Adherent Group Research Articles

폐쇄성 수면무호흡증 환자에서 양압기 치료에 대한 1년 이상 순응군과 비순응군의 비교

Background and Objectives: The use of positive airway pressure (PAP) is the treatment of choice for patients with obstructive sleep apnea (OSA), however, poor adherence remains a major cause of treatment failure. The objective of this retrospective study was to compare the differences between adherent and non-adherent groups to auto-titration PAP (APAP) therapy for more than one year in patients with OSA. Materials and Methods: Total 111 patients with OSA who had completed the 3 months compliance assessment for Korean national health insurance coverage were enrolled. They were allocated to adherent (using APAP for more than 12 months) or non-adherent group. Patients’ medical records, polysomnographic data, and APAP use data at the time of passing adaptation period were analyzed, and the differences between the two groups were compared. Results: The number of patients in the adherent group was 66 (59.5%), and the non-adherent group was 45 (40.5%). There were no significant between-group differences in body mass index, Epworth sleepiness scale, apnea-hypopnea index (AHI), and APAP device data by binary logistic regression analysis. However, patients with severe OSA (AHI≥30) were more likely to be compliant with PAP therapy than patients with mild to moderate OSA (odds ratio 3.433, 95% confidence interval 1.329–8.870, p=0.011). Conclusion: The percentage of patients who used APAP devices for more than 12 months was 59.5% in this study. Disease severity (AHI≥30) seems to be a predictor for APAP compliance for more than one year in patients with OSA.

243.11: Adherence Measurement in Adolescent Liver Transplant Recipients: Is It Useful for Long-term Outcome Assessment?

Introduction: Advances in pediatric liver transplantation have led to an increasing number of patients reaching adolescence in whom poor adherence rate increases, becoming a prevalent risk factor for rejection and other adverse outcomes. Being a modifiable factor, its monitoring is a common practice in long-term follow-up and interventions on it are a priority for transplant programs. However, improvements in adherence do not correlate with long-term clinical results, these being the objective variables of graft functionality. The objective of this study is to correlate adherence measurement by both objective and subjective methods, with graft dysfunction and/or pathological liver biopsy, and to measure long-term clinical results as ideal transplant (single transplant, monodrug, no clinical complications associated with immunosuppression and normal growth). Methods: Measurement and analysis of adherence using objective (variability in drug levels, >2 SD) and subjective methods (SMAQ questionnaire and medical impression) in 62 adolescents with liver transplantation who came for a follow up visit from August 2019 to March 2020 at Garrahan Hospital. Association was searched between the different adhesion methods and chronic graft injury (defined as three months or more of increased transaminases and/or pathological liver biopsy -rejection or fibrosis >2 on the Knodell-Ishak scale) using univariate logistic regression models. A p<0.05 was considered as significant, and STATA 15 was used. Results: Of the patients surveyed, 50% were female, median age of 15.8 years (10.6-18.5), 10 patients received a retransplant (16%) and 40 had more than 10 years post-transplant (64.5%). 55.7% lived in CABA/AMBA and 40.9% in the rest of the country. No statistically significant association was seen between any of the adherence measurement methods with graft dysfunction and/or pathological liver biopsy (p 0.66 and 0.53 for variability, 0.96 and 0.11 for SMAQ questionnaire and 0.35 and 0.19 for subjective opinion). A total of 13 patients (21%) with ideal transplant results were obtained with a mean follow-up of 12.37 years. Conclusion: With the data collected, it is not possible to correlate in a statistically significant way the measurement of poor adherence with graft dysfunction and/or pathological biopsies. Potential biases of this study are sample size, follow-up time and the population studied (adherent group that attends control). However, since variability is an objective method and is related to adverse effects related to immunosuppression, we consider that drug measurement and its variability is the best method. Measurement of adherence is necessary since it allows evaluating interventions aimed at improving it, despite the fact that it is not directly related to clinical results. The focus on long-term transplant care has shifted to long-term consequences of immunosuppressive treatment, and it should be measured with objective variables (“ideal transplant”).

