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Elisabeth Van Aken,1,2 Mérédis Favreau,3 Eva Ramboer,3 Kris Denhaerynck,4,5 Karen MacDonald,4 Ivo Abraham,4,6– 8 Heidi Brié3 1Department of Ophthalmology, AZ Sint-Elisabeth, Zottegem, Belgium; 2Department of Head and Skin, Ghent University, Ghent, Belgium; 3Medical Department, Novartis Pharma, Vilvoorde, Belgium; 4Department of Research and Consulting, Matrix45, Tucson, AZ, USA; 5Department of Public Health, University of Basel, Basel, Switzerland; 6Center for Health Outcomes and Pharmacoeconomic Research, University of Arizona, Tucson, AZ, USA; 7Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA; 8Department of Family and Community Medicine, College of Medicine – Tucson, University of Arizona, Tucson, AZ, USACorrespondence: Heidi BriéN.V. Novartis Pharma S.A, Medialaan 40, B-1800 Vilvoorde, BelgiumTel +32.2.246.1774Email heidi.brie@novartis.comAim: Evaluate long-term real-world treatment patterns and associated effectiveness and safety outcomes in patients with diabetic macular edema (DME) treated ≥ 36 months with 0.5mg ranibizumab.Methods: Open-label observational effectiveness study in 9 Belgian clinics. Included were primary treated eyes of 55 DME patients between August 2014 and March 2015 and followed for 3.5± 1.8 years. Eyes were 21.8% treatment (TX)-naïve, 9.1% non-naïve with exclusive prior anti-VEGF treatment (PRIOR-anti-VEGF), and 63.6% non-naïve with other prior treatments (PRIOR-other). Intravitreal injections with ranibizumab were administered per ophthalmologists’ best clinical judgment. Trend testing of changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) over time occurred using mixed regression analysis.Results: The mean±SD number of treatments in the first year was 5.1± 3.0 (TX-naïve), 4.5± 2.7 (PRIOR-anti-VEGF) and 5.6± 3.1 (PRIOR-other). At 12 months, BCVA increased by 8.9± 16.4 letters from 59.7± 9.3 at baseline in TX-naïve (p< 0.0001), by 11.8± 9.9 from 61.6± 8.5 in PRIOR-anti-VEGF (p=0.03), and by 4.2± 10.6 from 58.2± 14.6 in PRIOR-other groups (p=0.0002). BCVA remained stable for the remainder of follow-up in all groups. CRT decreased over the first 2 months by monthly rates of − 43.8μm in TX-naïve (p=0.04), − 75.7μm in PRIOR-anti-VEGF (p=0.02), and − 65.8μm in PRIOR-other eyes (p=0.0003), showing stability afterwards. No unknown adverse events were recorded; a painful eye following injection was registered with a possible relationship to the treatment.Conclusion: This real-world study confirms the effectiveness of ranibizumab in preventing a decline in BCVA and demonstrated initial improvement and subsequent retention of BCVA in DME patients ≥ 36 months. Ranibizumab initially reduced and then maintained CRT. However, these data reveal that treatment intensity and BCVA and CRT outcomes are lower than those found in early efficacy trials. Under-treatment likely accounts for this efficacy-effectiveness gap. Yet, intravitreal ranibizumab is an effective and safe long-term treatment for DME under conditions of significant heterogeneity in patients and treatment patterns.Keywords: diabetic macular edema, ranibizumab, best-corrected visual acuity, central retinal thickness, long-term effectiveness

