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Summary Background Despite the availability of effective and well-tolerated direct acting antivirals (DAAs) against hepatitis C virus (HCV) infection, a substantial number of HCV patients remain untreated. Novel strategies targeting HCV patients with poor adherence are urgently needed to enable HCV elimination. Methods We implemented a physician-operated HCV hotline (HCV-Phone) that was promoted within the patient community and referral networks. Previously diagnosed HCV patients were contacted via the HCV-Phone and offered low-barrier access to DAA therapy. Patients/referring physicians could directly call or send messages to the HCV-Phone. The HCV-Phone related and unrelated visits as well as DAA treatment initiations throughout 2019 were documented. Patients were followed until October 2020. This study analyzed treatment initiation, adherence to scheduled visits and outcomes in patients in whom management was assisted by the HCV-Phone. Results Out of 98 patient contacts via the HCV-Phone 74 attended treatment assessment at our clinic. While 15 (20%) patients were HCV-RNA negative and 1 (1%) patient did not initiate therapy, 58 patients were recruited for DAA therapy via the HCV-Phone. A total of 21 additional patients who started DAAs without HCV-Phone assistance required the use of the HCV-Phone infrastructure later on during treatment, resulting in a total of 79 HCV-Phone related DAA therapies. The poor adherence of patients previously diagnosed with HCV at our clinic is underlined by the long duration from HCV diagnosis to DAA therapy of median 37.0 months (IQR 2.7–181.1 months). A total of 55 (70%) HCV patients achieved a sustained virological response (SVR), 5 (6%) discontinued therapy, 1 (1%) had a reinfection, while 10 (13%) and 8 (10%) patients were lost during DAA therapy or follow-up, respectively. Conclusion The implementation of a physician-operated phone hotline for patients with HCV infection facilitated treatment initiation in an HCV population with poor adherence. Mainly due to losses to follow-up, the SVR rate remained suboptimal with 70%.

The 1500mg/day dietary sodium-restriction commonly recommended for patients with heart failure has recently been questioned. Poor adherence to sodium restricted diets makes assessing the efficacy of sodium restriction challenging. Therefore, successful behavioral interventions are needed. We reviewed sodium restriction trials and descriptive studies of sodium restriction to: 1) determine if sodium restriction was achieved in interventions among heart failure patients; and 2) characterize predictors of successful dietary sodium restriction. Among 638 identified studies, 10 intervention trials and 25 descriptive studies met inclusion criteria. We used content analysis to extract information about sodium restriction and behavioral determinants of sodium restriction. Dietary sodium was reduced in seven trials; none achieved 1500 mg/day (range=1938–4564mg/day). The interventions implemented in the interventional trials emphasized knowledge, skills, and self-regulation strategies, but few addressed the determinants correlated with successful sodium restriction in the descriptive studies (e.g., social/cultural norms, social support, taste preferences, food access, self-efficacy). Findings suggest incorporating determinants predictive of successful dietary sodium restriction may improve the success of interventional trials. Without effective interventions to deploy in trials, the safety and efficacy of sodium restriction remains unknown.

Background: Poor adherence to treatment is a worldwide problem and is also recognised in managing low back pain (LBP). Objective: This review aims to evaluate the rate of adhering to physical activity advice. Data sources: A systematic review was conducted by searching 12 databases from January 2000 to December 2019. Study selection: Studies were eligible when assessing LBP patients' adherence to activity advice. Data extraction: Key data extracted related to adherence to home-based exercise and/or physical activity advice given to patients over 18 who suffer from non-specific LBP. Data synthesis: After screening, 28 studies (out of 1171) were eligible for analysis. Given the studies' outcomes, a qualitative summary was created. Results: Adherence rates varied from 8% to 91%. Bias was likely in three out of 18 randomised trials. Outcomes of the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies ranged from 5 to 11 positive scores out of 14. Limitations: Variability in describing activity advice, the use of different types of outcomes and the use of subjective measurement tools compromised the outcomes of this review. Conclusions: The proportion of fully adhering patients is unclear. Therefore, more objective and uniform assessment tools are needed to assess adherence in future studies.

Low adherence and persistence values, which indicate real-life efficiency, have been widely reported in patients suffering from COPD (Chronic Obstructive Pulmonary Disease). Poor adherence may be related to treatment dosage, thus, simplifying the dosing regimen might improve adherence. The objective of the present study was either to evaluate adherence and persistence in primary drugs used in COPD treatment after 3 years in real life and assess whether the different dosing regimen affects adherence levels to therapy.A pharmacological, observational, non-interventional, retrospective study was carried out by taking into consideration the drugs dispensed between 1 January 2011 and 31 December 2018 at the hospital pharmacy of Pescara. Adherence was reckoned as the ratio between Received Daily Dose (RDD) and Prescribed Daily Dose (PDD). Treatment persistence was reckoned as the time from the start of treatment until its discontinuation. The evaluation of the two drug used indices was carried out by using three different dose regimens: Defined Daily Dose (DDD), minimum daily dose, maximum daily dose.During the study period, 52,374 patients met the inclusion criteria, and after applying the exclusion criteria, 3432, 3608, and 3594 were eligible for analysis by maximum daily, dose, DDD, and minimum daily dose, respectively. For the majority of active ingredients, adherence data was less than 0.8, that is the cut-off universally accepted as ideal value for adherence. In terms of adherence, a statistically significant difference has been highlighted in active ingredients requiring a single daily inhalation, with respect to active ingredients requiring multiple inhalations. Persistence curves have shown no statistically significant difference.It would be appropriate to promote the use of drugs which require a single daily dose in order to improve adherence in these patients.

Background Lymphedema affects many women who are treated for breast cancer. We examined the effectiveness of an education-only (EO) versus education plus sleeve compression/exercise intervention (lymphedema education and prevention [LEAP]) on lymphedema incidence and range of motion (ROM) in a group-randomized trial across 38 cooperative group sites. Methods The treating institution was randomly assigned to either EO or LEAP by a study statistician. All patients at a treating institution participated in the same intervention (EO or LEAP) to minimize contamination bias. Participants completed surveys, arm volume measurements, and self-reported ROM assessments before surgery and at 12 and 18 months after surgery. Lymphedema was defined as a ≥10% difference in limb volume at any time post-surgery up to 18 months after surgery or diagnosis by a health provider. Cochran-Mantel-Haenszel tests were used to compare lymphedema-free rates between groups, stratified by lymph node surgery type. Self-reported ROM differences were compared between groups. Results A total of 554 participants (56% LEAP) were included in the analyses. At 18 months, lymphedema-free rates were 58% (EO) versus 55% (LEAP) (P = .37). ROM for both arms was greater in LEAP versus EO at 12 months; by 18 months, most women reported full ROM, regardless of group. In LEAP, only one-third wore a sleeve ≥75% of the time; 50% performed lymphedema exercises at least weekly. Conclusion Lymphedema incidence did not differ by intervention group at 18 months. Poor adherence in the LEAP group may have contributed. However, physical therapy may speed recovery of ROM. Further research is needed to effectively reduce the incidence and severity of lymphedema in patients who have breast cancer.

