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Aims: Proprotein convertase subtilisin/kexin type 9 monoclonal antibodies (PCSK9 mAbs) are recommended for high-risk patients if the low-density lipoprotein cholesterol (LDL-C) targets are not achieved with statins and ezetimibe. We studied persistence and adherence to 1) PCSK9 mAbs and 2) statins and ezetimibe in a nationwide cohort of incident PCSK9 mAb users., Methods and Results: Information on all PCSK9 mAb users ≤80 years from 2015 through 2023 were extracted from the Norwegian Drug Registry. Discontinuation was defined as a gap in treatment ≥180 days and ≥90 days. Adherence was measured as the proportion of days covered (PDC) during the initial year of PCSK9 mAb therapy. We analyzed adherence of statins and ezetimibe before and after PCSK9 mAb initiation. Of 4,784 patients initiating PCSK9 mAbs, median age was 63 years, 41% were female, 61% had atherosclerotic disease, and 34% had familial hypercholesterolemia. Within three years after initiation, 17% experienced a PCSK9 mAb treatment gap exceeding 180 days. In the 12-month period preceding PCSK9 mAb initiation, 74% dispensed statins whereas 67% dispensed ezetimibe. These numbers were reduced to 35% for statins and 42% for ezetimibe during the 12-month period after PCSK9 mAb initiation. Atherosclerotic disease, using ≥3 statins previously, and older age were significantly associated with discontinuation of statins and ezetimibe., Conclusion: In this high-risk cohort of incident PCSK9 mAb users, more than 1 out of 2 stopped taking statin treatment whereas 40% discontinued ezetimibe. There is a major potential for improving adherence to oral LLD treatment following initiation of PCSK9 mAb., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Purpose Hypertension is a common cardiovascular co-morbidity after kidney transplantation and contributes to shortened graft and patient survival outcomes. However, by contrast with adherence to immunosuppressive drugs, adherence to antihypertensive treatment in kidney transplant recipients has been seldom explored. The aim of the current study was to assess adherence to antihypertensive drugs in kidney transplant recipients from the Cliniques Universitaires Saint-Luc and to look for demographic and clinical characteristics associated with drug adherence. Methods Demographic and clinical data were collected from medical files in a standardised case report form. Blood pressure was measured in the sitting position after 5 min rest, using validated oscillometric devices. Drug adherence was assessed by drug dosage in urine using liquid chromatography coupled with tandem mass spectrometry. Results Our analysis included 53 kidney transplants recipients (75% of men, mean age: 57.2 ± 12.6 years, time since kidney transplantation: 9.5 ± 7.3 years, blood pressure: 130 ± 16/78 ± 11 mmHg on 2.1 ± 1.1 antihypertensive drugs). The proportion of patients showing full drug adherence, partial drug adherence, and total non-adherence to antihypertensive drugs was 79% (N = 42), 15% (N = 8), and 6% (N = 3), respectively. Adherent patients did not differ from less or non- adherers in any of the analysed characteristics. Conclusion The proportion of patients adhering to antihypertensive drug treatment among kidney transplant recipients appears similar to that reported for immunosuppressive drugs in renal transplanted patients (∼70%), but much higher than that observed in patients with drug-resistant hypertension (30–40%). Our results need further confirmation in a large, multicenter, prospective cohort.

Abstract To evaluate the prevalence of self-reported drug adherence and factors associated, as well as clinical health outcomes, for industry workers with hypertension (HTN) and diabetes mellitus (DM). This was a cross-sectional study of 137 Brazilian industry workers with HTN and/ or DM. Self-reported adherence was assessed, and the disease control was defined through blood pressure and capillary glycemia values. Data were descriptively analyzed and the factors associated with adherence were evaluated using the Poisson model with robust variance to calculate prevalence ratios. The prevalence of self-reported drug adherence was 79.6% and the prevalence of disease control was 53.8%. There was no statistically significant association between the two variables. In the controlled disease group, non-adherence was associated with being under 40 years of age, not having a partner, and having a risky alcohol consumption habit. In the uncontrolled disease group, adherence was highest for participants aged 40 years and older. The prevalence of self-reported drug adherence was high, but the prevalence of disease control was low and not associated with adherence, indicating that the self-reported adherence measure may be inaccurate. Our findings identify some factors that explain non-adherent behavior in the workforce.

Copyright of Namık Kemal Tıp Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The influence of immunosuppressive therapy on immunogenicity after COVID-19 vaccination remains unclear. This study surveys patients who receive immunosuppressive therapy about whether or not they paused their immunosuppressive medication while receiving SARS-CoV-2 vaccination. Methods: In this prospective observational study, immunosuppressed participants were asked by phone and email about their medication before and during vaccination and who—if anyone—advised them to pause their medication. In addition, a baseline paper-based questionnaire contributes general characteristics regarding age, gender, immunosuppressive medication(s) and the chronic disease(s) requiring immunosuppressive therapy. Results: Of 207 surveyed participants, 59 persons (28.5%) paused their immunosuppressive medication before/during vaccination. Persons with rheumatic conditions and women were significantly more likely to pause immunosuppressive therapy than others. Over half of those who paused their medication reported receiving a recommendation from their specialist and 22.0% (13 of 59) decided to pause medication themselves without consulting a physician in advance. Conclusions: Besides lack of evidence, many immunosuppressed individuals and their treating physicians choose to pause medication before COVID-19 vaccination and accepting the risk of worsening their underlying disease. Trial registration: DRKS00023972, registered 12/30/2020. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate the effect of telephone monitoring, in combination with texts, on medication adherence and blood pressure (BP) control in primary hypertension. Method: Data were collected from August to December 2016. Seventy‐seven adults were randomized to the intervention and control groups. A 12‐week intervention consisted of regular text messages and phone calls. The control group received usual hypertension care. The outcomes were evaluated with blood pressure measurement and medication adherence self‐efficacy scale short form. Results: Medication adherence in Week 12 was found to be significantly higher in the intervention group than in the control group. Mean systolic and diastolic BP levels in Weeks 4, 8 and 12 were statistically significantly lower in the intervention group than in the control group (p < 0.05). Conclusion: Using text messaging and nurse‐led telephone monitoring improved adherence and BP control in adults with hypertensive in primary care. Summary statement: What is already known about this topic? Despite advances in the treatment of hypertension, blood pressure (BP) control and medication adherence in hypertensive patients is not at the desired level.There is need to alternative approaches to improve BP control and medication adherence.Few researchers have examined the effect of telephone monitoring in combination with text messaging on medication adherence and BP control in adults with hypertension. What this paper adds? We provided nurse‐led telephone monitoring and sent SMS with one‐way text messaging and individualized, patient‐tailored content, resulting in improved adherence to drug treatment and reduced blood pressure at the end of the three‐month study period.At the end of the 3‐month study period, the rates of blood pressure control in the intervention group were statistically significantly higher than those of the control group. The implications of this paper Nurses should integrate SMS combined with telephone monitoring into public health for hypertension management.Telephone monitoring, in combination with SMS, may be helpful hypertension care during a disaster or pandemic. [ABSTRACT FROM AUTHOR]

