Grouping of unused agricultural by-product biomass for fuel conversion in South Korea through multivariate analysis

While biomass holds significance as a resource, its abundance in South Korea is limited. Therefore, in this study analyzed the chemical characteristics of agricultural by-products produced and evaluated their fuel potentiality. To achieve this objective, multivariate analysis was utilized to create biomass clusters with diverse feature. All investigated biomass types showed heating values of at least 12.6 MJ/kg, adhering to South Korea's Bio-solid recovered fuel (SRF) standard, once the moisture content was reduced to 20 % or less. However, the biomasses only met the heating value of Level 3 of the European standard for SRF, which is at least 15 MJ/kg. Groups were formed based on a multivariate analysis using four variables: the high heating value, and carbon, nitrogen, and ash contents. The groups were centered around wood chips and hog fuel, with a cluster of lignocellulosic biomass materials surrounding them. The clusters formed around four groups. When the biomasses in each group were mixed, the combustion characteristics were compared to the ignition, maximum, and burn-out temperatures. Utilizing biomass grouping, by-products from agriculture and livestock in South Korea can be effectively employed as energy sources.

Metabolic dysfunction-associated fatty liver disease increases the risk of type 2 diabetes mellitus in young Korean adults

AIMS

To investigate the impact of Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) on the risk of type 2 diabetes mellitus in young Korean adults.

METHODS

Data were sourced from the Korean National Health Insurance Service-Health Screening Cohort, comprising adults aged 20-39 who underwent health examinations between 2009 and 2012. Participants were grouped based on the presence of MAFLD and nonalcoholic fatty liver disease (NAFLD), both individually and in combination. The categorizations included Neither-FLD, NAFLD-only, MAFLD-only, or Both-FLD. Incident diabetes was identified through claims data during the follow-up period.

RESULTS

Among 6,232,656 participants, 676,747 (10.8 %) had MAFLD. During a median follow-up of 9.5 years, 182,291 incident diabetes cases were identified. Multivariate analysis revealed a significantly higher diabetes risk in the MAFLD group compared to those in the Non-MAFLD group (HR = 6.148, 95 % CI, 6.084-6.212). Notably, diabetes incidence was highest in FLI ≥ 60 subgroup with BMI ≥ 23 and metabolic syndrome.

CONCLUSIONS

MAFLD is associated with a 6.1-fold increased diabetes risk in young adults, underscoring the urgent need for early intervention to mitigate this risk.

NMR based Serum metabolomics revealed metabolic signatures associated with oxidative stress and mitochondrial damage in brain stroke

Brain stroke (BS, also known as a cerebrovascular accident), represents a serious global health crisis. It has been a leading cause of permanent disability and unfortunately, frequent fatalities due to lack of timely medical intervention. While progress has been made in prevention and management, the complexities and consequences of stroke continue to pose significant challenges, especially, its impact on patient's quality of life and independence. During stroke, there is a substantial decrease in oxygen supply to the brain leading to alteration of cellular metabolic pathways, including those involved in mitochondrial-damage, leading to mitochondrial-dysfunction. The present proof-of-the-concept metabolomics study has been performed to gain insights into the metabolic pathways altered following a brain stroke and discover new potential targets for timely interventions to mitigate the effects of cellular and mitochondrial damage in BS. The serum metabolic profiles of 108 BS-patients were measured using 800 MHz NMR spectroscopy and compared with 60 age and sex matched normal control (NC) subjects. Compared to NC, the serum levels of glutamate, TCA-cycle intermediates (such as citrate, succinate, etc.), and membrane metabolites (betaine, choline, etc.) were found to be decreased BS patients, whereas those of methionine, mannose, mannitol, phenylalanine, urea, creatine and organic acids (such as 3-hydroxybutyrate and acetone) were found to be elevated in BS patients. These metabolic changes hinted towards hypoxia mediated mitochondrial dysfunction in BS-patients. Further, the area under receiver operating characteristic curve (ROC) values for five metabolic features (methionine, mannitol, phenylalanine, mannose and urea) found to be more than 0.9 suggesting their high sensitivity and specificity for differentiating BS from NC subjects.

Predictors of adverse effects to antiseizure drugs in adult patients with epilepsy from Colombia: A case-control study

INTRODUCTION

Adverse drug reactions (ADRs) to antiseizure therapy can worsen the quality of life, reduce adherence, and potentially lead to treatment discontinuation and uncontrolled seizures.

OBJECTIVES

The aim of the study was to develop a prognostic model for ADRs to antiseizure therapy in adult patients with epilepsy from Colombia.

METHODS

This case-control study included adult patients with epilepsy, who were separated into two groups: one group with ADRs to antiseizure therapy (cases), as determined by a complete evaluation conducted by an epileptologist, and another group without ADRs (controls). Variables were analyzed to identify statistical differences between the two groups and were then selected to construct a prognostic model using logistic regression. The Bonferroni method was applied for multiple comparisons.

RESULTS

Three hundred fifty-four patients with epilepsy were studied. One hundred and fifty (42%) patients had ADRs and 204 (57%) patients did not have ADs. A total of 362 ADRs were reported, with a third of them being general symptoms and most frequently occurring with older-generation antiseizure drugs (58%). Female sex, drug-resistant epilepsy, LEV, and CZP were risk factors, whereras the presence of tumoral etiology, absence of seizure triggers, and VPA were identified as protective factors. A prognostic model was constructed using previously reported risk factors for ADRs to antiseizure therapy and other variables available in this population study. In the multivariable analysis, the number of previously used antiseizure drugs (1, 2, or ≥3), TPM, CZP, LEV, PHT, and female sex were predictors of ADRs. The corrected p-values were estimated by the Bonferroni method; however, not all the variables achieved statistical significance with this adjustment.

CONCLUSIONS

In adult patients with epilepsy from Colombia, we found that the number of previously used antiseizure drugs, TPM, CZP, LEV, PHT, and female sex were predictive factors for ADRs to antiseizure therapy.

Geochemical soil dynamics on a bimodal post-collisional intrusive complex

The importance of environmental quality for global social and ecological development, including soil degradation, cannot be overstated. Trace elements dispersed in the environment due to anthropogenic or geogenic activities can result in ecotoxicological impacts, negatively influencing environmental quality. The reference values for soil quality concerning trace elements are primarily based on geological, geomorphological, and pedological patterns. However, intrinsic geological factors may diverge some concentration levels from established norms. Therefore, conducting comprehensive surveys of environmental quality reference values becomes imperative, incorporating geological, geomorphological, and pedological patterns. A deeper understanding of the distribution of these elements is also required. Multivariate analysis proves crucial in compartmentalizing the most relevant factors, particularly in regions marked by bimodal magmatism arising from post-collisional distensional processes, such as the Santa Angélica intrusive suite in southeast Brazil. This study collected soil samples from pastures and natural grasslands with minimal anthropogenic intervention at two depths. These samples underwent various chemical and physical analyses. Statistical techniques such as correlation analysis, principal component analysis, hierarchical clustering, and geostatistics were utilized to interpret the data. The analysis revealed a correlation between the clay fraction and trace elements, demonstrating that clustering is an effective methodology for ascertaining landscape distribution patterns of these components. When compared to quality reference values, it was observed that most soil content levels exceeded both global and local standards. This study suggests that the presence of barium (Ba) in the soil might be due to the isomorphic replacement of feldspathic minerals in acidic and intermediate rocks, whereas molybdenum (Mo) seems to be associated with soils in the domain of porphyritic allanite granite. However, additional research is warranted to determine the concentration factor of Mo in this scenario accurately.

Nonadherence to Clinical Practice Guidelines for Opioid Prescribing in Patients with Chronic Low Back Pain: A Pain Research Registry-Based Study

INTRODUCTION

This study measured the prevalence and impact of nonadherence to clinical practice guidelines (CPGs) that recommend using nonpharmacological and nonopioid treatments such as nonsteroidal anti-inflammatory drugs (NSAIDs) before considering opioids in patients with chronic low back pain.

METHODS

Participants within the PRECISION Pain Research Registry provided data during the period from April 2016 through October 2021. The prevalence of nonadherence to CPGs was based on current or prior use of 6 common nonpharmacological treatments, NSAIDs, and opioids for low back pain. The primary outcome measures were low back pain intensity, back-related disability, and pain impact on health-related quality of life.

RESULTS

The prevalence of nonadherence to CPGs was 68 (18.0%) participants among the 378 participants currently using opioids. Participants having some post-high school education (OR, 0.41; 95% CI, 0.22-0.74) or at least a college education (OR, 0.26; 95% CI, 0.12-0.56) were at decreased risk of treatment that was nonadherent to CPGs in a multivariate analysis. Participants whose treatment was nonadherent to CPGs reported significantly worse clinical outcomes across all 3 measures (P ≤ .001; Cohen's d range, 0.41 to 0.62).

CONCLUSION

Up to one-fifth of patients with chronic low back pain may be prescribed opioids in a manner that is not adherent to CPGs, thereby placing them at risk for poor outcomes.

Rural-Urban Differences in Age at Autism Diagnosis: A Multiple Model Analysis

Objective: Early recognition of autism is important, but diagnosis age varies among children. Recent studies have aimed to identify factors affecting age of diagnosis and several studies have attempted to explore geographic variation in age at diagnosis of autism. However, there is a lack of research examining geographic variations with multiple models to find whether geographic differences can be explained by risk factors such as socioeconomic status and differences in child characteristics. This study aimed to address this gap of knowledge by comparing age at diagnosis of autism between the group of people living in the center of the province and the group of people living in the rest of the province, considering potential medical and socioeconomic confounders. Method : The study population consisted of 50 autistic children born in East Azerbaijan Province between 2004 and 2016. Initially, univariate testing by ANOVA was performed to identify family and individual factors contributing to differences in age at autism diagnosis. Following this, the association between living in the center of the province and age at diagnosis in univariate and multivariate analyses was examined. Results: Results from the initial univariate analysis indicate a significant association between living in the center of province and early diagnosis. However, inclusion of possible confounders in multiple model illustrates that these geographical disparities in age at diagnosis can be explained by differences in socioeconomic and medical status. Conclusion: Although geographic variation in age at diagnosis of autism was observed, analyses show that differences in individual and family-level factors may contribute to geographic differences. In this study, most of the observed variation was accounted for by family-level factors rather than geographic policies. Findings prove that multiple strategies are required to identify targeted interventions and strategies.