Background: A major drawback to the management of hypertension among patients is poor adherence to pharmacother- apy. Factors that influence non-adherence to antihypertensive drugs could vary, depending on the prevailing condition of patient and setting. Knowledge of adherence patterns and behavior of hypertensive patients to pharmacotherapy could improve health-directed policies towards hypertension management. Objective: The objective of this study was to determine factors that influence adherence to oral antihypertensive drugs among patients attending two district hospitals in the Volta Region of Ghana. Methods: The study was cross-sectional. Respondents were hypertensive patients attending Krachi West District (n=187) and Hohoe Municipal (n=183) hospitals between March 2016 to May 2016. Data was collected using a structured question- naire and Morisky 8 Item Measurement of adherence scale. Results: Adherence to oral antihypertensive drugs was 89.2%. However, more than half of these respondents appeared to have uncontrolled blood pressure; and this may be due to self-response bias, blood pressure being measured only on the day of the interview or use of fake drugs (which was not assessed in this study). The strongest predictors of adherence were; knowledge on hypertension, perception of severity of condition and the amount of alcohol consumed in a day by respondents. Conclusion: Good adherence to oral antihypertensive drugs was observed in this population despite uncontrolled hyper- tension in a number of the respondents. The three independent predictors of adherence to antihypertensive medications in this study were respondent’s knowledge about hypertension, perception of severity of their condition and the amount of alcohol consumed in a day. Regular patient education and counseling by medical practitioners should be encouraged in these settings to improve patient adherence. Keywords: Adherence; antihypertensive drug; hypertension; Ghana.

espanolLa institucionalidad de salud se enfrenta a dos situaciones que se contraponen al desafio de incorporar la atencion de los hombres en el sistema de salud, uno es la invisibilidad historica de la salud masculina y el otro es la escasa adherencia de hombres a intervenciones preventivas y promocionales de salud. En consecuencia, el objetivo general del estudio fue caracterizar las representaciones sociales que hombres adultos entre 20 y 45 anos, inscritos en el CESFAM Pelequen de la comuna de Malloa, le atribuyen al proceso salud enfermedad y las estrategias preventivas y curativas que implementan para enfrentar estos estados. La metodologia contemplo la aplicacion de tres tecnicas cualitativas para la produccion de informacion: entrevista individual semiestructurada, grupo focal y revision documental de historias clinicas. En general se concluye que los hombres han elaborado construcciones sociales dicotomicas en torno al estado de salud y enfermedad que no favorecen acciones promocionales y preventivas. Le otorgan significados al proceso salud enfermedad, que en algun caso los aproxima al cuidado de la salud, pero no los hace adherentes al sistema, dadas sus prioridades, donde es fundamental la inmediatez en la atencion de salud y no la adherencia a tratamientos. EnglishThe health institutions face two situations that are opposed to the challenge of incorporating men’s attention into the health system, one is the historical invisibility of men’s health and the other is the poor adherence of men to preventive and promotional interventions of health.Consequently, the general objective of the study is to characterize the social representations that adult men between 20 and 45 years old, enrolled in the CESFAM Pelequen in the commune of Malloa, attribute to the health-disease process and the preventive and curative strategies they implement to face these state.The methodology contemplated the application of three qualitative techniques for the production of information: semi-structured individual interview, focus group and documentary review of medical records.Key words:Health, disease, social representations, masculinitiesCarolina Galaz LlanosIn general, it is concluded that men have elaborated dichotomous social constructions around the state of health and disease that do not favor promotional and preventive actions. They give meanings to the health-disease process, which in some cases brings them closer to health care, but does not make them adhere to the system, given their priorities, where immediacy in health care is essential, not adherence to treatments.

Background The purpose of this pilot trial was to determine the feasibility of a self‐managed lymphedema randomized control trial to test the effectiveness of a head and neck‐specific exercise protocol. Methods Nine participants were randomized to receive usual treatment provided by an Australian metropolitan teaching hospital (n = 4) or usual treatment with an added head and neck exercise regime (n = 5). Feasibility was assessed through ease of recruitment, adherence, and safety. Lymphedema reduction and quality of life (QOL) data were assessed at baseline (0 week) and follow‐up (6 weeks). Results The study was feasible in terms of safety and participant retention. However, a slow recruitment rate and low adherence may impact future trials. There were no significant differences in lymphedema reduction or QOL between groups. Conclusion This pilot feasibility study demonstrated that a self‐management trial can be implemented, however, modifications will be required due to the slow recruitment and poor adherence rates. Level of evidence 1b: Individualized randomized control trial.

Colorectal cancer screening has been shown to prevent or detect early colorectal cancer and reduce mortality; yet, adherence to screening recommendations remains low, particularly in rural settings.RCT.Adults (n=7,812) aged 50-75 years and due for colorectal cancer screening in a largely rural health system were randomly assigned to either the intervention (n=3,906) or the control (n=3,906) group in September 2016, with analysis following through 2018.A mailed motivational messaging screening reminder letter with an option to call and request a free at-home fecal immunochemical screening test (intervention) or the standard invitation letter detailing that the individual was due for screening (control). Multifaceted motivational messaging emphasized colorectal cancer preventability and the ease and affordability of screening, and communicated a limited supply of test kits.Colorectal cancer screening participation within 6 months after mailed invitation was ascertained from the electronic medical record.Colorectal cancer screening participation was significantly improved in the intervention (30.1%) vs the usual care control group (22.5%; p0.001). Individuals randomized to the intervention group had 49% higher odds of being screened over follow-up than those randomized to the control group (OR=1.49, 95% CI=1.34, 1.65). A total of 13.2 screening invitations were needed to accomplish 1 additional screening over the usual care. Of the 233 fecal immunochemical test kits mailed to participants, 154 (66.1%) were returned, and 18 (11.7%) tested positive.A mailed motivational messaging letter with a low-cost screening alternative increased colorectal cancer screening in this largely rural community with generally poor adherence to screening recommendations. Mailed colorectal cancer screening reminders using motivational messaging may be an effective method for increasing screening and reducing rural colorectal cancer disparities.

