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Adolescents with suboptimal medication taking may deceive caregivers about non-adherence. We conducted a 5-year longitudinal study of adolescents monitored simultaneously with both easily manipulated (e.g., self-report) and hard to manipulate (e.g., microelectronic data) strategies. Adolescents with repeatedly high adherence on the former and low adherence on the latter were invited along with their parental figures ("parents") to participate. We conducted focus groups and semi-structured interviews, separately for adolescents and parents, to elucidate drivers of discordant measures. Forty-seven adolescents and 26 parents participated in focus groups and 4 adolescents were interviewed. Adolescents described hiding pills, discarding pills, and lying. Their motivations included fear of disappointing those who care about them, desire to avoid admonishment by parents and clinic staff, and desire to avoid remedial adherence counseling. Both adolescents and parents considered negative feedback for prior poor adherence to be key motivation to hide current poor adherence from clinic staff. Providing positive feedback for truth-telling, rather than for "evidence" of excellent adherence, might help adolescent patients and their parents to develop stronger treatment alliances with each other and with clinic staff. Such alliances would allow adherence interventions to be better targeted and more fruitful in increasing adherence.

Pediatric kidney transplant recipients are distinguished from adult recipients by the need for many decades of graft function, the potential effect of CKD on neurodevelopment, and the changing immune environment of a developing human. The entire life of an individual who receives a transplant as a child is colored by their status as a transplant recipient. Not only must these young recipients negotiate all of the usual challenges of emerging adulthood (transition from school to work, romantic relationships, achieving independence from parents), but they must learn to manage a life-threatening medical condition independently. Regardless of the age at transplantation, graft failure rates are higher during adolescence and young adulthood than at any other age. All pediatric transplant recipients must pass through this high-risk period. Factors contributing to the high graft failure rates in this period include poor adherence to treatment, potentially exacerbated by the transfer of care from pediatric- to adult-oriented care providers, and perhaps an increased potency of the immune response. We describe the characteristics of pediatric kidney transplant recipients, particularly those factors that may influence their care throughout their lives. We also discuss the risks associated with the transition from pediatric- to adult-oriented care and provide some suggestions to optimize the transition to adult-oriented transplant care and long-term outcomes.

Peritoneal surface malignancies are a group of aggressive cancers involving the peritoneum. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy can improve outcomes and survival in select patients. Despite significant advancements in care, racial disparities in peritoneal malignancy outcomes persist and may have even worsened over time. Poor adherence to guideline-recommended therapy introduces wide variability in patient care and often results in fewer options and suboptimal treatment of vulnerable populations. This review explores biological, sociodemographic, and environmental factors that contribute to disparities in peritoneal malignancy outcomes.

The effect of direct oral anticoagulants (DOACs) on evolution of a post-thrombotic syndrome (PTS) is unknown.This retrospective study included patients (n = 98) with a PTS occurring after a proximal deep-vein thrombosis (DVT). The PTS progression was assessed by the Villalta scale change over time from when patients were started on DOACs for the prevention of DVT recurrence according to current guidelines. The PTS evolution was compared between patients with good (n = 63) vs. poor (n = 35) DOACs adherence, defined by using a medication possession ratio cut point of 0.80. The mean follow-up was 41.7 ± 17.7 and 27.5 ± 10.5 months in patients with good or poor adherence, respectively. The primary endpoint of PTS improvement (defined when the Villalta score became5 and/or decreased by ≥30% from baseline) was higher in patients with good vs. poor adherence (66.7% vs. 20%, p 0.001). None of the patients in the good adherence group experienced at any time of follow-up the co-primary endpoint of PTS worsening (defined as the Villalta score increase ≥30%), which instead occurred in 12 (34.3%) of those with poor adherence (p 0.001). All study-defined primary endpoints occurred within 2 years. The mean values of the Villalta partial scores related to the subjective symptoms (patient-rated) and to the potentially reversible physician-rated signs were significantly improved in the good adherence group, while they were unchanged among patients with poor adherence.In this study a good vs. poor DOACs adherence was associated with a more favorable progression of PTS over a long-term follow-up. Larger studies are needed to explore the clinical efficacy of DOACs on PTS manifestations.

BackgroundMedication overuse headache (MOH) is characterized by a pre-existing primary or secondary headache associated with medication overuse.AimsTo identify the clinical, epidemiological, and therapeutic profiles associated with MOH and poor adherence to treatment.MethodsA cross-sectional, comparative, descriptive, analytical study was carried out to assess the characteristics of patients with MOH treated at the Hospital Geral de Fortaleza (HGF).Results103 patients participated, 95 (92.2%) women and 8 (7.8%) men. Of these, 55 (53.4%) patients answered that had already been instructed about the MOH, however they continue to abuse medication for many reasons i.e.: difficulty in bearing pain, and fear of worsening the pain. When asked about what could be done to improve adherence to treatment, in a general way, 28 (27.2%) were unable to inform, 37 (35.9%) answered that most frequent consultations could help. Furthermore, 19 (18.4%) believe that psychological counseling wound bring benefits.ConclusionThe lack of guidance or interest in the guidelines provided are real and important obstacles to treat MOH. Changes in the care model that include effective communication, more frequent return, family and psychotherapy support and close monitoring by the physician or nurses are factors that should be considered in headache clinics.

