
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Affiliation(s)
- M Francesca Cordeiro
- Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, UK
- Glaucoma & Retinal Neurodegeneration Research Group, Institute of Ophthalmology, University College London, London, UK
| | - Philippe Denis
- Service d'Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | | | | | | | - Julián García-Feijoo
- Department of Ophthalmology, San Carlos Clinical Hospital, UCM, Instituto de Investigaciones Oftalmologicas Ramon Castroviejo, Madrid, Spain
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Walsh JL, Quinn KG, Hirshfield S, John SA, Algiers O, Al-Shalby K, Giuca AM, McCarthy C, Petroll AE. Acceptability, Feasibility, and Preliminary Impact of 4 Remotely-Delivered Interventions for Rural Older Adults Living with HIV. AIDS Behav 2024; 28:1401-1414. [PMID: 38170275 DOI: 10.1007/s10461-023-04227-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 01/05/2024]
Abstract
People living with HIV (PLH) who live in rural areas of the United States (US) face more challenges to obtaining medical care and suffer higher mortality rates compared to non-rural PLH. Compared with younger PLH, older PLH (age 50+) also face additional challenges to maintaining their health and wellbeing. Despite the heightened barriers to receiving care and remaining adherent to treatment among older rural PLH, few interventions to increase viral suppression and improve quality of life exist for this population. We pilot-tested four remotely-delivered interventions-group-based social support, group-based stigma-reduction, individual strengths-based case management, and individual technology detailing-aimed to improve care engagement and quality of life in rural older PLH in the southern US. Participants (N = 61, Mage = 58, 75% male) completed surveys and self-collected blood specimens at baseline and 3 months; in between, they were randomized to 0-4 interventions. We assessed feasibility, acceptability, and preliminary impact on medication adherence, viral suppression, quality of life, depressive symptoms, and hypothesized mediating mechanisms. More than 80% participated in assigned intervention(s), and 84% completed the study. Interventions were highly acceptable to participants, with more than 80% reporting they would recommend interventions to peers. More than 80% found the social support and case management interventions to be relevant and enjoyable. We found promising preliminary impact of interventions on quality of life, medication adherence, depressive symptoms, internalized stigma, and loneliness. Remotely-delivered interventions targeting rural older PLH are feasible to conduct and acceptable to participants. Larger scale study of these interventions is warranted.
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Affiliation(s)
- Jennifer L Walsh
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Katherine G Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sabina Hirshfield
- STAR Program, Department of Medicine, SUNY Downstate Health Sciences University, New York, NY, USA
| | - Steven A John
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Olivia Algiers
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kamal Al-Shalby
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Boston, MA, USA
| | - Anne-Marie Giuca
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Geriatric Psychiatry, Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Caitlin McCarthy
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrew E Petroll
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA.
- Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
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Tandon A, Saseen JJ, Fink RM, Billups SJ. Primary Care and Infectious Disease Provider Adherence to HIV Pre-exposure Prophylaxis (PrEP) Prescribing and Monitoring Recommendations. AIDS Behav 2024; 28:1270-1275. [PMID: 37542629 DOI: 10.1007/s10461-023-04154-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/07/2023]
Abstract
This study aimed to compare primary care (PC) and infectious diseases (ID) provider adherence to HIV pre-exposure prophylaxis (PrEP) prescribing and monitoring parameters outlined in Centers for Disease Control/Department of Health and Human Services (CDC/DHHS) guidelines. This retrospective cohort analysis from 2017 to 2022 used prescription and laboratory order data to identify patients prescribed PrEP by PC or ID providers. Primary endpoints assessed were adherence to baseline and follow-up HIV monitoring recommendations in the 12 months following the initial PrEP prescription. Secondary endpoints included appropriate PrEP prescription order quantities (≤ 90-day supply), appropriate renal function monitoring, and identification of factors independently associated with follow-up HIV monitoring adherence. Of the 324 eligible patients identified, 112 received PrEP from an ID specialist and 212 from a PC provider. Patients prescribed PrEP from an ID specialist were more likely to have appropriately completed baseline HIV monitoring (OR = 2.56, 95% CI 1.20, 5.47), follow-up HIV monitoring (OR = 1.81, 95% CI 1.08, 3.05), and renal function monitoring (OR = 2.81, 95% CI 1.69, 4.68); The ID group was also more likely to have PrEP prescriptions appropriately authorized for a days' supply of ≤ 90 days (OR = 4.41, 95% CI 2.60, 7.48). Patients receiving PrEP care from ID specialists had better adherence to all assessed PrEP prescribing and monitoring recommendations compared to those receiving care from PC providers.