Background Delusional disorder is an uncommon psychotic disorder. The first-line treatments for this chronic and resistant condition are antipsychotic medications, usually associated with several side effects that can exacerbate poor adherence. Conversely, aripiprazole is a well-tolerated antipsychotic drug that is effective in the treatment of other psychotic disorders. Here, we aimed to systematically review and summarize the currently available literature to evaluate the effectiveness and tolerability of aripiprazole in delusional disorders. Methods A comprehensive literature search from inception until February 2020 was performed in PubMed, Cochrane Database of Systematic Reviews, and Scopus databases using The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results We identified 21 single cases of delusional disorders, mostly somatic type, treated with aripiprazole. All studies reported patient clinical improvements after the beginning of the treatment with aripiprazole. The average dose of aripiprazole was 11.1 mg/day, and the average time to achieve a clinical response was 5.7 weeks. Few adverse effects were reported, including asthenia, extrapyramidal symptoms, hyperprolactinemia, and insomnia. Conclusions Our findings suggest that aripiprazole may be an effective treatment for delusional disorders with good tolerability. Further studies comparing aripiprazole with other antipsychotics in the treatment of delusional disorders are needed.

About one-third of women of reproductive age are obese, predisposing both mother and baby to unfavourable pregnancy outcomes and initiating an intergenerational cycle of chronic metabolic disorders. Here we summarise recent research on the influence of maternal metabolic health on offspring susceptibility to future cardiometabolic diseases. Current primary lifestyle approaches (i.e., diet and exercise interventions) to halt the succession of inherited and epigenetic metabolic abnormalities have met with limited success due to late implementation, poor adherence, and/or generic guidelines. In our opinion, such interventions must commence prior to conception to improve both maternal and child health outcomes, with new approaches urgently needed to increase adherence to primary lifestyle changes among reproductive-age women.

Purpose Adherence to vitamin supplementation recommendations after bariatric surgery is generally poor, which is associated with nutritional deficiencies. Patients’ own perspectives and reasons for poor adherence to vitamin supplementation recommendations have not yet been studied in depth. The purpose of this study was first to measure the accuracy of self-reported adherence to supplementation recommendations by using objective measures of vitamin D levels in blood and thereafter to explore perceptions of barriers and facilitators to participants’ adherence to supplementation recommendations. Material and Method Participants were recruited from a prospective study investigating the outcome of bariatric surgery in adolescents with severe obesity. Mixed methods were used, including a quantitative part where vitamin D levels were analysed through 25(OH)D levels in blood and/or a questionnaire on adherence to supplementation programmes 5 years after surgery (n = 40) plus a qualitative part with semi-structured interviews (n = 20). Results We found a convergence between self-reported adherence to vitamin supplementation and vitamin D 25(OH)D levels in blood indicating honestly in self-reported responses. The qualitative evaluations resulted in the categories awareness and personal capability and external factors. In the analysis, an overall theme emerged; capacity is crucial for adherence in youth who have undergone bariatric surgery. Conclusion Bariatric surgery is a comprehensive procedure that requires lifelong treatment afterwards. There is coherence between what adolescents actually do and what they say they do. Capacity is crucial for adherence and social support has been shown to be important.

Majority of people with chronic diseases have poor adherence to their therapeutic regimen. It can result in various complications physialogically with undesirable metabolic conditions. The main objective of this study is to assess the level of satisfaction attained after medication in comorbidities (either having diabetes only or having hypertension only or having Hypertension and Diabetes) and also focussed on creating awareness in patients who do not follow the medication. A prospective cross sectional study was conducted at tertiary care hospital, Khammam, Telangana. 200 patients were approached and were interviewed with their consent. The purpose of the same was to collect the information on socio demographics, medication that is followed, and behavioural characteristics. A structured questionnaire MMAS-8 an eight itemed scale was involved to identify individuals, determine their levels, the reliability and validity of the medication followed. The scrutiny of this study found that there is a better medication adherence in individual’s diseases (Hypertension, Diabetes) whereas in hypertension and diabetes condition high and low adherence were reported because of their awareness, negligence and risk factors respectively. The study concludes that there is an increase in Medication adherence in individual diseases whereas in hypertension and diabetes there are equal ranges of both low and high adherence.

Zufan Gebrehiwot, Yohannes Tadiwos School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, EthiopiaCorrespondence: Yohannes TadiwosSchool of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, EthiopiaTel +251 912039585Email ytadios@yahoo.comBackground: Antimicrobial resistance (AMR) results in treatment failure and spread of the infection, which will cause prolonged illness, increased mortality, and financial burdens. Some factors that are responsible for inappropriate use of antimicrobials include lack of expertise by health care professionals and problems in diagnosis.Objective: To assess the knowledge and belief related to AMR among health care professionals in HFSUH in Harar, Ethiopia.Methodology: A cross-sectional study was conducted on 153 physicians, nurses, and pharmacists from HFSUH, which were selected using stratified sampling with proportional allocation. Data were collected from March 1 to March 30, 2017, and were analyzed using the Statistical Package for Social Sciences (SPSS 20.0).Results: Only 132 participants were willing to participate from the 153 health care providers; of whom, 35 (26.5%) were physicians, 86 (65.2%) were nurses, and 11 (8.3%) were pharmacists. MRSA was mentioned as the prominent resistant bacteria by 74.3% of the physician, 59.3% of the nurses, and 63.6% of the pharmacists. The majority consider the overuse of antibiotics, poor infection control, sub-standard antibiotic, and patients’ poor adherence as factors for AMR. AMR was considered a problem worldwide, country, and hospital level. Forty percent of the physicians, 32.6% of the nurses, and 63.6% of the pharmacists consider the patient influence on the prescriber as the cause; whereas, 31.4% of the physician, 48.8% nurses, and 36.4% of the pharmacists consider the failure of previous treatment as the major cause of unnecessary antimicrobial prescription.Conclusion: The information the health care professionals have about the different resistant bacteria, on the different factors that cause unnecessary antibiotic prescription and on how to use susceptibility testing is low. All professionals should take regular AMR training and select antibiotics based on tests and minimize the risk of AMR.Keywords: antimicrobial resistance, health care professionals, Hiwot Fana Specialized University Hospital

Accurately diagnosing gastroparesis relies upon gastric emptying scintigraphy (GES) being performed correctly. Jointly published protocol guidelines have long been available; however, the extent to which practitioners adhere to these guidelines is unknown. This study aimed to assess national compliance with established GES protocol guidelines. We developed a questionnaire addressing the key protocol measures outlined in the Consensus Recommendations for Gastric Emptying Scintigraphy. Survey questions addressed patient information collection (15), patient preparation and procedure protocol (16), meal content and preparation (7), imaging (3), interpretation (4), reporting (7), and institutional demographic data (7). The anonymous questionnaire was distributed electronically to members of the Society of Nuclear Medicine and Medical Imaging (SNMMI) and non-member recipients of the SNMMI daily email newsletter. One response per medical institution was permitted. A total of 121 out of 872 potential medical institutions (MI) responded (13.9%); 49 (40.4%) were academic/teaching medical centers. The annual number (mean) of GES procedures was 199.9 (range 5–2000 GES/year). On average, MI performed 33.5/52 (64%) of protocol measures according to guidelines while academic medical centers performed 31.5/52 (61%) of protocol measures according to guidelines. Only 4 out of 88 MI (4.5%) performed GES while adhering to three critical measures: validated study duration; controlled blood glucose levels; and proper restriction of medications. Low compliance with GES protocol guidelines, even among academic medical centers, raises the likely possibility of misdiagnosis and improper management of upper gastrointestinal symptoms. These results highlight a need for increased awareness of protocol guidelines for gastric scintigraphy.

