Search

Studies internationally have found that a high treatment burden is associated with several long-term conditions and poor quality of life. To translate, culturally adapt, and provide evidence of reliability, validity, and factor structure of the Multimorbidity Treatment Burden Questionnaire for use among Arabic-speaking adults with multimorbidity. Standard guidelines for the cross-cultural adaptation of self-report measures were followed. The original 10-item MTBQ was translated into Arabic by professional translators using forward-backward translation. An expert group, including the creator of the MTBQ, participated in the cultural adaptation and content validity, followed by cognitive interviewing and pilot testing. The questionnaire was then tested on 177 Arabic-speaking patients with multimorbidity recruited from community pharmacies in the United Arab Emirates. The distribution of responses, dimensionality, internal consistency reliability, and construct validity were examined. The content validity of the MTBQ-A was good (Content Validity Index = 0.94), and cognitive interviews found that the items were well understood. The scale showed positive skewness and high floor effects. Factor analysis supported a two-dimensional structure (factor loadings >0.4): factor one was named "Self-management and social support," and factor two was named "Burden of visiting health care services and health care professionals". The questionnaire had good internal consistency (α = 0.83). As predicted, a higher MTBQ score in both factors was associated with poor health-related quality of life in all dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression (p values < 0.05); and negatively correlated with self-efficacy in taking medication (p < 0.01) and in learning about medication (p < 0.01). The Arabic MTBQ is a valid and reliable measure of treatment burden with good construct validity and internal consistency. This easy-to-understand questionnaire can be used to assess the perceived treatment burden among Arabic-speaking patients with multimorbidity. [ABSTRACT FROM AUTHOR]

Background: Hypertension is a common problem in South Africa and is known to be inadequately treated and poorly controlled. Objectives: The objective of the study was to investigate what proportion of patients prescribed antihypertensive medication had controlled blood pressure (BP) and to identify factors associated with poor control. Method: In May and June 2012, clinic-attending adults who had been prescribed antihypertensive medication were recruited into this cross-sectional study. A questionnaire administered by field assistants investigated participants’ socio-demographic characteristics, medical history, perception of health, use of traditional healers, illness perceptions, beliefs about medication, compliance with the medication and suggestions as to how to improve hypertensive treatment. BP measurements were taken. Logistic regression analysis identified the determinants of poor BP control. Results: Of the 500 participants, the mean age was 58 years, 78% were female and the majority had never been to school, or had only attended primary school. One third had adequately controlled BP (< 140/90 mmHg). Factors associated with poor BP control included being prescribed more than one antihypertensive medication, self-reported asthma and poor compliance with the medication, although the latter was not significant after adjusting for other variables. Participants with diabetes and those with a family history of a stroke were more likely to have good BP control. Conclusion: Only one third of participants had adequately controlled BP, and almost half did not understand their high BP at all. Many had concerns about taking medication, but most felt that it was necessary. Participants suggested that better health education and ensuring that medication was available in the clinics could improve BP control. [ABSTRACT FROM PUBLISHER]

Objective: The objective of the study was to identify factors associated with being overweight or obese, and perceptions of weight by hypertensive patients living in rural South Africa. Design: This was a nested cross-sectional study. Setting: The setting was primary healthcare clinics close to Manguzi Hospital, KwaZulu-Natal. Subjects: Subjects were 109 males and 391 females, prescribed at least one antihypertensive medication aged ≥ 18 years. Outcome measures: The primary outcome measure was body mass index (BMI) ≥ 25 kg/m2. The secondary outcome measure was recognition of being overweight by those with a BMI ≥ 25 kg/m2. Results: The mean age was 58 years. Three hundred and ninety-one (78%) participants were female, and the majority had never been to school or had attended primary school only. Three hundred and eleven (62%) participants were overweight or obese, with a BMI ≥ 25 kg/m2. Factors associated with being overweight or obese included having high cholesterol [adjusted odds ratio (OR) 10.62, 95% confidence interval (CI): 1.22-92.4, p-value 0.032], and having never smoked (adjusted OR 3.22, 95% CI: 1.38-7.52, p-value 0.007. Human immunodeficiency virus (HIV) was associated with a lower risk of being overweight or obese (adjusted OR 0.52 for BMI ≥ 25, 95% CI: 0.31-0.89, p-value < 0.0001). Only 12% of participants who were overweight or obese perceived that they were overweight. Participants with a BMI ≥ 25 kg/m2 were most likely to recognise they were overweight if they had high cholesterol, diabetes or HIV. Conclusion: Almost two thirds of participants were overweight or obese, and of these, only 12% perceived that they were overweight. Educating patients about obesity, particularly when they have other cardiovascular risk factors such as hypertension, is of public health importance. [ABSTRACT FROM AUTHOR]