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Affiliation(s)
- Anushka Tandon
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Joseph J Saseen
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rhianna M Fink
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Sarah J Billups
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
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McGrady ME, Ketterl TG, Webster RT, Schwartz LE, Brock MY, Szulczewski L, Burke M, Hommel KA, Pai ALH, Mara CA, Steele AC, Regan GG, Norris RE. Feasibility pilot trial of a tailored medication adherence-promotion intervention for adolescents and young adults with cancer: Study design and protocol. Contemp Clin Trials 2024; 139:107483. [PMID: 38431133 PMCID: PMC10960689 DOI: 10.1016/j.cct.2024.107483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/13/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Medication non-adherence is common among adolescents and young adults (AYAs) with cancer and associated with poor health outcomes. AYAs with cancer endorse multiple barriers to adherence that differ across individuals, suggesting that tailoring intervention content to an AYA's specific barriers may have the potential to improve adherence. The purpose of this manuscript is to report on ORBIT-guided Phase I design efforts to create the first tailored adherence-promotion intervention for AYAs with cancer and the study protocol for the ongoing Phase II pilot feasibility trial. METHODS Phase I design included qualitative interviews (n = 15 AYAs) to understand patient preferences for adherence-promotion care, development and refinement of a best-worst scaling exercise barriers tool (n = 5 AYAs), and development of intervention modules and a tailoring algorithm. In the ongoing Phase II pilot feasibility trial, AYAs (ages 15-24 years) with cancer currently taking oral chemotherapy or prophylactic medication will be recruited from three children's hospitals. Feasibility, acceptability, and usability will be assessed and these outcomes along with data on medication adherence will be used to inform the next phases of intervention development and testing. CONCLUSIONS If promising, this program of research ultimately has the potential to equip clinicians with additional strategies for supporting adherence among AYAs with cancer. NCT05706610.
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Affiliation(s)
- Meghan E McGrady
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Tyler G Ketterl
- Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Rachel Tillery Webster
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA; Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Laura E Schwartz
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Margaret Y Brock
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lauren Szulczewski
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Kevin A Hommel
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ahna L H Pai
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Constance A Mara
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Amii C Steele
- Division of Pediatric Psychology and Neuropsychology, Levine Children's Hospital at Atrium Health, Charlotte, NC, USA
| | - Gillian G Regan
- Division of Pediatric Psychology and Neuropsychology, Levine Children's Hospital at Atrium Health, Charlotte, NC, USA
| | - Robin E Norris
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Gray A, Ward MK, Fernandez SB, Nawfal ES, Gwanzura T, Li T, Sheehan DM, Jean-Gilles M, Beach MC, Ladner RA, Trepka MJ. Exploring the use of self-management strategies for antiretroviral therapy adherence among women with HIV in the Miami-Dade County Ryan White Program. J Behav Med 2024; 47:282-294. [PMID: 37946027 PMCID: PMC10947905 DOI: 10.1007/s10865-023-00459-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
Women with HIV (WWH) face increased difficulties maintaining adherence to antiretroviral therapy (ART) due to a variety of demographic and psychosocial factors. To navigate the complexities of ART regimens, use of strategies to maintain adherence is recommended. Research in this area, however, has largely focused on adherence interventions, and few studies have examined self-reported preferences for adherence strategies. The purpose and objectives of this study were to explore the use of ART self-management strategies among a diverse sample of WWH, examine demographic and psychosocial differences in strategy use, and assess the association between strategies and ART adherence. The current study presents secondary data of 560 WWH enrolled in the Miami-Dade County Ryan White Program. Participants responded to questionnaire items assessing demographic and psychosocial characteristics, use of adherence strategies, and ART adherence during the past month. Principal component analysis identified four categories among the individual strategies and multivariable binomial logistic regression assessed adherence while controlling for individual-level factors. The majority of WWH reported optimal ART adherence, and nearly all used multiple individual strategies. The number of individual strategies used and preferences for strategy types were associated with various demographic and psychosocial characteristics. Adjusting for demographic and psychosocial characteristics, optimal ART adherence during the past month was associated with the use of four or more individual strategies. When conducting regular assessments of adherence, it may be beneficial to also assess use of adherence strategies and to discuss with WWH how using multiple strategies contributes to better adherence.