Given the prevalence of poor adherence to therapy and the biases of self-reporting across healthcare, we hypothesized that an engaging, personalized therapy may improve adherence and treatment outcomes in the home. We tested this hypothesis in the initial indication of amblyopia, a neurodevelopmental disorder for which available treatments are limited by low adherence. We designed a novel digital therapeutic that modifies patient-selected cinematic content in real-time into therapeutic visual input, while objectively monitoring adherence. The therapeutic design integrated a custom-designed headset that delivers precise visual input to each eye, computational algorithms that apply real-time therapeutic modifications to source content, a cloud-based content management system that enables treatment in the home, and a broad library of licensed content. In a proof-of-concept human study on the therapeutic, we found that amblyopic eye vision improved significantly after 12 weeks of treatment, with higher adherence than that of available treatments. These initial results support the utility of personalized therapy in amblyopia and may have broader relevance for improving treatment outcomes in additional indications.

Objective:The objective was to evaluate maternal Mediterranean diet (MD) pattern adherence during pregnancy and its association with small for gestational age (SGA) and preterm birth. A secondary objective of the current study was to describe the sociodemographic, lifestyle and obstetric profile of the mothers studied as well as the most relevant paternal and newborn characteristics.Design:The current study is a two-phase retrospective population-based study of maternal dietary habits during pregnancy and their effect on newborn size and prematurity. The descriptive first phase examined maternal dietary habits during pregnancy along with the maternal sociodemographic, lifestyle and obstetric profile in a cross-sectional period study. In the second phase, newborn outcomes were evaluated in a nested case–control study. Adherence to MD during pregnancy was measured with the Spanish version of Kidmed index.Setting:Obstetrics ward of the La Fe Hospital in Valencia.Participants:All mother–child pairs admitted after delivery during a 12-month period starting from January 2018 were assessed for eligibility. A total of 1118 provided complete outcome data after signing informed consent.Results:14·5 % met the criteria of poor adherence (PA); 34·8 %, medium adherence (MA); and 50·7 %, optimal adherence (OA). Medium adherence to MD was associated in the adjusted scenarios with a higher risk of giving birth to a preterm newborn. No association was found between MD adherence and SGA.Conclusions:Early intervention programmes geared towards pregnant women, where women were aided in reaching OA to MD, might reduce the risk of preterm newborn.

espanolAntecedentes. La diabetes mellitus tipo 2 (DM 2) es una enfermedad metabolica que se manifiesta por niveles de glucosa en sangre superiores a los limites normales. Las malas condiciones sociales y economicas son algunos de los principales factores de riesgo de la mala adherencia al tratamiento. Objetivo. Describir la relacion entre nivel socioeconomico y el apego al tratamiento farmacologico en pacientes con DM2. Metodos. Estudio observacional, transversal y descriptivo en 130 pacientes, utilizando la encuesta Haynes-Sackett, Morisky- Green y medicion del nivel socioeconomico (AMAI NSE). Se realizo previa aprobacion del Comite Local de Etica e Investigacion y firma del consentimiento informado. Resultados. La edad promedio fue de 56 (DE 10,66) anos; 74 % correspondian al sexo femenino, 75 % referian ser casados, 61,5 % reportaba tener algun tipo de trabajo. El 29 % tenia un nivel socioeconomico medio bajo, 18 % nivel bajo alto. La relacion entre nivel socioeconomico y el apego al tratamiento, es estadisticamente significativa (p= 0,031; IC95 % 0,001-0,060). Conclusion. Se encontro asociacion estadisticamente significativa entre el nivel socioeconomico de los pacientes y el mal apego al tratamiento; predomino el nivel medio alto en pacientes con apego al tratamiento. EnglishBackground. Type 2 diabetes mellitus (DM2), is a metabolic disease that is manifested by blood glucose levels above normal limits, the impact of social and economic inequalities is considered as one of the main risk factors for poor adherence to treatment. Objective. Describe the relationship between socioeconomic status and adherence to drug treatment in patients with DM2. Methods. Observational, cross-sectional and descriptive study in 130 patients, using the Haynes-Sackett, Morisky-Green survey and measurement of socioeconomic status (AMAI NSE). It was carried out with the prior approval of the Local Ethics and Research Committee and signed informed consent. Results. The average age was 56 (SD 10.66) years, 74% corresponded to the female gender, 75% reported being married, 61.5% reported having some type of work. The socioeconomic level was 29% with medium low level, 18% with high low level. The relationship between socioeconomic status and adherence to treatment is significant (p= 0.031; 95% CI 0.001-0.060). Conclusion. An association of the socioeconomic level of the patients and the poor attachment to the treatment were found, the medium high level prevailed in those patients with adherence to the treatment.

Hypertension is a chronic medical condition characterized by an elevated arterial blood pressure with increasing prevalence in developing countries including Nigeria. One of the integral elements in management of hypertension is adherence to medication and life-style modification. This study aimed to assess adherence level for anti-hypertensive medications among adult hypertensive patients attending public hospitals in Kano State, Nigeria. The study was a cross sectional prospective survey involving 600 patients from six public healthcare facilities selected by multistage sampling technique. Adherence status was assessed using Morisky medication adherence scale. Sociodemographic data and other factors that may influence adherence to hypertension medications were evaluated. Out of the 598 patients that participated in the study, only 178 (29.8%) have their BP controlled based on JNC8. Three hundred and thirty two (55.5%) out of 598 patients have good adherence, while 266 (45.5%) have poor adherence. Of the 178 patients who had good BP control, 120 (67.5%) have good adherence while 58 (32.5%) have poor adherence. BP control was significantly higher in those that adhered to antihypertensive medication compared with non-adhering patients (χ2 = 14.526; df = 1; p-value = < 0.001). Additionally, Chi-square test showed significant association between number of antihypertensives and blood pressure control. (χ2=37.556, df=3, p

Background : Rheumatic heart disease (RHD) contributed to a large number of proportion amoung cardiovascular problems in developing county, especially Indonesia. Secondary prophylaxis method using intramuscular injection of Benzathin Penicillin-G (BPG) has been known as the most effective strategy in the prevention of RHD. However, whether this prevention method also resulting in prevention of disease severity in Indonesian patients remained to be examined. Objectives : This study aimed to assess the difference of rheumatic valve severity in Indonesian pediatric patients between adequate and poor adherence to secondary prophylaxis by using intramuscular BPG injection. Methods : This cross-sectional study was conducted at Pediatric Cardiology Department of Saiful Anwar General Hospital from November 2018 to June 2019. Patients with documented history of RHD were included. Frequency of intramuscular BPG injection during the last one year was recorded. Adherence was measured using the proportion of days covered (PDC) and adequate adherence was defined as PDC ≥0.90. The severity of RHD was assessed based on the severity of the mitral and / or aortic valve using echocardiography. Bivariate analysis and multivariate logistic regression analysis was used to identify characteristics associated with rheumatic valve severity. Results : A significant difference of rheumatic mitral and/or aortic valve severity was observed between adequate adherence compared to poor adherence group (p = 0.016). Rheumatic mitral and/or aortic valve were found to be more severe in patients who has one or more episode of ARF recurrence (p = 0.003). Multivariate logistic regression analysis demonstrated that adherence to secondary prophylaxis within the last 1 year has the strongest influence on the severity of rheumatic mitral and/or aortic valve (p = 0.049; OR 7.20). Conclusion : The adherence to secondary prophylaxis has the strongest related the rheumatic valve severity compared to other factors.

