Translation, cultural adaptation and validation of the revised patients' attitudes towards deprescribing (rPATD) questionnaire in Romanian older adults

BACKGROUND

Deprescribing is part of ensuring appropriate medication use and may reduce medication-related harm. Capturing the beliefs and attitudes of patients towards deprescribing by using a validated tool may support optimizing medication use in practice.

OBJECTIVES

To translate, culturally adapt and validate the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire in Romanian and to investigate the attitudes and beliefs of older adults towards deprescribing.

METHODS

The rPATD questionnaire was translated using forward-backward translation into Romanian and culturally adapted. The psychometric properties were evaluated in older adults ≥65 years of age. Structural validity was assessed by item load on factors using an exploratory factor analysis (EFA) which was compared to the original English version and the internal consistency by Cronbach's alpha. Construct validity was evaluated by calculating the Spearman's rank correlation coefficients between the factor scores obtained using the revised version of the Romanian rPATD and scores on the Beliefs about Medicines Questionnaire (BMQ) Specific Concerns Romanian version. Floor and ceiling effect were also examined.

RESULTS

We translated the questionnaire and administered it to 224 participants (median age 72 years [interquartile range: 68.0; 77.0]). In the EFA individual items loaded onto 4 factors, grouped similarly to the English version (Involvement, Burden, Appropriateness, Concerns about Stopping factors). Two items from each of the Involvement and Appropriateness factors were removed to improve factor loading and avoid cross-loading. The Cronbach's alpha values for the 4 factors ranged between 0.522 and 0.773. The scores for Burden and Concerns about Stopping factors were found to be positively correlated with BMQ Specific Concerns score. We identified a ceiling effect for one of the four factors (Involvement) and no floor effects.

CONCLUSIONS

The Romanian rPATD was validated in 4 factor structure similar to the original English questionnaire. The Romanian version of the questionnaire may support the health care professionals in Romania to initiate and support patient-centered deprescribing.

DICA endoscopic classification: 2-year analysis from an international, multicenter prospective study

Background

Diverticulosis of the colon is the most frequent anatomical alteration detected during colonoscopy. The endoscopic classification “DICA”(Diverticular Inflammation and Complication Assessment) has been recently developed in order to have an objective endoscopic description of the colon harbouring diverticula. Aim of this multicentre, international, prospective study was to assess the predictive value of this classification in term of acute diverticulitis and surgery occurrence on a 2-year observational follow-up period.

Methods

2215 prospective patients at the first diagnosis of diverticular disease were enrolled after exclusion of radiological signs of acute diverticulitis; inflammatory bowel diseases; ischemic colitis; prior colonic resection; patients with severe liver failure (Child-Pugh C) or severe kidney failure; pregnant women; patients who are currently using or who have received any laxative agents or mesalazine or probiotics or antibiotics < 2 weeks prior to the enrollment; inability to comply with study protocol; patients with or history of cancer, of any origin, within 5 years before enrollment; history of alcohol, drug, or chemical abuse.

Results

1377(62.15%) patients were classified as DICA 1, 599(27,04%) as DICA 2 and 239(10.80%) as DICA 3. The risk of acute diverticulitis occurrence/recurrence, as well as the risk of surgery, were significantly linked to the severity of DICA score at entry. Overall, acute diverticulitis occurred in 123 (5,5%) patients: it occurred in 32 (2,3%) DICA 1, 53 (8,9%) DICA 2 and 32 (16.4%) DICA 3 patients respectively (p < 0,0001). Overall, surgery occurred in 35 (1,6%) patients: it occurred in 2 (0.1%) DICA1, 15 (2,5%) DICA 2 and 18 (7,6%) DICA 3 patients respectively (p < 0,0001).

Conclusions

The 2-year results of this prospective study seems to confirm that DICA endoscopic classification has a significant prognostic role on the risk of acute diverticulitis occurrence/recurrence and surgery in these patients.

Key messages

DICA is the first endoscopic classification of diverticular disease. The risk of occurrence/recurrence of acute diverticulitis and the risk of surgery are strictly linked to the severity of DICA score.