Standardized ileal digestibility of amino acids of protein sources associated with exogenous enzymes for broilers

Objective

Two experiments were conducted to evaluate the effect of enzyme complex (EC) on the standardized ileal digestibility (SID) of amino acids (AA) in corn gluten meal (60%) (CGM), soy protein concentrate (SPC), dried bovine plasma (DBP) and poultry offal meal (POM). Experiments I and II were conducted with broilers in the pre-starter (1 to 7 days of age) and starter (1 to 21 days of age) phases, respectively.

Methods

The treatments consisted of a protein-free diet (PFD) containing feedstuffs either supplemented with EC (xylanase, amylase, and protease) or not. In Experiment I, a total of 360 one-day-old male Cobb-500® broiler chicks were randomly housed in 45 pens, resulting in five replicates with eight birds each, totalizing eight treatments and one PFD group. In Experiment II a total of 270 one-day-old male Cobb-500® broiler chicks were randomly housed in 45 pens, resulting in five replicates with six birds each, totalizing eight treatments and one PFD group. The PFD groups were used to assess the endogenous AA losses. The birds were slaughtered to collect the ileal content.

Results

In the pre-starter phase, the SID of arginine, branched chain-aminoacids, glycine, serine, aspartate, and glutamic acid increased with EC addition. The EC improved the SID of arginine and glutamic acid of CGM; the SID of valine and cystine of SPC; the SID of leucine, glycine, and aspartate of POM and the SID of isoleucine of DBP. In the starter phase, the SID of isoleucine, phenylalanine and glycine increased in EC-supplemented diets. The EC improved the SID of isoleucine of DBP; the SID of phenylalanine of CGM and POM. The SID of AA of SPC was not influenced by the EC.

Conclusion

The addition of an enzyme complex to broiler pre-starter and starter diets is efficient in increasing the SID of AA on SPC, POM and DBP.

Discussion of "Exponential-family Embedding with Application to Cell Developmental Trajectories for Single-cell RNA-seq Data"

Exponential-family singular value decomposition (eSVD) is a new approach for embedding multivariate data into a lower-dimensional space. It provides an elegant dimension reduction framework with flexibility to handle one-parameter exponential family distributions and proven consistency. This approach adds a valuable new tool to the toolbox of data analysts. Here we discuss a number of open problems and challenges that remain to be addressed in the future in order to unleash the full potential of eSVD and other similar approaches.

Treatment satisfaction and its association with anxiety, depression and fear of COVID-19 among Lebanese inpatients with schizophrenia

Background:

The patient’s evaluation of treatment and its associated outcomes define the treatment satisfaction. The quality of treatment satisfaction and healthcare service has been affected by depression, anxiety and fear of the current coronavirus disease 2019 (COVID-19) pandemic.

Objective:

Therefore, this study aimed to assess factors associated with treatment satisfaction among Lebanese inpatients with schizophrenia, namely depression, anxiety and fear of COVID-19.

Methods:

A cross-sectional study was conducted between September and November 2020, enrolled 118 patients with chronic schizophrenia consecutively admitted to Psychiatric Hospital of the Cross, Lebanon. The Functional Assessment of Chronic Illness Therapy-Treatment Satisfaction-Patient Satisfaction Scale (FACIT-TS-PS) was used to assess treatment satisfaction, the Lebanese Anxiety Scale -10 (LAS-10) was used to assess anxiety, Montgomery-Asberg Depression Rating Scale (MADRS) to assess depression and the Fear of COVID-19 Scale to assess the level of fear of the COVID-19 pandemic.

Results:

The mean scores of the scales were as follows: treatment satisfaction (65.20; SD 16.11; median=71), LAS-10 (13.65; SD 6.02), MADRS (9.09; SD 6.69) and fear of COVID-19 (18.59; SD 6.78). Higher depression (r= -0.46, p<0.001) was significantly associated with lower treatment satisfaction. Female gender (beta=7.51, p=0.029) was significantly associated with higher treatment satisfaction score. Fear of COVID-19 did not show any significant association with the treatment satisfaction score.

Conclusions:

Results of this study found that depression and gender were associated with treatment satisfaction among inpatients with schizophrenia. No association has been found between fear of COVID-19 and treatment satisfaction among those patients. More research is warranted to evaluate treatment satisfaction and associated factors among chronic inpatients with schizophrenia, specifically during the COVID-19 pandemic, in order to improve treatment satisfaction and subjective well-being of patients.

Calculating cumulative effects in GIS using a stepless multivariate model

The paper present a streamlined workflow, using multivariate analyses of environmental variables in combinations with GIS overlay analyses that provide methods to extract and analyse major environmental and climatic gradients by using fishnet polygons as sample units. The method opens for illustrating multivariate results as geographical maps and as PCA plots using sample scores as coordinates. Then the PCA sample scores can be allocated to fishnets polygons and each sample score can be assigned with its ID and other attributes to each fishnet polygon. This is used to construct a cumulative impact model based on PCA fishnet polygon frequency scores and further to measure representativity of nature protected areas. It also provide possibilities for testing of a range of different hypothesis. The method present the numerical results visually in both the PCA sample score plot and in a geographical map, and can be used as a part of cumulative impact analysis to assess representativeness of mapped or modelled valued environmental components (VECs). It can be applied to existing as well as planned or potential infrastructure and other technical developments. •

The Stepless Multivariate Model is an explicit, transferable and reproducible procedure to conduct systematic assessment of cumulative impacts based on an analysis of representativity.

•

The method can be used to illustrate the analysis both geographically and numerically.

•

The procedure in the method has a potential wide range of applications and can form a basis for hypothesis testing.

Patterns of medication errors involving pediatric population reported to the French Medication Error Guichet

Background

Medication error is a global threat to patient safety, particularly in pediatrics. Yet, this issue remains understudied in this population, in both hospital and community settings.

Objectives

To characterize medication errors involving pediatrics reported to the French Medication Error Guichet, and compare them with medication errors in adults, in each of the hospital and community settings.

Methods

This was a retrospective secondary data analysis of medication errors reported throughout 2013-2017. Descriptive and multivariate analyses were performed to compare actual and potential medication error reports between pediatrics (aged <18 years) and adults (aged >18 and <60 years). Two subanalyses of actual medication errors with adverse drug reaction (ADR), and serious ADR were conducted.

Results

We analyzed 4,718 medication error reports. In pediatrics, both in hospital (n=791) and community (n=1,541) settings, antibacterials for systemic use (n=121, 15.7%; n=157, 10.4%, respectively) and wrong dose error type (n=391, 49.6%; n=549, 35.7%, respectively) were frequently reported in medication errors. These characteristics were also significantly more likely to be associated with reported errors in pediatrics compared with adults. In the hospital setting, analgesics (adjusted odds ratio (aOR)=1.59; 95% confidence interval (CI) 1.03:2.45), and blood substitutes and perfusion solutions (aOR=3.74; 95%CI 2.24:6.25) were more likely to be associated with reported medication errors in pediatrics; the latter drug class (aOR=3.02; 95%CI 1.59:5.72) along with wrong technique (aOR=2.28; 95%CI 1.01:5.19) and wrong route (aOR=2.74; 95%CI 1.22:6.15) error types related more to reported medication errors with serious ADR in pediatrics. In the community setting, the most frequently reported pediatric medication errors involved vaccines (n=389, 25.7%). Psycholeptics (aOR=2.42; 95%CI 1.36:4.31) were more likely to be associated with reported medication errors with serious ADR in pediatrics. Wrong technique error type (aOR=2.71; 95%CI 1.47:5.00) related more to reported medication errors with ADR in pediatrics.

Conclusions

We identified pediatric-specific medication error patterns in the hospital and community settings. Our findings inform focused error prevention measures, and pave the way for interventional research targeting the needs of this population.

Patient satisfaction with medication therapy adherence clinic services in a district hospital: a cross-sectional study

Background:

Patient satisfaction is one of the essential indicators for assessing the quality of healthcare services being delivered, including pharmacy ambulatory care service, as it determines the practicability and sustainability of the service provided. As such, pharmaceutical care services provided during medication therapy adherence clinic (MTAC) sessions need to be assessed to maximise its effectiveness and benefits to the patients.

Objective:

This study aimed to assess the association between patient satisfaction and socio-demographic characteristics, as well as the predictors for patient satisfaction.

Methods:

This was a cross-sectional study conducted at the medical outpatient department in Hospital Port Dickson from January until October 2019. Convenience sampling method was used to recruit potential study participants. Patient satisfaction was measured using Validated Patient Satisfaction with Pharmacist Services Questionnaire (PSPSQ2.0), consisted of quality of care and interpersonal relationship between pharmacist and patient domains. Descriptive data were presented as mean and standard deviation or numbers and percentages, while Independent Sample t-test, ANOVA and post-hoc analysis, and multiple linear regression were used for inferential data analysis.

Results:

There were 37 (25%) diabetes MTAC, 36 (24.3%) respiratory MTAC, and 75 (50.7%) warfarin MTAC patients recruited. On average, the mean overall satisfaction score was 3.30(SD=0.43). The mean satisfaction score in the interpersonal relationship domain [3.35(SD=0.44)] was higher than the quality of care domain [3.26(SD=0.45)]. There was a significant association between gender, education level, and patient satisfaction towards pharmaceutical care service (p<0.05). Gender and education level statistically predicted respondents’ satisfaction with MTAC services (p<0.001).

Conclusions:

The overall patient satisfaction towards MTAC services in this setting was high. Gender and education level were significant predictors for patient satisfaction. These findings could potentially contribute to the planning of MTAC services in the future.

Pharmacists' and pharmacy technicians' scopes of practice in the management of minor ailments at community pharmacies in Indonesia: a cross-sectional study

Background:

Managing minor ailments in community pharmacy is an evolving pharmacy service in developing countries. Defined scopes of practice for pharmacy staff are essential for the safe management of minor ailments. Limited research exists regarding the perceptions of Indonesian pharmacists’ and pharmacy technicians’ scopes of practice in providing minor ailments management services.

Objective:

To evaluate pharmacists’ and pharmacy technicians’ understanding of their scopes of practice, perceived competency and factors influencing the delivery of minor ailments services in Indonesian community pharmacies.