Association between adherence to three healthy dietary patterns and risk of cognitive disorders:Meta-analysis

To investigate the association between adherence to healthy dietary patterns, such as Mediterranean dietary pattern(MED), dietary approaches to stop hypertension(DASH), Mediterranean-DASH intervention for neurodegenerative delay with cognitive disorders(MIND), and the incidence of cognitive disorders. Prospective studies on the association of MED, DASH and MIND with cognitive disorders in Chinese and English literatures were retrieved from PubMed, Wanfang, CNKI and VIP databases by title/abstract retrieval strategy from database establishment to February 28, 2022. Relative risk and its 95% confidence intervals were extracted to calculated the pooled effect and dose-response relationship. Heterogeneity was calculated by using Q test and I~2, and publication bias were analyzed by funnel plot, Begg&apos;s test and Egger&apos;s test. Totally, 124 977 participants and 15 studies about the relationship between healthy dietary patterns and cognitive impairment diseases were included in this study. Compared with the lower adherence group, the relative risks of cognitive disorders were 0.84(95%CI 0.84-0.97) for participants with higher adherence to MED, 0.79(95%CI 0.79-1.00) for participants with higher adherence to DASH, 0.48(95%CI 0.32-0.71) for participants with higher adherence to MIND, respectively. Subgroup analysis showed that the risk of mild cognitive impairment was 0.76(95%CI 0.65-0.90) for participants with higher adherence to MED, and 0.63(95%CI 0.48-0.82) for DASH. No significant association were observed in the relationship of MED, DASH with dementia. Different scoring method for dietary patterns, dietary survey method, study area, follow-up time and sample size might be the main sources of heterogeneity. Higher adherence to MED, DASH and MIND were associated with lower risk of cognitive disorders. MED and DASH were associated with a reduced risk of mild cognitive impairment rather than dementia.

Association between the Severity of Dental Caries and the Degree of Adherence to the Mediterranean Diet in the Pediatric Population.

Children who show better eating practices are less likely to suffer from severe caries than those who eat a diet rich in sugars. In the present study, we aimed to establish the relationship between the severity of dental caries and adherence to the Mediterranean diet. A cross-sectional study was carried out in which 263 children aged 2 to 14 years old were examined intraorally to analyze the presence and severity of caries. Children’s parents/caregivers completed the KIDMED questionnaire to determine their degree of adherence to the Mediterranean diet. The results showed that the prevalence of caries is greater than 80% in children with medium or low adherence to the Mediterranean diet, and remains significant at 67% in the high adherence group (p = 0.010). A statistically significant negative correlation of weak magnitude (r = −0.29; p < 0.001) was found between adherence and the number of carious teeth. Caries severity in the first molars is also influenced by adherence to the diet in a statistically significant way. In conclusion, there is an association between adherence to the Mediterranean diet and the prevalence, extension, and severity of caries in the pediatric population.

Abstract P300: Patterns Of Adherence To Home Blood Pressure Monitoring Among Men And Women In The Electronic Framingham Heart Study

Blood pressure (BP) measures in women more sharply increase with age compared with men, with a widening disparity in older women. The use of home blood pressure monitoring (HBPM) among women may improve this inequity. However, sex-related differences in adherence to HBPM are not well understood. We analyzed data from electronic Framingham Heart Study participants who were given a Withings digital BP cuff and instructed to perform HBPM weekly for 1 year. Adherence was defined as ≥1 BP measurement per week, averaged over 4-week segments. HTN status was self-reported. Group-based trajectory modeling (GBTM) was used to identify trajectory patterns of adherence. We investigated the association of 3 adherence patterns with HTN status stratified by sex using multinomial logistic models adjusting for age group, marital status, education, employment status, income, non-BP cardiac medication use, subjective health, depression and anxiety. Among 1,048 participants (59% female, mean age 53±9 years, 25% with HTN), we identified 3 trajectory groups corresponding to distinct patterns of HBPM adherence: early discontinuation (N = 458, 58% female, 21% HTN), gradual decrease (N = 360, 60% female, 27% HTN), and high adherence (N = 230, 57% female, 31% HTN, Figure 1 ). Women with HTN compared to women without HTN had 80% higher odds of being in the high adherence group versus early discontinuation group (aOR 1.80; 95% CI 1.02-3.17). This pattern was not observed for men (aOR 1.12; 95% CI 0.68-1.63). In this middle-aged eCohort, HTN was associated with high adherence to HBPM in women but not men. The targeted prescription of HBPM for woman should be studied to see if it can reduce sex disparities in BP control.

Associated factors to insulin adherence in type 1 diabetes in Tehran and Karaj, Iran.

