Treatment Adherence Research Articles

Impact of anxiety symptoms on dialysis adherence and complication rates: A longitudinal observational study

BACKGROUND Anxiety is a common psychological comorbidity in patients undergoing dialysis, yet its impact on treatment adherence and complication rates remains understudied. We designed a longitudinal observational study to investigate these relationships, based on the hypothesis that higher anxiety symptoms would be associated with increased complication rates and negatively associated with adherence to the dialysis regimen. AIM To investigate the relationship between anxiety symptoms, dialysis adherence, and complication rates in patients undergoing dialysis over a 24-month period. METHODS This observational study analyzed data from 250 adult patients who underwent hemodialysis or peritoneal dialysis at three Affiliated Hospitals of Youjiang Medical University for Nationalities over a period of 24 months. Anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale-Anxiety subscale at baseline and every 6 months. Dialysis adherence was evaluated through attendance records, interdialytic weight gain, and patient-reported medication adherence. We recorded complications (infections, cardiovascular events, and hospitalizations) and used mixed-effects models and survival analyses to infer associations between anxiety symptoms, adherence measures, and complication rates. RESULTS Higher anxiety symptoms were significantly associated with poorer dialysis adherence, including increased missed sessions [incidence rate ratio = 1.32, 95% confidence interval (CI): 1.18-1.47, P < 0.001], greater interdialytic weight gain (β = 0.24, 95%CI: 0.15-0.33, P < 0.001), and lower medication adherence (odds ratio = 0.85, 95%CI: 0.78-0.93, P < 0.001). Patients with clinically significant anxiety (Hospital Anxiety and Depression Scale-Anxiety subscale ≥ 8) had a higher risk of complications [hazard ratio (HR) = 1.68, 95%CI: 1.32-2.14, P < 0.001], particularly infections (HR = 1.89, 95%CI: 1.41-2.53, P < 0.001) and cardiovascular events (HR = 1.57, 95%CI: 1.18-2.09, P = 0.002). The relationship between anxiety and complications was partially mediated by adherence measures. CONCLUSION Anxiety symptoms in patients undergoing dialysis are associated with poorer treatment adherence and increased complication rates. Regular screening and targeted interventions to address symptoms may improve adherence and clinical outcomes.

HCV Treatment Outcomes in PWID: Impact of Addiction History on SVR12

People who inject drugs (PWIDs) experience high rates of hepatitis C virus (HCV) infection, primarily due to needle sharing and limited healthcare access, resulting in a disproportionate disease burden within this population. This prospective study evaluated treatment outcomes in 432 adult patients with chronic hepatitis C (CHC) treated with direct-acting antivirals (DAAs) at the University Clinical Center of Serbia. Patients were categorized into two groups based on a history of drug addiction: PWIDs (163, 37.7%) and non-PWIDs (269, 62.3%). The PWID group was further categorized into subpopulations of problematic PWIDs (39, 23.9%), ex-PWIDs (124, 76.1%), and PWIDs on OST (96, 58.9%). The PWID group demonstrated significantly lower treatment adherence, with an intention-to-treat (ITT) rate of 82.8%, compared to 96.3% in the control group (p < 0.001). In contrast, no significant differences were observed in per-protocol (PP) outcomes between the two groups. Additionally, PWIDs were significantly younger (p < 0.001) and had higher rates of psychiatric disorders (p < 0.001), alcohol abuse (p < 0.001), and HCV genotype 1a (p < 0.001). Advanced fibrosis was predictor of PP treatment failure among PWIDs, while mood disorders and alcohol use disorder were associated with interruptions before the scheduled completion time. For non-PWIDs, older age and advanced fibrosis emerged as key predictors of PP treatment failure. The loss to follow-up was most commonly observed in the problematic PWID subgroup (p = 0.001). These findings highlight the importance of addressing barriers in PWIDs through integrated care strategies that concurrently manage addiction and HCV.

Pharmacist-led interventions at hospital discharge: a scoping review of studies demonstrating reduced readmission rates.