Methods:

Cross-sectional surveys were conducted during January-February 2020 of pharmacists and pharmacy technicians attending seminars conducted by relevant Indonesian Associations in Central Java, Indonesia. Percentage of common responses (PCR) described similarity of perceived scopes of practice for pharmacists and pharmacy technicians. Univariate and multivariate analyses identified associations of scopes of practice with pharmacy characteristics.

Results:

A total of 185 pharmacists and 142 pharmacy technicians participated. Pharmacy technicians performed minor ailment consultations, however, if considered beyond their scope of practice, they referred the patient to the pharmacist (T=120/142, 84.5%). Vaginal thrush, bacterial conjunctivitis, gastro-oesophageal reflux disease, and acute pain were minor ailments perceived only within a pharmacist’s scope (PCR above 60%). Of 34 minor ailments, 11 showed PCR values between 40-60% overlapping pharmacists and pharmacy technicians perceived scopes of practice (allergy/rash, back pain, cold sores, dermatitis, diarrhoea, eczema, hayfever, haemorrhoids, rheumatism, sore throat, and superficial wounds). Back pain, cold sores, dermatitis, and sore throat associated pharmacists’ scope of practice with years of practice experience (p-value<0.05). Pharmacy technicians perceived their scopes of practice to be wider than perceived by pharmacists.

Conclusions:

Discordance between pharmacists’ and pharmacy technicians’ perceived scopes of minor ailments management highlights the need for clearly defined scopes of practice for each professional group. Each professional group must practise within their competence to ensure safe pharmacy practices.

The competency of Indonesian pharmacy students in handling a self-medication request for a cough: a simulated patient study

Background

Cough is a common symptom for which people frequently present to community pharmacies. Previous articles from developing countries have shown that the provision of self-medication consultation for cough in community pharmacies were suboptimal, with knowledge deficiency being a contributing factor. However, little is known regarding the ability of pharmacy students in handling self-medication consultations in developing countries.

Objectives

To measure the competency of Indonesian pharmacy students in providing self-medication consultations for patients with chronic cough and to identify factors associated with the provision of appropriate advice.

Method

This study is a cross-sectional study. A simulated patient method using a product and a symptom-based request of chronic cough was used in students from a pharmacy school in Indonesia. The nature and amount of information gathered and advice provided by pharmacy students were noted and audio-recorded. A logistic regression analysis was performed to identify factors associated with the provision of appropriate advice.

Results

The information gathered by participating students was not comprehensive. The most common types of information gathered were related to the nature and duration of the cough. Information relating to accompanying symptoms, medications, and allergies was gathered in less than 60% of the participating students for both product and symptom based scenarios. The appropriate advice of direct medical referral was provided in 54% and 56% of the 183 participating students for the product and symptom-based request scenarios respectively. Asking about symptom duration and prior medical conditions were positively associated with the provision of appropriate advice in the symptom and product based requests respectively.

Conclusion

Student competency in self-medication consultation for chronic cough needs to be improved. Appropriate information-gathering is a predictor of appropriate advice. Further qualitative research identifying factors affecting students' competence in providing self-medication consultation is required, so that suitable interventions are developed and implemented.

Determinants of COVID-19 vaccine acceptance in a high infection-rate country: a cross-sectional study in Russia

Background:

COVID-19 vaccine development is proceeding at an unprecedented pace. Once COVID-19 vaccines become widely available, it will be necessary to maximize public vaccine acceptance and coverage.

Objective:

This research aimed to analyze the predictors of COVID-19 vaccine acceptance in Russia.

Methods:

A cross-sectional online survey was conducted among Russian adults from September 26^th to November 9^th, 2020. Predictors of the intent to take up COVID-19 vaccination were explored using logistic regression.

Results:

Out of 876 participants, 365 (41.7%) would be willing to receive the vaccine if it became available. Acceptance increased for a vaccine with verified safety and effectiveness (63.2%). Intention to receive the COVID-19 vaccine was relatively higher among males (aOR=2.37, 95% CI 1.41-4.00), people with lower monthly income (aOR=2.94, 95%CI 1.32-6.57), and with positive trust in the healthcare system (aOR=2.73, 95% CI 1.76-4.24). The Russian people were more likely to accept the COVID-19 vaccine if they believed that the vaccine reduces the risk of virus infection (aOR=8.80, 95%CI 5.21-14.87) or relieves the complications of the disease (aOR=10.46, 95%CI 6.09-17.96). Other barriers such as being unconcerned about side-effects (aOR=1.65, 95%CI 1.03-2.65) and the effectiveness and safety of the vaccination (aOR=2.55, 95%CI 1.60-4.08), also affected acceptance.

Conclusions:

The study showed the usefulness of the health belief model constructs in understanding the COVID-19 vaccination acceptance rate in the Russian population. This rate was influenced by sociodemographic and health-related characteristics, and health beliefs. These findings might help guide future efforts for policymakers and stakeholders to improve vaccination rates by enhancing trust in the healthcare system.

Self-medication consultations in community pharmacy: an exploratory study on teams' performance, client-reported outcomes and satisfaction

Background:

Community pharmacy teams (CPTs) have an established role in assisting self-medication, contributing to the safe and effective use of non-prescription medicines.

Objective:

The study aimed to describe CPTs’ performance in self-medication consultation, client-reported outcomes, and satisfaction. A secondary purpose was to develop an explanatory model for better understanding clients’ satisfaction with this service.

Methods:

Descriptive, cross-sectional exploratory study. Data were collected in a purposive sample of pharmacy clients recruited in six community pharmacies in Portugal. CPTs adopted a structured approach to self-medication consultations, encompassing 11 quality criteria (five for case evaluation and six for counselling). An evaluation score, a counselling score and an overall quality score were estimated. Client-reported outcomes and satisfaction were ascertained via a follow-up telephone interview. Besides descriptive statistics, the association with several independent variables on the clients’ overall satisfaction was explored, using linear regression.

Results:

Product-based dispensing was more frequent for lower educated clients. Reported compliance with the criteria by CPTs was overall high (93.95% of maximum compliance), mostly missing the ‘other medication’ questioning. Most clients (93%) reported improvement after the consultation. Clients’ satisfaction score was 4.70 out of 5. The variables that seem to better explain clients’ overall satisfaction are pharmacy loyalty, the evaluation score, and the female gender.

Conclusions:

Clients’ reported outcomes were favourable, as well as satisfaction with the service. Clients’ satisfaction appears to be determined by consultation quality (evaluation score), suggesting the advancement of the pharmacists’ clinical role. A larger study is warranted to confirm these findings.

Polypharmacy among older Brazilians: prevalence, factors associated, and sociodemographic disparities (ELSI-Brazil)

Background:

Polypharmacy has become an increasingly public health issue as population age and novel drugs are developed. Yet, evidence on low- and middle-income countries (LMIC) is still scarce.

Objective:

This work aims to estimate the prevalence of polypharmacy among Brazilians aged 50 and over, and investigate associated factors.

Methods:

A cross-sectional study was conducted using data from the baseline assessment of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a nationally representative study of persons aged 50 years and older (n=9,412). Univariate and bivariate analyses described the sample. Robust Poisson regression was used to estimate prevalence ratios and predict probabilities of polypharmacy.

Results:

Prevalence of polypharmacy was estimated at 13.5% among older adults in Brazil. Important disparities were observed in regard to gender (16.1% among women and 10.5% among men), race (16.0% among whites and 10.1% among blacks) and geographic region (ranging from 5.1% in the North to 18.7% in the South). The multivariate analysis showed that polypharmacy is associated with various sociodemographic/individual factors (age, gender, race, education, region, health status, body mass index) as well as with several variables of healthcare access/utilization (number of visits, same physician, provider’s knowledge of patient’s medications, gate-keeper, and difficulty managing own medication). Overall, the more utilization of health services, the higher the probability of polypharmacy, after adjusting for all other model covariates.

Conclusions:

Polypharmacy prevalence is relatively low in Brazil, compared to European countries. After controlling for variables of healthcare need and demographic characteristics, there is still substantial residual variance in polypharmacy prevalence. Policies to identify inappropriate prescribing and reduce regional discrepancies are necessary.

Dispensing errors in Lebanese community pharmacies: incidence, types, underlying causes, and associated factors

OBJECTIVES

To assess the incidence, types, the causes of as well as the factors associated with dispensing errors in community pharmacies in Lebanon.

METHODS

An observational cross-sectional study was conducted in 286 pharmacies located all over Lebanon. Data were collected by senior pharmacy students during their experiential learning placement. Collected data included information on the types of dispensing errors, the underlying causes of errors, handling approaches, and used strategies for dispensing error prevention. Data were analyzed using multiple logistic regression to determine factors that were associated with dispensing errors.

RESULTS

In the twelve thousand eight hundred sixty dispensed medications, there were 376 dispensing errors, yielding an error rate of 2.92%. Of these errors, 67.1% (252) corresponded to dispensing near-miss errors. The most common types of dispensing errors were giving incomplete/incorrect use instructions (40.9% (154)), followed by the omission of warning(s) (23.6% (89)). Work overloads/time pressures, illegible handwriting, distractions/interruptions, and similar drug naming/packaging were reported as the underlying causes in 55% (206), 23.13% (87), 15.15 % (57), and 7% (26) of the errors respectively. Besides, high prescription turnover volume, having one pharmacist working at a time, and extended working hours, were found to be independent factors that were significantly associated with dispensing errors occurrence (p<0.05).

CONCLUSIONS

This study sheds light on the need to establish national strategies for preventing dispensing errors in community pharmacies to maintain drug therapy safety, considering identified underlying causes and associated factors.

Frailty Significantly Associated with a Risk for Mid-term Outcomes in Elderly Chronic Coronary Syndrome Patients: a Prospective Study

INTRODUCTION

Frailty is a condition of elderly characterized by increased vulnerability to stressful events. Frail patients are more likely to have adverse events. The purposes of this study were to define frailty in patients aged ≥ 70 years with chronic coronary syndrome (CCS) and to evaluate mortality and prognostic significance of frailty in these patients.

METHODS

We included 99 patients, ≥ 70 years old (mean age 74±5.3 years), with diagnosis of CCS. They were followed-up for up to 12 months. The frailty score was evaluated according to the Canadian Study of Health and Aging (CSHA). All patients were divided as frail or non-frail. The groups were compared for their characteristics and clinical outcomes.