Introduction Poor adherence to the 2011 American Society for Radiation Oncology (ASTRO) evidence-based guideline on whole-breast irradiation (WBI) has been reported. We utilized theMednet to assess the views of the updated 2018 guideline among radiation oncologists (ROs). Methods We identified 11 questions asked by community ROs on theMednet, a web-based platform, between October 27, 2014 and May 2, 2017 that were updated in the 2018 guideline. New answers provided by senior authors of the 2018 guideline, cited guidelines, and polls to survey ROs were disseminated in 3 theMednet's newsletters between March 16, 2018 and May 1, 2018. Any question with less than 60% consensus was resubmitted on October 9, 2019 and assessed on February 13, 2020. Results A total of 792 ROs responded to the initial surveys. In each survey, the answer choice(s) that received the majority of the votes aligned with the 2018 guideline. The strongest consensus was for the use of hypofractionated (HF)-WBI regardless of histology (97%), followed by HF-WBI boost dose (92%), molecular subtype (90%), grade (88%), and concurrent use of trastuzumab (87%). The least consensus was for age at which HF-WBI should be offered with 53% of respondents, specifically 73% of academic ROs versus 47% of community ROs (P = .001), agreeing with the guideline. The re-submitted survey 19 months later showed 77% of 287 new respondents now agreed with the guideline regarding age. Conclusion The majority of ROs concur with the 2018 WBI guideline in theMednet surveys, with better agreement among academic ROs than community ROs for certain components of the guideline. Further research into the different practice patterns may optimize patient care.

Background PrEP efficacy for HIV prevention is highly correlated with the degree of adherence. The objective of this analysis was to identify PrEP users who did not correctly take their dose in high HIV exposure situations and to explore potential predictors of this behaviour. Methods Study participants completed a personal web-based diary during their entire follow-up providing daily information on pill intake and sexual activity. They also completed a socio-behavioural questionnaire. The association between the number of unprotected high HIV exposure sex days (as a measure for suboptimal adherence) and potential predicting factors was examined using a logistic regression followed by a negative binomial regression model. We also constructed a risk index score for predicting poor adherence. Results A total of 40.8% of participants did not correctly use PrEP in at least one situation of high HIV exposure during follow-up. Not having a HIV negative steady partner, reporting more than 10 occasional or more than 10 anonymous partners in the last 3 months, using chemsex drugs , receiving money for sex and a history of more than one Sexually Transmitted Infection (STI) were significantly associated with unprotected high HIV exposure sex. The risk index score yielded a poor discriminative power (Area Under the Curve 0.62 and 0.64). Conclusions We observed a high proportion of suboptimal adherence. Even if none of the participants acquired HIV during the study, tailored adherence support is needed to specific men who have sex with men such as those taking chemsex drugs and those engaging in paid sex.

Despite advances in pharma and high-technology medicine, the rate of burdensome hospital admissions and mortality in patients with chronic heart failure (CHF) remains high. Over half of all admission-entailing decompensations have been repeatedly shown to emerge from non-compliance with outpatient prescriptions. Poor adherence to medication and non-medication treatment can only be broken by improving the patient’s awareness of the disease and his closer monitoring by healthcare professionals. The power of clinical and laboratory illness monitoring in line with the recommended quality criteria of medical aid in heart failure (HF) is strongly limited today by time resources available in outpatient and midwifery clinics. Meanwhile, an international and certain domestic experience has been built up to run CHF outpatient centres with involvement of specially-trained nursing and senior medical staff. Analytic evidence on such centres suggests a reduction in mortality and hospitalisation rate among the visiting patients. To combat existing drawbacks of CHF outpatient care, the National Medical Research Center of Cardiology in alliance with the Specialist Society of Heart Failure have developed the nurses’ guidelines for CHF rooms and are launching a medical staff training programme to manage CHF rooms, registry and data analysis. Furthermore, a procedure has been developed for patient routing to regional CHF outpatient cabinets that is being actively deployed in the Tyumen Region.

Paro cardiaco en salas de recuperacion posanestesica, entidad poco frecuente en esterilizacion tubaria. Factores descencadenantes como sobresedación, bloqueo espinal alto,uso de opiodes, toxicidad sistemica por anestesicos locales. La ligadura de trompas como metodo anticonceptivo definitivo que se realiza de preferencia bajo anestesia raquidea. Paciente de 35 años en su puerperio de 12 horas, se somete a salpingoclasia bilateral bajo anestesia raquidea, con dosis de fentanil de 20 mcg y bupivacaina pesada de 12 mg.Nivel de dermatoma alcanzado de T6 (ideal para el procedimiento quirurgico), sin ninguna otra administracion medicamentosa. En la unidad de recuperacion postanestesica presenta paro cardiaco con inicio de manera inmediata de soporte vital avanzado con buenos resultados posteriores. Se le pracrican los examenes complementarios e interconsultas correspondiente. Paciente es dada de alta hospitalaria sin secuelas neurologicas a los 4 dias posteriores al evento. Prevenir y tratar la causa correspondiente del paro cardiaco.