Phenotyping of subjects for large scale studies on patients with IBS

BACKGROUND

Irritable bowel syndrome (IBS) is a complex condition with multiple factors contributing to its aetiology and pathophysiology. Aetiologically these include genetics, life-time events and environment, and physiologically, changes in motility, central processing, visceral sensitivity, immunity, epithelial permeability and gastrointestinal microflora. Such complexity means there is currently no specific reliable biomarker for IBS, and thus IBS continues to be diagnosed and classified according to symptom based criteria, the Rome Criteria. Carefully phenotyping and characterisation of a 'large' pool of IBS patients across Europe and even the world however, might help identify sub-populations with accuracy and consistency. This will not only aid future research but improve tailoring of treatment and health care of IBS patients.

PURPOSE

The aim of this position paper is to discuss the requirements necessary to standardize the process of selecting and phenotyping IBS patients and how to organise the collection and storage of patient information/samples in such a large multi-centre pan European/global study. We include information on general demographics, gastrointestinal symptom assessment, psychological factors, quality of life, physiological evaluation, genetic/epigenetic and microbiota analysis, biopsy/blood sampling, together with discussion on the organisational, ethical and language issues associated with implementing such a study. The proposed approach and documents selected to be used in such a study was the result of a thoughtful and thorough four-year dialogue amongst experts associated with the European COST action BM1106 GENIEUR (www.GENIEUR.eu).

An insight into statin use and its association with muscular side effects in clinical practice

BACKGROUND

Muscular complaints are known side-effects of statin therapy, ranging from myalgia to clinically important myositis and rhabdomyolysis. We investigated the statin use and association with the presence and characteristics of muscular complaints.

METHODS

We conducted a prospective observational study in internal medicine departments. Patients with statin therapy before hospitalization were interviewed for muscular complaints. When muscular complaints were reported, information on type and severity of muscular symptoms, location and time to onset was collected.

RESULTS

We identified 85 patients with statin treatment at hospital admission out of 521 included. Nine (10.59%) patients reported muscular complaints associated with statin therapy. A cluster of symptoms (cramps, stiffness, decreased muscle power) was reported, affecting both upper and lower limbs. The severity of pain was in most of the cases moderate or severe. All patients reported that pain was intermittent. Five reported that pain was generalized. Symptoms appeared in the first month of treatment or three months after the drug initiation. Creatine kinase was raised in one patient. In two cases drug interactions were probably responsible for muscular complaints.

CONCLUSION

In the studied set of patients muscular symptoms were a rather frequent effect of statin therapy. As this side-effect could be troublesome for patients and could lead to more severe outcomes, their timely detection and management is important.

A cross-cultural investigation of attachment style, catastrophizing, negative pain beliefs, and symptom severity in irritable bowel syndrome

BACKGROUND

Little information exists regarding whether psychosocial variables in irritable bowel syndrome (IBS) vary by geographic location. Adult attachment is an important psychological concept rooted in childhood relationship experience that has not been previously studied in IBS. Catastrophizing and negative pain beliefs have been described in IBS and may be affected by attachment.

AIMS

In this cross-cultural study, we determined: (i) whether attachment differs between IBS patients and controls, (ii) whether geographic location has a significant effect on attachment style, catastrophizing and negative pain beliefs, and (iii) how all three variables correlate with IBS symptom severity.

METHODS

463 IBS patients, with moderate to severe symptom scores, and 192 healthy controls completed validated questionnaires about attachment, catastrophizing, negative pain beliefs and IBS-SSS in nine locations, USA (New York, Los Angeles), Mexico, Italy (Rome, Bari), Romania, Iran, India, and China.

KEY RESULTS

Attachment anxiety and avoidance scores were significantly higher in IBS patients than in controls (p < 0.001). This was particularly true for the fearful-avoidant attachment category, especially in China and Romania. Path analysis showed that attachment anxiety and avoidance had indirect effects on IBS-SSS through catastrophizing (p < 0.0001) and negative pain beliefs (p = 0.005). All three psychosocial measures varied significantly depending on location.

CONCLUSIONS & INFERENCES

In the IBS population studied, attachment style was significantly different in IBS compared to a control population. Geographic differences in attachment, catastrophizing and negative pain beliefs were documented and their correlation with symptom severity and thus, research of psychosocial variables in IBS should take into account the location of the population studied.

Conducting multinational, cross-cultural research in the functional gastrointestinal disorders: issues and recommendations. A Rome Foundation working team report

BACKGROUND

Cross-cultural, multinational research can advance the field of functional gastrointestinal disorders (FGIDs). Cross-cultural comparative research can make a significant contribution in areas such as epidemiology, genetics, psychosocial modulators, symptom reporting and interpretation, extra-intestinal co-morbidity, diagnosis and treatment, determinants of disease severity, health care utilisation, and health-related quality of life, all issues that can be affected by geographical region, culture, ethnicity and race.