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Affiliation(s)
- Aaliyah Gray
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA.
| | - Melissa K Ward
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
- Research Center for Minority Institutions, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Sofia B Fernandez
- Research Center for Minority Institutions, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
- School of Social Work, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Ekpereka S Nawfal
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Tendai Gwanzura
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Tan Li
- Research Center for Minority Institutions, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
- Department of Biostatistics, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Diana M Sheehan
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
- Research Center for Minority Institutions, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Michele Jean-Gilles
- Department of Health Promotion and Disease Prevention, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
| | - Mary Catherine Beach
- Berman Institute of Bioethics, Johns Hopkins University, 2024 East Monument Street, Room 2-511, Baltimore, MD, 21287, USA
| | - Robert A Ladner
- Behavioral Science Research Corporation, 2121 Ponce de Leon Boulevard, Suite 240, Coral Gables, FL, 33134, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
- Research Center for Minority Institutions, Florida International University, 11200 SW 8th St, Academic Health Center 5, Miami, FL, 33199, USA
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Cirnigliaro G, Battini V, Castiglioni M, Renne M, Mosini G, Cheli S, Carnovale C, Dell'Osso B. Evaluating the 6-month formulation of paliperidone palmitate: a twice-yearly injectable treatment for schizophrenia in adults. Expert Rev Neurother 2024; 24:325-332. [PMID: 38445396 DOI: 10.1080/14737175.2024.2325655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/27/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Paliperidone Palmitate is the only antipsychotic that has been developed in three different intramuscular long-acting injectable (LAI) dosing regimen: monthly (PP1M), quarterly (PP3M), and from 2020 also twice-yearly (PP6M). The latter was approved for the maintenance treatment of adults with schizophrenia and clinically stabilized with PP1M or PP3M. AREAS COVERED Data from studies evaluating efficacy in the maintenance treatment of schizophrenia with PP6M are reviewed. Since no post-marketing safety studies are currently available, data from spontaneous reporting system databases, FAERS and Eudravigilance, are analyzed and the reported treatment-emergent adverse events of PP6M are discussed. EXPERT OPINION The efficacy of PP6M is comparable to that of PP3M in terms of relapses prevention in patients with schizophrenia previously stabilized on PP3M or PP1M. Also, the maintenance of clinical efficacy in the long term has been demonstrated. Data from pharmacovigilance analyses, as well as from phase 3 studies, show that PP6M is generally well tolerated, consistently with PP3M safety data. PP6M allows a longer dosing interval than any other LAI antipsychotics, potentially reducing nonadherence and disease relapses. In future, an increase in the prescription rates of PP6M is expected and real-world efficacy and tolerability studies will be conducted.
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Affiliation(s)
- Giovanna Cirnigliaro
- Department of Biomedical and Clinical Sciences (DIBIC), Department of Psychiatry, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Vera Battini
- Pharmacovigilance & Clinical Research, International Centre for Pesticides and Health Risk Prevention, Department of Biomedical and Clinical Sciences (DIBIC), ASST Fatebenefratelli-Sacco University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Michele Castiglioni
- Department of Biomedical and Clinical Sciences (DIBIC), Department of Psychiatry, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Marica Renne
- Department of Biomedical and Clinical Sciences (DIBIC), Department of Psychiatry, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Giulia Mosini
- Pharmacovigilance & Clinical Research, International Centre for Pesticides and Health Risk Prevention, Department of Biomedical and Clinical Sciences (DIBIC), ASST Fatebenefratelli-Sacco University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Stefania Cheli