Purpose: Evidence has shown that 50% of patients, including type 2 diabetes mellitus (DM), are non-adherent to the prescribed antidiabetic medication regimen. Some barriers lead to nonadherence in people with DM type 2. The study aimed to identify factors related to adherence in patient with DM and to assess the correlation between barriers to adherence type 2 DM patients. Methods: The cross-sectional study was conducted in 63 primary healthcare centers in Surabaya, Indonesia. Patients with DM type 2 were recruited between April and September 2019 using convenient sampling technique. Ethics approval was obtained (80/EA/KEPK/2019). Results: A total of 266 patients with type 2 DM participated in this study. Of the respondents, 201 (75.2%) were female. Unwanted drug effects, changes in medication regimens, and refilling the prescription when the drugs run out were most reported factors that affected adherence. Spearman correlations and linear regression tests were used to examine the relationship between barriers to medication adherence, and education with medication adherence. A significant difference was observed between the level of education and adherence (p = 0.031). The results showed an association between barriers to medication and adherence to medication (r = 0.304; p < 0.001) which was confirmed in regression analysis (R = 0.309, R square = 0.095, p <0.001). Conclusions: Barriers to adherence are common and affect adherence to therapy. It is essential to expand the roles of health care professionals in the community to include counseling, barrier-monitoring, education, and problem-solving to improve patient medication adherence. [ABSTRACT FROM AUTHOR]

INTRODUCTION: We aimed to evaluate adherence and determine the factors that are related to adherence in patients on levothyroxine therapy. METHODS: Patients older than 18 years old and using levothyroxine for primary hypothyroidism were recruited. Demographical and clinical features, practices of using levothyroxine, and compliance were evaluated through a questionnaire. Those who answered the frequency of not using/skipping the drug as never/rarely, sometimes, and frequently/often were grouped as high, medium, and low adherence, respectively. RESULTS: Data of 335 patients -282(84.18%) female and 53(15.82%)- male, with a mean age of 47.36+-12.50 were analyzed. 330 (98.50%) patients were taking levothyroxine in the morning, and 332 (99.10%) were taking fast. 8(%2.41) patients were taking the drug just before the meal, and 66(19.88%) were taking it in 15 minutes. 66.66% of 145 patients using a medication that interferes with the absorption of levothyroxine were using it less than 2 hours of levothyroxine. There were 218 (65.08%) high, 98 (29.25%) medium and 19 (5.67%) low adherence patients. Drug adherence was not associated with demographical features, the cause and duration of hypothyroidism, the presence of comorbid disease, and thyroid hormones. Higher education level and familial thyroid disease were associated with high adherence (p=0.008 and p=0.013, respectively). DISCUSSION AND CONCLUSION: Drug adherence was medium/ low in 34.92% of hypothyroid patients. A considerable amount of patients did not leave enough time between levothyroxine and meal or other medications. For effective treatment of hypothyroidism, it is important to inform patients about hypothyroidism and levothyroxine use and increase drug compliance.

In this article, we have presented a mathematical model to study the dynamics of hepatitis C virus (HCV) disease considering three populations namely the uninfected liver cells, infected liver cells, and HCV with the aim to control the disease. The model possesses two equilibria namely the disease-free steady state and the endemically infected state. There exists a threshold condition (basic reproduction number) that determines the stability of the disease-free equilibrium and the number of the endemic states. We have further introduced impulsive periodic therapy using DAA into the system and studied the efficacy of the DAA therapy for hepatitis C infected patients in terms of a threshold condition. Finally, impulse periodic dosing with varied rate and time interval is adopted for cost effective disease control for finding the proper dose and dosing interval for the control of HCV disease.

Background Adherence to oral anticancer medication is important in cancer chemotherapy, with the advent of many oral anticancer regimens to ensure adequate cytologic response. Literature on adherence to oral anticancer therapy in India is very less. Materials and Methods This is a cross sectional analytical study consisting of all fit patients > 18 years of age taking oral anticancer therapy, with or without intravenous (IV) chemotherapy. Adherence was determined using Morisky–Green–Levine (MGL) scale, and factors affecting adherence details about cancer and treatment were obtained. All fit patients were recruited. Information was obtained using Tamil questionnaire and pro forma. Observation Of 152 patients, only 111 patients were found to be adherent to treatment. The mean age of the study population was 49.03 ± 13.48 years. Only 12.5% of patients were aware of the diagnosis, treatment, and outcome. The study population consisted mainly of patients with chronic myeloid leukemia, colorectal carcinoma, breast carcinoma, and stomach carcinoma, which amounted for 78.3% of the study population. Bivariate analysis concluded that duration of treatment, adverse drug reaction (ADR), duration of oral anticancer drug intake in a month, coadministration with IV anticancer drugs, and frequency of drug intake (anticancer drug) were significant factors affecting drug adherence. Multivariate analysis of the above variables was insignificant, but ADR tended toward significance. Conclusion Drug adherence plays a major role in treatment outcome in cancer patients. ADR was independently associated with decreased drug adherence. Key interventions which should include counseling and behavioral modifications will reduce nonadherence.

Designing Incentives to Promote Treatment Adherence Premature cessation of antibiotic therapy is common and can severely compromise health outcomes, potentially leading to worsening health, disease transmission, and antibiotic resistance. In "Design of Incentive Programs for Optimal Medication Adherence in the Presence of Observable Consumption," Sze-chuan Suen, Diana Negoescu, and Joel Goh investigate the problem of designing a schedule of incentive payments to induce socially optimal treatment adherence levels in settings in which treatment adherence can be observed but patient preferences for treatment adherence are heterogeneous and unobservable to a health provider. The novel elements of this problem stem from its institutional features: there is a single incentive schedule applied to all patients, incentive payments must be increasing in patients' adherence, and patients cannot be a priori prohibited from any given levels of adherence. The authors develop models to design optimal incentives incorporating these features and conduct a numerical study of the tuberculosis epidemic in India. Premature cessation of antibiotic therapy (nonadherence) is common in long treatment regimens and can severely compromise health outcomes. In this work, we investigate the problem of designing a schedule of incentive payments to induce socially optimal treatment adherence levels in a setting in which treatment adherence can be observed (e.g., through directly observed therapy for tuberculosis), but patient preferences for treatment adherence are heterogeneous and unobservable to a health provider. The novel elements of this problem stem from its institutional features: there is a single incentive schedule applied to all patients, incentive payments must be increasing in patients' adherence, and patients cannot be a priori prohibited from any given levels of adherence. We develop models to design optimal incentives incorporating these features, and they are also applicable in other problem contexts that share the same features. We also conduct a numerical study using representative data in the context of the tuberculosis epidemic in India. Our study shows that our optimally designed incentive schedules are generally cost-effective compared with a linear incentive benchmark. [ABSTRACT FROM AUTHOR]