Type 1 diabetes mellitus (T1DM) is a chronic metabolic disorder, and its prevalence and incidence are increasing globally. Insulin therapy is the basis of T1DM management that can prevent numerous complications. Identifying and resolving the factors involved in patients' non-adherence can reduce complications, mortality, and economic burden. In this cross-sectional study, a sample of patients with T1DM were included from Alborz and Tehran cities of Iran in 2020. Patients filled the questionnaires consisting of sociodemographic and diabetes characteristics, weight and height measurements, 8-item Morisky Medication Adherence Scale (MMAS), and barriers to insulin therapy. Patients with < six scores of MMAS were considered to have low adherence, while ≥ 6 scores showed moderate/high adherence. Data were analyzed using SPSS, and a P-value of less than 0.05 was considered statistically significant. 189 patients with T1DM with a mean (± SD) age of 17.95 (± 10.98) years were enrolled in the study, and 73.5% of patients had moderate/high adherence to insulin therapy. Younger age and owning insurance were significantly associated with being classified in the higher adherence group. The barriers that were significantly associated with non-adherence were forgetting to buy, physician inaccessibility, cost, exhaustion from the long-term injection, forgetfulness, injection site reaction, and rebellion against parents in the < 20 years age group. The main barriers in ≥ 20 years age group were forgetting to buy and insufficient injection instruction. The identified barriers to insulin injection would be helpful for policymakers and clinicians to increase insulin adherence among patients with T1DM. The online version contains supplementary material available at 10.1007/s40200-022-01105-0.

Impact of an education program on metabolic indicators for patients undergoing percutaneous coronary intervention in Erbil city

Background: Regular education program provides better medication and diet adherence leading to better metabolic control. Therefore, the aim of the study was conducted to improve metabolic indicators including body mass index (BMI), blood pressure (BP), glycated hemoglobin (HbA1c), total cholesterol, triglyceride, and low-density lipoprotein (LDL), and high-density lipoprotein (HDL). Methods: A quasi-experimental study was conducted among 200 patients with coronary heart disease patients in Erbil City from March 2021 to May 2022, the participants of the study were randomly assigned to the control and intervention groups. The education program was performed for the intervention group; the metabolic indicators were measured for patients before attending the program and three months later after ending the program. Results: There was a high statistically significant difference between control and intervention groups for adherence to diet (p&lt;0.00) and medication (p&lt;0.00), after given education program, all metabolic indicators statistically significant improved (body mass index p&lt;0.00, systolic and diastolic BP p&lt;0.00, HbA1c p&lt;0.02 and total cholesterol p&lt;0.00, triglyceride p&lt;0.03, low, HDL p&lt;0.00).Conclusion: The findings of the study proved that education programs had a positive effect on the metabolic indicators of patients undergoing percutaneous coronary intervention.

The influence of mat Pilates training adherence on strength and flexibility parameters in breast cancer survivors undergoing hormone therapy.

The aim of this study was to evaluate the influence of adherence to mat Pilates training on lower and upper body strength and flexibility in breast cancer survivors. Breast cancer survivors (≥40 years) with cancer stages 0–III undergoing hormone therapy participated in this study. For this secondary investigation only the intervention group was analyzed, divided into low and high training adherence. Participants performed a 60-min session of mat Pilates, 3 times/wk, for 24 weeks. Concentric, eccentric, and isometric hip flexor-extensor muscle peak torque, and isometric maximal strength parameters of the shoulder abductors, trunk extensors, and handgrip were assessed. Physical activity level was analyzed as a control variable. The results showed that high training adherence improved (P<0.05) left shoulder abductor strength parameters and lower and upper body flexibility compared to baseline. The low training adherence group improved (P<0.05) trunk extensors, right and left shoulder abductor strength parameters, handgrip strength, and extensor-flexor peak torque compared to baseline. There were no differences (P>0.05) between high and low adherence for physical activity level before and after the intervention. Therefore, it appears that higher training adherence most influences some strength parameters and flexibility, while fewer sessions enable the achievement of significant results for shoulder abductor and hip extensor-flexor muscle strength parameters.

Resistant hypertension is associated with an increased cardiovascular risk compared to patients controlled on a similar multi-drug regimen.