- Pharmacovigilance & Clinical Research, International Centre for Pesticides and Health Risk Prevention, Department of Biomedical and Clinical Sciences (DIBIC), ASST Fatebenefratelli-Sacco University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Carla Carnovale
- Pharmacovigilance & Clinical Research, International Centre for Pesticides and Health Risk Prevention, Department of Biomedical and Clinical Sciences (DIBIC), ASST Fatebenefratelli-Sacco University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Bernardo Dell'Osso
- Department of Biomedical and Clinical Sciences (DIBIC), Department of Psychiatry, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
- Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford Medical School, Stanford University, Stanford, CA, USA
- CRC "Aldo Ravelli" for Neurotechnology & Experimental Brain Therapeutics, University of Milan, Milan, Italy
- Centro per lo studio dei meccanismi molecolari alla base delle patologie neuro-psico-geriatriche, Università degli Studi di Milano, Milan, Italy
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Krogstad Mudzingwa E, de Vos L, Atujuna M, Fynn L, Mugore M, Mabandla S, Hosek S, Celum C, Bekker LG, Daniels J, Medina-Marino A. High study participation but diverging adherence levels: qualitatively unpacking PrEP use among adolescent girls and young women over two years in Eastern Cape, South Africa. J Behav Med 2024; 47:320-333. [PMID: 38081955 PMCID: PMC10944421 DOI: 10.1007/s10865-023-00462-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 11/10/2023] [Indexed: 03/17/2024]
Abstract
In Southern and Eastern Africa, initiation of daily oral pre-exposure prophylaxis (PrEP) for HIV prevention has been high among adolescent girls and young women (AGYW) offered PrEP. However, persistence and prevention-effective use of PrEP among this critical group continues to be a challenge. We conducted a qualitative sub-study of AGYW from the Community PrEP Study in Eastern Cape Province, South Africa who had high rates of pick up for monthly PrEP refills over two years, but differing levels of PrEP adherence based on tenofovir-diphosphate (TFV-DP) measurements in dried blood spots (DBS). Contrasting 22 AGYW with low versus high levels of TFV-DP in DBS, we qualitatively explored factors which influenced PrEP persistence vs. non-persistence, unique patterns of PrEP use (e.g., discarding or stockpiling), and participant recommendations for improving AGYW prevention-effective use of PrEP in the future. Results showed that PrEP misconceptions and mistrust among participants' social networks negatively influenced adherence. In comparison, supportive families and/or partners and personal trust that PrEP works positively influenced adherence. Those with low adherence described being motivated to come to the site for other study benefits (e.g., reimbursement money, snacks, sanitary pads) and discarding PrEP to avoid stigma associated with being seen with pills. Future PrEP implementation strategies should focus on involving families and partners in PrEP support for AGYW and minimizing PrEP stigma at a community level.Trial registration NCT03977181. Retrospectively registered on June 6, 2019.
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Affiliation(s)
- Emily Krogstad Mudzingwa
- The Desmond Tutu HIV Centre, University of Cape Town, Desmond Tutu Health Foundation, 3 Woodlands Road, Woodstock, Cape Town, 7915, South Africa
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
| | - Lindsey de Vos
- Research Unit, Foundation for Professional Development, Buffalo City Metro, Eastern Cape Province, South Africa
| | - Millicent Atujuna
- The Desmond Tutu HIV Centre, University of Cape Town, Desmond Tutu Health Foundation, 3 Woodlands Road, Woodstock, Cape Town, 7915, South Africa
| | - Lauren Fynn
- The Desmond Tutu HIV Centre, University of Cape Town, Desmond Tutu Health Foundation, 3 Woodlands Road, Woodstock, Cape Town, 7915, South Africa
| | - Matinatsa Mugore
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Selly Mabandla
- HIV/AIDS, STIs and TB Directorate, Buffalo City Health District, Eastern Cape Provincial Department of Health, Bisho, South Africa
| | - Sybil Hosek
- Department of Psychiatry, Stroger Hospital of Cook County, Chicago, IL, USA
- Division of Infectious Diseases, Stroger Hospital of Cook County, Chicago, IL, USA
| | - Connie Celum
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Desmond Tutu Health Foundation, 3 Woodlands Road, Woodstock, Cape Town, 7915, South Africa
| | - Joseph Daniels
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Andrew Medina-Marino
- The Desmond Tutu HIV Centre, University of Cape Town, Desmond Tutu Health Foundation, 3 Woodlands Road, Woodstock, Cape Town, 7915, South Africa.