A two-strain model, comprising of drug-sensitive and drug-resistant strains, is proposed for the dynamics of Human Immunodeficiency Virus (HIV) spread in a community. A treatment model is introduced by taking drug adherence into account. The treatment-free model is analyzed for the effect of treatment availability and drug adherence on disease dynamics. The analysis revealed that for the treatment-free model, at least one strain faces competitive exclusion, and co-existence of both strains is not possible. On the contrary, both strains may co-exist in presence of treatment. The analysis carried out was both local, as well as global. A comprehensive bifurcation analysis showed periodic behaviour and all solutions approached a stable limit cycle for a wide range of parametric values. Overall, we concluded that the treatment availability and drug adherence play a significant role in determining the dynamics of HIV spread. Numerical simulations are performed to validate the analytical results using MATLAB. [ABSTRACT FROM AUTHOR]

Objective: To determine various factors affecting adherence to antihypertensive medications. Methodology: An observational descriptive study conducted in Medical Out-Patient Department of Lady Reading Hospital Peshawar from June 2019 to October 2019. A total of 250 adult hypertensive patients of both genders were included. Adherence to medication was assessed using 'proportion of days covered' method. A score of ≥ 80% was considered as 'good adherence'. Four factors affecting adherence, were specifically studied: 'Asymptomatic state' of the patient; 'Affordability of medications; influence of the 'Local GP'; and 'Adverse effects' of the drugs. SPSS version 21 used for data analysis; correlation carried out; chi square (Χ2) p≤0.05 considered statistically significant. Results: Out of 250 patients, 67(26.8%) were males and 183(73.2%) females. Mean age was 56.13 years ±10.30 SD. Overall, 108(43.2%) patients had good adherence and 142(56.8%) had poor adherence (Χ2(4)=250.0, r(4)=0.89, p=0.001). The most common factor affecting adherence was the 'asymptomatic' state (56.3%, p=0.001); followed by 'non-affordability' (21.1%, p=0.001); 'Local GP' influence (14.8%, p=0.001); and drugs' adverse effects (7.8%, p=0.003). Patients taking 'combination' of drugs, ARBs and BBs had 60%, 58% and 18% adherence, respectively (Χ2(4)=35.41, r(4)=0.50, p=0.018). Conclusion: Factors associated with poor adherence to medications include 'asymptomatic state' of the patient, 'non-affordability' of drugs, 'influence of local practitioner' and 'adverse effects' of drugs; all significantly inversely correlated with adherence. Economic status, duration of hypertension and drug groups also significantly correlated with adherence [ABSTRACT FROM AUTHOR]

Pharmacokinetics is a scientific branch of pharmacology that describes the time course of drug concentration within a living organism and helps the scientific decision-making of potential drug candidates. However, the classical pharmacokinetic models with the eliminations of zero-order, first-order and saturated Michaelis–Menten processes, assume that patients perfectly follow drug regimens during drug treatment, and the significant factor of patients' drug adherence is not taken into account. In this study, therefore, considering the random change of dosage at the fixed dosing time interval, we reformulate the classical deterministic one-compartment pharmacokinetic models to the framework of stochastic, and analyze their qualitative properties including the expectation and variance of the drug concentration, existence of limit drug distribution, and the stochastic properties such as transience and recurrence. In addition, we carry out sensitivity analysis of drug adherence-related parameters to the key values like expectation and variance, especially for the impact on the lowest and highest steady state drug concentrations (i.e. the therapeutic window). Our findings can provide an important theoretical guidance for the variability of drug concentration and help the optimal design of medication regimens. Moreover, The developed models in this paper can support for the potential study of the impact of drug adherence on long-term treatment for chronic diseases like HIV, by integrating disease models and the stochastic PK models. [ABSTRACT FROM AUTHOR]

Abdul Majeed,1 Muhammad Rehman,1 Iltaf Hussain,1 Imran Imran,2 Muhammad Usman Saleem,3 Hamid Saeed,4 Furqan K Hashmi,4 Muqarrab Akbar,5 Muhammad Asad Abrar,1 Basit Ramzan,6 Muhammad Omer Chaudhry,7 Muhammad Islam,4 Naveed Nisar,8 Muhammad Fawad Rasool1 1Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan; 2Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan; 3Department of Biosciences, Faculty of Veterinary Sciences, Bahauddin Zakariya University, Multan, 60800, Pakistan; 4University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, 54000, Pakistan; 5Department of Political Science, Bahauddin Zakariya University, Multan, 60800, Pakistan; 6Al Shifa Pharmacy, Multan, Pakistan; 7School of Economics, Bahauddin Zakariya University, Multan, 60800, Pakistan; 8Department of Pharmaceutics, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, PakistanCorrespondence: Muhammad Fawad RasoolDepartment of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University Multan, Multan, PakistanTel +923008639046Email fawadrasool@bzu.edu.pkAim: The current study was conducted to assess the factors contributing to treatment adherence and its impact on the quality of life (QoL) in type 2 diabetes mellitus (T2DM) patients.Methods: A cross-sectional study was conducted between January 2020 to March 2020 among T2DM patients. The data was collected from T2DM out-patient clinics. The participants were recruited by using a simple random sampling method. To assess the association of demographics with the level of adherence, binary logistics regression analysis was applied. Moreover, the Mann–Whitney U-test was used to evaluate the impact of adherence on QoL.Results: A total of 384 patients participated in this study. Amongst them, 60.2% were male and 39.8% were female. Low adherence was seen in illiterate patients and patients older than 40 years. The results showed that good QoL in T2DM patients was significantly associated with treatment adherence (p= 0.004).Conclusion: The finding of the current study showed that the non-adherence prevailed in illiterate strata of the study population and the medication adherence significantly affects the QoL in T2DM patients. These findings suggest that health regulatory agencies should focus on implementing disease-education interventions for improving the adherence to medications in patients with long-term conditions.Keywords: type 2 diabetes, drug adherence, quality of life

Background:  Taking medication is an integral part of many people’s lives, yet medication as a concept is heavily stigmatized in society. Patients tend to shy away from taking medication in public in an effort to keep from appearing “sick” or “ill” and will oftentimes skip doses when they are outside the comfort of their home.  Ava by Dispensus aims to eliminate the discomfort coupled with taking medication, with the ultimate goal of improving drug adherence, by creating a device that makes it convenient and inconspicuous to take medication publicly. Faculty Adviser:  Prof. Michelle Khine, Department of Biomedical Engineering  mkhine@uci.eduCraig LauerSamir Shreim, Lecturer, Biomedical Engineering      sshreim@uci.edu