Asthma is the most common chronic disease of childhood leading to an ongoing burden on the emergency departments all around the world. The present study was conducted with the aim to assess the awareness and misconceptions related to the terminology, triggers and management among the caregivers of asthmatic children in Makkah, Saudi Arabia. An observational cross-sectional study was conducted among the asthmatic children above 6 months of age at the Maternity and Children’s Hospital in Makkah, Saudi Arabia during the period between March 2018 and July 2018. Data were collected by a structured questionnaire that includes demographic data, knowledge and awareness of the terminology, severity, triggers, follow-up and management of the disease with a focus on Metered-Dose Inhalers (MDIs), nebulizer therapy and Inhaled Cortico-Steroids (ICS). A total 242 children were included in the study 64.5% were males, 35.5% were females. A majority (71.5%) of caregivers believed that nebulizers are more effective than MDIs to treat their children. Among the 242 children, 47.1% use spacer devices regularly and only 40.5% of them have used ICS. The main reason for not using steroid inhalers and spacer devices as stated by most caregivers (68% and 49.3% respectively). was “never recommended by physicians”. 73.1% of the children had no Asthma follow up outside the ED. 73.7% of caregivers who reported having a smoker in their homes did not know the harmful effects of smoking on their children. Many misconceptions about the terminologies, triggers, the nature of the ED medications and outpatient treatment were found among the caregivers of the children included in the study. Physicians poor adherence to current asthma treatment guidelines and the lack of well structured follow up and educational programs may be contributing to the caregivers inconsistencies with outpatient treatment and follow up.

Introduction. Celiac disease, an autoimmune enteropathy, occurs in susceptible individuals and is treatable with a gluten-free diet. These may not be supplemented with vitamins. Objective. To assess the nutritional health of children who have biopsy-proven celiac disease. Methods. Charts were reviewed between July 1, 2007, and June 30, 2017. Results. A total of 252 children ages 0 to 21 years had biopsy-proven celiac disease, mean age 11 ± 4.1 years. Body mass index Z-score was 0.2 ± 1.2 at diagnosis. Except for vitamin D, few had deficiencies at diagnosis. At 1-year follow-up, there was no significant change in anthropomorphics or vitamin status. Adherence to follow-up was poor; at 5 years after diagnosis, 39% adhered to follow-up. Conclusion. Despite a rigorous, proactive protocol for contacting and following children with celiac disease, adherence to follow-up was poor. New strategies, such as follow-up through the primary care provider, are needed.

Bariatric surgeries have been demonstrated to be safe and effective treatment options for morbid obesity patients, but operative risks and high health care costs limit their clinical application. Endoscopic bariatric therapies are emerging as valuable alternatives for patients with doubts about bariatric surgery or ineligible for it. Endoscopic sleeve gastroplasty (ESG), a relatively novel technique of endoscopic bariatric therapies, has gained standing in the past few years. The safety, feasibility, repeatability, and potential for reversibility of ESG have been proven by multicenter studies. Compared to other weight loss strategies, current evidence demonstrates that ESG offers satisfactory efficacy in weight loss. Even though it is inferior to laparoscopic sleeve gastrectomy, it has lower risks of adverse events than surgical interventions and intragastric balloon within one-year follow-up. Furthermore, ESG may be the ideal weight control strategy for patients who have poor adherence to behavioral interventions. Even so, trends in decreased weight loss effect over time, post-procedure weight regain, post-procedure gut hormone alteration, and possible effects of race and ethnicity on ESG still remain undetermined due to very limited reports and very short follow-ups. Further clinical trials are required to validate and answer these questions.

Background: Acute coronary syndrome (ACS) patients are widely treated with long-term beta-blocker therapy after cardiac event. Especially for low-risk patients, the benefits of beta-blockers on survival and the optimal therapy duration remain unclear. We investigated the effect of adherence to beta-blockers on long-term survival of ACS patients. Methods and results: A total of 1855 consecutive ACS patients who underwent angiography and survived 30 days after were followed for a median of 8.6 years. During follow-up, 30.1% (n = 558) of patients died. Adherence was assessed as yearly periods covered by medication purchases and investigated as a dynamic time-dependent variable in Cox proportional hazards models. In a univariable model, non-adherence to beta-blockers was associated with higher all-cause mortality (Hazard ratio [HR] 2.99, 95% confidence interval [CI] 2.50−3.57; p

Background The problem of nonadherence to therapy is a key reason of insufficient asthma control. Evaluating the beliefs about asthma medication, cognitive and emotional perceptions may help to identify patients with poor adherence to treatment in clinical practice which need additional attention in order to increase the likelihood of them taking their asthma medication according to the prescribed treatment protocol. The purpose of this study is to assess whether beliefs about asthma medication, cognitive and emotional factors are related to poor treatment adherence of asthma medication in a sample of asthma patients in Latvia. Methods Study subjects were asthma patients attending outpatient pulmonologist consultations in Latvia during September 2013 to December 2015. Beliefs about asthma medicine, cognitive and emotional factors related to asthma were determined in a cross-sectional, self-administered survey. The validated Beliefs about Medicines Questionnaire (BMQ) and the Brief Illness Perception Questionnaire (brief IPQ) were used. Treatment adherence was assessed using 5-item version of the Medication Adherence Reporting Scale (MARS). The total sample size was 352 patients. Logistic regression models were used to predict poor adherence to asthma treatment. The validity of each logistic regression model was assessed by the Hosmer/Lemeshow test. The main outcome measure was self-reported adherence to treatment. Results The more the patients agreed with the statement “My future health depends on my asthma medication” the lower the possibility of poor adherence to asthma treatment (OR 0.42; 95% CI 0.24–0.74). The more concerned the patients were in regard to long-term effects of their medication (OR 2; 95% CI 1.22–3.27), the higher the probability of poor treatment adherence. Conclusions Screening asthma patients using the BMQ may help to identify those to benefit from interventions targeting their concerns and medication beliefs in order to improve adherence to asthma medication.