Background: In sub-Saharan Africa where genotypic anti-retroviral (ARV) drug resistance testing is rarely performed and poor adherence is blamed for the inability to achieve viral suppression and treatment failure, programmatic approaches to preventing and handling these are essential. This study was aimed at assessing the virological outcomes among HIV patients receiving second-line anti-retroviral therapy (ART) in Southwestern Nigeria.Methodology: This was a 5-year observational retrospective study of randomly selected people living with HIV (PLWHIV) who have been switched to second-line ART for at least six months before the commencement of the study in multiple comprehensive ART sites across the three levels of care, in Ondo and Ekiti States, Southwestern Nigeria, from January 2015 to December 2019. Quantitative viral load analysis was done using polymerase chain reaction (PCR) assay. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 24.0.Results: A total of 249 (71 males and 178 females) subjects eligible for the study were recruited using simple random sampling technique. The mean age (± SD) of the subjects was 44.21 ± 11.45 years. The mean number of years the patients have been on ART regimen was 7.92 ± 2.68 years. The mean number of years the patients were on first line ART regimen before being switched to second line was 4.27 ± 2.63 years. Patients with viral load 1000 RNA copies/ml (unsuppressed viral load or virological failure).Conclusion: About 13% of the patients on second line ART had unsuppressed viral load of more than 1000 RNA copies/ml indicating virological failure. Thus, critical factors such as poor adherence to ART and drug resistance chiefly contributing to virological failure have to be routinely checked. Keywords: suppression, ART, resistance, virological, failure, Nigeria French title: Preuve d'échec virologique chez les patients sous traitement antirétroviral de deuxième intention dans le sud-ouest du Nigeria: une indication pour le test de résistance aux médicaments contre le VIH Contexte: En Afrique subsaharienne, où les tests génotypiques de résistance aux antirétroviraux (ARV) sont rarement effectués et où une mauvaise observance est imputée à l'incapacité d'obtenir la suppression virale et l'échec du traitement, des approches programmatiques pour les prévenir et les gérer sont essentielles. Cette étude visait à évaluer les résultats virologiques chez les patients VIH recevant un traitement antirétroviral (TAR) de deuxième intention dans le sud-ouest du Nigeria. Méthodologie: Il s'agissait d'une étude rétrospective d'observation de 5 ans portant sur des personnes vivant avec le VIH (PVVIH) sélectionnées au hasard et passées à un TAR de deuxième intention pendant au moins six mois avant le début de l'étude dans plusieurs sites de TAR complets aux trois niveaux. de soins, dans les États d'Ondo et d'Ekiti, dans le sud-ouest du Nigéria, de janvier 2015 à décembre 2019. L'analyse quantitative de la charge virale a été effectuée à l'aide d'un test de réaction en chaîne par polymérase (PCR). Les données ont été analysées à l'aide du logiciel Paquet statistique pour les sciences sociales (SPSS) version 24.0. Résultats: Un total de 249 (71 hommes et 178 femmes) sujets éligibles à l'étude ont été recrutés à l'aide d'une technique d'échantillonnage aléatoire simple. L'âge moyen (± ET) des sujets était de 44,21±11,45 ans. Le nombre moyen d'années pendant lesquelles les patients ont été sous traitement antirétroviral était de 7,92±2,68 ans. Le nombre moyen d'années pendant lesquelles les patients étaient sous traitement antirétroviral de première ligne avant de passer en deuxième ligne était de 4,27 ± 2,63 ans. Les patients avec une charge virale 1000 ARN copies/ml (charge virale non supprimée ou échec virologique). Conclusion: Environ 13 % des patients sous TAR de deuxième ligne avaient une charge virale non supprimée de plus de 1000 copies d'ARN/ml indiquant un échec virologique. Ainsi, les facteurs critiques tels qu'une mauvaise adhésion au TARV et la résistance aux médicaments contribuant principalement à l'échec virologique doivent être systématiquement vérifiés. Mots clés: suppression, TAR, résistance, virologique, échec, Nigeria

Poor adherence is a global health issue, affecting all chronic conditions and all age groups. Medications will only work if they are taken, and ongoing adherence to medication and treatment is difficult in chronic illness. Average adherence rates are approximately 50% in paediatric patients with asthma, and this can lead to poor disease control and an increase in morbidity. Thus, it is prudent to consider and discuss non-adherence, whether it be intentional or unintentional, to avoid unnecessary escalation of treatment. In this review, we discuss the fundamentals of adherence and the importance of goal setting. We discuss the challenges in varying age-groups, and methods that can be incorporated in various settings to optimize adherence. We explore how the advent of e-health (the combination of healthcare and technology) has impacted upon our ability to monitor adherence.

Acute coronary syndrome is a factor for poor prognosis and recurrent cardiovascular events. Adequate antiplatelet therapy is crucial in patients with the acute coronary syndrome for risk reduction. Such treatment is well described in four documents issued by the European Society of Cardiology, which precisely illustrate the use of antiplatelets in the settings of ST-elevated and non-ST elevated myocardial infarction. Despite its unquestioned role in the treatment of acute coronary syndrome, recent real-world-data from Polish registries reveal poor adherence to the guidelines-recommended antiplatelet treatment in Poland. Thus, we present here a comprehensive review of the use of antiplatelets in the settings of the acute coronary syndrome. Each phase of the treatment, i.e. pre-hospital, in-hospital and post-hospital, is discussed separately for a better understanding of the decision-making process at each step. We also present unpublished data from Polish registries (e.g. PL-ACS 2019, National Registry of Procedures of Invasive Cardiology, RECEPTOmetrPEX panel) regarding adherence to the guidelines-recommended treatment in Poland, thus highlighting the points of care which should be immediately improved. It has to be stressed here that careful assessment of ischaemic and bleeding risk has to be performed in each patient with acute coronary syndrome individually and repeated at successive phases of the treatment. Only such an approach allows for appropriate antiplatelet therapy tailoring.