Avec la mise sur le marché des thérapies ciblées orales administrées en ambulatoire, le rôle du pharmacien dans l'accompagnement des patients atteints d'un cancer s'est considérablement consolidé. Cela s'est traduit concrètement par la mise en place des entretiens pharmaceutiques "chimiothérapie orale" dont l'un des objectifs majeurs est de renforcer l'adhésion médicamenteuse. With the introduction of oral targeted therapies administered on an outpatient basis, the role of the pharmacist in supporting cancer patients has been considerably strengthened. This has resulted in the introduction of "oral chemotherapy" pharmaceutical interviews, one of the major objectives of which is to reinforce adherence to medication. [ABSTRACT FROM AUTHOR]

Hypertension is a common cardiovascular co-morbidity after kidney transplantation and contributes to shortened graft and patient survival outcomes. However, by contrast with adherence to immunosuppressive drugs, adherence to antihypertensive treatment in kidney transplant recipients has been seldom explored. The aim of the current study was to assess adherence to antihypertensive drugs in kidney transplant recipients from the Cliniques Universitaires Saint-Luc and to look for demographic and clinical characteristics associated with drug adherence. Demographic and clinical data were collected from medical files in a standardised case report form. Blood pressure was measured in the sitting position after 5 min rest, using validated oscillometric devices. Drug adherence was assessed by drug dosage in urine using liquid chromatography coupled with tandem mass spectrometry. Our analysis included 53 kidney transplants recipients (75% of men, mean age: 57.2 ± 12.6 years, time since kidney transplantation: 9.5 ± 7.3 years, blood pressure: 130 ± 16/78 ± 11 mmHg on 2.1 ± 1.1 antihypertensive drugs). The proportion of patients showing full drug adherence, partial drug adherence, and total non-adherence to antihypertensive drugs was 79% (N = 42), 15% (N = 8), and 6% (N = 3), respectively. Adherent patients did not differ from less or non- adherers in any of the analysed characteristics. The proportion of patients adhering to antihypertensive drug treatment among kidney transplant recipients appears similar to that reported for immunosuppressive drugs in renal transplanted patients (∼70%), but much higher than that observed in patients with drug-resistant hypertension (30–40%). Our results need further confirmation in a large, multicenter, prospective cohort. [ABSTRACT FROM AUTHOR]

Abstract Background Dialysis patients have a high pill burden, increasing their care complexity. A previous study in our institution’s dialysis unit found notable discrepancies between medication prescriptions, purchases and patient reports of medication use: overall adherence to medication was 57%, on average; staff reported patients took 3.1 more medication types than actual purchases; concordance of patient purchases and nurse reports was found in 5.7 out of 23.6 months of patient follow-up. We sought to investigate patients and staff concepts and attitudes regarding medication care and to understand better the previously identified inconsistencies. Methods We performed a qualitative research based on the grounded theory approach, using semi-structured, in-depth, interviews with patients and staff from the same dialysis unit studied previously, at the Hadassah Medical Center, Jerusalem, Israel. Results Though all respondents described a seemingly synchronized system of care, repeated questioning revealed that staff distrust patient medication reports. Patients, on their part, felt that their monitoring and supervision were bothersome and belittling. Along with patients, nurses and physicians, we identified a “fourth” factor, which influences medication care – the laboratory tests. They serve both as biological parameters of health, but also as parameters of patient adherence to the prescribed medication regimens. Conclusions Participant responses did not clearly resonate with previous findings from the quantitative study. The central role of laboratory tests should be carefully considered by the staff when interacting with patients. An interaction process, less adversarial, centering on the patient attitudes to medication care, might establish better communication, better cooperation and better patient outcomes.

Introduction: Anti-retro viral (ARV) drugs are the corner stone of management of HIV infection. ARVs have been consistently proven to reduce mortality due to HIV. The aim of this study was to identify the level of drug adherence and related challenges for adherence. Method: A cross- sectional study was conducted in the antiretroviral therapy (ART) clinic of a tertiary care teaching hospital. Patients who were above 18years of age, on ART for at least six months and underwent counselling before starting ART were included in the study (n=143). Demographic variables and clinical profile were noted and level of drug adherence and associated factors were assessed using Morisky Green Levine Test and check list respectively. Data was analysed in SPSS version 22. Results: Most of the study subjects (89.5%) had high level of medication adherence and 10.5% had medium level adherence. Factors contributing to high adherence level were confidentiality and trust among health workers, concerned about their own health, understanding about the prescribed drugs, idea about disease progression, effectiveness and knowledge of ARVs. Conclusion: Drug adherence was found to be high among HIV- infected patients in this study and various reasons contributed for the high adherence among the study subjects.

Abstract Objective Management of heart failure is complex and multifaceted but adherence to medications remains the cornerstone of preventing avoidable readmissions, premature deaths, and unnecessary healthcare expenses. Despite of evidence-based efficacy on anti-failure drugs, poor adherence is pervasive and remains a significant barrier to improving clinical outcomes in heart failure population. Results We enrolled 459 patients with diagnosis of heart failure admitted at a tertiary cardiovascular hospital in Dar es Salaam, Tanzania. The mean age was 46.4 years, there was a female predominance (56.5%), 67.5% resided in urban areas and 74.2% had primary education. Of the 419 participants eligible for assessment of medication adherence, 313 (74.7%) had poor adherence and 106 (25.3%) had good adherence. Possession of a health insurance was found to be the strongest associated factor for adherence (adjusted OR 8.7, 95% CI 4.7–16.0, p

Background : Specifically young women are at risk for a poor outcome after ST-elevation myocardial infarction (STEMI). We aimed to investigate sex- and age-specific differences in outcome and associate these results with adherence to a guideline-directed optimal medical therapy (OMT). Methods : Administrative insurance data (≈26 million insured) were screened for patients aged 18-60 years with STEMI. Patient demographics, details on in-hospital treatment, adherence to OMT and its effect on mortality were assessed. Adherence to OMT was analyzed using multistate models and an association of those with death was fitted using multivariable Cox regression models with time-dependent co-variables. Results : Overall, 59,401 patients (19.3% women), median age 52 (interquartile range 48, 56) presented with STEMI. Female sex was associated with a poor outcome early after STEMI (90-day mortality: odds ratio 1.22, 95% confidence interval (CI) 1.12-1.32, p < 0.001). Overall survival was reduced in women compared to same-aged men. The ten-year survival rate was 19.7% (18.1-21.2%) versus 19.6% (18.9-20.4%) in men ( p < 0.001). Although long-term drug adherence was low, its intake was associated with a better outcome. Specifically younger women showed a markedly lower mortality when on OMT (hazard ratio (HR) 0.22 (95% CI 0.19-0.26) versus HR 0.31 (95% CI 0.28-0.33) in men, p int < 0.001). Conclusions : Specifically young women were at risk for a poor outcome in the early phase after STEMI. Although long-term adherence to OMT was low, it was generally associated with a lower mortality, specifically in women. Our findings emphasize on early and long-term preventive measures in all patients after STEMI.