Poor adherence to complex medication regimens is a global problem that affects the treatment of chronic diseases, which involves polypharmacy and requires long-term administration of medications. The most significant barrier to medication adherence in older adults is patient-related factors. The purpose of this study was to find evidence from the current literature to evaluate the effectiveness of electronic medication packaging (EMP) devices on improving medication adherence in older patients. MEDLINE and EMBASE databases were searched based on inclusion/exclusion criteria, focusing on medication adherence and EMP devices with specific technological features. Search results included studies with experiences of patients with four different devices and various medical conditions. Study results indicated that EMP devices may improve medication adherence in older patients. However, due to insufficient evidence that supports their effectiveness specifically in the aging population, further clinical validation in older adults is recommended to draw strong conclusions. [ Journal of Gerontological Nursing, 46 (3), 27–36.]

Polypharmacy is a common observation among older adults secondary to their complex medical needs requiring management with 1 or more medications. The use of numerous medications may result in medication-related problems such as inappropriate indications, therapeutic duplication, adverse effects, drug interactions, unnecessary medications, poor adherence, and a strain on health care resources. Nurse practitioners will be required to review and streamline the appropriate and safe use of medications in patients to minimize some of the highlighted concerns. This article uses a case-based approach to showcase various issues that a nurse practitioner may encounter as it relates to polypharmacy and pharmacotherapeutic considerations. Tools are also explored to assess polypharmacy in the field.

Background and aim The Adherence to Guidelines in the Treatment of patients with Chronic Heart Failure trial showed a poor adherence to the current therapeutic guidelines in 660 chronic heart failure (CHF) patients. The second phase, Adherence to Guidelines in the Treatment of patients with Chronic Heart Failure follow-up, was aimed to determine if periodic echocardiographic evaluations could improve the prognosis of CHF patients and/or increase the adherence to the guidelines. Material and methods Among 528 CHF patients with reduced ejection fraction from the ALERT registry, 436 patients accepted to participate in the second phase of the study between February and September 2013 and completed the 3-year follow-up phase between February and September 2016. They were randomized into two groups: Group A (n = 218) followed by clinical evaluation and ECG every 3 months, and echocardiography every 6 months and Group B (n = 218) monitored only with clinical evaluation and ECG every 3 months. Results The number of vascular events that occurred resulted as similar in both the groups: there were 78 hospitalizations (37 in Group A vs. 41 in Group B); 9 home-treated vascular events (4 in Group A and five in Group B); and 16 cardiovascular deaths (9 and 7, respectively). The adherence to the guidelines at the end of the trial resulted as significantly improved in both the groups in comparison with the basal evaluation, without differences between the two groups. Conclusion A strict follow-up of CHF patients was associated with a lower number of events and an improvement in the adherence to the guidelines. Periodic echocardiography does not modify these results.

Background/objectives Adherence is a major challenge in topical glaucoma therapy, particularly in an African context. We report a pilot study assessing adherence independently for the first time in an African context. Subjects/methods Participants with newly diagnosed open-angle glaucoma received a weighed bottle of Lumigan 0.01% with counselling on therapy. The bottles were returned monthly for renewal and weighed on return to estimate drops taken during the period. Data collection was for one year with a short compliance questionnaire. Results 11 patients participated. 5 (45%) failed to complete one full year of topical therapy. The overall mean number of drops per eye per day was 1.74 (SD 0.69) for the 6 with one year of monthly returned bottles and controlled IOPs at each visit. Self-perception of compliance in these patients was good. Conclusion The signs of poor adherence based on both self-report (previous literature), and in this small-scale study of an objective measure suggest medication may not be the first-line treatment of choice in this environment. Our report does, however, raise the possibility that those patients who return for repeat prescriptions and review are indeed adhering to their treatment regimens.

The objective of the study: to analyze the efficacy of endobronchial valve block ( EBV ) during ou t-p atient treatment of patients with destructive pulmonary tuberculosis who refused i n-p atient treatment and therapy with ant i-t uberculosis drugs. Subjects and methods. Treatment outcomes of 129 patients were randomly studied, the patients suffered from destructive pulmonary tuberculosis and demonstrated low adherence to therapy with ant i-t uberculosis drugs and staying in hospital. EBV was used in one group (66 patients), and it was not used in patients from another group (63 patients). Results. The use of EBV in patients with poor adherence to inpatient treatment and chemotherapy allowed achieving sputum conversion in 36 (58.1%) patients and healing of cavities in 43 (65.2%). Among the patients in whom no EBV was used, sputum conversion was achieved in 12 (20.7%) patients ( p = 0.001, χ 2 ) and cavities were healed in 14 (22.2%) patients ( p = 0.001, χ 2 ). Efficacy and safety of EBV was demonstrated when used on the ou t-p atient basis in the above category of patients.

The commonness and related Weight of ailment because of asthma, it required to get an ideal control of the malady and improve the results of these patients. In any case, it has been seen that there is poor adherence to the treatment, which prompts the problematic control of the illness. To read the adherence for treatment in these patients to survey the effect of Wellbeing instruction and self-activity plan to improve adherence. A forthcoming report Was done in a sum of 986 asthma patients over a time of 3 years. When incorporated into the examination, the patients are followed up after 12 Weeks of non-adherence to the treatment. It was seen that solitary 108 patients (10.95%) had normal non-adherence, and 878 patients (89.05%) Were adherence to the treatment. Elements that Were related to poor adherence Were: LoWer instructive level, poor financial status, changes in routine, and patient's evil mentalities toward Wellbeing. Subsequent to utilizing the different systems for improving the adherence in these patients, the adherence expanded in patients (61.32%) among the prior defaulted patients, while the staying 188 patients (38.68%) Were seen as non-adherence even after different instructive procedures. Nonadherence in asthma the executives is an unavoidable truth and adherence improving system likely as a viable decent doctor and patient relationship. Individualized composed activity plans dependent on pinnacle expiratory stream are proportionate to activity plans dependent on indications.