The long-term risk associated with resistant hypertension compared to other phenotypes of hypertension is still unclear. We aimed to assess cardiovascular and renal outcomes over 10 years of follow-up of patients with uncontrolled resistant hypertension (uRH) compared to a similarly treated (≥ 3 medication classes including a diuretic) and adherent group whose blood pressure is under control. This retrospective cohort study utilized the computerized database of Maccabi Healthcare Services, a state-mandated health provider covering 25% of the Israeli population. Clinical outcomes were assessed using Cox regression multivariable analyses. A total of 1487 patients (50% males, mean age at baseline = 68.3 ± 10.4 years) were included in the uRH cohort and 1343 patients (50% males, 66.2 ± 10.6 years) in the controlled hypertension reference group (Controlled hypertension on multi drug regimen- CH-MDR). After adjusting for age, sex, BMI and patients' comorbidities, uRH was associated with a Hazard Ratio of 1.35 (95% CI: 1.08-1.69) for incidence of ischemic heart disease, 1.51 (1.06-2.16) for secondary cardiovascular events, and 1.36 (1.00-1.86) for risk of stroke or transient ischemic attack compared to the reference group. Patients with uRH were found to have more hospitalization days (mean, 4.2 vs. 3 days per year, p < 0.001), and more emergency room visits (83.3% vs. 77%, p < 0.001). Overall, uRH was associated with a 19% (95% CI 11% to 29%) increase in direct healthcare expenditures during the first year of follow-up. uRH is associated with a substantial increased risk of both cardiovascular and cerebrovascular events, when compared to similarly treated hypertensive patients whose blood pressure is under control.

Real-world association of adherence with outcomes and economic burden in patients with tuberculosis from South Korea claims data.

Objectives: We analyzed tuberculosis (TB)-related costs according to treatment adherence, as well as the association between treatment adherence, treatment outcomes, and costs related to drug-susceptible TB in South Korea. Methods: Patients who had newly treated TB in South Korea between 2006 and 2015 were selected from nationwide sample claims data and categorized into adherent and non-adherent groups using the proportion of days TB drugs covered. Patients were followed-up from the initiation of TB treatment. The mean five-year cumulative costs per patient were estimated according to adherence. Moreover, we evaluated the relative ratios to identify cost drivers such as adherence, treatment outcomes, and baseline characteristics using generalized linear models. Four treatment outcomes were included: treatment completion, loss to follow-up, death, and the initiation of multidrug-resistant TB treatment. Results: Out of the 3,799 new patients with TB, 2,662 were adherent, and 1,137 were non-adherent. Five years after initiating TB treatment, the mean TB-related costs were USD 2,270 and USD 2,694 in the adherent and non-adherent groups, respectively. The TB-related monthly cost per patient was also lower in the adherent than in the non-adherent (relative ratio = 0.89, 95% CI 0.92–0.98), while patients who were lost to follow-up spent more on TB-related costs (2.52, 2.24–2.83) compared to those who completed the treatment. Conclusion: Non-adherent patients with TB spend more on treatment costs while they have poorer outcomes compared to adherent patients with TB. Improving patient adherence may lead to effective treatment outcomes and reduce the economic burden of TB. Policymakers and providers should consider commitment programs to improve patient’s adherence.

Clinical characteristics and outcomes of Japanese atrial fibrillation patients with poor medication adherence: A sub-analysis of the GENERAL study

BackgroundOral anticoagulation therapy is essential for preventing stroke in patients with atrial fibrillation (AF). However, poor anticoagulant adherence may hamper medication safety and effective prevention of stroke. MethodsGENERAL is a prospective cohort study of AF patients taking rivaroxaban prescribed by general practitioners in Japan. In this study, anticoagulant adherence was calculated as the proportion of days covered (PDC), and patients were retrospectively divided into two groups: good adherence (PDC ≥80 %) and poor adherence (<80 %). ResultsOf 5680 patients in the GENERAL study, the poor adherence group consisted of 223 patients (3.9 %). Baseline clinical characteristics were almost comparable regarding age (PDC ≥80 % vs. <80 %: 73.9 vs. 74.0 years, p = 0.92) and sex (male 64.6 % vs. 66.8 %, p = 0.52). The PDC <80 % group more often had various co-morbidities, and had significantly higher CHADS2 (2.14 vs. 2.28, p = 0.04) and CHA2DS2-VASc scores (3.12 vs. 3.31, p = 0.045). There was no significant difference in HAS-BLED score (1.41 vs. 1.47, p = 0.39).During 2-year follow-up, the incidences of stroke or systemic embolism (1.14 vs. 3.56 % per patient-year, p < 0.01), major bleeding (0.59 vs. 1.78 % per patient-year, p < 0.01), and net clinical outcome (the composite of stroke, systemic embolism, major bleeding, or death) (3.49 vs. 7.78 % per patient-year, p < 0.01) were significantly higher in the poor adherence group; however, there was no significant difference in all-cause (1.89 vs. 2.73 % per patient-year, p = 0.23) and cardiovascular mortality (0.86 vs. 1.49 % per patient-year, p = 0.18). Multivariate analysis revealed that the poor adherence group was independently associated with stroke or systemic embolism (adjusted hazard ratio 3.12, 95 % confidence interval 1.79–5.47), major bleeding (2.87, 1.31–6.34), and net clinical outcome, (2.02, 1.39–2.93), but not with all-cause (1.18, 0.64–2.17) or cardiovascular death (1.39, 0.60–2.93). ConclusionsPoor anticoagulant adherence, as measured by PDC <80 %, was associated with higher incidence of stroke or systemic embolism and major bleeding in the GENERAL study.