Introducción: La resistencia a antirretrovirales compromete la efectividad del tratamiento de pacientes con infección por VIH, llevando a falla virológica e inmunológica, deterioro clínico y comprometiendo tratamientos futuros. Los niños y adolescentes tienen mayor riesgo de desarrollo de resistencia asociados a terapias prolongadas, mala adherencia y limitadas opciones terapéuticas. Se desconoce la prevalencia y patrones de resistencia adquirida en población pediátrica panameña. Objetivos: Conocer la prevalencia y describir los patrones de resistencia adquirida en población pediátrica infectada con falla virológica en el período 2009-2019 Material y Método: Estudio descriptivo. Se incluyeron sujetos menores de 18 años de edad, con al menos un año de tratamiento, en falla virológica y que contaban con una prueba de genotipaje. Se realizó revisión de los expedientes clínicos para la obtención de los datos. Se describen las características demográficas, historial de tratamiento, resistencia a familias de antirretrovirales y mutaciones específicas Resultados y conclusiones: 13 pacientes fueron incluidos en el estudio de un total de 72 pacientes con infección de VIH atendidos en el período de estudio, para una prevalencia de resistencia del 18% de sujetos en terapia con resistencia. Se encontró 92% de resistencia a Inhibidores de la transcriptasa reversa análogo de nucleósidos, 61.5% a inhibidores de la transcriptasa reversa no análogos de nucleósidos y 23% de resistencia a Inhibidores de proteasa, las mutaciones M184V y K103N fueron las más frecuentes. Se requiere mantener la vigilancia de resistencia en niños con el fin de ajustar las recomendaciones de tratamiento.

Objectives: The objective of this study was to determine the level of adherence and possible barriers to secondary prophylaxis among patients with Rheumatic heart disease (RHD). Methodology: It is a cross-sectional study conducted at the largest tertiary care cardiac center of Karachi, Pakistan. We included patients with RHD, based on transthoracic echocardiography and adherence to the secondary prophylaxis and possible barriers were assessed using a structured questionnaire. Results: Among total of 195 patients 66.7% (130) were female, mean age was 32.25 ± 13.78 years. Rural residents were 51.3% (100) and 59.5% (116) of the patients were illiterate. Benzathine Penicillin injection was prescribed to 56.4% (110) patients, out of them 70.0% (77) of the patients were counseled regarding duration of secondary prophylaxis. The most common reason for non-adherence was reported to be a painful injection (19.1%). Conclusion: Majority of the RHD patients are not being prescribed and effectively counseled regarding secondary prophylaxis. Low adherence to the secondary prophylaxis was observed and the common reasons for non-adherence were painful injection, non-availability of nearby health facility, friends/family advising them otherwise, allergic reaction, and patients feeling sick and unable to take injection.

Dry eye disease (DED) is an ocular condition with a high prevalence globally. The survey was conducted to understand factors that influence the treatment of DED in Kazakhstan and Uzbekistan and the properties of artificial tears required in its treatment. Purpose. The survey aimed to understand the prevalence of DED in the population of Kazakhstan and Uzbekistan, whether associated ocular diseases and patient lifestyle affected DED treatment, the properties of artificial tears required in the treatment of DED, and the use of artificial tears in conditions other than DED. Material and methods.A total of 457 ophthalmologists participated in the survey that was conducted between June–July 2019 in selected cities of Kazakhstan and Uzbekistan. The questionnaire assessed the number of patients with DEs, associated ocular diseases, contributing factors to poor adherence to DED treatment, major concerns in DED and properties of artificial tears required in the treatment of DED. Results.About 73 % of the doctors in Kazakhstan and all the doctors in Uzbekistan reported that DE-associated ocular diseases and lifestyle of a patient contribute to poor adherence to DED therapy. Doctors in Kazakhstan and Uzbekistan ranked hydration at 1.613 and 1.928, respectively, while considering the properties of artificial tears required for the treatment of DED. Conclusion.A majority of the doctors in Kazakhstan and Uzbekistan considered DE-associated ocular diseases and patient lifestyle as major contributing factors to poor adherence to DED treatment. Doctors from both countries considered hydrating property of artificial tears to be the most important ones for the management of DE.