RESULTS

Fifty patients were classified as frail, and 49 patients as non-frail. The 12-month Major Adverse Cardiac Events (MACE) rate was 69.4% in frail patients and 20% in non-frail patients. Frailty increases the risk for MACE as much as 3.48 times. Two patients died in the non-frail group and 11 patients died in the frail group. Frailty increases the risk for death as much as 6.05 times. When we compared the aforementioned risk factors by multivariate analysis, higher CSHA frailty score was associated with increased MACE and death (relative risk [RR] = 22.94, 95% confidence interval [CI] 3.33-158.19, P=0.001, for MACE; RR = 7.41, 95% CI 1.44-38.03, P=0.016, for death).

CONCLUSION

Being a frail elderly CCS patient is associated with worse outcomes. Therefore, frailty score should be evaluated for elderly CCS patients as a prognostic marker.

Prevalence of Behavioral Health Problems Among Adults With and Without Communication Disabilities

BACKGROUND

Adults with communication disabilities (CDs) experience poor health and health care outcomes. Few studies have examined behavioral health outcomes among this population. We compare the behavioral health of adults with CDs to their peers without such disabilities.

METHODS

Retrospective cohort study examining the 2012 National Health Interview Survey Voice, Speech, and Language Supplement. We compared adults (> 17 years old) with voice only (n = 2169), speech/language (SL) only (n = 730), and speech/language and voice (SLV; n = 450) disabilities to adults without CDs (n = 29,873). Outcomes include behavioral health diagnoses (eg, depression), substance misuse (eg, excessive alcohol or tobacco use), experiences (eg, nonspecific psychological distress), and health care utilization. Unadjusted Pearson's χ² and adjusted logistic regression analyses controlling for sociodemographic, health, and other disability measures were conducted.

RESULTS

Adults with CDs more frequently reported diagnoses (7.1% to 35.9% vs 1.8% to 8.6%), substance misuse (SL only: 15.5% vs 5.5%), and nonspecific psychological distress (SL only: 14.7%; SLV: 22.3% vs 2.3%) compared with adults without CDs (all P < .001). These findings were consistent for all outcomes and in multivariate analyses. Odds ratios ranged from 1.4 (99.7% CI, 1.1-1.7) to 5.0 (99.7% CI, 3.6-6.8). Adults with CDs more frequently endorsed visiting mental health professionals compared with adults without CDs (voice only: 11.4%; SL only: 19.1%; SLV: 23.1%; vs 6.8%, all P < .001), but these differences became nonsignificant in multivariate analyses.

CONCLUSIONS

Adults with CDs experience poorer behavioral health and health care outcomes compared with persons without CDs. Barriers to identification and treatment related to CDs must be addressed for persons with CDs.

Conchology Variations in Species Identification of Pachychilidae (Mollusca, Gastropoda, Cerithiodea) through Multivariate Analysis

Pachychilidae is one of the freshwater gastropod family which was previously known under the Potamididae and Thiaridae families. Studies on freshwater gastropods especially on conchcology examinantions are still inadequate compared to marine gastropods. Morphological and morphometric studies of gastropods are practically used to identify and differentiate between species and necessary to complement molecular studies due to its low cost and tolerable resolving power of discrimination. The aim of the current study is to provide information on morphological and morphometric characteristics of Pachychilidae in Bintulu, Sarawak stream. A total of 20 individuals from each species of Sulcospira testudinaria, Sulcospira schmidti, Brotia siamensis, and Tylomelania sp. from Pachychilidae familiy were collected at three different sites from a small stream within the Bintulu area. Fourteen measurement of shell morphometrics were converted into proportioned ratios and analysed for univariate and multivariate analysis. Three shell morphometric (Aperture width, AW; Whorl width, WW2; and, Interior anterior length, AINL) of Pachychilidae indicated significant differences (P < 0.05) between species. However, multivariate analysis revealed that these shell morphometrics are pre-eminent factors to discriminate genus Sulcospira, Brotia and Tylomelania, as well as between Sulcospira species. This current study also suggests that these three characteristics are unique to Sulcospira species due to strong distinction among species. Findings on these three characteristics are significant for Sulcospira spp. as this study is the first shell morphometric report on the Pachychilidae species in Sarawak.

Prevalence of potentially inappropriate prescriptions in primary care and correlates with mild cognitive impairment

Background:

Potentially inappropriate prescribing is clearly associated with adverse health consequences among older people. Nevertheless, scarce evidence exists regarding the prevalence of potentially inappropriate prescriptions (PIP) in Albania, a Western Balkans country.

Objective:

The aim of this study was to assess the prevalence of PIP among older Albanian patients in primary care and to determine the associated sociodemographic and medical factors, including the presence of mild cognitive impairment (MCI).

Methods:

Cross-sectional study in two primary healthcare centers located in two different cities of Albania, a middle-income country in the Western Balkans. The Montreal Cognitive Assessment (MoCA) tool was applied to evaluate MCI. PIPs were assessed by two trained pharmacists using the Beers criteria 2019 update. Multivariate logistic regression analysis was conducted for possible risk factors predicting PIP in the study population.

Results:

At least one PIP was identified among 40.23 % of the participants (174 older patients) and 10.35 % had more than one PIP. MCI was detected among 79.31 % of the patients. The most commonly represented drug groups in PIP were diuretics (24.71 %), benzodiazepines in the presence of MCI and antidepressants (both 8.62 %). The lack of electrolytes monitoring was the most common reason for PIP. According to the multivariate analysis, the only statistically significant association observed was between PIP and number of drugs prescribed [three to four drugs (OR 3.34; 95% CI 1.65:6.76), five or more than five drugs (OR 4.08; 95% CI 1.42:11.69)].

Conclusions:

About four out of 10 older Albanian patients experience PIP in primary care. Further studies are needed for a comprehensive estimation of the prevalence and factors associated with PIP, particularly among elderly with mild cognitive impairment.

Primary Care Physician Characteristics Associated with Prescribing Potentially Inappropriate Medication for Elderly Patients: Medicare Part D Data

BACKGROUND

Despite the high risk of adverse drug events associated with potentially inappropriate medications (PIMs), primary care physicians (PCPs) continue to prescribe them for the elderly. The objective of this study was to explore PIM prescribing behavior in relation to characteristics among PCPs practicing in the United States.

METHODS

We conducted a retrospective cohort study of PCPs in the 2013 to 2015 Medicare Part D Public Use File. We obtained physician characteristics from the 2015 American Medical Association (AMA) Masterfile. For each PCP, we calculated the ratio of primary care-relevant PIM claims to all drug claims (PIM rate) based on Beers Criteria. We used a multivariate regression model to assess the associations between physician characteristics and PIM rate.

RESULTS

The study sample contained 111,461 PCPs who specialized in family medicine, internal medicine, general practice and geriatric medicine. Although the mean PIM rate was low at 4.9%, it varied widely across PCPs with the bottom quartile at 1.2% and the top quartile at 10.1%. PCPs in the top quartile were on average older, more likely to be male, have a DO degree, practice in the South, and have a smaller Medicare patient panel. A multivariate analysis confirmed that even after adjusting for patient panel characteristics, physician characteristics including gender, age, professional degree, specialty, practice location, practice size, and patient panel size were associated with PIM rate.

CONCLUSION

Identifying PCPs with higher PIM rates can guide future interventions to increase safe prescribing for elderly populations.

Factors Influencing User Satisfaction with Information Systems: A Systematic Review

User satisfaction has been considered as the measure of information system effectiveness success. User satisfaction is difficult to define but is considered an evaluation construct. Globally health organizations, particularly hospitals, invest a huge amount of money on information system projects. If hospital information systems (HISs) are to be successful, factors influencing or related to user satisfaction should be taken into account at the time of designing, developing or adopting such systems. The current study aimed to provide a comprehensive review of factors related to user satisfaction with information systems. The researchers systematically searched PubMed, Science Direct, and IEEE electronic databases for articles published from January 1990 to June 2016. A search strategy was developed using a combination of the following keywords: "model," "user satisfaction," "information system," "measurement," "instrument," and " tool." Reported dimensions, factors, and their possible influence on user satisfaction with information systems were extracted from the studies wherever was possible. Overall factors influencing user satisfaction with information systems can be categorized in seven dimensions: Information quality, system quality, vendor support quality, system use, perceived usefulness, user characteristics, and organizational structure & management style. If all these factors are considered properly in the process of developing, designing, implementing, or purchasing information systems, the higher user satisfaction with the system will be likely. Otherwise, it would end up with unsatisfied users that will finally contribute to the system failure.

Work fatigue among Lebanese community pharmacists: prevalence and correlates

Objective:

To assess work fatigue and its associated factors among community pharmacists in Lebanon.

Methods:

This cross-sectional study was conducted between March and July 2018. A proportionate sample of 435 community pharmacists was selected from all regions of Lebanon. A standardized self-administered questionnaire, distributed by trained interviewers, was used to assess the studied variables.

Results:

The results showed that 50.12% of the pharmacists had emotional work fatigue [95%CI 0.454-0.549], 55.01% had mental work fatigue [95%CI 0.503-0.597], and 54.78% had physical work fatigue [95%CI 0.501-0.595]. Higher mental work fatigue was significantly associated with higher stress (Beta=0.185) and having a master’s degree compared to a bachelor’s degree (Beta=2.23). Higher emotional work fatigue was significantly associated with higher stress (Beta=0.219), working more than 40 hours compared to ≤ 16 hours (Beta=2.742), and having 6 months to less than 1 year of practice compared to less than 6 months (Beta=-5.238). Higher physical work fatigue was significantly associated with higher stress (Beta=0.169) and having better soft skills (Beta=-0.163).

Conclusions:

Work-related fatigue is high among community pharmacists and touches all aspects: physical, mental, and emotional. In our study, community pharmacists’ fatigue levels were associated with educational level, years of experience, working hours, stress, depression, and soft skills, while no relation was found with gender, age, position in the pharmacy, and economic status. Interventions are recommended to tackle this public health problem that affects pharmacists, and eventually, patients.

Genetic parameters for worm resistance in Santa Inês sheep using the Bayesian animal model

Objective

The objective of this study was to estimate the genetic parameters for worm resistance (WR) and associated characteristics, using the linear-threshold animal model via Bayesian inference in single- and multiple-trait analyses.