Kamban Hirasen,1,* Denise Evans,1,* Nelly Jinga,1 Rita Grabe,2 Julia Turner,2 Sello Mashamaite,2 Lawrence C Long,1,3 Matthew P Fox1,3,4 1Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 2Right to Care, Johannesburg, South Africa; 3Department of Global Health, Boston University School of Public Health, Boston, MA, USA; 4Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA*These authors contributed equally to this workCorrespondence: Denise Evans Tel +27 10 001 0637Email devans@heroza.orgIntroduction: The best method to measure adherence to antiretroviral therapy (ART) in resource-limited settings has not yet been established, particularly among adolescents and young adults (AYAs). The use of mobile technology may address the need for standardized tools in measuring adherence in this often marginalized population.Methods: We conducted a cross-sectional validation study among AYAs (18– 35 years) attending a South African HIV clinic between 07/2015-09/2017. We determine the diagnostic accuracy of two modes of delivering an adherence questionnaire (self-administered electronic vs interviewer-administered paper-adherence questionnaire) comprising two self-reported adherence tools (South African National Department of Health (NDoH) adherence questionnaire and the Simplified Medication Adherence Questionnaire (SMAQ)) to identify poor adherence compared to; 1) a detectable viral load (≥ 1000 copies/mL) and 2) a sub-optimal concentration of efavirenz (EFV) (EFV ≤ 1.00 μg/mL) measured by therapeutic drug monitoring (TDM).Results: Of 278 included participants, 7.1% and 7.3% completing the electronic- and paper-questionnaires had a detectable viral load, while 14.7% and 16.5% had a sub-optimal concentration of EFV, respectively. According to viral load monitoring, the electronic-adherence questionnaire had a higher sensitivity (Se) in detecting poor adherence than the paper-based version across the NDoH adherence questionnaire (Se: 63.6% vs 33.3%) and SMAQ (Se: 90.9% vs 66.7%). In contrast, when using blood drug concentration (EFV ≤ 1.00 μg/mL), the paper-adherence questionnaire produced a higher sensitivity across both adherence tools; namely the NDoH adherence questionnaire (Se: 50.0%vs 38.1%) and SMAQ (Se: 75.0% vs 57.1%).Conclusion: When using more accurate real-time measures of poor adherence such as TDM in this young adult population, we observe a higher sensitivity of an interviewer-administered paper-adherence questionnaire than an identical set of self-administered adherence questions on an electronic tablet. An interviewer-administered questionnaire may elicit more accurate responses from participants through a sense of increased accountability when engaging with health care workers.Keywords: antiretroviral therapy, adherence, adolescents, virologic suppression, therapeutic drug monitoring, South Africa

The 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease for treatment of atherosclerosis in asymptomatic individuals is an advance over previously published recommendations. However, since all guidelines are based on a limited quantity of published studies and result from a consensus of experts in different fields of medicine, omissions and errors are inevitable. The present manuscript identifies four areas in these 2019 AHA/ACC guidelines that alternative approaches or changes would result in improved outcomes and reductions in atherosclerotic events. First, the goal for the reduction in the prevalence of cardiovascular disease should be total (100%) eradication of the disease. This is a feasible goal as the facilities and resources to accomplish this task are currently available. Second, guidelines should acknowledge that atherosclerosis is a reversible disease as has previously been documented by multiple studies. If reversible, then under the appropriate clinical circumstances, it is preventable. Third, the goal for LDL cholesterol reduction should be

Implantable and long-lasting drug delivery systems provide sustained delivery of drug over a period of weeks to months. These systems can provide many advantages in the delivery of drugs for conditions in which the patient is required to take medications frequently for an indefinite period of time, such as less frequent dosing and improved quality of life. This chapter will cover infectious, inflammatory, endocrine, and neurodegenerative diseases. In the majority of these diseases, frequent dosing is required by the patient, leading to poor adherence by them. Therefore long-acting implants and systems are evaluated as novel methods for drug delivery, which can reduce dosing frequency and improve patient adherence, in turn improving efficacy of treatment.

Tight glycaemic control is essential, and good adherence is associated with a lower risk of all-cause mortality and hospitalisation in people with T2D. A significant number of people with T2D do not take medication as prescribed and therefore have poor outcomes. The key factors for not achieving targets include therapeutic inertia and adherence. Reasons for poor adherence include perception of treatment, complexity of treatment and adverse effects. Poor adherence leads to inadequate glycaemic control, which increases the risk of diabetic complications and mortality. There is evidence to suggest that education and monitoring is important in medication adherence.

This study aimed to assess the impact of phenylketonuria (PKU) and its treatment on parent and child health-related quality of life (HRQoL), and to identify the parenting-related correlates of parent and child HRQoL, as well as metabolic control. Eighteen mothers of 2 to 12-year-old children with PKU participated and completed a series of self-report questionnaires including the Phenylketonuria Impact and Treatment Quality of Life Questionnaire (PKU-QOL). Mothers reported that the most significant impact of PKU on HRQoL was in relation to impact of their child's anxiety during blood tests on their own HRQoL, and guilt related to poor adherence to dietary restrictions and supplementation regimens. Higher reported intensity of child emotional and behavioural difficulties and parenting stress were associated with higher scores for PKU symptoms on the PKU-QOL, higher scores for emotional, social and overall impact of PKU, and higher scores for impact of dietary restriction. Where mothers reported greater use of overreactivity as a parenting strategy, children tended to have better lifetime phenylalanine (Phe) levels; however, the overall impact of PKU and the impact of supplement administration on mothers' HRQoL was worse for these families. These findings have implications for a holistic family-centred approach to the care of children with PKU and their families.

Poor adherence to seasonal malaria chemoprevention (SMC) might affect the protective effectiveness of SMC. Here, we evaluated the population pharmacokinetic properties of amodiaquine and its active metabolite, desethylamodiaquine, in children receiving SMC under directly observed ideal conditions (n = 136), and the adherence of SMC at an implementation phase in children participating in a case-control study to evaluate SMC effectiveness (n = 869). Amodiaquine and desethylamodiaquine concentration-time profiles were described simultaneously by two-compartment and three-compartment disposition models, respectively. The developed methodology to evaluate adherence showed a sensitivity of 65-71% when the first dose of SMC was directly observed and 71-73% when no doses were observed in a routine programmatic setting. Adherence simulations and measured desethylamodiaquine concentrations in the case-control children showed complete adherence (all doses taken) in < 20% of children. This result suggests that more efforts are needed urgently to improve the adherence to SMC among children in this area.

While continuous positive airway pressure (CPAP) is an effective first-line therapy for sleep apnea, CPAP fails in one third of patients mainly due to poor adherence to the CPAP device and masks. The role of the medical team is to guide the patient in choosing the best mask, thus insuring good CPAP therapy adherence. Once a suitable mask is found, the brand of the mask does not affect patient satisfaction or CPAP adherence. For the majority of patients, nasal masks are by far more suitable than oronasal masks. Orosanal masks are indicated in case of nasal stuffiness or when an air leak manifests through the mouth. Re-evaluation of the efficacy of CPAP therapy is recommended when switching to oronasal masks.

Introduction Anti-seizure medications are used to manage epilepsy and require long-term adherence to maintain therapeutic drug levels. We assessed adherence to levetiracetam and the use of a digital intervention to improve adherence in patients with epilepsy. Methods 30 participants with epilepsy were randomized 1:1 either to a digital email adherence intervention or control group. All patients were provided levetiracetam equipped with electronic monitoring caps to assess patient adherence to medication. Patients were followed for 6 months, with return visits at 1 month, 3 months, and 6 months. Results Subjects randomized to the control arm (n = 15) took 66% of the prescribed doses compared to the intervention group, who took 65% of prescribed doses (n = 15). Nine participants did not complete the study. Of the twenty-one participants that completed the study, the overall rate of adherence was 72% of prescribed doses taken. Two subjects in the control group and three subjects in the intervention group were adherent every month of the study—taking at least 80% of prescribed doses. Those randomized to the control group took the correct number of doses 44% of days in the study, and those in the intervention group took the correct number of doses 37% of days. Discussion Poor adherence to levetiracetam is common. An internet-based email survey intervention did not improve adherence to levetiracetam in epilepsy patients. Further advances in adherence are needed to help patients receive the maximum benefit of their medical treatments.