Traditional Heart-Healthy Diet and Medication Adherence in the Norton Sound Region: An 18-Month Telehealth Intervention.

Introduction. Innovations are needed for preventing cardiovascular disease (CVD) and for reaching diverse communities in remote regions. The current study reports on a telemedicine-delivered intervention promoting a traditional heart-healthy diet and medication adherence with Alaska Native men and women residing in the Norton Sound region of Alaska. Methods. Participants were 299 men and women with high blood pressure or high cholesterol smoking daily who were randomized to receive telemedicine-delivered counseling and printed materials on diet and medication adherence or on smoking and physical activity. Intervention contacts were at baseline and 3-, 6-, and 12-months follow-up, with a final assessment at 18 months. Nutrition outcomes were the ratio of heart-healthy foods and traditional heart-healthy foods relative to all foods reported on a 34-item food frequency questionnaire. Recent and typical adherence for heart medications were self-reported. Results. Intervention effects were significant for the heart-healthy foods ratio at 6 months only (p = 0.014) and significant for the traditional heart-healthy foods ratio at 6 months only for those aged 47+ (p = 0.031). For recent and typical medication adherence, there were no significant group differences by time. Discussion. In a remote region of Alaska, telemedicine proved feasible and acceptable for engaging Alaska Native men and women in counseling on CVD risk behaviors. The findings indicate that more touchpoints may be necessary to impart comprehensive lasting change in heart-healthy eating patterns. Medication adherence group differences were not significant; however, medication adherence was high overall.

Impact of anxiety and depression disorders on adherence to anticoagulant therapy among patients with atrial fibrillation

Aim. To determine the possible impact of anxiety and depression disorders on the adherence of patients with atrial fibrillation (AF) to anticoagulant the rapy.Material and methods. The study included outpatients with AF of any type. After signing the informed consent, patients filled out questionnaires and scales that determined the level of anxiety and personal predisposition (MMAS-8, MMAS-4, SF-36, SHAI, STAI, HADS, NEO-FFI).Results. A total of 117 outpatients treated for AF were included. The mean age of patients was 74±5 years (men, 38%). Based on MMAS-4 and MMAS-8 results, adherent and non-adherent cohorts of patients were formed. Low adherence group had significantly higher situational anxiety according to STAI (45,9±9,9 vs 41,1±10,7, p=0,045) and depression according to HADS (7,9±3,6 vs 5,9±3,5, p=0,018). SF 36 showed that non-adherent patients had a lower general health (41,6±12,9 vs 52,2±20,0, p=0,01). Five-factor model revealed an association between low compliance and low extraversion (21,3±6,6 vs 26,4±7,2, p=0,002). Pharmacokinetic data on blood concentrations of anticoagulants or its metabolites at the second visit were available in 76 (67%) patients. Assessment of pharmacokinetic and compliance data revealed a moderate direct correlation (Matthews correlation coefficient (MCC), 0,345) and a weak direct correlation with the MMAS-8 (MCC, 0,177). The difference in MMAS-4 and MMAS-8 scores between high and low pharmacokinetic adherence groups was significant on both scales (p=0,011 and 0,015, respectively).Conclusion. The rationale for widespread introduction of standardized questionnaires and scales (MMAS 4, MMAS 8, STAI, HADS, SF 36, Big 5) was shown in order to early identify patients with low adherence to treatment. The results highlight the need for further study of the contribution of psychiatric disorders to low compliance to anticoagulant therapy.