Methods

Data were collected from a herd of Santa Inês breed sheep. All information was collected with animals submitted to natural contamination conditions. All data (number of eggs per gram of feces [FEC], Famacha score [FS], body condition score [BCS], and hematocrit [HCT]) were collected on the same day. The animals were weighed individually on the day after collection (after 12-h fasting). The WR trait was defined by the multivariate cluster analysis, using the FEC, HCT, BCS, and FS of material collected from naturally infected sheep of the Santa Inês breed. The variance components and genetic parameters for the WR, FEC, HCT, BCS, and FS traits were estimated using the Bayesian inference under the linear and threshold animal model.

Results

A low magnitude was obtained for repeatability of worm-related traits. The mean values estimated for heritability were of low-to-high (0.05 to 0.88) magnitude. The FEC, HCT, BCS, FS, and body weight traits showed higher heritability (although low magnitude) in the multiple-trait model due to increased information about traits. All WR characters showed a significant genetic correlation, and heritability estimates ranged from low (0.44; single-trait model) to high (0.88; multiple-trait model).

Conclusion

Therefore, we suggest that FS be included as a criterion of ovine genetic selection for endoparasite resistance using the trait defined by multivariate cluster analysis, as it will provide greater genetic gains when compared to any single trait. In addition, its measurement is easy and inexpensive, exhibiting greater heritability and repeatability and a high genetic correlation with the trait of resistance to worms.

Factors Associated with Post-Endodontic Treatment Pain Performed by Students in an Endodontic Graduate Program

Introduction

The aim of this study was to evaluate the possible associations between pre-established clinical variables and manifestation of postoperative pain after endodontic treatments performed by graduate students in endodontics, from June 2016 to December 2017.

Methods and Materials

A total of 998 dental patient charts were included in the study. All the patients underwent the same clinical protocol. Possible associations between postoperative pain and clinical variables were investigated, including age, gender, type of tooth, type of treatment, pulpal diagnosis, periradicular diagnosis, instrumentation system used, number of sessions, previous symptom, procedural accident, and endodontic sealer extrusion. Patients were contacted by telephone 24 h and 7 days after treatment completion and were asked about the degree of postoperative pain they had experienced, using a four-level scoring system: 0, no pain; 1, mild pain (no medication was needed); 2, moderate pain (an analgesic or anti-inflammatory was needed); 3, severe pain. Fischer's exact test, Pearson's test, and logistic regression were used for the statistical analysis of the data. A significance level of 0.05 was used.

Results

A total of 8.6% of the patients reported having experienced postoperative pain, 50% of which reported mild pain, 47.7%, moderate pain, and 2.3%, severe pain. The only variable significantly associated with postoperative endodontic pain was pre-endodontic treatment symptoms (Pearson's test, P=0.0047). The logistic regression analysis indicated that the association between use of the Reciproc system and sealer extrusion posed a significant risk for postoperative endodontic pain.

Conclusion

Based on this retrospective cohort study, the incidence of moderate and severe pain after endodontic treatment was low, and the only variable associated with a higher frequency of patients reporting postoperative endodontic pain was previous pain/symptoms. Therefore, in these cases, pain management methods such as the use of analgesics before treatment or immediately after treatment should be considered.

A Kernel for Multi-Parameter Persistent Homology

Topological data analysis and its main method, persistent homology, provide a toolkit for computing topological information of high-dimensional and noisy data sets. Kernels for one-parameter persistent homology have been established to connect persistent homology with machine learning techniques with applicability on shape analysis, recognition and classification. We contribute a kernel construction for multi-parameter persistence by integrating a one-parameter kernel weighted along straight lines. We prove that our kernel is stable and efficiently computable, which establishes a theoretical connection between topological data analysis and machine learning for multivariate data analysis.

Factors associated with quality of life among community pharmacists in Lebanon: results of a cross-sectional study

Objective:

The objective of this study was to assess the quality of life and the factors associated with it among community pharmacists in Lebanon.

Methods:

This cross-sectional study was carried out between March and July 2018, enrolling 435 pharmacists, using a proportionate random sample of community pharmacies from all districts of Lebanon. The validated Arabic translation of the Short-Form 12 (SF12v2) was used to derive 2 summary scores: physical and mental component summaries (PCS and MCS).

Results:

Lebanese community pharmacists scored a mean PCS-12 and MCS-12 of 48.9 (SD 7.1) and 48.8 (SD 8.5), respectively. Higher age (Beta= -0.08), having a PhD degree (Beta= -4.54), higher depression score (Beta= -0.25), higher emotional work fatigue (Beta= -0.13) and higher physical work fatigue (Beta=-0.14) were significantly associated with lower physical QoL (lower PCS-12 scores). Increased stress (Beta= -0.17), higher insomnia (Beta= -0.21), higher depression (Beta= -0.2) and working for over 40 hours per week (Beta= -0.2) were significantly associated with lower mental QoL (lower mental MCS-12 scores).

Conclusions:

Our research has found a strong correlation between quality of life and psychological factors, including stress, burnout, insomnia, and depression among community pharmacists.

Potentially inappropriate medications among the elderly in primary care in Thailand from three different sets of criteria

Objective:

The primary objective was to examine potentially inappropriate medications (or PIMs) in the elderly using three different criteria: Beers 2015, STOPP version 2, and Winit-Watjana (for Thai elderly patients). The secondary objective was to examine PIM-related factors.

Methods:

This is a retrospective cross-sectional study. Eligible patients were aged ≥65 years in a primary care unit. Demographic data, medical prescriptions in the past year, clinical data and diagnoses were collected from electronic medical records. PIMs, including the use of ≥2 medications, were identified using the three criteria. Descriptive and analytical statistics were conducted. The type I error was 0.05. Multiple logistic regression analysis was used to examine associations between PIMs and other factors.

Results:

A total of 400 patients were recruited, and 1,640 prescriptions were reviewed. The median age was 70.5 years, and the median numbers of diseases, medications, and prescriptions were 3 (interquartile range or IQR=2), 11 (IQR=20), and 3 (IQR=4), respectively. Of all the patients, 213 (53.3%) showed a use of ≥5 medications, and 301 (75.3%) were prescribed PIMs. Of the 1,640 prescriptions, 60% had at least one PIM. The Winit-Watjana criteria, Beers 2015 criteria and STOPP version 2 identified 66.8%, 59.0% and 40.3% of the patients receiving PIMs, respectively. Approximately 16% of the patients showed at least one potential drug-drug interaction. The use of duplicate drug classes accounted for the highest proportion of potential drug-drug interactions (41.3%). Polypharmacy (odds ratio or OR 3.93, 95% confidence interval or 95%CI 2.17-71.2) and the presence of ≥4 diseases (OR 2.78, 95%CI 1.39-5.56) were associated with PIMs.

Conclusions:

PIMs are common among the elderly patients in primary care in Thailand. Prescriptions of the elderly with polypharmacy or multiple concurrent diagnoses should be reviewed for PIMs because they have a high chance of receiving PIMs.

Adults with Housing Insecurity Have Worse Access to Primary and Preventive Care

OBJECTIVE

Housing insecurity has been linked to high-risk behaviors and chronic disease, although less is known about the pathways leading to poor health. We sought to determine whether housing insecurity is associated with access to preventive and primary care.

METHODS

We conducted weighted univariate, bivariate, and multivariate analyses by using 2011 to 2015 Behavioral Risk factor Surveillance Survey data (N = 228,131 adults). The independent variable was housing insecurity derived from the question on worry about paying rent or mortgage. The outcome measures were health services utilization (no usual source of care, no routine checkup in the past 1 year, and delayed medical care due to cost), self-rated health (number of days reported physical, mental health not good, and poor overall health), and number of chronic diseases (0, 1, 2 or more). The covariates included age, sex, race/ethnicity, income, level of education, marital status, and number of children in the family. We also adjusted for state fixed effects and survey year. We performed χ² tests and binary logistic regressions on categorical variables and ran t tests and estimated linear regression models on continuous variables. Multinomial logistic regressions were estimated for the number of chronic diseases.

RESULTS

Of the 228,131 adults in the study sample, 28,704 adults reported housing insecurity. We found that those with housing insecurity were more likely to forgo routine check-ups and lack usual sources of care. Low-income individuals, minorities, the unmarried, and middle-aged adults were more likely to report housing insecurity.

CONCLUSION

Housing insecurity is associated with worse access to preventive and primary care. Interventions to enhance access for these patients should be developed and studied.

Attitudes of Lebanese pharmacists towards online and live continuing education sessions

Background:

Continuing education (CE) is an internationally recommended approach as a lifelong learning model for pharmacists, enabling them to maintain the necessary knowledge, skills and ethical attitudes so as to remain current and competent in their practice.

Objectives:

The objective of this study is to 1) describe factors associated with taking different types of CE courses among pharmacists in Lebanon, and 2) assess the correlation between types of CE activity and the attitude of Lebanese pharmacists (motivation and value) and their computer literacy.

Methods:

This is a cross-sectional observational study conducted between February and May 2017, using a random sample of Lebanese pharmacists from all districts of Lebanon. All pharmacists were eligible to participate; the sample consisted of those who agreed to complete the questionnaire. The questionnaire includes questions about computer literacy, motivation and value about CE, in addition to sociodemographic characteristics of pharmacists.

Results:

Out of the 750 questionnaires distributed, 628 (83.73%) were filled out and returned to be analyzed. The mean age of the participants was 39.04 (SD 10.57) years, 66.9% of them were females, and 41.1% of them had a bachelor degree in pharmacy and worked in Mount Lebanon. Among the 628 respondents, 567 (90.3%) have earned at least one CE credit. Of those, 5.4% took mainly online courses, 15.4% took mainly live courses and the remaining took both types of CE. Higher motivation (aOR=1.05; CI 0.994-1.109) and higher value (aOR=1.076; CI 0.968-1.197) were associated with higher odds of taking live CE courses. Higher motivation (aOR=1.07; 95%CI 0.994-1.152) was associated with higher odds of taking online CE courses. Higher motivation (aOR=1.059; 95%CI 1.006-1.114) and higher general confidence with computer use (aOR=1.058; 95%CI 1.012-1.106) were significantly associated with higher odds of taking both types of CE courses.