Anita M Leys,1,2 Eva Ramboer,3 Mérédis Favreau,3 Kris Denhaerynck,4,5 Karen MacDonald,4 Ivo Abraham,4,6– 8 Heidi Brié3 1Department of Ophthalmology, Universitair Ziekenhuis Gasthuisberg, KULeuven, Leuven, Belgium; 2Oogartsen, Alken, Belgium; 3Novartis Pharma, Vilvoorde, Belgium; 4Matrix45, Tucson, AZ, USA; 5Department of Public Health, University of Basel, Basel, Switzerland; 6Center for Health Outcomes and Pharmacoeconomic Research, University of Arizona, Tucson, AZ, USA; 7Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA; 8Department of Family and Community Medicine, College of Medicine – Tucson, University of Arizona, Tucson, AZ, USACorrespondence: Heidi BriéN.V. Novartis Pharma S.A., Medialaan 40, Vilvoorde B-1800, BelgiumTel +3222461774Email heidi.brie@novartis.comPurpose: To evaluate long-term, real-world treatment patterns and outcomes of ranibizumab 0.5 mg for neovascular age-related macular degeneration (nAMD) in a Belgian cohort.Patients and Methods: This Belgian (BE) cohort of the 5-year global observational LUMINOUS study included 229 patients with nAMD. Outcomes included visual acuity (VA), central retinal thickness (CRT) and safety.Results: The mean age was 79.5± 7.7 years. The majority of patients (67.7%) were female and all patients were Caucasian. Most patients previously received ranibizumab with only 17.5% of patients being treatment-naïve. The injection frequency declined over time irrespective of prior treatment status (p< 0.0001), with treatment-naïve eyes receiving a mean of 4.2± 2.9 yearly injections and prior-ranibizumab eyes 3.6± 2.7. Regression analysis confirmed first-year VA increases for treatment-naïve eyes (p=0.002) followed by a slight decrease of − 1.8 letters per year. For prior-ranibizumab eyes, the visual changes over 1 year were statistically non-significant (p=0.90) but declined slightly after year one (p< 0.0001). Anatomically, the CRT of treatment-naïve eyes decreased over time from baseline (p< 0.0001), whereas the CRT of prior-ranibizumab eyes remained stable (p=0.43). No new safety findings were identified.Conclusion: LUMINOUS-BE reconfirms the well-characterized benefit-risk profile of ranibizumab for nAMD treatment. The observed low injection frequency reflects a need for more rigorous treatment in real-world settings.Clinical Trial Registration: NCT01318941.Keywords: ranibizumab, effectiveness, safety, treatment patterns, neovascular age-related macular degeneration, Belgium

Jean-Marie Rakic,1 Anita Leys,2 Heidi Brié,3 Kris Denhaerynck,4 Christy Pacheco,4 Stefaan Vancayzeele,3 Christine Hermans,3 Karen MacDonald,4 Ivo Abraham4,5 1Department of Ophthalmology, Centre Hospitalier Universitaire de Liège, Site du Sart Tilman, Liège, Belgium; 2Leuven University Eye Hospital, Leuven, Belgium; 3Novartis Pharma, Vilvoorde, Belgium; 4Matrix45, Tucson, AZ, USA; 5Center for Health Outcomes and Pharmacoeconomic Research, University of Arizona, Tucson, AZ, USA Introduction: The aim of this study was to examine ranibizumab treatment patterns in "real-world" practice and clinical settings, as well as to assess quality of life outcomes over a 24-month period. Materials and methods: This was a prospective, observational, multicenter, open-label study of 0.5 mg of ranibizumab administered intravitreally. Patients were followed over 24 ± 3 months with intermediate data points at 6 ± 2 months and 12 ± 2 months, and a limited data point at 2.5 ± 1 month that coincided with the end of the loading phase. Outcomes included visual acuity (Early Treatment Diabetic Retinopathy Study), visual function (National Eye Institute Visual Function Questionnaire-25 [NEI VFQ-25]), quality of life (Health Utilities Index Mark III [HUI3]), and safety. Results: A total of 267 patients with wet age-related macular degeneration (mean ± standard deviation [SD] age = 78.5 ± 7.3 years; 62.4% were female; 34.5% with dual eye involvement; 74.9% were treatment-naïve) were treated (309 eyes were treated). The mean ± SD Early Treatment Diabetic Retinopathy Study score at baseline was 56.3 ± 14.3 letters. The mean ± SD number of injections over 24 months was 7.6 ± 4.1, including 2.5 ± 0.7 and 5.9 ± 3.6 during the loading and maintenance phases, respectively, with corresponding treatment intervals of 4.8 ± 1.4 weeks and 11.5 ± 9.5 weeks, respectively. Improvements in visual acuity over baseline were reached at 2.5 months and maintained at 6 months (both P < 0.0001). The mean visual acuity increase over baseline at 12 months was not significant (P = 0.08); the decline over baseline at 24 months statistically significant (P = 0.02). Overall, 94.3% of patients showed stable or improved disease at 6 months and 81.5% of patients showed stable or improved disease at 24 months. At 6 months, improvements over baseline were significant for VFQ-25 (P = 0.03) and HUI3 (P = 0.02), but not at 12 months and 24 months. Improvements in VFQ-25 and HUI3 were maintained at 24 months in 38% and 34% of patients, respectively. In total 78 serious adverse events were reported in 40 patients and 77 nonserious adverse events in 34 patients. Nine serious adverse events and nine nonserious adverse events in 14 patients were suspected to be related to ranibizumab treatment. Conclusion: The "real-world" clinical effectiveness of ranibizumab was evidenced by the initial improvements over baseline in visual acuity and quality of life, as well as the maintenance of these outcomes at baseline levels at 24 months, and this was observed under variable treatment conditions. The findings underscore the need for individualized treatment with regular monitoring to achieve optimal vision and quality of life outcomes. Keywords: ranibizumab, age-related macular degeneration, neovascular macular degeneration, visual acuity, visual function, quality of life