Cystoisospora belli is an intestinal Apicomplexan parasite associated with diarrheal illness and disseminated infections in humans, mainly immunocompromised individuals such as those living with the human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). An irregular administration of highly active antiretroviral therapy (HAART) in HIV patients may increase the risk of opportunistic infections like cystoisosporiasis. We describe here a case of C. belli infection in a Colombian HIV patient with chronic gastrointestinal syndrome and poor adherence to HAART. His clinical and parasitological cure was achieved with trimethoprim-sulfamethoxazole treatment. Although a reduction in the number of C. belli cases has been observed since the use of HAART, this parasite still has to be considered as a differential diagnosis of diarrheal disease in HIV/AIDS patients. Effective interventions enhancing adherence to HAART should be included in HIV patient care programs.Cystoisospora belli es un parásito intestinal del filo Apicomplexa asociado con enfermedades diarreicas e infecciones diseminadas en humanos, principalmente en individuos inmunocomprometidos, como aquellos infectados con el virus de la inmunodeficiencia humana (HIV) o el síndrome de inmunodeficiencia adquirida (sida). El cumplimiento inadecuado de la terapia antirretroviral de gran actividad (TARGA) puede aumentar el riego de infecciones oportunistas, incluida la cistoisosporiasis. Se describe el caso de infección por C. belli en un paciente colombiano con HIV, que presentó un síndrome gastrointestinal crónico e incumplía el tratamiento con la TARGA. Después del diagnóstico parasitológico, el paciente fue tratado con trimetoprimsulfametoxazol, lográndose la recuperación clínica y la cura parasitológica. Aunque se ha observado una reducción en el número de casos de C. belli desde la implementación de la TARGA, este parásito aún debe considerarse en el diagnóstico diferencial de las enfermedades diarreicas en pacientes con HIV/sida. Los programas de atención deben incluir intervenciones efectivas que potencien el cumplimiento de la TARGA en estos pacientes.

PURPOSE: Prior studies of mixed insurance populations have demonstrated poor adherence to surgical standard of care (SOC) for penile cancer. We used data from the Surveillance, Epidemiology and End Results (SEER) cancer registry linked to Medicare to calculate SOC adherence to surgical treatment of penile cancer in insured men over the age of 65, focusing on potential social and racial disparities. METHODS: This is an observational analysis of patients with T2–4 penile cancer of any histologic subtype without metastasis in the SEER-Medicare database (2004–2015). SOC was defined as penectomy (partial or radical) with bilateral inguinal lymph node dissection (ILND) based on the National Comprehensive Cancer Network guidelines. We calculated proportions of those receiving SOC and constructed multivariate models to identify factors associated with receiving SOC. RESULTS: A total of 447 men were included. Of these men, 22.1% (99/447) received SOC while 18.8% (84/447) received no treatment at all. Only 23.3% (104/447) had ILND while 80.9% (362/447) underwent total or partial penectomy. Race and socioeconomic status (SES) were not associated with decreased SOC. Increasing age (OR 0.93, 95%CI:0.89–0.96), Charlson Comorbidity Index score ≥ 2 (OR 0.53, 95%CI:0.29–0.97), and T3-T4 disease (OR 0.34, 95%CI:0.18–0.65) were associated with not receiving SOC on adjusted analysis. CONCLUSIONS: Rates of SOC are low among insured men 65 years of age or older with invasive penile cancer, regardless of race or SES. This finding is largely driven by low rates of ILND. Strategies are needed to overcome barriers to SOC treatment for men with invasive penile cancer.

Socio-cultural settings and lifestyles of communities in Taenia solium taeniosis/cysticercosis (TSTC) in endemic areas influence significantly the epidemiology of the disease. This study investigated the community perceptions and practices influencing the occurrence and endemicity of TSTC. A cross-sectional survey focusing on pig-keeping households was carried out in three wards of Iringa District Council as a representative of other TSTC endemic areas. Questionnaire and observation checklists were employed for data collection. Eighty-seven (99%) of the 88 surveyed households had pit latrines, and 84(95%) of the households were found using their latrines. These latrines varied from good to a very good quality according to subjective qualitative scores. About 294 (85%) pigs were enclosed and 52(15%) were free roaming. The results indicated poor adherence to routine pig inspection at sales (50% inspection) and less pork inspection at slaughter (50% uninspected). Furthermore, there were no authorized centres for slaughter and sales. Health Officers and farmers were comfortable with the boiling form and home prepared pork (>90%). Health Officers perceived deep-frying and roasting of pork as inappropriate preparation methods. Generally, the social cultural practices and life style in the study area promoted the endemicity of Taenia solium life cycle. A strategy for surveillance on socio-cultural practices in the community is important during planning for TSTC control. This community needs sustainable health education on TSTC diseases control

African American emerging adults (age 18–29 years) tend to have poor asthma outcomes, possibly due to poor adherence to medication. Few studies have explored barriers to controller adherence in this population. This study utilized electronic daily diaries to assess barriers to adherence and asthma symptoms among 141 African American emerging adults with uncontrolled persistent asthma and poor adherence. Participants reported symptoms M = 3.43 days (of 7 days). They reported unintentional (e.g., forgetting) and intentional (e.g., choosing not to take) barriers to adherence, but forgetting, being too busy, and sleeping through a dose were the most common. Significant correlations were found between symptoms and barriers, as well as asthma control and medication adherence in the expected directions. Asthma symptoms and number of barriers were significant predictors of asthma control. Existing intervention strategies such as text-messaging may prove effective to address these barriers, but measuring and addressing adherence remains complex.