Adherence to medication by adolescents and young adults with childhood-onset systemic lupus erythematosus.

Background: Approximately 20% of all cases systemic lupus erythematous (SLE) are juvenile onset. Children and adolescents with SLE usually present with more severe illness and have a higher mortality rate compared to adults with SLE. Adherence to medications in children and adolescents has a major impact on disease control as well as short- and long-term outcomes. Improved understanding of adherence rates, risk factors for non-adherence, and barriers to adherence are essential in order to increase patient adherence with medication regimens. The aim of our study was to evaluate adherence to medications among children and young adults with pediatric-onset SLE and identify barriers for non-adherence by utilizing several adherence evaluation methods.Methods: Adherence to medications of patients aged 12-25, with childhood-onset SLE was assessed as follows: (1). The brief medication questionnaire (BMQ): self-report tool for screening adherence and barriers to adherence. (2). Mycophenolic acid (MPA) serum level. (3). Medication possession ratio (MPR): data assessing 90-day refills and dispense prior to patient's enrollment was collected.Results: Of the 38 patients who were enrolled in the study, 65% were found to be non-adherent according to at least 1 measurement method. Forty-four percent of patients were found to be non-adherent based on the self-reported questionnaire (BMQ). Of those taking MMF, 33% had an MPA level < 1mcg/mL and were defined as non-adherent. Seventeen percent of patients were found to be non-adherent according to pharmacy refills rate. Forty-six percent of patients stated that their medications caused side effects, 33% of patients indicated difficulty remembering to take the medications, and 25% reported difficulty paying for medications. The disease activity index (SLEDAI) score of the "adherent group" at diagnosis was significantly lower compared to the "non-adherent" group. Patients with private insurance had more access barriers to obtaining medications compared to patients with public insurance.Conclusion: Non-adherence to medications is highly prevalent among cSLE patients. Higher SLEDAI score is a risk factor for non-adherence. Adherence to medications should be routinely evaluated among adolescence and young adults with cSLE and barriers to adherence need to be addressed to decrease morbidity and improve patient outcomes.

Tenofovir-Diphosphate in Dried Blood Spots vs Tenofovir in Urine/Plasma for Oral Preexposure Prophylaxis Adherence Monitoring.

BackgroundTenofovir-diphosphate (TFV-DP) measured in dried blood spots (DBS) and tenofovir (TFV) measured in urine/plasma have been used to measure TFV-based oral pre-exposure prophylaxis (PrEP) adherence. However, there are limited data comparing these 3 metrics and their appropriate use for PrEP adherence monitoring.MethodsWe collected DBS, urine, and plasma samples from HIV-negative adults randomized to a low (2 doses/week), moderate (4 doses/week), or perfect (7 doses/week) adherence group (via directly observed therapy) of tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) for 6 weeks, followed by a 4-week washout phase. Drug concentrations were measured using liquid chromatography tandem mass spectrometry. Linear mixed-effects modeling was used to examine associations between drug concentrations and dosing time.ResultsAmong 28 participants, the median age was 33 years, and 12 (43%) were female. At steady state, 25th percentile TFV-DP concentrations were 466, 779, and 1375 fmol/3 mm punch in the low, moderate, and perfect adherence group, respectively. Correlation was stronger between quantifiable TFV-DP and plasma TFV (r = 0.65; P < .01) than between TFV-DP and urine TFV (r = 0.50; P < .01). Among all participants, each additional week of cumulative dosing on average led to a mean increase of 158 fmol/3 mm punch (P < .001) in TFV-DP during the dosing phase. Each additional day after the last dose was associated with 43 fmol/3 mm punch lower TFV-DP (P = .07).ConclusionsTFV-DP levels in DBS provide valuable insight into both dosing recency and cumulative doses from variable adherence patterns. Our observed benchmark TFV-DP concentrations were slightly higher than prior predicted estimates based on convenience samples.