Background: Studies in developed countries suggest that acetaminophen use is associated with increased risk of asthma, but it is unclear whether this association is causal. Objective: To determine the relation among acetaminophen use, asthma, and allergy, and to explore potential biases in acetaminophen use, in a developing country population. Methods: We surveyed 7649 adults and children from Butajira, Ethiopia, collecting data on self-reported symptoms of allergic disease, skin sensitization to Dermatophagoides pteronyssinus and cockroach, acetaminophen use, and potential confounders. We then collected detailed data on indications for acetaminophen use and reasons for aspirin avoidance in a nested follow-up study. Results: Allergic symptoms increased significantly with frequency of acetaminophen use, with odds ratios in those using >3 tablets in the past month relative to none 1.89 (95% CI, 1.51-2.36) for wheeze, 2.14 (1.72-2.67) for nocturnal shortness of breath, 2.52 (1.99-3.20) for rhinitis, and 1.90 (1.39-2.61) for eczema. Cockroach sensitization was also more common in the highest acetaminophen category (odds ratio, 1.40; 95% CI, 1.10-1.79), but D pteronyssinus sensitization was not. Less than 1% of participants with asthma or wheeze in our nested study reported avoidance of aspirin because of asthma symptoms. None volunteered using acetaminophen to treat allergic symptoms. Conclusion: There is a dose-related association between acetaminophen use and self-reported allergic symptoms in this population that is not a result of aspirin avoidance, reverse causation, or other bias. Acetaminophen may therefore be involved in the etiology of asthma and allergic disease. [Copyright &y& Elsevier]

Background: Health services in many countries are promoting digital-first models of access to general practice based on offering online, video, or telephone consultations before a face-to-face consultation. It is claimed that this will improve access for patients and moderate the workload of doctors. However, improved access could also potentially increase doctors' workload.Objective: The aim of this study was to explore whether and under what circumstances digital-first access to general practice is likely to decrease or increase general practice workload.Methods: A process map to delineate primary care access pathways was developed and a model to estimate general practice workload constructed in Microsoft Excel (Microsoft Corp). The model was populated using estimates of key variables obtained from a systematic review of published studies. A MEDLINE search was conducted for studies published in English between January 1, 2000, and September 30, 2019. Included papers provided quantitative data about online, telephone, or video consultations for unselected patients requesting a general practice in-hours consultation for any problem. We excluded studies of general practitioners consulting specialists, consultations not conducted by doctors, and consultations conducted after hours, in secondary care, in specialist services, or for a specific health care problem. Data about the following variables were extracted from the included papers to form the model inputs: the proportion of consultations managed digitally, the proportion of digital consultations completed without a subsequent consultation, the proportion of subsequent consultations conducted by telephone rather than face-to-face, consultation duration, and the proportion of digital consultations that represent new demand. The outcome was general practice workload. The model was used to test the likely impact of different digital-first scenarios, based on the best available evidence and the plausible range of estimates from the published studies. The model allows others to test the impact on workload of varying assumptions about model inputs.Results: Digital-first approaches are likely to increase general practice workload unless they are shorter, and a higher proportion of patients are managed without a subsequent consultation than observed in most published studies. In our base-case scenarios (based on the best available evidence), digital-first access models using online, telephone, or video consultations are likely to increase general practitioner workload by 25%, 3%, and 31%, respectively. An important determinant of workload is whether the availability of digital-first approaches changes the demand for general practice consultations, but there is little robust evidence to answer this question.Conclusions: Digital-first approaches to primary care could increase general practice workload unless stringent conditions are met. Justification for these approaches should be based on evidence about the benefits in relation to the costs, rather than assumptions about reductions in workload. Given the potential increase in workload, which in due course could worsen problems of access, these initiatives should be implemented in a staged way alongside careful evaluation. [ABSTRACT FROM AUTHOR]