Neurotoxic effects caused by high phenylalanine (Phe) in patients with phenylketonuria (PKU) can be avoided through dietary treatment. However, achieving the recommended Phe levels has been a challenge. This study aimed to investigate factors associated with adherence to PKU treatment among patients followed at a medical genetics public service in southern Brazil. Twenty-nine patients (early diagnosed, n = 20; late-diagnosed, n = 9) with classical (n = 16) or mild PKU (n = 13) aged 6-34 years (16.4 ± 7.5) and 16 caregivers were included. Blood Phe levels were recorded, and assessment tools measuring barriers to treatment, IQ, knowledge about disease, treatment, and perceived adherence were collected. Classical PKU patients showed higher current blood Phe levels than mild PKU patients (U = 37.000, p = 0.003). Lifetime and childhood Phe levels were associated with recent metabolic control (τ = 0.76, p = 0.000; τ = 0.70, p = 0.000, respectively). The perception of barriers to treatment was associated with a higher blood Phe level (τ = 0.39, p = 0.003). Tolerance to Phe, metabolic control throughout childhood, and perceived difficulty in living with demands of treatment are important factors of greater vulnerability to poor adherence in PKU patients.

The use of interactive mobile and wearable technologies for understanding and managing health conditions is a growing area of interest for patients, health professionals and researchers. Self-tracking technologies such as smartphone apps and wearable devices for measuring symptoms and behaviours generate a wealth of patient-centric data with the potential to support clinical decision making. However, the utility of self-tracking technologies for providing insight into patients' conditions is impacted by poor adherence with data logging. This paper explores factors associated with adherence in smartphone-based tracking, drawing on two studies of patients living with axial spondyloarthritis (axSpA), a chronic rheumatological condition. In Study 1, 184 axSpA patients used the uMotif health tracking smartphone app for a period of up to 593 days. In Study 2, 108 axSpA patients completed a survey about their experience of using self-tracking technologies. We identify six significant correlates of self-tracking adherence, providing insight into the determinants of tracking behaviour. Specifically, our data provides evidence that adherence correlates with the age of the user, the types of tracking devices that are being used (smartphone OS and physical activity tracker), preferences for types of data to record, the timing of interactions with a self-tracking app, and the reported symptom severity of the user. We discuss how these factors may have implications for those designing, deploying or using mobile and wearable tracking technologies to support monitoring and management of chronic diseases.

Background. Coronavirus disease (COVID-19) is highly contagious and dynamic confinement measures have shown to significantly reduce the number of infections, however, they can alter the availability of food, affecting adherence to a gluten-free diet (GFD) and quality of life (QoL) in celiac disease (CD). The objective of this study was to evaluate the limiting factors, adherence to a gluten-free diet and quality of life in people with celiac disease in a COVID-19 pandemic period. Methods. On-line surveys were applied regarding adherence to the GFD, CV, and factors that have generated difficulty in carrying out a GFD in this setting. Results. 216 surveys of celiac patients over 15 years of age were analyzed, of which 91% were women with an average age of 36 + 10.7 years and with 5.8 + 6.0 years of the disease. 56.48% had excellent adherence to the GFD and 43.52% had a good QoL. The high cost of gluten-free foods was the question with the highest response percentage, associated with regular and poor adherence to the GFD (p-value = 0.001) and with poor QoL (p-value = 0.023). Conclusion. In a COVID-19 pandemic period, the cost of food is associated with regular and poor adherence to the GFD and with poor QoL.Alternate abstract: Introduccion La enfermedad por coronavirus (COVID-19) es altamente contagiosa y las medidas de confinamiento dinamico han demostrado que reducen significativamente el numero de contagios, sin embargo, pueden alterar la disponibilidad de alimentos afectando la adherencia a la dieta libre de gluten (DLG) y la calidad de vida (CV) en la enfermedad celiaca (EC). El objetivo de este estudio fue evaluar los factores que limitan, la adherencia a la dieta libre de gluten y la calidad de vida en personas con enfermedad celiaca en periodo de pandemia por COVID-19. Metodos Se aplicaron encuestas on-line respecto a adherencia a la DLG, CV y acerca de los factores que han generado dificultad para llevar una DLG en este escenario. Resultados Se analizaron 216 encuestas de enfermos celiacos, mayores de 15 anos, de los cuales un 91% eran mujeres con un promedio de edad de 36 + 10,7 anos y con 5,8 + 6,0 anos de enfermedad. El 56,48% tenia una excelente adherencia a la DLG y un 43,52% una buena CV. El costo elevado de los alimentos sin gluten fue la pregunta con mayor porcentaje de respuesta, asociandose con regular y mala adherencia a la DLG (valor p=0,001) y con pobre CV (valor p=0,023). Conclusion En periodo de pandemia por COVID-19, el costo de los alimentos se asocia con adherencia regular y mala a la DLG y con pobre CV.

PEl Ácido Valproico (AVP), fármaco ampliamente conocido por sus propiedades antiepilépticas para el manejo de la epilepsias parciales y simples. Es también utilizado dentro de la Psiquiatría como estabilizador del humor y apoyo en el tratamiento de episodios de manía donde el uso del litio está contraindicado. Presentamos el caso de un hombre de 53 años con trastorno esquizoafectivo no especifico y mala adherencia al tratamiento, quien al iniciar manejo con AVP desarrolló una intoxicación por este fármaco, independiente a los niveles en suero de este, revolviéndose con líquidos intravenosos y reajuste de dosis.