AIMS

To identify methodological challenges for cross-cultural, multinational research, and suggest possible solutions.

METHODS

This report, which summarises the full report of a working team established by the Rome Foundation that is available on the Internet, reflects an effort by an international committee of FGID clinicians and researchers. It is based on comprehensive literature reviews and expert opinion.

RESULTS

Cross-cultural, multinational research is important and feasible, but has barriers to successful implementation. This report contains recommendations for future research relating to study design, subject recruitment, availability of appropriate study instruments, translation and validation of study instruments, documenting confounders, statistical analyses and reporting of results.

CONCLUSIONS

Advances in study design and methodology, as well as cross-cultural research competence, have not matched technological advancements. The development of multinational research networks and cross-cultural research collaboration is still in its early stages. This report is intended to be aspirational rather than prescriptive, so we present recommendations, not guidelines. We aim to raise awareness of these issues and to pose higher standards, but not to discourage investigators from doing what is feasible in any particular setting.

Surveys on therapeutic effects of "halotherapy chamber with artificial salt-mine environment" on patients with certain chronic allergenic respiratory pathologies and infectious-inflammatory pathologies

Halotherapy (HT), derived from speleotherapy in salt mines, is also a drug-free therapeutic method. HT effects vary depending on the therapeutic method and the structure of halotherapy environment. The purpose of this article is to show the HT effects of "halotherapy chamber with artificial salt-mine environment" of the National Institute of Rehabilitation, Physical Medicine and Balneoclimatology (INRMFB), on patients with bronchial asthma and other chronic, infectious-inflammatory and allergic respiratory diseases, describing the clinical effects on certain nonspecific resistance factors, on markers of inflammatory processes and on certain immunological changes. Patients were clinically assessed, with the application of hematologic investigations, analysis of nonspecific resistance to infection and of inflammatory process markers, immunologic assessments, analysis of sodium and potassium concentrations, of mineralocorticoid function and other biochemical tests. For the experimental HT therapy performed in the "halotherapy chamber with artificial salt-mine environment" of INRMFB, 15 patients suffering from bronchial asthma, allergic rhinitis, chronic bronchitis, chronic obstructive bronchopneumopathy were selected, based on specific medical indications and contraindications and applying ethical principles, as well as 4 patients with similar pathologies for the control group, who underwent in-home drug treatment. After the specific halotherapy treatment on patients with bronchial asthma, chronic bronchitis and chronic obstructive bronchopneumopathy, which also showed other chronic, infectious-inflammatory and allergic respiratory pathologies, triggering of anti-inflammatory (and also anti allergic) mechanisms and healing effects on inflammatory process were noted. Data acquired also proved the halo therapeutic effect causing the reduction of sensitiveness of body in patients with bronchial asthma.

Immediate and late benefits of treating very elderly people with hypertension: results from active treatment extension to Hypertension in the Very Elderly randomised controlled trial

OBJECTIVE

To assess if very elderly people with hypertension obtain early benefit from antihypertensive treatment.

DESIGN

One year open label active treatment extension of randomised controlled trial (Hypertension in the Very Elderly Trial (HYVET)).

SETTING

Hospital and general practice based centres mainly in eastern and western Europe, China, and Tunisia.

PARTICIPANTS

People on double blind treatment at the end of HYVET were eligible to enter the extension.

INTERVENTIONS

Participants on active blood pressure lowering treatment continued taking active drug; those on placebo were given active blood pressure lowering treatment. The treatment regimen was as used in the main trial-indapamide SR 1.5 mg (plus perindopril 2-4 mg if required)-with the same target blood pressure of less than 150/80 mm Hg.

MAIN OUTCOME MEASURES

The primary outcome was all stroke; other outcomes included total mortality, cardiovascular mortality, and cardiovascular events.

RESULTS

Of 1882 people eligible for entry to the extension, 1712 (91%) agreed to participate. During the extension period, 1682 patient years were accrued. By six months, the difference in blood pressure between the two groups was 1.2/0.7 mm Hg. Comparing people previously treated with active drug and those previously on placebo, no significant differences were seen for stroke (n = 13; hazard ratio 1.92, 95% confidence interval 0.59 to 6.22) or cardiovascular events (n = 25; 0.78, 0.36 to 1.72). Differences were seen for total mortality (47 deaths; hazard ratio 0.48, 0.26 to 0.87; P = 0.02) and cardiovascular mortality (11 deaths; 0.19, 0.04 to 0.87; P = 0.03).