Background: The high prevalence of uncontrolled hypertension in Pakistan is predominantly attributed to poor medication adherence. As more than 137 million people in Pakistan use cell phones, a suitable mobile health (mHealth) intervention can be an effective tool to overcome poor medication adherence., Objective: We sought to determine whether a novel mHealth intervention is useful in enhancing antihypertensive therapy adherence and treatment outcomes among patients with hypertension in a low- to middle-income country., Methods: A 6-month parallel, single-blinded, superiority randomized controlled trial recruited 439 patients with hypertension with poor adherence to antihypertensive therapy and access to smartphones. An innovative, multifaceted mHealth intervention (Multi-Aid-Package), based on the Health Belief Model and containing reminders (written, audio, visual), infographics, video clips, educational content, and 24/7 individual support, was developed for the intervention group; the control group received standard care. The primary outcome was self-reported medication adherence measured using the Self-Efficacy for Appropriate Medication Adherence Scale (SEAMS) and pill counting; the secondary outcome was systolic blood pressure (SBP) change. Both outcomes were evaluated at baseline and 6 months. Technology acceptance feedback was also assessed at the end of the study. A generalized estimating equation was used to control the covariates associated with the probability of affecting adherence to antihypertensive medication., Results: Of 439 participants, 423 (96.4%) completed the study. At 6 months post intervention, the median SEAMS score was statistically significantly higher in the intervention group compared to the controls (median 32, IQR 11 vs median 21, IQR 6; U=10,490, P<.001). Within the intervention group, there was an increase in the median SEAMS score by 12.5 points between baseline and 6 months (median 19.5, IQR 5 vs median 32, IQR 11; P<.001). Results of the pill-counting method showed an increase in adherent patients in the intervention group compared to the controls (83/220, 37.2% vs 2/219, 0.9%; P<.001), as well as within the intervention group (difference of n=83, 37.2% of patients, baseline vs 6 months; P<.001). There was a statistically significant difference in the SBP of 7 mmHg between the intervention and control groups (P<.001) at 6 months, a 4 mmHg reduction (P<.001) within the intervention group, and a 3 mmHg increase (P=.314) within the controls. Overall, the number of patients with uncontrolled hypertension decreased by 46 in the intervention group (baseline vs 6 months), but the control group remained unchanged. The variables groups (adjusted odds ratio [AOR] 1.714, 95% CI 2.387-3.825), time (AOR 1.837, 95% CI 1.625-2.754), and age (AOR 1.618, 95% CI 0.225-1.699) significantly contributed (P<.001) to medication adherence. Multi-Aid-Package received a 94.8% acceptability score., Conclusions: The novel Multi-Aid-Package is an effective mHealth intervention for enhancing medication adherence and treatment outcomes among patients with hypertension in a low- to middle-income country., Trial Registration: ClinicalTrials.gov NCT04577157; https://clinicaltrials.gov/study/NCT04577157., (©Muhammad Arshed, Aidalina Mahmud, Halimatus Sakdiah Minhat, Poh Ying Lim, Rubeena Zakar. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 19.06.2024.)

Copyright of Archives of the Turkish Society of Cardiology / Türk Kardiyoloji Derneği Arşivi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To evaluate the compliance of the practice with the evidence-based criteria in relation to interventions developed to improve the immunosuppressive adherence of adults in postkidney transplantation. Method: A best practice implementation project, based on the Joanna Briggs Institute's Practical Application of Clinical Evidence Systemand Getting Research into Practice audit tool for promoting change in health practice, was conducted. A baseline and a follow-up audit were conducted in a kidney transplant clinic, including a sample of kidney transplant patients with a maximum of 30 days postoperatively, and health professionals working in the post-transplant period. Results: The basic audit revealed that the parameters related to the professionals' knowledge did not reach adequate compliance; the involvement of patients in strategies to overcome barriers that interfere with nonadherence; guidelines for specific therapeutic regimens for patients and the prescription of immunosuppressants according to the patient's routine. To solve the identified weaknesses, training strategies were implemented with the professionals, follow-up by telephone contact with the patients and the elaboration and distribution of an educational booklet with guidance on the use of immunosuppressants, leading to an increase from 50 to 87.5% of conformity in the evaluated service. Conclusion: The evidence implementation project provided improvements in clinical practice behaviors. It demonstrated that there are strategies that facilitate the implementation of evidence regarding the promotion of interventions to improve immunosuppressive adherence. Additional audits are still needed to improve and assess the quality of interventions promoted by professionals regarding drug adherence in the post-transplant period, as well as to verify the behavior of patients, ensuring that the project will be maintained and supported. [ABSTRACT FROM AUTHOR]

Introduction: Gout is the leading cause of inflammatory arthritis and is also correlated with multiple comorbidities, including cardiovascular disease (CVD), whose future risk can be lowered by urate-lowering therapy (ULT) in gout patients. It is, however, still not clear whether its effect is associated with the days of usage and the adherence rate of ULT.Methods: Data were collected from Taiwan's National Health Insurance Research Database. The study period was from 1999/1/1 to 2013/12/31. In addition, patients with newly diagnosed gout from 2000 to 2012 and usage of antigout preparations (allopurinol or benzbromarone) within half a year among age ≥20 years old were enrolled in the study. The outcome of interest is CVD. New diagnosis of CVD after half a year of diagnosis of gout was included in the CVD group. Moreover, conditional logistic regression was used to evaluate the odds ratio of CVD in relation to the days of usage and to the adherence rate of ULT after the adjustment for potentially confounding variables.Results: A total of 3,706 gout patients with and without CVD have been included in the final analysis after a 1:1 propensity score that matched for age, sex, comorbidities, aspirin, and statin. The days of usage of allopurinol was

Background One critical barrier to the uptake of mental health programmes is the so-called physical healthcare gap, a concern raised by the unattended physical comorbidity and early mortality of persons with severe mental illness. Aims To evaluate the extension of physical healthcare gap among persons with severe mental illness under chronic drug therapies. Method A population-based cohort study was carried out, using Lombardy healthcare utilisation databases. Prevalent patients treated with blood pressure-, lipid- or glucose-lowering agents were identified in January 2017. Among these, those who were receiving care for depression, schizophrenia, bipolar disorder or personality disorder formed the study cohort. A reference cohort was randomly selected from prevalent patients treated with chronic therapies without signs of severe mental disorders, to be matched with study cohort members for gender, age and number of previous contacts with the National Health System. One-year adherence to healthcare was measured through the proportion of days covered (drug adherence), and exposure to selected recommendations (clinical control adherence). Results The 55 162 patients with severe mental illness were less likely to have high adherence to blood pressure-lowering, lipid-lowering or antidiabetic agents than the reference cohort by −24% (95% CI −26 to −22%), −10% (95% CI −14 to −6%) and −25% (95% CI −29 to −21%), respectively. The 9250 patients with diabetes and severe mental illness had −18% (95% CI −22% to −13%) reduced likelihood to meet recommendations for the clinical management of diabetes, compared with the reference cohort. Conclusions Adherence to chronic drug therapies was sensibly worse among patients living with mental illness than those without signs of mental disorders.