Conclusions:

A high percentage of Lebanese pharmacists enrolled in the CE system, mainly driven by motivation and value of CE, in addition to a higher general confidence in computer use. Further efforts should be exerted by the Lebanese Order of Pharmacists to motivate pharmacists and help them improve their computer literacy, which is expected to improve not only enrollment in CE activities, but also the completion of their CE requirements.

Anaemia in heart failure patients: the prevalence of haematinic deficiencies and the role of ACE inhibitors and aspirin doses as risk factors

Background:

Patients with heart failure often have comorbidities that alter the progression of heart failure and impact on prognosis. One such comorbidity is anaemia, and clinicians have started to appreciate the full gravity of its impact on heart failure patients. Yet, the extent of the problem is not fully understood, particularly the role of heart failure therapy itself as a risk factor for developing anaemia.

Objective:

This study aimed to investigate the prevalence of anaemia in a cohort of heart failure patients. The impact of using different ACEIs and different doses of aspirin was also explored, together with the prevalence of haematinic deficiencies.

Methods:

Medication lists and pathology results were examined to establish the prevalence of ACEIs use, and the use of aspirin at its most common doses of 100mg and 150mg, together with haematinic deficiencies. Multinomial logistic regression and the Student’s t-test were utilised for the analysis of data. Statistical significance was pre-set at p<0.05.

Results:

Ninety-six patients were eligible for analysis, with 26% having anaemia. The use of ACEIs had a RR of 17.4 for the presence of anaemia. Perindopril was associated with a RR of 20.8, while the use of ramipril was not significantly associated with such a high RR. Haematinic anaemia occurred only at a rate of 3.3%, but borderline deficiencies were found in more than a third of all patients. An aspirin dose of 150mg was associated with a higher risk for anaemia, compared to a dose of 100mg.

Conclusions:

ACEIs are associated with the presence of anaemia, with perindopril posing more risk than ramipril when used in heart failure patients. The dose of aspirin may also be a factor in the development of anaemia, with lower doses being safer. Despite the lack of high prevalence of haematinic anaemia among this cohort of patients, borderline haematinic deficiencies were common.

Evaluation of medication adherence among Lebanese diabetic patients

Background:

Diabetes type 2 is considered one of the main public health concerns. Lack of adherence to treatment leads to poor therapeutic outcome, poor glycemic control, and high risk for developing diabetes complications.

Objectives:

The aim of this study is to evaluate adherence to oral antidiabetic medication in Diabetes type 2 Lebanese patients, and to evaluate factors leading to low adherence.

Methods:

A cross-sectional study was conducted in outpatients endocrinology clinics of two hospitals and four private clinics located in Beirut-Lebanon. Data was collected using a well-structured questionnaire by trained pharmacists. Adherence level was measured by the Lebanese Medication Adherence Scale (LMAS-14). Bivariate and multivariate analyses were conducted using SPSS version 20.

Results:

Overall, 245 patients were included in the study with the majority being females (54.3%) and obese (47.8%). Only 29% of the participants had controlled glycemia (HbA1c <7%) with 31.8% of subjects had high adherence to their medication compared to 68.2% with low adherence. Increased working hours/day was associated with a decrease in adherence to oral antidiabetic medication (OR=0.31; 95% CI 0.11:0.88; p=0.029). Other factors significantly associated with decreased adherence to treatment were forgetfulness, high drug costs, complex treatment regimens, experiencing side effects, and perception of treatment inefficacy. Postponing physician office visits also decreased the probability of being adherent to oral antidiabetic medication (OR=0.36; 95% CI 0.15:0.86; p=0.022). Skipping or doubling the dose in case of hypo/hyperglycemia and the sensation of treatment burden also decreased medication adherence (OR=0.09; 95% CI 0.02:0.34; p=0.001, and OR=0.04; 95% CI 0.01:0.13; p<0.001 respectively).

Conclusions:

Adherence to oral antidiabetic medication is low for Lebanese patients, which leads to a poor glycemic control and increases the diabetes complications. Intervention programs including patient education strategies are essential to improve medication adherence.

Influence of self-efficacy management on adherence to self-care activities and treatment outcome among diabetes mellitus type 2

Background:

High level of self-efficacy and adherence to self-care activities have a positive impact on the achievement of glycemic goal among diabetic patients. In Sudan, there is a gap in knowledge related to self-efficacy management and its influence on adherence to self-care activities and overall disease control.

Objective:

To identify the influence of management self-efficacy on adherence to self-care activities and treatment outcome among Sudanese patients with type 2 diabetes mellitus.

Methods:

A cross-sectional study was conducted at two health care facilities in Sudan from April to May 2016. Patients with type 2 diabetes mellitus were included. Convenience sampling method was adopted. Diabetes Management Self-Efficacy Scale and the Revised Summary of Diabetes Self-care Activities were used to collect data through a face-to-face interview. Logistic regression analysis was performed. A p value <0.05 was considered to be significant. Data were processed using the software SPPS v 21.0.

Results:

A total of 392 patients were included. Respondents classified with high level of self- efficacy across all domains were 191 (48.7%). Moreover, high level of education [adjusted OR 0.5 (0.3-0.7), (p=0.001)] and formal health education on diabetes [adjusted OR 2.4 (1.6-3.7), (p<0.001)], were found to be significantly associated with high level of diabetes management self-efficacy. Patients who had high level of self-efficacy to manage nutrition, physical exercise activity and medication were found more adherent to general diet, exercise activity, and medication taking, respectively. Patients with controlled disease were 87(22.2%). The only predictor of diabetes control was diabetes management self-efficacy [OR 2.1(1.3- 3.5), (p=0.002)].

Conclusions:

Diabetes management self-efficacy was associated with high level of education and receiving health education. Self-efficacy was significantly associated with adherence to self-care activities and glycemic control. Substantial efforts are still needed to empower the patients with self-efficacy and improving adherence to self-care activities through appropriate interventions.

Association between Multiple Recurrent Events with Multivariate Modeling: A Retrospective Cohort Study

BACKGROUND

Recurrent event data are often encountered in biomedical research, for example, recurrent infections or recurrent hospitalizations for patients after renal transplant. In many studies, there are more than one type of events of interest. We aimed to identify the association between two types of events using multivariate joint modeling and then apply this statistical method in the clinical data set.

STUDY DESIGN

A retrospective cohort study.

METHODS

Overall, 342 subjects with breast cancer whose records were registered for follow-up in a Cancer Research Center at Shohadaye Tajrish Hospital, Tehran, Iran from 2006 to 2015 were investigated. These patients were monitored for at least 6 months after diagnosis and their latest status were recorded. Joint frailty model was used for modeling the relationship between two types of recurrences with Frailty package in R software.

RESULTS

When the terminal event was considered as death, three-year and five-year survival rates for the patients were 0.79 and 0.68, respectively. Given the results obtained from a fitted joint frailty model, the risk of multiple recurrences (local and metastases) increased for the patients with tumor grades greater than I.

CONCLUSION

With regard to the significant variance of the frailty component of the metastases event, it can be inferred that patients with the same predictive variables are prone to different levels of metastases risk and, on the other hand, given the low frequency of types of recurrences, caution should be exercised when considering the obtained results.

Frequency of occurrence of medication discrepancies and associated risk factors in cases of acute hospital admission

Background

Medication discrepancies are a common occurrence following hospital admission and carry the potential for causing harm. However, little is known about the potential risk factors involved in medication discrepancies.

Objective

The objective of this study was to determine how frequently medication discrepancies occur and their associated risk factors, in patients hospitalized via the emergency department of the Spaarne Gasthuis Hospital, located in The Netherlands.

Methods

This retrospective observational study examines 832 hospital admissions which took place between April 1st and June 30th, 2015. Medication reconciliation was performed within 24 hours of admission and medication discrepancies were registered. The primary outcome recorded in the study was the proportion of patients experiencing one or more medication discrepancies, as verified by the physician. As a secondary outcome, the association between these discrepancies and pre-specified variables was analyzed using univariate and multivariate logistic regression.

Results

At least one medication discrepancy was found to have occurred with 97 of the 832 patients (11.7%), the most common discrepancies involving incorrect drug dose (44.9%) and omission of medication (36.4%). In the univariate analysis, age (OR=1.03 [95% CI 1.02:1.04] p<0.001) and number of pre-admission medications taken (OR=1.13 [95%CI 1.09:1.17] p<0.001) were revealed to be significantly associated with the risk of medication discrepancies. Sex, type of medical specialty, and surgical versus non-surgical specialty were found not to be significantly associated with discrepancies. In the multivariate analysis, both the number of pre-admission medications (OR=1.10 [95%CI 1.06:1.15] p<0.001) and age (OR=1.02 [95%CI 1.01:1.03] p=0.004) were independently associated with the risk of medication discrepancy.

Conclusions

Of the total number of patients, 11.7% experienced one or more medication discrepancies following admission to the hospital. Elderly patients taking multiple drugs were found to be particularly at risk.

Swedish patients' trust in the bioequivalence of interchangeable generics. What factors are important for low trust?

Background:

Generic substitution (GS), is a cost-containment strategy meant to contain pharmaceutical expenditure without compromising health objectives. In order to shape GS into a policy that is both efficient and safe it is crucial to understand which factors are most important for patients’ trust in GS.

Objective:

To assess Swedish patients’ level of trust in the bioequivalence of cheap and expensive generic medicines, and the association between trust and various factors.

Methods:

A cross-sectional study was conducted. Questionnaires were handed out at 12 community pharmacies in Sweden, selected through stratified sampling, between March and April 2015. The questionnaire included seven socio-demographic questions in addition to 18 items divided into three sections: the ‘views on generic medicine’-scale, information on and prior experiences of GS, financial aspects and change of color/name. Odds Ratios (ORs) were estimated applying adjusted logistic regression analyses with trust in the bioequivalence of generic medicines used as outcome variable and various factors as predictors.

Results:

A total of 719 patients participated (response rate 85.7%). The results show that 70.7% of the respondents’ trust that cheap and expensive interchangeable generic medicines are equal. Of the respondents 36.0% considered the change in appearance and 40.8% the change in names to complicate adherence. Lower trust in the bioequivalence of generic medicines were associated with being female (aOR=1.82, 95%CI 1.20:2.75, p<0.01), patients perceiving that changes in product name and appearance make adherence more complicated (aOR=2.18, 95%CI 1.48:3.19, p<0.001), disagreeing in that GS saves money for me (the customer) (aOR=2.68, 95%CI 1.58:4.55, p<0.001) or that GS saves money for society (aOR=3.21, 95%CI 1.46:7.08, p<0.01).