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Codina CJ. Can We Talk about Concordance? Br Ir Orthopt J 2024; 20:105-106. [PMID: 38618147 PMCID: PMC11012207 DOI: 10.22599/bioj.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
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Walsh EA, Post K, Massad K, Horick N, Antoni MH, Penedo FJ, Safren SA, Partridge AH, Peppercorn J, Park ER, Temel JS, Greer JA, Jacobs JM. Identification of patient subgroups who benefit from a behavioral intervention to improve adjuvant endocrine therapy adherence: a randomized-controlled trial. Breast Cancer Res Treat 2024; 204:547-559. [PMID: 38231313 DOI: 10.1007/s10549-023-07228-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/11/2023] [Indexed: 01/18/2024]
Abstract
PURPOSE Adjuvant endocrine therapy (AET) reduces breast cancer morbidity and mortality; however, adherence is suboptimal. Interventions exist, yet few have improved adherence. Patient characteristics may alter uptake of an intervention to boost adherence. We examined moderators of the effect of a virtual intervention (STRIDE; #NCT03837496) on AET adherence after breast cancer. METHODS At a large academic medical center, patients taking AET (N = 100; Mage = 56.1, 91% White) were randomized to receive STRIDE versus medication monitoring. All stored their medication in digital pill bottles (MEMS Caps) which captured objective adherence. Participants self-reported adherence (Medication Adherence Report Scale) at 12 weeks post-baseline. Moderators included age, anxiety, and depressive symptoms (Hospital Anxiety and Depression Scale), AET-related symptom distress (Breast Cancer Prevention Trial Symptom Scale), and AET-specific concerns (Beliefs about Medications Questionnaire). We used hierarchical linear modeling (time × condition × moderator) and multiple regression (condition × moderator) to test the interaction effects on adherence. RESULTS Age (B = 0.05, SE = 0.02, p = 0.003) and AET-related symptom distress (B = -0.04, SE = 0.02, p = 0.02) moderated condition effect on self-reported adherence while anxiety (B = -1.20, SE = 0.53, p = 0.03) and depressive symptoms (B = -1.65, SE = 0.65, p = 0.01) moderated objective adherence effects. AET-specific concerns approached significance (B = 0.91, SE = 0.57, p = 0.12). Participants who received STRIDE and were older or presented with lower anxiety and depressive symptoms or AET-related symptom distress exhibited improved adherence. Post hoc analyses revealed high correlations among most moderators. CONCLUSIONS A subgroup of patients who received STRIDE exhibited improvements in AET adherence. The interrelatedness of moderators suggests an underlying profile of patients with lower symptom burden who benefitted most from the intervention. STUDY REGISTRATION NCT03837496.
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Affiliation(s)
- Emily A Walsh
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Fifth Floor, Coral Gables, FL, 33146, USA.
| | - Kathryn Post
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Katina Massad
- University of Missouri School of Medicine, Columbia, MO, USA
| | - Nora Horick
- Massachusetts General Hospital, Boston, MA, USA
| | - Michael H Antoni
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Fifth Floor, Coral Gables, FL, 33146, USA
| | - Frank J Penedo
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Fifth Floor, Coral Gables, FL, 33146, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Fifth Floor, Coral Gables, FL, 33146, USA
| | - Ann H Partridge
- Harvard Medical School, Boston, MA, USA
- Dana Farber Cancer Institute, Boston, MA, USA
| | - Jeffrey Peppercorn
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Elyse R Park
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jennifer S Temel
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Joseph A Greer
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jamie M Jacobs
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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48
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Wong NS, Chan DPC, Kwan TH, Lui GCY, Lee KCK, Lee SS. Dynamicity of HIV Pre-exposure Prophylaxis Usage Pattern and Association with Executed Adherence in MSM: An Implementation Study in Hong Kong. AIDS Behav 2024; 28:1327-1344. [PMID: 37775644 DOI: 10.1007/s10461-023-04167-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 10/01/2023]
Abstract
Pre-exposure prophylaxis (PrEP) use has been shown to be effective for HIV prevention in men who have sex with men (MSM). PrEP use coverage aside, maintenance of high PrEP adherence is crucial in ensuring the achievement of HIV prevention. In this PrEP implementation study in Hong Kong, we examined the patterns of PrEP use in MSM and evaluated their association with prevention-effective adherence for HIV prevention. In January 2020-June 2021 in Hong Kong, 312 recruited MSM (median 30 years old) were followed up for 1 year, with HIV and creatinine testing, consultation, and PrEP refill. No HIV breakthrough infection was observed. As a measure of prevention-effective adherence, executed adherence (EA) was expressed as the proportion of days with HIV risk that were protected by PrEP and/or condom in 6 months. In 65,585 diary entries of 215 MSM, the median proportion of EA achieved was 89% (IQR 84-93%). Three latent classes of PrEP users were identified by latent class analysis. Taking Class 1 "daily dominant PrEP" (n = 113, 53%) as reference, Class 2 "episodic PrEP" (n = 76, 35%) was adopted by MSM with less sexual activity, had less PrEP refill and lower EA level, while Class 3 "mixed PrEP schedule" (n = 26, 12%) MSM were more sexually active but with a similar EA level. The study findings showed varied and dynamic PrEP usage patterns in the real-world setting. Strategies for promoting adherence are needed to ensure the maintenance of high EA level among PrEP-using MSM especially those on episodic PrEP schedule.