Background: Literature review suggests that adherence to immunosuppressive drugs may be lower in recipients of living than of deceased donor kidney grafts, possibly because of profile differences. Objective: To compare the level of immunosuppressive adherence levels between patients with deceased and living (-related; -unrelated) donor grafts in Switzerland. Methods: Using data from two similar cross-sectional studies at two transplant centers in Switzerland, the level of adherence between the two groups was compared. Medication adherence was assessed by self-report or electronic monitoring. Possible explanatory factors included age, beliefs regarding immunosuppressive drugs, depressive symptomatology, pre-emptive transplantation, and the number of transplants received, were also considered. Data were analyzed using logistic regression analysis. Results: Unadjusted non-adherence odds were 2 to 3 times higher in living-related than deceased donor transplantation (ORs: 2.09-3.05; p<0.05). Adjustment for confounders showed that these differences were associated most with the younger age of living-related subjects and the belief that immunosuppressive drugs are less important for living-related donations. Conclusion: There is a lower immunosuppressive adherence in recipients of living-related donor kidneys, possibly owing to differences in patient profile (ie, health beliefs regarding their immunosuppressive needs), knowledge of which may enhance adherence if addressed. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although the focus of health care for people seeking asylum in Western European countries is usually on communicable diseases, there is little data about the general health care need of this population. In this study, we investigated the actual burden of disease among asylum seekers. METHODS: Data were collected from a Swiss Health Maintenance Organisation (HMO; a type of managed care organization in which physicians act as gate keepers) that was set up specifically to provide health care for asylum seekers. The data included socio-demographic characteristics, international classification of diseases (ICD-10) diagnoses and number of clinic visits. Descriptive statistics were used to assess the types of health problems and the number of clinic visits. Logistic regression analysis was used to determine whether age, gender or country or region of origin was predictive in terms of incidence of disease as diagnosed by using ICD classifications. RESULTS: The total number of asylum seekers (mean age 22 years; 38% women) enrolled in the HMO from 2000 through 2003 was 979. Half of this group came from the former country of Yugoslavia. The remainder came primarily from sub-Saharan Africa, Turkey, Iraq and Sri Lanka. The most common health problems encountered in the population included musculoskeletal diseases, respiratory diseases, depression and post-traumatic stress disorder. The prevalence of all disease clusters was significantly associated with age. One-fifth of the population did not request health care at all during the time they were enrolled in the HMO. It is not known whether those who did not visit the medical clinic did not require health care or just chose not to request clinic services. CONCLUSIONS: The most frequent health problems encountered in the study population were chronic medical conditions, not communicable acute diseases. Although health care services provided to asylum seekers usually focus on episodic acute care, what this group actually needs is continuity of care. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to explore nurses' responses to ethical dilemmas in daily nursing practice. Background. Concern about nurses' ethical competence is growing. Most nurses perceived that there were barriers in their work environment to ethical practice, compromising their ability to perform ethically. Since most research focuses on contextual barriers to nurses' ethical practice, little is known about how nurses involve themselves in ethical decision-making and action in daily care. Method. A meta-analysis of nurses' ethical behaviour was conducted using data from nine studies in four countries (n = 1592 registered nurses). In all studies, the Ethical Behaviour Test was used to measure nurses' ethical responses, based on an adapted version of Kohlberg's theory of moral development. Data were analysed using random-intercept regression analysis. Findings. All groups, except the expert group, displayed a uniform pattern of conventional ethical reasoning and practice. When nurses were faced with ethical dilemmas, they tended to use conventions as their predominant decision-guiding criteria rather than patients' personal needs and well-being. Conclusion. Conformist practice (following conventions rather than pursuing good for the patient) constitutes a major barrier for nurses to take the appropriate ethical actions, as creativity and critical reflection are absent. There is an urgent need to find ways to promote nurses' ethical development from conventional to postconventional ethical practice. More research is needed to strengthen existing empirical evidence. [ABSTRACT FROM AUTHOR]