Conclusions:

Seven out of ten respondents had trust in the bioequivalence of generic medicines, and one in three considered GS to complicate adherence. Four factors were associated with lower trust in GS, i.e. female gender, agreeing that changes in product name and appearance complicates adherence, disagreeing in that GS saves money for me or disagreeing in that GS saves money for the society. Low trust in GS needs to be addressed, not least in the communication between health professionals and patients.

Source of medicines and medicine information by self-reported persons living with hypertension and diabetes in rural and urban Ghana

Objectives:

This study was conducted to determine the source of medicines and medicine information of persons living with hypertension and diabetes in rural and urban Ghana and assessing if they are influenced by predisposing and enabling factors as defined by Andersen’s behavioural model.

Methods:

A population based cross sectional study was conducted in four (4) rural and four (4) urban districts in the Ashanti Region of Ghana. A multistage and proportional sampling method was used in enrolling participants aged 18 years and above. A pre-tested structured questionnaire was used to collect primary data from respondents. Data collected was exported to STATA for analysis. Descriptive analysis was performed. Chi-square tests/Fisher’s exact test and multinomial logistic regression models were used to establish association between variables.

Results:

A total of 336 self -reported persons with hypertension and diabetes were enrolled in the study with 199(59.23%) living in urban communities. The majority of participants with hypertension and diabetes living in the rural communities 77 (56.20%) were females contrasting with the male majority in urban communities 106 (53. 27%). In the rural communities, 49 (35.77%) of participants sourced medicines from the health centre while 45 (32.85%) and 35(25.55%) sourced medicines from the hospital and over the counter medicine shop (OTCMS) respectively. In the urban communities, 153 (76.88%) sourced medicines from the hospital while 33 (16.58%) sourced medicines from the pharmacy. The predisposing factor age (OR: 1.1, 95%CI 1.040-1.210) under OTCMS, age (OR 1.0, 95% CI: 1.002-1.066) under hospital and enabling factor socioeconomic status (OR: 0.3, 95%CI 0.085-0.855) under Hospital influenced participant’s source of medicine in the urban communities. The results also revealed that majority of participants in both rural 99 (72.26%), and urban 164 (82.41%) communities sourced medicine information mainly from public healthcare facilities, pre-disposing factors; age (OR 1.1 95%CI 1.032-1.270) under family member, age (OR 1.1, 95%CI 1.022-1.167) under friend health professional, age (OR 1.1, 95%CI 1.050-1.147) under nearest health institution, marital status (OR: 0.004, 95%CI 0.003-0.441) under friend health Professional were found to influence participants’ source of medicine information in the urban communities while in the rural communities the predisposing factor marital status (OR 10.6, 95%CI 1.044 -106.835), education (OR: 26.1, 95%CI 1.271-537.279) under friend health professional, age (OR 1.1, 95%CI 1.002-1.187), educational level (OR 30.6, 95%CI 1.718-546.668) under nearest health institution and enabling factor socio-economic status (OR 6.6, 95%CI 1.016 -43.510) under nearest health institution influenced one’s source of medicine information.

Conclusions:

Majority of inhabitants with hypertension and diabetes in both rural and urban communities, sourced medicines and medicine information from public health institutions though a larger proportion was recorded in the urban communities. More participants in the rural communities than in the urban communities sourced medicines and medicine information from community pharmacies. Participants’ source of medicine and medicine information was influenced by both predisposing and enabling factors.

Disparities in Hypertension Control Across and Within Three Health Systems Participating in a Data-Sharing Collaborative

INTRODUCTION

We aimed to standardize data collection from 3 health systems (HS1, HS2, HS3) participating in the San Francisco Bay Collaborative Research Network, and compare rates and predictors of uncontrolled blood pressure among hypertensive adults to identify opportunities for regional collaboration in quality improvement.

METHODS

Retrospective cohort study using deidentified electronic health record data from all primary care patients with at least 1 visit in a 2-year period, using standard data definitions in a common data repository. Primary outcome was uncontrolled blood pressure at the most recent primary care visit.

RESULTS

Of 169,793 adults aged 18 to 85 years, 53,133 (31.3%) had a diagnosis of hypertension. Of these, 18,751 (35%) had uncontrolled blood pressure at their last visit, with the proportion varying by system (29%, HS1; 31%, HS2; and 44%, HS3) and by clinical site within each system. In multivariate analyses, differences between health systems persisted, with HS2 and HS3 patients having a 1.15 times (95% CI, 1.11 to 1.19) and 1.46 times (95% CI, 1.42 to 1.50) greater relative risk of uncontrolled blood pressure compared with HS1. Across health systems, hypertensive patients were more likely to have uncontrolled blood pressure if they were uninsured, African Americans, current smokers, obese, or had fewer than 2 primary care visits during the 2-year measurement period.

CONCLUSIONS

After controlling for standard individual predictors of hypertension control, significant and substantial differences in hypertension control persisted between health systems, possibly due to local quality improvement programs among other factors. There may be opportunities to share best practices and address common disparities across health systems.

Management of allergic rhinitis in the community pharmacy: identifying the reasons behind medication self-selection

Background:

Community pharmacists have a key role to play in the management of allergic rhinitis (AR). Their role is especially important because the majority of medications used to treat AR are available for purchase over-the-counter (OTC), allowing patients to self-select their own medications and bypass the pharmacists. Patients’ self-selection often results in suboptimal treatment selection, undertreated AR and poor clinical outcomes. In order for pharmacists to optimise the care for AR patients in the pharmacy, pharmacists need to be able to identify patient cohorts who self-select and are at high risk of mismanagement.

Objectives:

This study aimed to compare the demographics, clinical characteristics and medication selected, between pharmacy customers who choose to self-select and those who speak with a pharmacist when purchasing medication for their AR in a community pharmacy and identify factors associated with AR patients’ medication(s) self-selection behaviour.

Methods:

A cross-sectional observational study was conducted in a convenience sample of community pharmacies from the Sydney metropolitan area. Demographics, pattern of AR symptoms, their impact on quality of life (QOL) and medication(s) selected, were collected. Logistic regressions were used to identify factors associated with participants’ medication self-selection behaviour.

Results:

Of the 296 recruited participants, 202 were identified with AR; 67.8% were female, 54.5% were >40 years of age, 64.9% had a doctor’s diagnosis of AR, and 69.3% self-selected medication(s). Participants with AR who self-select were 4 times more likely to experience moderate-severe wheeze (OR 4.047, 95% CI 1.155-14.188) and almost 0.4 times less likely to experience an impact of AR symptoms on their QOL (OR 0.369, 95% CI 0.188-0.727).

Conclusions:

The factors associated with AR patients’ self-selecting medication(s) are the presence of wheeze and the absence of impact on their QOL due to AR symptoms. By identifying this cohort of patients, our study highlights an opportunity for pharmacists to engage these patients and encourage discussion about their AR and asthma management.

Potentially inappropriate medication use among older patients attending a geriatric centre in south-west Nigeria

Objectives

To determine the prevalence and describe factors associated with the use of potentially inappropriate medication (PIM) among older patients.

Methods

Cross sectional study of 400 older patients selected systematically at the geriatric centre, University College Hospital, Ibadan between July and September 2016. With the aid of semi-structured questionnaires, information on the socio-demographic characteristics, lifestyle habits, healthcare utilisation and morbidities was obtained. The Beer's criteria 2015 update was used to identify the PIMs. Predictors of PIMs were determined using multivariate analyses at alpha 0.05.

Results

Age was 70.2 (SD=5.9) years and 240 (60%) were females. General prescription pattern showed antihypertensives (34.7%) as the commonest medications used. The point prevalence of PIMs use was 31%. In all, 10 PIMs were used by the respondents. The majority (81.5%) were using one PIM, while (17.7%) used two PIMs and (0.8%) 3 PIMs. NSAIDs (72.6%) were the commonest PIMs identified, followed by the benzodiazepines (24.2%). Respondents had an average of 1.9 morbidities, and mulitmorbidity found in 60.5%. Logistic regression analysis showed self-rated health assessed as better compared with age-mates [OR =1.718 (1.080-2.725)] and being physically active [OR =1.879 (1.026-3.436)] as the most significantly associated with PIMs use.

Conclusions

The use of PIMs among older patients in our setting was high with NSAIDs being the most frequently used medications. An interdisciplinary approach, of medication review by pharmacists', working with physicians may improve prescribing practices among older persons. Therefore, it is necessary to create public health awareness on the use of PIMs among older persons.

Knowledge of pharmacists and parents towards antibiotic use in pediatrics: a cross-sectional study in Lebanon

Objectives

to assess the knowledge of both parents and community pharmacists regarding antibiotics use and resistance in pediatrics in Lebanon.

Methods

A cross-sectional study was conducted between June and August 2017 in community pharmacies. A pre-established questionnaire targeting knowledge of parents and pharmacists regarding antibiotics use/misuse was carried out. An index of knowledge was computed to assess factors associated with good knowledge on antibiotics use/misuse.

Results

The study showed that 28.7% of pharmacists did not know which factors may contribute to antimicrobial resistance. Concerning the misuse of antibiotics, pharmacists blamed at first parents (90.1%), at second level physicians (72.8%), and third themselves (59.4%). Furthermore, pharmacists believed that the socioeconomic problems of the country (86.1%), the level of resistance to the molecule of choice (80.8%), the lack of consultation time (71.2%) and the lack of national guidelines/recommendations (66.3%) might be additional factors contributing to antimicrobial resistance. In case of acute otitis media, the majority of pharmacists chose the correct treatment, dose and duration according to international guidelines; this was in contrast to the results obtained in case of pharyngitis. Female pharmacists had a significantly higher knowledge score compared to their male counterparts (ORa=2.51). Half of parents (42.6%) declared that antibiotics act against both viruses and bacteria, 55.9% still believe that the presence of fever requires the administration of antibiotics, 50% didn't know the consequences of antibiotics misuse, 58.4% said that it is okay to give their child antibiotics without a physician's advice or based on a pharmacist's recommendation, and 66.7% trusted the pharmacist in the antibiotic prescription. Parents with a university level of education or a master's degree had significantly better knowledge compared to illiterate ones (ORa=9.04 and ORa=16.46, respectively).

