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Aims: To discern psychosocial factors of non-insulin antidiabetes drug (NIAD) adherence.Methods: A cross-sectional study based on the theory of planned behavior (TPB). Adults with type 2 diabetes (T2D) who were members of Diabète Québec, a provincial association of persons with diabetes, and were prescribed at least one NIAD were invited to complete a web-based questionnaire. We measured variables ascertaining TPB constructs and other factors potentially associated with NIAD adherence (e.g., habit, social support, and mental health). NIAD adherence was assessed using the 8-item Morisky Medication Adherence Scale. Factors were identified using a multivariate logistic regression model.Results: In our study, 901 participants (373 women; 515 retired; mean age: 62.7 years) with T2D for a mean of 10 years, completed the questionnaire. Participants exhibited a high intention to adhere to their NIAD treatment (mean score=5.8/6), positive attitudes toward adherence (mean score=5.5/6), and elevated perceived behavioral control in taking their medication (mean score=5.7/6). Only 405 (45%) participants reported high adherence (score=8/8). Perceived behavioral control, habit, older age, no perceived side effects, a longer period since T2D diagnosis and a lower number of NIAD daily doses were significantly associated with adherence (p<0.05).Conclusion: We identified several factors that may be modified for NIAD adherence and thereby provided insight into future adherence-enhancing intervention targets. [ABSTRACT FROM AUTHOR]

Summary: Background: There is evidence in the literature that inhaled corticosteroids (ICSs) are safe for pregnant women with asthma and their infants. Although this is useful information about ICS use during pregnancy, some articles must be viewed cautiously because of lack of power and adjustment for potentially important confounding variables. Objective: To summarize evidence on the potential effects of ICSs to treat asthma in pregnant mothers and their children with particular focus on study power. Methods: Studies published before September 1, 2007, and focusing mainly on ICS use for asthma treatment during pregnancy were researched in Pubmed and the Cochrane Library. Post hoc power calculations were completed using data reported in the published articles. Results: Twenty-three studies that evaluated the associations between ICS use during pregnancy and maternal and/or perinatal outcomes were retained. Only six studies on the association between ICS use and maternal outcomes reported significant results; five studies found significant associations between ICS use and perinatal outcomes. Regarding non-significant results, two studies on maternal outcomes and seven studies on perinatal outcomes had a power higher than 80% to detect a relative risk of 1.5 or a mean birth weight difference of 500g. Conclusion: While there currently is some degree of evidence to support the safety of ICS use during pregnancy, this review highlights the limited statistical power of several studies published in this area. [Copyright &y& Elsevier]

Summary: Background: Combination therapy should be prescribed to patients with moderate to severe asthma after daily long-term treatment with inhaled inhaled corticosteroids (ICS) has been tried without obtaining adequate control and it is not indicated to be used as first line treatment in asthma. Objectives: To describe the use of combination therapy for the treatment of asthma and to evaluate to which extent it is prescribed as recommended. Methods: A cohort of 14559 new users of a combination therapy identified between January 1, 2000 and September 30, 2003 was selected from beneficiaries of the Régie de l’assurance maladie du Québec. We evaluated whether the combination therapy was prescribed according to the Canadian Asthma Guidelines. A logistic regression analysis was also performed to identify patient''s and physician''s characteristics associated with the adherence to the recommendations of the Canadian Asthma Guidelines for the prescription of a combination therapy. Results: Only 40% of users of combination therapy filled a prescription of ICS in the year preceding the initiation of the therapy and this proportion decreased by 21.8% from 2000 to 2003. Patients who received their first combination therapy in an emergency department were less likely to have used ICS previously, but patients treated by a respiratory physician and patients with co-morbidities, markers of asthma severity and markers of uncontrolled asthma were more likely to have used ICS previously. Conclusion: Combination therapy has not been used according to the Canadian Asthma Guidelines in a large proportion of patients. [Copyright &y& Elsevier]

Background: Four studies investigating the association between inhaled corticosteroid (ICS) use during pregnancy and perinatal mortality reported no significantly increased risk. These studies must be interpreted with caution because they have insufficient statistical power and a lack of adjustment for potential confounders. Objectives: We sought to evaluate whether asthmatic women exposed to ICSs during pregnancy are more at risk of perinatal mortality than asthmatic women not exposed. We also sought to estimate the risk of perinatal mortality as a function of the daily ICS dose taken during pregnancy. Methods: From the linkage of 3 administrative databases from Quebec, a cohort including 13,004 single pregnancies from asthmatic women was constructed. We used a 2-stage sampling cohort design to obtain information on cigarette smoking from the medical charts of 487 mothers. The final estimates of the odds ratios (ORs) of perinatal mortality were estimated with a logistic regression model. Results: The cohort was formed of 4,140 women who used greater than 0 to 250 μg/d ICS, 1,140 women who used greater than 250 μg/d ICS, and 7,724 nonusers of ICSs during pregnancy. Women exposed to ICSs (any dose) had a nonsignificant increased risk of perinatal mortality (OR, 1.07; 95% CI, 0.70-1.61). The use of greater than 250 μg/d ICS was associated with a nonsignificant 52% increased risk of perinatal mortality (OR, 1.52; 95% CI, 0.62-3.76). Conclusion: The risk of perinatal mortality was not found to be significantly associated with ICS use during pregnancy. The result associated with higher doses of ICSs is limited due to a lack of statistical power and a possibility of residual confounding by asthma severity and control. [ABSTRACT FROM AUTHOR]