Atopic dermatitis (AD) is a common, chronic inflammatory skin disease that oftentimes requires complex therapy. Poor adherence is a major barrier to AD treatment success. An interspecialty, virtual roundtable panel was held, through which clinical dermatologists, allergists, and behavioral and social psychologists discussed AD management and adherence. Relevant literature was reviewed, and the content of this article was organized based on the roundtable discussion. Current guidelines for AD treatment include maintenance and acute therapy for mild-to-severe AD. Therapy is often complex and requires significant patient involvement, which may contribute to poor treatment adherence. Behavioral and social psychology strategies that may help improve adherence include scheduling timely follow-up appointments, using a clearly written eczema action plan (EAP), reducing perceived treatment burden, utilizing anchoring techniques, sharing anecdotes, and rewarding children using positive reinforcement and stickers. There are multiple practical ways by which providers can improve both the management and treatment adherence of patients with AD.

Adherence to prescribed medication is an imperative issue which can be directly linked with the management of diabetes mellitus. WHO identifies poor adherence is the most significant cause of uncontrolled blood sugar level. A prospective observational study was conducted in in-patients admitted to general medicine department diagnosed with diabetes mellitus from September 2019 to February 2020. Data was collected from case sheets of patients for age, gender, and socio- economic data. Informed consent was obtained from patients or bystanders before study. Direct interview was conducted with patients using standardized questionnaire known as MMAS-8. Patient’s adherence to medications was assessed using scores obtained from the adherence scale. Among 100 in-patients 62 (62%) patients were male and 38 (38%) patients were female. Most of the patients had low adherence among both genders. Patients under age group of 41-60 years were more (58%) in which 46% had low adherence. It was observed that, married patients were more with low adherence (58%) followed by unmarried. When taking account of education of the patient, graduates and above were only 22 patients (22%) but most of them (16% ) had moderate/high adherence. Education of the patients had a significant positive correlation (i.e., p value = 0.0000002) between low adherence and high adherence of patients. This study showed that the adherence to anti-diabetic medications in diabetic patients were very less. It needs to be continuously evaluated in order to reduce complications and improve quality of life of patients. Keywords: Medication adherence, MMAS-8, Uncontrolled diabetes

Introduction: Poor adherence to pharmacological treatment is prevalent in schizophrenia, affecting more than half of patients at some time, with increased risks of clinical worsening, adverse outco...

Resistant hypertension (RH) is characterized by the use of three or more antihypertensive drugs without reaching the goal of controlling blood pressure (BP). For a definitive diagnosis of RH, it is necessary to exclude causes of pseudoresistance, including the white-coat effect, errors in BP measurement, secondary hypertension, therapeutic inertia, and poor adherence to lifestyle changes and pharmacological treatment. Herein, we report the history of a patient with long-standing uncontrolled BP, even when using seven antihypertensive drugs. Causes of secondary hypertension that justified the high BP levels were investigated, in addition to the other causes of pseudo-RH. In view of the difficult-to-control BP situation, it was decided to hospitalize the patient for better investigation. After 5 days, he had BP control with practically the same medications previously used. Finally, all factors related to the presence of pseudo-RH are discussed, especially poor adherence to treatment. Poor adherence to antihypertensive treatment is common in daily medical practice, and its investigation is of fundamental importance for better management of BP.

Objective:Cognitive screening is an efficient method of detecting cognitive impairment in adults and may signal need for comprehensive assessment. Cognitive screening is not, however, routinely used in youth aged 12–25, limiting clinical recommendations. The aims of this review were to describe performance-based cognitive screening tools used in people aged 12–25 and the contexts of use, review screening accuracy in detecting cognitive impairment relative to an objective reference standard, and evaluate the risk of bias of included studies.Method:Electronic databases (Scopus, Medline, PsychINFO, and ERIC) were searched for relevant studies according to pre-determined criteria. Risk of bias was rated using the Quality Assessment of Diagnostic Accuracy Studies-2. Dual screening, extraction, and quality ratings occurred at each review phase.Results:Twenty studies met the review inclusion criteria. A diverse range of screening tools (length, format) were used in youth aged 12–25 with or without health conditions. Six studies investigating cognitive screening were conducted as primary accuracy studies and reported some relevant psychometric parameters (e.g., sensitivity and specificity). Fourteen studies presented correlational data to investigate the cognitive measure utility. Studies generally presented limited data on classification accuracy, which impacted full screening tool appraisal. Risk of bias was high (or unclear) in most studies with poor adherence to the Standards for Reporting Diagnostic Accuracy Studies (STARD) criteria.Conclusions:Few, high quality studies have investigated the utility of cognitive screening in youth aged 12–25, with no screening measure emerging as superior at detecting cognitive impairment in this age group.