Adherence to fluid restrictions and dietary and medication guidelines as well as attendance at prescribed hemodialysis sessions of a hemodialysis regimen are essential for adequate management of end-stage renal disease. A literature review was conducted to determine the prevalence and consequences of nonadherence to the different aspects of a hemodialysis regimen and the methodological obstacles in research on nonadherence. Nonadherence to the prescribed regimen is a common problem in hemodialysis and is associated with increased morbidity and mortality. Research on nonadherence is associated with 2 major obstacles: inconsistencies in definitions and invalid measurement methods. Further research is needed to validate measurement methods and to establish clinically relevant operational definitions of nonadherence. [ABSTRACT FROM AUTHOR]

Abstract Background In spite of the high prevalence of allergic rhinitis (AR) and the evidence-based guidelines for treatment, little is known about the patients’ perceived knowledge level, expectations, preferences for treatment, and fear for side effects of treatment for AR. This study aimed at gaining insight into these patient-related factors. Methods This explorative cross-sectional survey study included a convenience sample of 170 patients with rhinitis and clinical suspicion of allergy at the department of Otorhinolaryngology and Allergology. Patients’ perceived knowledge level, expectations, patient preferences, and fear of side effects of allergy treatment were collected via a self-report questionnaire developed for the purpose of this study. Results 22% of all patients (38/170) reported to have knowledge about anti-allergic treatment. 40% (55/170) of rhinitis patients expected to be cured by the prescribed treatment, whereas 43% (73/170) of patients expected suppression of allergic symptoms. Nasal spray was the preferred route of anti-allergic drug administration in 30% (52/170) of patients, followed by oral treatment (24%; 42/170), combination therapy (16%; 30/170), and injection therapy (15%; 27/170). More patients would choose a combination treatment with step-down approach (31%; 53/170) than mono-therapy with a step-up approach (20%; 34/170). Fear for side effects was reported mainly for nasal corticosteroids (48%; 81/170) and less for oral antihistamines (33%; 36/170), leucotriene antagonists (21%, 36/170) and immunotherapy (19%, 33/170). Conclusions Patients consulting for rhinitis have high expectations of anti-allergic treatment, prefer a nasal spray above oral treatment, prefer combined treatment rather than monotherapy, and fear adverse events of anti-allergic treatment.

Abstract Background Language barriers have a major impact on both the quality and the costs of health care. While there is a growing body of evidence demonstrating the detrimental effects of language barriers on the quality of health care provision, less is known about their impact on costs. This purpose of this study was to investigate the association between language barriers and the costs of health care. Methods The data source was a representative set of asylum seekers whose health care was provided by a Swiss Health Maintenance Organisation (HMO). A cross-sectional survey was conducted: data was collected on all the asylum seekers' health care costs including consultations, diagnostic examinations, medical interventions, stays in the clinic, medication, and interpreter services. The data were analysed using path analysis. Results Asylum seekers showed higher health care costs if there were language barriers between them and the health professionals. Most of these increased costs were attributable to those patients who received interpreter services: they used more health care services and more material. However, these patients also had a lower number of visits to the HMO than patients who faced language barriers but did not receive interpreter services. Conclusion Language barriers impact health care costs. In line with the limited literature, the results of this study seem to show that interpreter services lead to more targeted health care, concentrating higher health care utilisation into a smaller number of visits. Although the initial costs are higher, it can be posited that the use of interpreter services prevents the escalation of long-term costs. A future study specially designed to examine this presumption is needed.

Abstract Background Electronic monitoring (EM) is used increasingly to measure medication non-adherence. Unbiased EM assessment requires fulfillment of assumptions. The purpose of this study was to determine assumptions needed for internal and external validity of EM measurement. To test internal validity, we examined if (1) EM equipment functioned correctly, (2) if all EM bottle openings corresponded to actual drug intake, and (3) if EM did not influence a patient's normal adherence behavior. To assess external validity, we examined if there were indications that using EM affected the sample representativeness. Methods We used data from the Supporting Medication Adherence in Renal Transplantation (SMART) study, which included 250 adult renal transplant patients whose adherence to immunosuppressive drugs was measured during 3 months with the Medication Event Monitoring System (MEMS). Internal validity was determined by assessing the prevalence of nonfunctioning EM systems, the prevalence of patient-reported discrepancies between cap openings and actual intakes (using contemporaneous notes and interview at the end of the study), and by exploring whether adherence was initially uncharacteristically high and decreased over time (an indication of a possible EM intervention effect). Sample representativeness was examined by screening for differences between participants and non-participants or drop outs on non-adherence. Results Our analysis revealed that some assumptions were not fulfilled: 1) one cap malfunctioned (0.4%), 2) self-reported mismatches between bottle openings and actual drug intake occurred in 62% of the patients (n = 155), and 3) adherence decreased over the first 5 weeks of the monitoring, indicating that EM had a waning intervention effect. Conclusion The validity assumptions presented in this article should be checked in future studies using EM as a measure of medication non-adherence.