Objectives: Telemedicine appears to be a promising tool for healthcare professionals to deliver remote care to patients with cardiovascular diseases especially during the COVID-19 pandemic. We aimed in this study to evaluate the value of telemedicine added to the short-term medical care of acute ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI).Methods: Two hundred acute STEMI patients after primary PCI were randomly divided into two groups. One hundred patients in group A (study group) received a monthly videoconferencing teleconsultation using a smartphone application for 3 months starting 1 week after discharge and at least a single face-to-face (F2F) clinic visit. We reviewed in each virtual visit the symptoms of patients, adherence to healthy lifestyle measures, medications, smoking cessation, and cardiac rehabilitation. Group B (control group) included 100 patients who received at least a single F2F clinic visit in the first 3 months after discharge. Both groups were interviewed after 4 months from discharge for major adverse cardiac events (MACE), adherence to medications, smoking cessation, and cardiac rehabilitation. A survey was done to measure the satisfaction of patients with telemedicine.Results: There was no significant difference between both groups in MACE and their adherence to aspirin, P2Y12 inhibitor, and beta-blockers. However, group A patients had better adherence to statins, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, smoking cessation, and cardiac rehabilitation. Sixty-one percent of patients stated that these videoconferencing teleconsultations were as good as the clinic visits, while 87% of patients were satisfied with telemedicine.Conclusions: Telemedicine may provide additional benefit to the short-term regular care after primary PCI to STEMI patients through videoconferencing teleconsultations by increasing their adherence to medications and healthy lifestyle measures without a significant difference in the short-term MACE. These virtual visits gained a high level of satisfaction among the patients.

Adherence to prescription medications is vital to the success of any treatment plan, especially for chronic health conditions, such as hypertension (HTN). Although there are different scales used in assessing adherence to prescription medications, most if not all, of those scales are not available in Arabic. The absence of essential assessment tools makes the appraisal of adherence to prescription medications very difficult for native Arabic speakers. Therefore, this study aimed to translate and validate the Hill-Bone Compliance to High Blood Pressure Therapy (CHBPT) scale, which is commonly used to assess adherence to antihypertensive medications, among a sample of Arabic-speaking patients with HTN. This was a single-center cross-sectional study that took place at a university-affiliated hospital. It interviewed adult (≥18 years) patients with HTN who were visiting the primary care clinics between January and November 2020. Non-Arabic speakers, those under 18 years of age, individuals without a diagnosis of HTN, and patients without any previously filled prescription medications for HTN within the past three months were excluded. The forward–backward translation method was used after receiving permission from the originators of the questionnaire to translate their scale to Arabic. Test-retest and Cronbach alpha methods were used to assess the reliability. Principal component analysis with varimax rotation was used to examine the construct validity. One hundred and forty-one patients consented and participated in the study. Most of the patients were ≥ 50 years old (75 %), male (72 %), and had another chronic health condition besides HTN (99 %). The translated scale had good internal consistency (Cronbach alpha = 0.83) and reliability (intraclass correlation coefficient of 0.9). The Kaiser-Meyer-Oklin was 0.82 indicating adequate sampling to conduct factor analysis; hence, three factors (e.g., subscales) were extracted similar to the original scale. The mean scores for appointment keeping, medication taking, and reducing sodium intake subscales, as well as for the overall scale were 5.62 ± 1.39, 33.94 ± 3.87, 9.73 ± 2.1, and 49.29 ± 5.21, respectively. The translated version of the Hill-Bone CHBPT scale has both good reliability and validity and will hopefully help healthcare providers assess and monitor HTN patients' adherence to their antihypertensive medication regimens. Multicenter studies should be conducted to verify the validity and reliability of the translated questionnaire among different Arabic-speaking patient populations with HTN. [ABSTRACT FROM AUTHOR]

Background: Management of resistant hypertension (RHTN) is challenging and often implies the use of complex polypharmacy and interventional therapies. The main objectives of this study were (i) to describe the characteristics of patients with RHTN referred to two expert centres; (ii) to identify predictors of blood pressure (BP) control after intensive management. Methods: We reviewed electronic medical files of all patients referred for RHTN to the Brussels and Torino centres, and extracted detailed clinical data, informations on drug adherence and psychological profile. All patients with confirmed diagnosis of RHTN, according to office and ambulatory BP monitoring (ABPM) measurements, were considered eligible. Results: 313 patients (51% men; age: 56 ± 12 years; office BP 177/98 mmHg; 24-hour ABPM 153/90 mmHg) were included. At the end of follow-up (median: 2 years [1–4]), only 26% of patients (n = 81) reached BP control. When compared to patients remaining resistant, patients eventually controlled had lower pulse pressure (71 vs. 82 mmHg, p

Introdution: Among infectious diseases, tuberculosis is one of the leading causes of death killing in nearly 1.5 million people yearly. Considering the importance of patient co-operation in drug therapy and resistance we decided to evaluate the rate of co-operation of tuberculosis infected patients in regard to their use of anti-tuberculosis drugs in Kerman. Methods: This descriptive study was conducted as a sectional and census study and 80 patients succeeded to finalize it. Demographic information was collected through a questionnaire by patients. To carry out the designed test, a urinary sample was taken from each patient and a few drops of each were added to the drug-specific reagents. On the basis of color variation which is special for rifampin, isoniazid and pyrazinamide, we made a decision on the co-operation of the patients. The collected data were analyzed by the the use of SPSS software version 18 and p-value

Background: The present study was conducted to investigate medication compliance and its determinants in glaucoma patients presenting to Shahid Motahari Clinic affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. The correlation between quality of life and the level of medication compliance was also evaluated in these patients. Materials and Methods: The present descriptive-analytical and cross-sectional study was conducted on 94 patients with glaucoma presenting to Motahari glaucoma clinic in Shiraz for routine follow-ups. A data collection form was used to record the patients’ demographic and clinical data, including age, gender, level of education, living status (alone/with the family), presence of chronic diseases, type of glaucoma, duration of the disease, type of medication, number of medicines used, visual acuity and degree of glaucoma measured through examining the optic nerve. The Morisky medication adherence scale was used to evaluate the patients’ adherence to glaucoma medication, and the glaucoma quality of life-15 questionnaire to assess their quality of life. The data collected were analyzed in SPSS-19. P

Reduced or absent compliance to anti-hypertensive treatment is a major obstacle to the achievement of blood pressure target in patients with arterial hypertension. Current available methods for therapeutic adherence assessment display low accuracy, limited applicability in clinical practice and/or high costs. We designed a prospective study to evaluate the accuracy of serial measurement of ARR to assess the therapeutic compliance to RAAS inhibitors. We prospectively enrolled 80 subjects: 40 patients with arterial hypertension and 40 normotensive controls. The ARR was evaluated at baseline and 2 and 8 week after initiation of a RAAS inhibitor in patients with hypertension, and at baseline and 2 weeks for the control group. Adherence to the prescribed therapy was confirmed by therapeutic drug monitoring. We observed a significant increase of renin levels and reduction of aldosterone levels after RAAS inhibitors initiation, with consequent reduction of ARR. Delta ARR (ΔARR), defined as relative change in ARR before and after treatment initiation, provided high accuracy for determination of therapeutic compliance, with an AUC of 0.900 at 2 weeks and 0.886 at 8 weeks. A cut-off of −48% of ΔARR provided 90% sensitivity and 75% specificity, at 2 and 8 weeks. In conclusion, the measurement of ΔARR is a powerful test, cheap and widely available to accurately identify the non-adherence to RAAS inhibitors treatment. Herein we propose the implementation of ΔARR in clinical practice through a multi-step flow-chart for the management of patients with uncontrolled blood pressure, with identification of those suspected of non-adherence, reserving therapeutic drug monitoring for non-adherence confirmation.