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Affiliation(s)
- Ngai Sze Wong
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
- S.H. Ho Research Centre for Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Denise Pui-Chung Chan
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
- S.H. Ho Research Centre for Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
| | - Tsz Ho Kwan
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
- S.H. Ho Research Centre for Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Grace Chung-Yan Lui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Shui Shan Lee
- S.H. Ho Research Centre for Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China.
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, 2/F, Postgraduate Education Centre, Prince of Wales Hospital, Shatin, Hong Kong, China.
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49
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Slatore CG, Hooker ER, Shull S, Golden SE, Melzer AC. Association of patient and health care organization factors with incidental nodule guidelines adherence: A multi-system observational study. Lung Cancer 2024; 190:107526. [PMID: 38452601 PMCID: PMC10999337 DOI: 10.1016/j.lungcan.2024.107526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 02/01/2024] [Accepted: 02/26/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Health care organizations are increasingly developing systems to ensure patients with pulmonary nodules receive guideline-adherent care. Our goal was to determine patient and organization factors that are associated with radiologist adherence as well as clinician and patient concordance to 2005 Fleischner Society guidelines for incidental pulmonary nodule follow-up. MATERIALS Trained researchers abstracted data from the electronic health record from two Veterans Affairs health care systems for patients with incidental pulmonary nodules as identified by interpreting radiologists from 2008 to 2016. METHODS We classified radiology reports and patient follow-up into two categories. Radiologist-Fleischner Adherence was the agreement between the radiologist's recommendation in the computed tomography report and the 2005 Fleischner Society guidelines. Clinician/Patient-Fleischner Concordance was agreement between patient follow-up and the guidelines. We calculated multivariable-adjusted predicted probabilities for factors associated with Radiologist-Fleischner Adherence and Clinician/Patient-Fleischner Concordance. RESULTS Among 3150 patients, 69% of radiologist recommendations were adherent to 2005 Fleischner guidelines, 4% were more aggressive, and 27% recommended less aggressive follow-up. Overall, only 48% of patients underwent follow-up concordant with 2005 Fleischner Society guidelines, 37% had less aggressive follow-up, and 15% had more aggressive follow-up. Radiologist-Fleischner Adherence was associated with Clinician/Patient-Fleischner Concordance with evidence for effect modification by health care system. CONCLUSION Clinicians and patients seem to follow radiologists' recommendations but often do not obtain concordant follow-up, likely due to downstream differential processes in each health care system. Health care organizations need to develop comprehensive and rigorous tools to ensure high levels of appropriate follow-up for patients with pulmonary nodules.
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Affiliation(s)
- Christopher G Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR 97239, USA; Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR 97239, USA; Division of Pulmonary & Critical Care Medicine, Department of Medicine, and Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
| | - Elizabeth R Hooker
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR 97239, USA
| | - Sarah Shull
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR 97239, USA
| | - Sara E Golden
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR 97239, USA
| | - Anne C Melzer
- Section of Pulmonary & Critical Care Medicine, VA Minneapolis Health Care System, 1 Veterans Dr, Minneapolis, MN 55417, USA
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50
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Perazzo H, Gonçalves JL, Cardoso SW, Grinsztejn B, Veloso VG, Luz PM. Pathways to Poor Adherence to Antiretroviral Therapy Among People Living with HIV: The Role of Food Insecurity and Alcohol Misuse. AIDS Behav 2024; 28:1173-1185. [PMID: 37523050 DOI: 10.1007/s10461-023-04141-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/01/2023]
Abstract
Daily adherence to antiretroviral therapy (ART) increases the length and quality of life of people living with HIV (PLHIV). We explored whether socioeconomic status directly impacts ART adherence and whether part of the effect is mediated by pathways through alcohol misuse or food insecurity. A cross-sectional study was conducted in Rio de Janeiro/Brazil (November/2019 to March/2020) with PLHIV aged ≥ 18 years. Validated instruments were used to measure alcohol use, food insecurity, and ART adherence. Using structural equation modeling we assessed the direct and indirect effects of variables on ART adherence. Participants reported significant challenges: hunger: 12%, alcohol use: 64%, and missing ART doses: 24%. Results showed that lower socioeconomic status increased poor adherence and that this effect was mediated through higher food insecurity. Alcohol misuse also increased poor adherence through a strong direct effect. Providing socio-economic support coupled with interventions to mitigate alcohol's harmful impact can aid HIV care.
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Affiliation(s)
- Hugo Perazzo
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Juliana L Gonçalves
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Sandra W Cardoso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil.
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