Background: Electronic monitoring (EM) is used increasingly to measure medication non-adherence. Unbiased EM assessment requires fulfillment of assumptions. The purpose of this study was to determine assumptions needed for internal and external validity of EM measurement. To test internal validity, we examined if (1) EM equipment functioned correctly, (2) if all EM bottle openings corresponded to actual drug intake, and (3) if EM did not influence a patient's normal adherence behavior. To assess external validity, we examined if there were indications that using EM affected the sample representativeness.Methods: We used data from the Supporting Medication Adherence in Renal Transplantation (SMART) study, which included 250 adult renal transplant patients whose adherence to immunosuppressive drugs was measured during 3 months with the Medication Event Monitoring System (MEMS). Internal validity was determined by assessing the prevalence of nonfunctioning EM systems, the prevalence of patient-reported discrepancies between cap openings and actual intakes (using contemporaneous notes and interview at the end of the study), and by exploring whether adherence was initially uncharacteristically high and decreased over time (an indication of a possible EM intervention effect). Sample representativeness was examined by screening for differences between participants and non-participants or drop outs on non-adherence.Results: Our analysis revealed that some assumptions were not fulfilled: 1) one cap malfunctioned (0.4%), 2) self-reported mismatches between bottle openings and actual drug intake occurred in 62% of the patients (n = 155), and 3) adherence decreased over the first 5 weeks of the monitoring, indicating that EM had a waning intervention effect.Conclusion: The validity assumptions presented in this article should be checked in future studies using EM as a measure of medication non-adherence. [ABSTRACT FROM AUTHOR]

Objective: Nonadherence with immunosuppressive regimen (NAH) is a major risk factor for poor outcome after renal transplantation (RTX). The aim of this study was to test the effectiveness of a 3 months educational-behavioral intervention aimed at remediating non-adherence in non-adherent RTX as assessed by electronic event monitoring. Methods: This randomized controlled trial (RCT) included 18 non-adherent renal transplant recipients (21.4% f. - age 45.6 ± 1.2 y) identified during a 3 months run-in period measuring NAH using Electronic Event Monitoring (EEM) and using an algorithm to classify patient as NA. NAH patients were randomly assigned to either intervention (IG, N = 6) or enhanced usual care group (EUC, N = 12). NAH was assessed by EEM in both the IG and EUC groups. After the 3 months intervention period, a 6 months follow-up was done. EUC implied usual care and notification of treating physician about NAH as well as severe depression or suicidal ideation if applicable. The 3 months intervention included one home visit and 3 follow-up telephone calls on a monthly basis by a nurse who used behavioral, educational and social support interventions for remediation of NAH. EEM out-prints allowed detailed feedback to patients concerning their individual medication taking dynamics in the IG. Results: EEM parameters improved from baseline until after 3 months intervention in the IG (N = 5) compared to EUC (N = 9) (see figure 1 and 2). The figures only show taking and timing adherence, and indicate the level of NA for being at risk. A generalized estimating equation type logistic regression using a binary sequence of daily EEM events (dose taken or not) showed that at the end of the 3 months intervention period the IG showed 36% lower non-adherence compared with the enhanced usual care group (β = -0.4512, p = 0.0836, two-tailed). At 9 months (after 6 months follow-up) no significant difference between the groups (β = 0.0253, p = 0.95, two-tailed) was found indicating a wean out effect when the intervention was stopped. Conclusions: The findings of this RCT suggest that it was feasible to remediate non-adherence with the immunosuppressive regimen, providing a possible pathway to improve clinical outcome in RTX. [ABSTRACT FROM AUTHOR]