Introduction: Heart Failure (HF) is a global health problem, and despite much progress in new therapies, its prognosis remains poor. This is due to a number of factors including lack of adherence to HF medications. Previous studies have shown high sensitivity C-reactive protein (hsCRP) to change with HF progression, and that plasma hsCRP levels can be used to predict HF progression and assessment of adherence to medications. This association however has not been studied in Sub-Saharan African (SSA) countries, including Tanzania. Aim: To study the association between hsCRP levels and HF medications adherence among HF patients attending the Jakaya Kikwete Cardiac Institute (JKCI) in Dar es Salaam, Tanzania. Materials and Methods: This was a hospital based crosssectional study, where all eligible adult HF patients were consecutively enrolled as they attended their regular clinics, until the sample size was reached. Patients’ socio-demographic and clinical information was collected through interviews and chart reviews. An 8-item Morisky tool was used to assess patients’ adherence to HF medications. Blood was collected and analysed for hsCRP, Complete Blood Count (CBC) and cholesterol panel. hsCRP was considered elevated when it was >5 mg/L. Data were analysed using Statistical Package for Social Sciences (SPSS) computer software, version 21. All tests were 2-sided, and a p-value of

Introduction: Heart Failure (HF) is a global health problem, and despite much progress in new therapies, its prognosis remains poor. This is due to a number of factors including lack of adherence to HF medications. Previous studies have shown high sensitivity C-reactive protein (hsCRP) to change with HF progression, and that plasma hsCRP levels can be used to predict HF progression and assessment of adherence to medications. This association however has not been studied in Sub-Saharan African (SSA) countries, including Tanzania. Aim: To study the association between hsCRP levels and HF medications adherence among HF patients attending the Jakaya Kikwete Cardiac Institute (JKCI) in Dar es Salaam, Tanzania. Materials and Methods: This was a hospital based crosssectional study, where all eligible adult HF patients were consecutively enrolled as they attended their regular clinics, until the sample size was reached. Patients' socio-demographic and clinical information was collected through interviews and chart reviews. An 8-item Morisky tool was used to assess patients' adherence to HF medications. Blood was collected and analysed for hsCRP, Complete Blood Count (CBC) and cholesterol panel. hsCRP was considered elevated when it was >5 mg/L. Data were analysed using Statistical Package for Social Sciences (SPSS) computer software, version 21. All tests were 2-sided, and a p-value of <0.05 was considered to indicate a significant association. Results: In total, 210 HF patients were enrolled. Their mean age was 54±15.9 years and 53.8% were females. In the total population, the mean hsCRP was 7.15±4.94 mg/L, and 122 (58.1%) patients had elevated hsCRP. Poor medications adherence was present in 138 (65.7%) patients. Patients with poor medications adherence were more likely to have elevated hsCRP levels (68.1%) when compared to patients with good adherence (38.9%), p<0.001. In multivariate logistic regression analysis, elevated hsCRP independently predicted poor medications adherence (OR=4.27, 95% CI 2.14-8.51, p<0.001), irrespective of other variables. Conclusion: HF patients with poor medications adherence are 4-times more likely to have elevated hsCRP, irrespective of other clinical and socio-demographic factors in this study cohort. These findings suggest that hsCRP levels can be considered as surrogate to HF medications adherence. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to evaluate adherence and determine the factors that are related to adherence in patients on levothyroxine therapy. Materials and Methods: Patients older than 18 years old and using levothyroxine for primary hypothyroidism were recruited. Demographical and clinical features, practices of using levothyroxine, and compliance were evaluated through a questionnaire. Those who answered the frequency of not using/skipping the drug as never/rarely, sometimes, and frequently/often were grouped as high, medium, and low adherence, respectively. Results: Data of 335 patients -282(84.18%) female and 53(15.82%)- male, with a mean age of 47.36±12.50 were analyzed. 330 (98.50%) patients were taking levothyroxine in the morning, and 332 (99.10%) were taking fast. 8(%2.41) patients were taking the drug just before the meal, and 66(19.88%) were taking it in 15 minutes. 66.66% of 145 patients using a medication that interferes with the absorption of levothyroxine were using it less than 2 hours of levothyroxine. There were 218 (65.08%) high, 98 (29.25%) medium and 19 (5.67%) low adherence patients. Drug adherence was not associated with demographical features, the cause and duration of hypothyroidism, the presence of comorbid disease, and thyroid hormones. Higher education level and familial thyroid disease were associated with high adherence (p=0.008 and p=0.013, respectively). Conclusion: Drug adherence was medium/ low in 34.92% of hypothyroid patients. A considerable amount of patients did not leave enough time between levothyroxine and meal or other medications. For effective treatment of hypothyroidism, it is important to inform patients about hypothyroidism and levothyroxine use and increase drug compliance. [ABSTRACT FROM AUTHOR]

Background: Epilepsy is considered as a chronic brain disorder characterized by recurrent derangement of the nervous system caused by sudden extreme discharge of the cerebral neurons. Aim: To evaluate the impact of applying evidence-based guidelines for epileptic patient on their knowledge, self efficacy, drug adherence and quality of life. Design: A Quasi-experimental design conducted on 54 epileptic patients underlying three phases; assessment, planning, implementing,and evaluating phase which emphasized on estimating the effect of the evidence based guidelines implementation before (Pre-test) and re-interviewed after one month and four months (follow-up) of implementation for the guidelines. Results: Reflected that there are a significant positive correlation were found between epileptic patient’s self efficacy and their family history, level of education and between total epileptic patients knowledge and their marital status in the posttest phase (Ps = .040, .013, .049) respectively. Conclusion: The majority of epileptic patients had low self efficacy and quality of life levels in the pre implementation of guidelines phase comparing to Post and follow-up guideline implementation phases. Also, the majority of them had high knowledge and perception level in the item related to disease crisis, perception of anticonvulsant drugs and adherence at post and follow-up guidelines implementation phases. Relevance to Clinical Practice: There are obvious needs to activate implementation of epileptic guidelines manual in the hospitals. [ABSTRACT FROM AUTHOR]