CONCLUSION

Very elderly patients with hypertension may gain immediate benefit from treatment. Sustained differences in reductions of total mortality and cardiovascular mortality reinforce the benefits and support the need for early and long term treatment. Trial registration Clinical trials NCT00122811.

A comparison of levocetirizine and desloratadine in the histamine-induced wheal and flare response in human skin in vivo

BACKGROUND

The histamine-induced wheal and flare response was used to compare quantitatively the antihistaminic potency of levocetirizine and desloratadine.

METHODS

In this double-blind, placebo-controlled crossover study, 24 healthy male non-atopic volunteers received weekly single doses of 1.25, 2.5 or 5 mg levocetirizine, 2.5, 5 or 10 mg desloratadine, or placebo. Four hours after dosing, histamine (100 mg/ml) skin prick tests were performed on the volar surface of both forearms. The diameters of the wheals and flares were measured 10 minutes later. Sedation was evaluated using a visual analogue scale and a motricity test. The effects of individual drug doses were compared using Student's t-test for paired data and the overall effects of the two drugs by ANOVA.

RESULTS

All doses of levocetirizine significantly (P < 0.0001) inhibited both wheals and flares in a dose-related manner. Only the 10 mg dose of desloratadine achieved significant inhibition of response. ANOVA showed levocetirizine to be significantly (P < 0.0001) more active than desloratadine. Neither drug caused significant sedation or loss of motricity.

CONCLUSION

Levocetirizine is significantly more effective than desloratadine in inhibiting wheal and flare responses to histamine in human skin in vivo, with 1.25 mg levocetirizine being more effective than 10 mg desloratadine.

Prevalence of childhood asthma, rhinitis and eczema in Scandinavia and Eastern Europe

There is evidence that the prevalence of allergies and asthma differs between populations in western and eastern Europe. This study investigated the prevalence of wheezing, rhinitis and eczema among schoolchildren in urban and rural areas of Scandinavia and the formerly socialist countries of Eastern Europe. A total of 79,000 children from two age groups (13-14 yrs and 6-7 yrs) in 18 study centres responded to a questionnaire within the International Study of Asthma and Allergy in Children (ISAAC). The 12 month period prevalence of symptoms of asthma, allergic rhinoconjunctivitis and atopic eczema was calculated. The prevalence of wheezing among the 13-14 yr old children was 11.2-19.7% in Finland and Sweden, 7.6-8.5% in Estonia, Latvia and Poland and 2.6-5.9% in Albania, Romania, Russia, Georgia and Uzbekistan (except Samarkand). The prevalence of itching eyes and flexural dermatitis varied in a similar manner between the three regions. The regional differences were less pronounced among the 6-7 yr old children in the seven participating centres. The highest prevalence of rhinitis was recorded in April-July in Scandinavia and during the winter months in the other countries. The prevalence of atopy-related disorders was higher in Scandinavia than in Estonia, Latvia and Poland, which in turn had a higher prevalence than five other countries of eastern Europe with a culture less similar to western Europe. This supports the hypothesis that "Western life style" is associated with a high prevalence of childhood allergy.

Increasing gallstone prevalence and cholecystectomy rate in a large Romanian town. A necropsy study

To study whether the increasing prevalence of gallstone disease noted in a 100-year interval in a large Romanian town has continued in recent years, we analyzed all necropsies (5234) performed during 10 years (1983-1992) in Cluj-Napoca. Gallstone disease (GD) was defined as the presence of stones or the absence of the gallbladder due to cholecystectomy. The results obtained were compared to those of the previous 10-year period (1973-1982). We found a significant increase of GD both in men (6.9% to 9.8%) (P < 0.001) and women (17.1% to 21.7%) (P < 0.001). The ratio of women to men with GD decreased as compared to the first time period (1.4/1 vs 1.8/1). The actual age-standardized prevalence of GD was higher than that calculated for the first time period: 7.6% in men (5.0% in 1973-1982) and 16.9% in women (8.4% in 1973-1982) (P < 0.001). The necropsy cholecystectomy rate rose markedly; 42.1% of the GD men and 43.0% of the GD women had undergone operation during their life. The present study indicates a higher prevalence of GD in the Romanian town than previously found. The actual prevalence is comparable with that of other central European countries, but it is less than that found in England, Scotland, or Sweden.