Objective: Even though light to moderate alcohol use might have beneficial effects on health, severe alcohol use is recognized as a major public health concern. Alcohol use has been studied to some extent in solid organ transplant populations, yet, very limited evidence has bee published on alcohol use and its correlates in the renal transplant population. The aim of this study was therefore to determine the prevalence and correlates of alcohol use in renal transplant recipients. Methods: This cross-sectional study is a secondary analysis of the Supporting Medication Adherence in Renal Transplantation (SMART) study. 284 patients were included in this analysis, 58.1% male, mean age: 54.02 y. (SD: 13.34); median years post transplantation 7 (IQR 3-11). The prevalence and frequency of alcohol use as well as the quantity of alcohol consumed were assessed by patient self-report using structured questionnaires. Patients were classified as being at low risk, moderate risk or severe risk based on WHO criteria. Selected psychosocial and behavioral correlates of alcohol use were explored to compare those patients consuming alcohol and those not given the small proportion of patients at risk. Results: 52.8% of the study participants reported to use alcohol. Of the 284 patients included in the analysis, 280 were drinking at low and 3 at moderate risk. However, 1 of the participants drinking at low risk according to WHO criteria was identified as binge drinker. Statistically significant correlates of alcohol use found in univariate analysis were, among others, male gender, current smoking, employment and higher education. In logistic regression analysis, male gender and paid work were found to increase the likelihood of consuming alcohol. Conclusions: Patterns of alcohol use and correlates are comparable to the general population. Severe alcohol use is less prevalent in renal transplant recipients compared to heart and liver transplantation (9% and 6%, respectively), where alcohol is known as an etiological factor in a proportion of patients with end-stage heart or liver disease. [ABSTRACT FROM AUTHOR]

Purpose Overweight and obesity are not unexpected following heart transplantation (HTx). The variability in body mass index (BMI) of populations has been observed, yet no study has addressed BMI disparities after HTx in different countries. We thus examined the variability in BMI of HTx recipients among countries who participated in the multi-continental BRIGHT study. Methods We conducted a secondary data analysis of the BRIGHT self-reported data for 1,373 HTx recipients in four continents, 11 countries, and 36 heart transplant centers. The BMI (kg/m2) was categorized into underweight (BMI < 18.5), normal weight (18.5 ≤ BMI < 25), overweight (25 ≤ BMI < 30), and obese (BMI ≥ 30). Controlling for age, gender, and education, the association between country and BMI was examined using multivariable linear regression. Results The median age was 56 years (IQR= 45, 63), 27.3% were female, and 34.1% had at least some university education. The mean BMI was 27.1 ± 5.7, and 59% were overweight or obese (see Figure). The highest mean BMI was in North America, followed by Australia, Europe, and South America. The regression analysis showed that higher age (B= 0.029, p=.013), male gender (B= 1.65, p<.001), and country (B= -0.11, p=.045) were significant predictors for higher BMI (R2= 0.03). The post-hoc analysis for the dummy-coded country showed that only the United States (B= 4.27, p <.001), Canada (B= 2.12, p=.005), and Australia (B= 2.24, p=.018) had a significantly higher BMI than the reference country with median BMI mean (Italy). Conclusion Our data show that overweight and obesity are highly prevalent in HTx with variation among geographical regions, which calls for population-specific weight control interventions. Despite the small variance in BMI explained by the predictors, our results about geographical disparities in BMI are comparable to the ISHLT registry data for the same period. More research is warranted to elucidate the etiologies and outcomes of these geographical differences. [ABSTRACT FROM AUTHOR]

Gender differences have been observed in health behavior, but have been understudied in transplantation. The aim of this study is to describe and compare gender differences in nonpharmacological health-related behaviors after heart transplantation (HTx) globally. This is a sub-analysis of the cross-sectional BRIGHT study (ClinicalTrials.gov ID: NCT01608477), including self-reported data of 1321 adult HTx recipients from 36-HTx-centers, 11-countries, and 4-continents. Design-adjusted, weighted Wald tests, weighted Chi-square, multiple linear regression and multivariate logistic regression were used when appropriate to compare gender differences in nonpharmacological health-related behaviors post-HTx (i.e. sun protection, diet keeping, physical activity, appointment keeping, alcohol use and smoking) globally and by continent. Overall, compared to males, females were more adherent to sun protection (p=0.00), to alcohol use and smoking cessation (OR 2.51 (95% CI [1.40-4.51])), females were less adherent to physical exercise (OR 2.18 (95% CI [1.28-3.73])). In Europe, compared to males, females were more adherent to sun protection alcohol use and smoking cessation (OR 3.78 (95% CI [1.73-8.27])). In Australia, compared to males, females were more adherent to sun protection A gender gap in post-HTx non pharmacological health behaviors was observed in sun protection, alcohol use and smoking cessation , with females being more adherent than males, yet less adherent regarding sufficient exercise. Gender specific approaches in adherence enhancing interventions should be developed and implemented [ABSTRACT FROM AUTHOR]