Hypertension is known to affect around the world with steadily upward prevalence. Due to the nature of unpresented signs and symptoms, adherence to medication treatment for hypertension is poor in many countries. The impacts of uncontrol hypertension are explainable by increasing numbers of people with stroke, heart disease, and chronic kidney disease, well-known complications of hypertension. Promotion patients' adherence to medication regimen needs understanding of factors contributing to the adherence. This systematic review aims to describe the factors influencing medication adherence among patients with hypertension. A total of 29peer-reviewed studies published between 2010 - 2020 were included for the final review following a PRISMA guideline. Factors influencing antihypertensive medication adherence are categorized as the sociodemographic, patient-related, treatment-related, disease-related, and healthcare service-related. Inadequate knowledge and improper perception of patients regarding hypertension, and forgetfulness, insufficient healthcare services and medications supply, quality shortage of health services and lack of social support especially for older adult, are the most significant factors influencing the antihypertensive drug adherence. These factors can be applied in improving medication adherence programs, non-communicable disease control program in an extensive setting by involving patients, family members and public broadly. Additionally, quality building programs for health care providers and implementing universal health care coverage for the patients can be strengthened since both are related to quality of service and accessibility of health care system that are initial parts of medication adherence. Finally, short message service (SMS) by Ministry of Health as a reminder for medication as well as awareness should be applied. [ABSTRACT FROM AUTHOR]

Introduction: SO-1105 is an oral mucosal adhesive tablet containing 50 mg of miconazole. It had been shown overseas that a once-daily application of the drug continues antifungal effect in the treatment of oropharyngeal candidiasis. We report the results of the phase 3 clinical study of this drug with miconazole gel as a control in Japan. Methods: The study included patients aged 20 years or older with oropharyngeal candidiasis who had oral lesions characterized by oropharyngeal candidiasis and whose fungi was confirmed by direct microscopic examination. The primary efficacy endpoint was the clinical cure rate on Day15 after 14 days of administration. The population analyzed for efficacy was per protocol set (PPS). Results: 120 subjects were included in PPS. In detail, 59 subjects were in the SO-1105 group (SO-1105 group) and 61 subjects were in the miconazole gel group (Gel group). For efficacy, the clinical cure rate on Day15 was 47.5% in SO-1105 group and 47.5% in Gel group, showing the similar efficacy between both groups. For safety, adverse drug reactions were observed in 29.0% of SO-1105 group and 24.6% of Gel group, showing the similar safety between both groups. Conclusion: The efficacy of SO-1105 was shown to be similar to that of miconazole gel. Meanwhile, SO-1105 is an adhesive tablet and is administered once-daily. For this, SO-1105 is expected to better compliance and useful drug for the elderly. Therefore, SO-1105 is considered to be widely used in clinical practice as one of the therapeutic drugs for oropharyngeal candidiasis. [ABSTRACT FROM AUTHOR]

Purpose: Patients with apparent treatment-resistant hypertension (a-TRH) are often poorly adherent to drug treatment and have an unusual personal history and psychological profile. The aim of this study was to identify predictors of drug adherence and drug resistance in a cohort of patients with aTRH, with emphasis on psychological characteristics. Methods: All patients with confirmed aTRH on standardized antihypertensive treatment were eligible. Drug adherence was assessed by drug dosages in urine using Liquid Chromatography coupled with tandem Mass Spectrometry (LC-MS/MS). Drug resistance was assessed by 24-hour ambulatory blood pressure adjusted for the number of antihypertensive drugs and for drug adherence. Psychological profile was assessed using a broad array of validated questionnaires. Results: The analysis included 35 consecutive patients. The proportion of adherent, partly adherent and totally non-adherent patients was 29, 40 and 31%, respectively. In regression analysis, independent predictors of poor drug adherence were recent hospital admission for hypertension, a lower ability to put things into perspective when facing negative events and a higher tendency to somatize, accounting for 51% of variability in drug adherence. Independent predictors of treatment resistance were a higher recourse to the strategies of blaming others and oneself, accounting for 37% of variability in drug treatment resistance. Conclusion: In patients with aTRH, poor adherence is frequent but does not entirely account for treatment resistance. Psychological characteristics appear as strong predictors of both drug adherence and drug resistance. Our results suggest that therapeutic drug monitoring and psychological evaluation should be an integral part of assessment of patients with aTRH.

Wen-Jiun Chou,1 Liang-Jen Wang,1 Chien-Ho Lin,2 Sun-Yuan Liang,3 Vincent Chin-Hung Chen,4 Yuh-Ming Hou,5 Rong-Rong Huang,6 Miao-Chun Chou,1 Chi-Yung Shang,7 Chi-Pui Ho,6 Meng-Chuan Lai8 1Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 2Department of Psychiatry, Chimei Medical Center, Tainan, 3Department of Psychiatry, Changhua Hospital, Changhua, 4Department of Psychiatry, Chang Gung Memorial Hospital and University, 5Chia-Yi Christian Hospital, Chiayi, 6Department of Child and Adolescent Psychiatry, Kai-Suan Psychiatric Hospital, Kaohsiung, 7Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; 8Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK Purpose: This prospective, single-arm, open-label, 8-week, multicenter study investigated the effectiveness of switching from immediate-release methylphenidate (IR-MPH) to osmotic controlled-release methylphenidate (OROS-MPH) in patients with attention-deficit/hyperactivity disorder (ADHD).Patients and methods: Overall, 296 patients with ADHD (mean age: 9.5 years) already on IR-MPH treatment were enrolled. Upon enrollment, a flexible dose of OROS-MPH was administered, replacing IR-MPH. Patients were assessed at baseline and weeks 2, 4, and 8 using the Swanson, Nolan, and Pelham version IV scale (SNAP-IV) and the Clinical Global Impression for ADHD symptoms. The Social Adjustment Inventory for Children and Adolescents assessed social functions, and the Chinese Health Questionnaire (CHQ) and Family Adaptation, Partnership, Growth, Affection, and Resolve evaluated parental and family functions.Results: Switching from IR-MPH to OROS-MPH yielded significant improvements in all ADHD symptoms, as rated by parents, teachers (SNAP-IV), and study investigators (Clinical Global Impression). CHQ scores and all Social Adjustment Inventory for Children and Adolescents subscores except spare time scores improved significantly. Patients with poor IR-MPH adherence had greater improvements in teacher-rated SNAP-IV and mothers’ mental health (CHQ) after switching. Conclusion: Switching from IR-MPH to OROS-MPH improved patients’ behavioral ADHD symptoms and social adjustment, and mental health of patients’ mothers. This was most evident in patients who previously exhibited poor IR-MPH adherence. Keywords: ADHD, central nervous system stimulant, drug adherence, family, social adjustment

Male breast cancer, a rare disease, is usually treated with adjuvant tamoxifen during early stages. Unfortunately, studies suggest a high rate of discontinuing adjuvant tamoxifen, but reasons for stopping this treatment are not always clear, and additional studies investigating this are needed. [ABSTRACT FROM AUTHOR]