Pharmaceutical products (non-sterile) are faced with the challenges of not exceeding the minimum limit of microbial presence tolerated for the respective formulations. Antacid suspensions which are multi-dose drug products that are utilized in the neutralization of gastric acid. This drug with neutral pH makes them to be liable to microbial contamination. This study was conducted to evaluate antacid suspensions marketed in Delta State, Nigeria based on their microbial quality. Six different brands of antacid suspensions were collected from different Pharmacies in Delta state and were analysed microbiologically to isolate and quantify the implicated bacteria and fungi using conventional cultural and biochemical techniques. The microbiological evaluation of these samples was determined using the agar-well diffusion method. Five out of the six brands evaluated were found to be populated with a hugenumber of bacteria (2.5 x 102 to > 2.2 x 102 CFU/ml) and fungi (2 x 102 to 8 x 102 CFU/ml). Staphylococcus aureus was absent in any of the antacids brands studied. However, there were presence of objectionable microorganisms, Escherichia coli and Candida albicans in three of the six brands. The results of this study reveal the microbial contamination level of some of the antacid (suspensions) marketed in Delta State which may be due to poor adherence to current good manufacturing practice by the manufacturers. Keywords: Antacid suspensions, Microorganisms, Microbiological quality, Brands.

Introduction: In Kampala Uganda, female sex workers (FSWs) have high HIV prevalence (33%). Oral PrEP is a novel HIV prevention intervention that offers hope to decrease HIV incidence in key populations especially among FSWs. Studies have shown that with poor adherence, oral PrEP has no efficacy, and therefore adherence to PrEP is critical among FSWs to maximize HIV prevention. However, implementation data on adherence to PrEP among FSWs is limited so this study sought to assess adherence to PrEP. Specifically, we sought to 1) determine the level of adherence to PrEP among FSWs, and 2) determine factors associated with PrEP adherence. Methods: This cross-sectional study was conducted from November to December 2018; 126 FSWs using PrEP were inter- viewed using a questionnaire. Adherence was categorically defined as high adherence and low adherence. Logistic regression was done. Results: Using long-term contraception methods (OR 0.06, 95% CI: 0.04-0.77) and not using condoms with clients (OR 0.07, 95% CI: 0.01-0.42) were negatively associated with high PrEP adherence. Conclusion: Barriers to PrEP adherence need to be addressed for successful PrEP implementation to improve adherence going forward. Service care providers should reinforce positive behaviors such as use of condoms devotedly during PrEP breaks. Keywords: Oral PrEP; adherence; female sex workers.

Background: Clinical trials often suffer from recruitment barriers and poor adherence, which increases costs and affects trial outcomes. Objective: To investigate the feasibility of Decentralized Clinical Trial (DCT) design elements to recruit, enroll, and engage patients with type 2 diabetes mellitus (T2DM). Methods: Patients with T2DM were recruited through a pharmacy and online recruitment using advert on Facebook, to 3 weeks monitoring of glucose and behaviometric parameters. Subjects recruited online could either complete an informed consent conversation in the pharmacy or through live video call managed by the study app. A continuous glucose monitoring (CGM) device to collect glucose data, and a hybrid smartwatch to monitor heart rate, track activity and sleep pattern were delivered by postal service to the participants’ home address. The devices were connected to a study specific app on the participant’s smartphone also capturing GPS data and questionnaire answers. Results: Twenty-six subjects (3 pharmacy, 23 online) with T2DM were recruited, 85% preferred online informed consent conversation. All participants were able to self-apply the CGM device, use the smartwatch, and download the app. GPS location was captured more than 100 times for each participant, and more than 90% completed all 3 questionnaires. All the participants felt safe with the informed consent process and they felt confident in participating from home. Three participants dropped-out during the study period leaving a retention rate at 87%. Conclusions: Use of DCT design elements to conduct a T2DM study is feasible regarding recruitment, data collection from various electronic devices, and participant engagement.

The aims of the present prospective clinical study were to determine objective, sensor-measured adherence to a mandibular advancement device (MAD) in patients with obstructive sleep apnea (OSA) and to identify partner-specific adherence-related factors. A total of 77 eligible participants with mild, moderate, or severe OSA and who were non-adherent to continuous positive airway pressure (mean age 56.2 years) participated in the study (32.5% women). The mean (range) observation time between MAD delivery and final follow-up was 8.3 (3.4-16.5) months. The mean apnea-hypopnea index (AHI) was 26.6 events/hr at baseline and 12.5 events/hr at the 8-month follow-up (both p

Para-occupational “take-home” exposure risks among forestry workers and their families in low-and middle-income countries (LMICs) have not been well characterized. This is a concern because research shows an association between chronic low-dose herbicide exposure and adverse health effects. This study explored take-home herbicide residue exposure risks among forestry workers in the Western Cape, South Africa, through the community-based participatory research approach of photovoice. A key finding of the study was the absence of provisions related to take-home exposure in the national legislation and workplace policies, which largely contributed to poor adherence to risk reduction practices at worksites, in addition to workers transporting residues to their homes. This study demonstrated evidence of the key omissions regarding take-home exposure at the policy level (e.g., recommendations for employers to reduce take-home risks among employees, and training of workers and their families on take-home exposure) and take-home herbicide residue exposure among worker’s families, including children.

Direct Oral Anticoagulants (DOACs) have shown to be at least effective and safer than anti-vitamin K (VKA) for the prophylaxis of cardioembolism during AF. These drugs do not need laboratory monitoring such as the VKA anticoagulants, but they are at risk of poor adherence and persistence as all drugs taken by mouth. Against this drawback, empathy may have an important role because it is important as a tool to be used for effective interpersonal communication. Patients like to be heard and understand that those who listen to them are immersed in their world. Empathy is part, and is a founding principle, of Narrative Medicine which today is a real discipline with many advantages because it is intrinsically therapeutic for the patient (in telling and being heard). Empathy prevents the disconnection that can intervene between the doctor and the patients. Have we ever wondered if we are sufficiently empathetic? Is it possible to measure our empathy? Yes, across Jefferson's scale. A high score on Jefferson's scale could certainly further improve the quality of the management of anticoagulated patients.

The HIV infection and the use of antiretroviral drugs is associated with side effects which may lead to mental health disorders. Mental health challenges may cause exaggerated health outcomes and negatively affect patients' self-care, leading to poor adherence to treatment.