Poor adherence to food safety and wholesome practices in meat processing and handling is a common phenomenon in some public abattoirs in Nigeria. The quality of beef consumed by the University community is an issue of concern. Information on the extent of beef patronage has not been documented. Thus, beef demand at the University of Ibadan abattoir was assessed. Ante-mortem and post-mortem inspections by the University Veterinarian were performed on slaughter days from January 2013 to April 2015. The data collected were customer: day of purchase, Department/Unit, sex and rank. The quantity demanded and the parts requested were also noted. Data were analyzed using descriptive statistics. The results showed that a total of 22,884 contacts were recorded. An increase in patronage from 42.24% in 2013 to 57.76% in 2014 was evident. Women (53.60%) requested for meat than male counterpart. The requests for 1-2kg, 2-4kg and above 4kg at a time were 58.9%, 19.1% and10.0% respectively. For the day of purchase, the patronage was higher on Fridays (59.20%) as compared to Wednesdays. The last week of the month attracted higher demand (36.20%) than weeks 1 (21.0%), 2 (22.3%) and 3 (20.5%). A noticeable increase in demand was during festive periods. A high percentage occurred in the number of customers that specified the actual parts (63.5%) of the meat requested and those that did not while females specified more (57.82%) than males. Highest preference for special parts was observed among the Professors (45%). More patronage was observed for people at closer Departments/Unit to the abattoir. It may be concluded that day of slaughter, proximity to slaughter house, sex, status and special occasions are vital factors that affect beef demand enterprise in the University of Ibadan. Keywords: Beef demand; slaughter house; University of Ibadan

Background In short-term studies, poor adherence to inhaled corticosteroids (ICS) has been associated with worse asthma control, but the association of long-term adherence and disease control remains unclear. Objective To assess the relationship between 12-year adherence to ICS and asthma control in patients with adult-onset asthma. Methods As part of the Seinäjoki Adult Asthma Study, 181 patients with clinically confirmed new-onset adult asthma and regular ICS medication were followed-up for 12 years. Adherence (%) to ICS was assessed individually ((µg dispensed/µg prescribed)×100) during the follow-up. Asthma control was evaluated after 12 years of treatment according to the Global Initiative for Asthma 2010 guideline. Results Asthma was controlled in 31% and not controlled (partly controlled or uncontrolled) in 69% of the patients. Patients with not-controlled asthma were more often male, older, nonatopic and used higher doses of ICS than those with controlled disease. The mean±sd 12-year adherence to ICS was 63±38% in patients with controlled asthma and 76±40% in patients with not-controlled disease (p=0.042). Among patients with not-controlled asthma, those with lower 12-year adherence (, Patients with not-controlled asthma and poor adherence show increased FEV1 decline. Special emphasis should be placed on ICS adherence in subjects who do not have controlled asthma, as they seem to be at higher risk of developing fixed airway obstruction. https://bit.ly/2LOXL4f

Background: Human immunodeficiency virus (HIV) infection causes a derangement in growth. Antiretrovirals promote immune function restoration and improvement in the quality of life. Variables such as poor adherence to drugs and unsuppressed viral load may negatively influence growth in HIV-infected children. The study aimed at determining the growth in HIV-infected males aged 8–17 years in Abakaliki who were on antiretrovirals. Methods: Acase–control hospital-based study, involving 80 HIV-infected males aged 8–17 years who were matched for age and socioeconomic class with 80 HIV‑uninfected controls. Growth parameters including the heights, weights, and body mass index (BMI) of subjects and controls were measured, and Z scores for age derived for height, weight, and BMI. Results: The mean height of subjects (1.420 ± 0.18 m) was significantly lower than that of controls (1.515 ± 0.17 m). The mean weight of subjects (35.09 ± 12.48 kg) was significantly low compared to controls (42.21 ± 12.95 kg). A significant difference was documented in the mean BMI for age among subjects (16.78 ± 2.12 kg/m2 ) and controls (17.93 ± 2.27 kg/m2 ). There was a significant relationship between CD4 count and growth (BMI) (P = 0.006) and between duration on highly active antiretroviral therapy and growth (P = 0.024). Conclusion: HIV‑infected males had significantly impaired growth despite the use of antiretroviral drugs. Keywords: Children, human immunodeficiency virus antiretroviral drugs, males, physical growth

Background Gout treatment is not optimized globally, often due to therapeutic inertia by physicians or poor adherence to urate-lowering medications by patients. A patient decision aid (PDA) to facilitate shared decision making (SDM) in gout treatment may overcome these physician-patient barriers. Objective The study explored the views of physicians and patients on a novel locally designed gout treatment PDA prototype. Design Qualitative descriptive design was used to gather data from in-depth-interviews (IDI) and focus group discussions (FGD). Data analysis was via thematic analysis. Emergent themes shaped a revised version of the PDA. Setting and participants Adult Asian patients with recent acute gout exacerbations and local Primary Care Physicians (PCP) in Singapore were purposefully chosen. 15 patients with gout and 11 PCPs participated across three IDIs and six FGDs, with the investigators exploring their views of a prototype gout treatment PDA. Results Patients and physicians generally concurred with the content and design of the PDA prototype. However, while patients preferred fewer treatment details, the PCPs desired more information. Patients preferred the display of statistics, while PCPs felt that numbers were not relevant to patients. The latter were hesitant to include treatment options that were unavailable in primary care. Both stakeholders indicated that they would use the PDA during a consultation. PCPs would need further training in SDM, given a lack of understanding of it. Conclusion and patient contribution Patients will be the prime users of the PDA. While their views differed partially from the physicians, both have jointly developed the novel gout treatment PDA.