Association of Mediterranean Diet With Cognitive Decline Among Diverse Hispanic or Latino Adults From the Hispanic Community Health Study/Study of Latinos

The Mediterranean diet may reduce the burden of Alzheimer disease and other associated dementias in Hispanic or Latino people. To investigate the association of a Mediterranean diet with cognitive performance among community-dwelling Hispanic or Latino adults. This cohort study analyzed data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and the Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA), an HCHS/SOL ancillary study. Cognition tests were administered in the HCHS/SOL from March 2008 to June 2011 (visit 1) and in the SOL-INCA from October 2015 to March 2018 (visit 2). Participants included in the present study had completed a diet assessment at visit 1 and neurocognitive evaluations at visits 1 and 2. Data were analyzed from September 2021 to May 2022. Mediterranean diet adherence was ascertained using the Mediterranean diet score (MDS) and was categorized as low (MDS: 0-4 points), moderate (MDS: 5-6 points), or high (MDS: 7-9 points). The mean of two 24-hour dietary recalls was used to calculate the MDS. Cognitive change between visits 1 and 2 was calculated by subtracting the cognitive score at visit 2 from the cognitive score at visit 1 and adjusting by the time elapsed between visits and cognitive score at visit 1. Neurocognitive tests administered were Brief Spanish-English Verbal Learning Test (B-SEVLT) Sum, B-SEVLT Recall, word fluency, and Digit Symbol Substitution Test (DSST). Results of each test were z score-transformed and the means were averaged to create a global cognition score. Complex sample linear regression analysis was used to ascertain the association between MDS and neurocognitive performance at each visit and neurocognitive change. A total of 6321 participants (mean [SE] age, 56.1 [0.18] years at visit 1; n = 4077 women [57.8%]) were included. Mediterranean diet adherence weighted frequencies were 35.8% (n = 2112 of 6321) for the low adherence group, 45.4% (n = 2795) for the moderate adherence group, and 18.8% (n = 1414) for the high adherence group. In the fully adjusted model, z score-transformed cognitive scores at visit 1 in the high vs low adherence groups were higher for B-SEVLT Sum (β = 0.11; 95% CI, 0.02-0.20), B-SEVLT Recall (β = 0.16; 95% CI, 0.07-0.25), and global cognition (β = 0.10; 95% CI, 0.04-0.16) tests. In the mean follow-up time of 7 years, cognitive change in the high vs low adherence groups was less pronounced for B-SEVLT Sum (β = 0.12; 95% CI, 0.05-0.20) and B-SEVLT Recall (β = 0.14; 95% CI, 0.05-0.23), but not for word fluency, DSST score, or global cognition score. Results of this cohort study suggested that high adherence to a Mediterranean diet was associated with better cognitive performance and decreased 7-year learning and memory decline among middle-aged and older Hispanic or Latino adults. Culturally tailored Mediterranean diet may reduce the risk of cognitive decline and Alzheimer disease in this population.

The relationship between CPAP and health literacy: Aprospective observational study.

We aimed to assess differences in health literacy between those who improved CPAP non-adherent and those who remained non-adherent. We included patients newly diagnosed with sleep apnea syndrome who had started CPAP therapy between February 2019 and October 2020 with ≥6 follow-up months or who self-interrupted CPAP therapy <6months. We recorded the CPAP wearing time after 3 and 6months. Patients were divided into the CPAP adherent (using CPAP for ≥4h per night) and non-adherent (self-interrupted CPAP therapy/using CPAP for <4h per night) groups. We compared the European Health Literacy Survey Questionnaire 47 (HLS-EU-Q47) score between those who were CPAP non-adherent after 3months and become CPAP adherent after 6months, and those who remained non-adherent after 6months. At 3months, 34 patients were CPAP non-adherent. After 6months, there were 7 and 27 patients in the CPAP adherent and non-adherent groups, respectively. There was a significant difference in the HLS-EU-Q47 score between the patients who became adherent to CPAP and who remained non-adherent after 6months. Previously non-adherent patients who subsequently became adherent tended to have higher health literacy.

Adherence to Statin Therapy and Attainment of LDL Cholesterol Targets in an Outpatient Population of Type 2 Diabetes Patients: Analysis in the DIAbetes and LifEstyle Cohort Twente (DIALECT).