Conclusions

Based on the results obtained, it would be necessary to implement educational campaigns in order to increase awareness on antibiotics misuse and resistance in pediatrics.

Factors associated with smoking cessation success in Lebanon

Objective:

The objective is to assess factors associated with the success rate of smoking cessation among Lebanese smokers in a smoking cessation center.

Methods:

A cross-sectional data study, conducted between March 2014 and March 2016 in an outpatient smoking cessation center with 156 enrolled patients. The patient’s nicotine dependence and motivation to quit smoking were evaluated according to the Fagerstrom Test for Nicotine Dependence and Richmond tests respectively.

Results:

The number of packs smoked per year decreased the odds of smoking cessation success (p=0.004, ORa=0.982, CI 0.97-0.994), while the compliance with the offered treatment increased the odds of success by 7.68 times (p<0.001, ORa=7.68, CI 3.438-17.187). Highly dependent and highly motivated smokers had more success in the quitting process compared to those with a lower dependence and motivation respectively.

Conclusion:

Our findings showed that many factors can influence smoking cessation, an experience described as difficult, most significantly the number of packs per year and compliance with the smoking cessation treatment. Moreover, although these outcomes are not representative of the entire Lebanese population, we believe that health authorities could utilize these results when implementing upcoming smoking cessations programs. All attempts at cessation should have a goal of reducing the number of packs smoked per year to improve the chances of ceasing into the future.

Predicting Outcome in Patients with Anti-GBM Glomerulonephritis

BACKGROUND AND OBJECTIVES

Large studies on long-term kidney outcome in patients with anti-glomerular basement membrane (anti-GBM) GN are lacking. This study aimed to identify clinical and histopathologic parameters that predict kidney outcome in these patients.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

This retrospective analysis included a total of 123 patients with anti-GBM GN between 1986 and 2015 from six centers worldwide. Their kidney biopsy samples were classified according to the histopathologic classification for ANCA-associated GN. Clinical data such as details of treatment were retrieved from clinical records. The primary outcome parameter was the occurrence of ESRD. Kidney survival was analyzed using the log-rank test and Cox regression analyses.

RESULTS

The 5-year kidney survival rate was 34%, with an improved rate observed among patients diagnosed after 2007 (P=0.01). In patients with anti-GBM GN, histopathologic class and kidney survival were associated (P<0.001). Only one of 15 patients with a focal class biopsy sample (≥50% normal glomeruli) developed ESRD. Patients with a sclerotic class biopsy sample (≥50% globally sclerotic glomeruli) and patients with 100% cellular crescents did not recover from dialysis dependency at presentation. In multivariable analysis, dialysis dependency at presentation (hazard ratio [HR], 3.17; 95% confidence interval [95% CI], 1.59 to 6.32), percentage of normal glomeruli (HR, 0.97; 95% CI, 0.95 to 0.99), and extent of interstitial infiltrate (HR, 2.02; 95% CI, 1.17 to 3.50) were predictors of ESRD during follow-up.

CONCLUSIONS

Dialysis dependency, low percentage of normal glomeruli, and large extent of interstitial infiltrate are associated with poor kidney outcome in anti-GBM GN. Kidney outcome has improved during recent years; the success rate doubled after 2007.

PODCAST

This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2017_11_21_CJASNPodcast_18_1_v.mp3.

Univariate and multivariate models for the prediction of life-threatening complications in 586 cases of deep neck space infections: retrospective multi-institutional study. J Laryngol Otol. 2017;131:779-784. [PMID: 28578716 DOI: 10.1017/s0022215117001153]

OBJECTIVE

To identify deep neck infection factors related to life-threatening complications.

METHODS

This retrospective multi-institutional study comprised 586 patients treated for deep neck infections between 2002 and 2012. The statistical significance of variables associated with life-threatening complications of deep neck infections was assessed.

RESULTS

During treatment, life-threatening complications occurred in 60 out of 586 cases. On univariate analysis, life-threatening complications were linked to: dyspnoea, neck movement disturbance and dysphonia (all p < 0.001); and parapharyngeal, anterior visceral or pretracheal deep neck involvement (all p < 0.002). Aetiology was significantly linked to tonsils (p < 0.001). Regarding infection type, fasciitis was a significant factor (p < 0.001). Candida albicans was a significant bacterial culture (p < 0.001). A multivariate step-wise model disclosed fewer significant variables: retropharyngeal space (p = 0.005) and major blood vessels area (p = 0.006) involvement, and bacterial culture C albicans (p < 0.001).

CONCLUSION

It can be predicted that patients with deep neck infections, with neck movement disturbances, dysphonia, dyspnoea and swelling of the external neck, accompanied by severe pain, and inflammatory changes in the retropharyngeal space and large vessel areas, with culture-confirmed infection of C albicans, are likely to develop life-threatening complications.

[Evolution of Asthma Prevalence and Sociodemographic and Health Factors Associated in Madrid Region (1996-2013)]

OBJECTIVE

Asthma is an important public health issue. The goal of this study is to analyse the trends in self-reported asthma prevalence in the Madrid Region and its association with socio-demographic and health factors.

METHODS

Data from the "Non-Communicable Disease Risk Factor Surveillance System" in adult population (SIVFRENT-A) 1996-2013 were used. Prevalences and 95% CI were estimated for: current asthma, cumulative prevalence of asthma and asthma attack in the last 12 months, in five periods. Changes in inter-period prevalence were estimated by calculating prevalence ratios (PR) with 95% CI by Poisson regression. The association between asthma prevalence socio-demographic and health variables was evaluated by multivariate logistic regression.

RESULTS

Current prevalence of asthma and cumulative prevalence of asthma increased per study period an average of 14%. Asthma attack prevalence in the last 12 months increased an average of 19%. It was associated (statistically significant) to an increase of current prevalence of asthma, cumulative prevalence of asthma and asthma attack prevalence in the last 12 months: being a woman, ORa: 1.55; ORa: 1.35 and ORa: 1.46 respectively; have poor self-perceived health, ORa: 3.09; ORa: 2.63 and ORa: 2.89; and intense physical activity, ORa: 1.48; ORa: 1.32 and ORa: 1.49. In the case of current prevalence of asthma and cumulative prevalence of asthma also be studying, ORa: 1.34 and ORa: 1.46 respectively.

CONCLUSIONS

Self-reported asthma prevalence increased in the last decades. The prevalence was higher in woman, persons with poor self-perceived health and adults with intense physical activity.

Risk of Febuxostat-Associated Myopathy in Patients with CKD

BACKGROUND AND OBJECTIVES

Febuxostat, a nonpurine xanthine oxidase inhibitor, is widely used to treat hyperuricemia. Although febuxostat-associated rhabdomyolysis was reported in some patients with CKD, the association between CKD and febuxostat-associated myopathy remains uncertain.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Our retrospective cohort study included 1332 patients using febuxostat in Taipei Medical University-Wanfang Hospital from February of 2014 to January of 2016. The primary predictor was time-averaged eGFR as calculated by the equation proposed by the 2009 Chronic Kidney Disease Epidemiology Collaboration. The outcome was febuxostat-associated myopathy defined as elevated creatine kinase levels during febuxostat use that were not attributed to other muscular injuries.

RESULTS

The median duration of febuxostat use was 224 days (25th, 75th percentiles: 86, 441.5 days). Of 1332 study participants, 1222 (91.7%) had CKD; the median eGFR was 20.8 ml/min per 1.73 m2 (25th, 75th percentiles: 9.0, 35.4 ml/min per 1.73 m2). Forty-one of the participants had febuxostat-associated myopathy (3.2%). All patients with myopathy had CKD, and the incident rate was 0.013 (95% confidence interval, 0.01 to 0.02) events per 100 patient-days in patients with CKD. Of 41 patients with myopathy, 37 had myositis, and four had rhabdomyolysis. Myopathy resolved in 17 patients who withdrew from treatment and eight patients who continued febuxostat treatment. Among the evaluated predictors, multivariate analysis showed that only the lowest eGFR tertile was significantly associated with myopathy in febuxostat users. The odds ratio of the lowest eGFR tertile to the highest tertile was 4.21 (95% confidence interval, 1.7 to 10.43). This finding remained consistent among subgroups stratified by age, sex, diabetes status, coronary artery disease, and statin or fibrate use.

CONCLUSIONS

Patients with severely reduced eGFR had higher risk of myopathy with treatment of febuxostat. Regular monitoring of creatine kinase level is suggested for early detection of febuxostat-associated myopathy, particularly in patients with CKD.

Identifying the white matter impairments among ART-naïve HIV patients: a multivariate pattern analysis of DTI data

OBJECTIVE

To identify the white matter (WM) impairments of the antiretroviral therapy (ART)-naïve HIV patients by conducting a multivariate pattern analysis (MVPA) of Diffusion Tensor Imaging (DTI) data METHODS: We enrolled 33 ART-naïve HIV patients and 32 Normal controls in the current study. Firstly, the DTI metrics in whole brain WM tracts were extracted for each subject and feed into the Least Absolute Shrinkage and Selection Operators procedure (LASSO)-Logistic regression model to identify the impaired WM tracts. Then, Support Vector Machines (SVM) model was constructed based on the DTI metrics in the impaired WM tracts to make HIV-control group classification. Pearson correlations between the WM impairments and HIV clinical statics were also investigated.

RESULTS

Extensive HIV-related impairments were observed in the WM tracts associated with motor function, the corpus callosum (CC) and the frontal WM. With leave-one-out cross validation, accuracy of 83.08% (P=0.002) and the area under the Receiver Operating Characteristic curve of 0.9110 were obtained in the SVM classification model. The impairments of the CC were significantly correlated with the HIV clinic statics.

CONCLUSION

The MVPA was sensitive to detect the HIV-related WM changes. Our findings indicated that the MVPA had considerable potential in exploring the HIV-related WM impairments.

KEY POINTS

• WM impairments along motor pathway were detected among the ART-naïve HIV patients • Prominent HIV-related WM impairments were observed in CC and frontal WM • The impairments of CC were significantly related to the HIV clinic statics • The CC might be susceptible to immune dysfunction and HIV replication • Multivariate pattern analysis had potential for studying the HIV-related white matter impairments.