Comparative prevalence of gallstone disease at 100-year interval in a large Romanian town, a necropsy study

The prevalence of gallstone disease in a large Romanian town was determined on 6275 necropsies performed during a 10-year period (1973-1982). The "crude" prevalence of gallstone disease in women was 17.1% and in men, 6.9%. Age-standardized prevalence was 8.4% in women and 5.0% in men. This rate is lower than the prevalence of gallstones in northern or central European countries, but it is higher than that established in some southern countries of Europe. A comparison of the "crude" prevalence of gallstone disease was compared with that calculated for a similar 10-year period 100 years ago (1873-1882), on 1538 necropsies performed in the same town. Prevalence of gallstones rose significantly in a century (from a mean of 1.2% to 11.3%; P less than 0.001), a finding consistent with the concept that gallstone disease is a "disease of civilization."

[Contribution of sequential scintigraphy with 131I-BSP to the differential diagnosis of jaundice (author's transl)]

Patients with constitutional hyperbilirubinemia and with extra intrahepatic cholestasis have been explored by means of sequential scintigraphy, with the following results: 1. in Gilbert's syndrome liver uptake and output of 131I-BSP were normal; 2. in the Dubin-Johnson syndrome liver uptake and plasma clearance of 131I-BSP were normal; the substance was retained for a long period (2 hrs) in the liver without any tendency to be excreted; 3. in the Rotor syndrome 131I-BSP uptake was delayed and liver clearance prolonged; 4. in total biliary obstruction no intestinal activity could be recorded even in the late registrations (the latest after 24 hrs); 5. in partial extrahepatic biliary obstruction there was a normal liver uptake with an abnormal retention in the choledochus and a delayed excretion (more than 2 hrs); and 6. in intrahepatic cholestasis 131I-BSP liver uptake, retention and excretion were delayed; differentiation of these cases from total biliary obstruction is difficult. Late determinations, the last 24 hrs after injection of the tracer, were performed in these cases, in order to exclude a total obstruction with parenchymal injuries, by assessing the enteral output.

Der Beitrag der sequentiellen Szintigraphie mit 131J-BSP zur Ikterus-Differentialdiagnose

Es wurden mittels sequentieller Szintigraphie Patienten mit konstitutioneller Hyperbilirubinämie und mit extra- und intrahepatischer Cholestase untersucht. Folgende Ergebnisse wurden festgestellt: 1. im Gilbert-Syndrom waren Leberaufnahme und Ausscheidung des 131J-BSP normal; 2. im Dubin-Johnson-Syndrom waren Plasmaclearance und Leberaufnahme des 131J-BSP normal; in der Leber wurde der Farbstoff lange (2 Std.) ohne Ausscheidungstendenz gespeichert; 3. beim Rotor-Syndrom war die Leberaufnahme des 131J-BSP verzögert und die Leberclearance verlängert; 4. bei komplettem Verschluß des Gallenganges zeigte sich auch bei den Spätaufnahmen (letzte Aufnahme nach 24 Std.) noch immer keine Darmaktivität; 5. bei inkomplettem Gallengangverschluß war die Leberaufnahme normal, mit einer abnormalen Speicherung im Choledochus und Verzögerung der Ausscheidung (über 2 Std.); und 6. bei intrahepatischer Cholestase waren Leberaufnahme, Speicherung und Ausscheidung des 131J-BSP verzögert; diese Fälle sind schwierig vom kompletten Gallengangverschluß zu differenzieren. In diesen Fällen haben wir aber die letzten Registrierungen 24 Std. nach der Injektion des Indikators durchgeführt, um aus der Darmausscheidung einen kompletten Verschluß mit Parenchymschädigung auszuschließen.

Metabolism of bile acids by strains of Acinetobacter anitratum and Acinetobacter lwoffii

The activity of two species of bacteria: Acinetobacter anitratum and Acinetobacter lwoffii, isolated from jejunum of patients with achlorhydria and Reichel-Polya resection towards bile salts was investigated. These species were not previously tested from this view point. All strains tested hydrolyzed bile salts; conjugates of deoxycholic acid were hydrolyzed more readily than those of cholic acid. This feature may be used as a bacteriological taxonomic criterion.