Objective: To assess adherence to statin therapy and its association with sociodemographic data, medical characteristics, LDLc levels, and LDLc target attainment in real-world T2D patients treated in secondary care. Research Design and Methods: Cross-sectional analyses were performed on baseline data of 393 patients in the DIAbetes and LifEstyle Cohort Twente (DIALECT). The medication possession ratio (MPR), calculated with pharmacy dispensing data, was used to determine adherence to statins for an intended period of 24 months. Statins were included in the analyses if they were used for at least six consecutive months with at least three dispenses. Adherence was defined as an MPR ≥80%. Associations with adherence were assessed using descriptive statistics and binary logistic regression. Results: Overall, 80% of the patients had a statin prescription and of those, 89% were adherent. The proportion of patients who reached LDLc targets of ≤2.5 mmol/L and <1.8 mmol/L differed significantly between the adherent, nonadherent and non-statin group (90% vs. 74% vs. 46%; p < 0.01 and 56% vs. 26% vs. 6%; p < 0.01, respectively). Serum LDLc levels were lower in the adherent versus the nonadherent and non-statin group (1.76 ± 0.60 vs. 2.23 ± 0.90 vs. 2.71 ± 0.67 mmol/L; p < 0.01). Higher HbA1c levels were independently associated with nonadherence (OR: 1.05, 95% CI 1.01–1.08; p < 0.01). Mediation adherence (OR: 2.88, 95% CI 1.04–7.97; p = 0.041) and lower BMI (OR: 0.88, 95% CI 0.81–0.96; p < 0.01) were independently associated with attaining the LDLc target of ≤2.5 mmol/L. Conclusion: In patients with T2D treated in secondary care, statin adherence was relatively high and was associated with significantly lower LDLc levels. It is important to identify nonadherence as it appeared an important determinant of failure to reach LDLc targets. The finding that many patients who failed to attain LDLc targets did not receive statin treatment offers an opportunity to improve diabetes care.

Adherence to a gluten-free diet in celiac disease patients from Paraguay

Introduction and aimThe treatment for celiac disease is a gluten-free diet that should be strictly and permanently carried out. Our aims were to determine adherence to the gluten-free diet and the risk factors for non-adherence. Materials and methodsAn observational, cross-sectional, comparative study was conducted. It included individuals of both sexes and of any age that presented with celiac disease, lived in Paraguay from January to April 2021, and agreed to participate in the survey. Incomplete questionnaires were excluded. Non-probabilistic convenience sampling was utilized. Adherence was measured using the Leffler questionnaire. The study was approved by the Ethics Committee of the Universidad Privada del Este. ResultsThe sample consisted of 371 respondents, 322 (87%) of whom were adults, with a mean age of 38 ± 12 years, and 49 (13%) of whom were children and adolescents, with a mean age of 10 ± 5 years. Female sex was predominant (85%). Adherence to the gluten-free diet was detected in 59% of the adults and 73% of the children and adolescents. The factors significantly associated with adherence included belonging to the child and adolescent age group and having had the diagnosis for a longer time: 9 ± 8 years for the adherence group and 7 ± 8 years for the non-adherence group. ConclusionsThe present study demonstrated the frequency of adherence to the gluten-free diet in celiac patients in Paraguay. Psychologic and nutritional support is recommended for individuals with celiac disease that do not adhere to their treatment.

Clinical and psychosocial factors affecting treatment adherence in children with rheumatic heart disease.

The present study aimed to investigate the outcomes of psychiatric symptoms and family functions on treatment adherence in children, in addition to sociodemographic characteristics and clinical factors related to the disease. The research sample consisted of 43 children who were followed up with rheumatic heart disease diagnosis during the study. Clinical features were obtained from the patient files. The family assessment device evaluating family functioning and the strengths and difficulties questionnaire scale to screen emotional and behavioural problems in children were used. Considering the regularity of treatment in our patients, there were 31 (72%) patients adherent to secondary prophylaxis regularly, 7 (6.9%) patients were partially adherent, and 5 (11.6%) patients non-adherent. Patients were divided into treatment adherent (Group 1) and non-adherent (Group 2). There was no statistically significant impact on treatment adherence whether the patients receive enough information, lifestyle, fear of developing adverse effects, fear of addiction, lack of health insurance, difficulties in reaching the drug or hospital. However, the fear of syringes on treatment adherence had an effect statistically significantly (p = 0.047). Forgetting to get a prescription and/or take the drug when the time comes was statistically higher in the non-adherent group (p = 0.009). There was no statistically significant effect of psychosocial factors on treatment adherence between groups. Providing an effective active recall system, involving primary care workers, providing training on the disease and its management, and a comprehensive pain management programme can improve the process, especially for cases where secondary prophylaxis is missed.