Substantial numbers of hospital readmissions occur due to medication-related problems. Pharmacists can implement different interventions at hospital discharge that aim to reduce those readmissions. It is unclear which pharmacist-led interventions at hospital discharge are the most promising in reducing readmissions. This scoping review aimed to summarise pharmacist-led interventions conducted at hospital discharge that demonstrated a reduction in readmissions. We searched the MEDLINE, EMBASE and CINAHL databases up to February 2024. We included studies that focused on pharmacist-led interventions at hospital discharge and reported significant readmission reductions. Two reviewers independently screened titles, abstracts and full texts. Data extracted included study characteristics, populations and the type of implemented pharmacist-led interventions along with the reduction in readmission rates achieved. We included 25 articles for data synthesis. Many of the studies included either implemented at least two interventions concurrently or were part of broader programmes involving other healthcare professionals. The most common pharmacist-led interventions associated with reduced readmission rates included medication reconciliation, counselling and post-discharge follow-up by telephone. Follow-up primarily aimed to improve patients' treatment adherence through education about their medications. Furthermore, many studies reported on multi-component interventions that began at hospital admission or during inpatient stays, not only at discharge. Successfully reducing readmissions through pharmacist-led interventions at hospital discharge suggests the effectiveness of a holistic approach incorporating multiple interventions. While these findings offer insights for pharmacists, further research should focus on conducting high-quality studies using a multifaceted approach to identify the most appropriate timing and combination.

Barriers to Antiretroviral Treatment Adherence Among Refugees Living with HIV/AIDS in Douala, Cameroon

The success of antiretroviral treatment (ART) depends on adherence. Adherence is necessary to reduce the risk of resistance, restore immunity, and reduce incidence, morbidity and mortality. Data on the ratio of refugees and conflict-affected people living with HIV and on ART needs are scarce. The objective of this study is to identify barriers to ART adherence among refugees living with HIV/AIDS in Douala. In a cross-sectional, analytical study conducted among refugees living with HIV/AIDS in Douala and followed in health facilities that are partners of the High Commissioner for Refugees (HCR). Adherence was evaluated on the basis of patient declarations (declared adherence) and the regularity of the renewal of their prescriptions (calculated adherence). The quantitative data collected with the anonymous questionnaire administered after informed consent was entered with Epi Info version 7.1.3.0. Descriptive and inferential analysis was carried out with SPSS version 17.0, which allowed us to determine the association between predisposing factors and adherence to antiretroviral treatment using Pearson's Chi-square test. 200 refugees meeting our inclusion criteria were interviewed. The average length of follow-up was 4 years. The average age was 40.66 ± 9.35 years and the sex ratio was 2.39 in favour of the female sex. 91.5% of the refugees had started treatment more than a year ago. The level of reported compliance was significantly lower than the overall level of calculated compliance (67.5% vs. 71.0%, P=0.000). The main obstacles to adherence were forgetting and lack of food. People who received accurate information about their illness were more observant (P=0.000). Adherence to antiretroviral treatment was best when the year of initiation of treatment was two years or more (P=0.000) and the patient knew the duration of treatment (p=0.000). The low adherence rate (<95%) among refugees was related to several factors. The difference observed between the results of the two methods used to estimate adherence shows us the need for biological methods in assessing the level of treatment adherence. Measures will be needed to improve the level of adherence among refugees, including the strengthening of psycho-social support.

Treatment adherence and effectiveness in patients treated with carfilzomib-based therapy combinations for relapsed/refractory multiple myeloma in Germany: interim results from the non-interventional CARO study

Therapy adherence can significantly influence the outcome of cancer patients. The prospective, non-interventional CARO study (NCT02970747) investigated adherence, effectiveness, and safety of carfilzomib in patients with relapsed/refractory multiple myeloma (RRMM) in the German real-world setting. In total, 359 patients were included at 69 sites. Data on carfilzomib combination regimens were evaluated for three treatment cohorts: carfilzomib with lenalidomide and dexamethasone (KRd), with dexamethasone only (Kd) or with daratumumab and dexamethasone (KdD). Encouragingly, patients maintained levels of treatment adherence ≥95% to carfilzomib across cohorts. The effectiveness outcomes of CARO were in line with previous data. Median PFS (95% CI) was 17.5 months (14.5, 24.7 [KRd]), 13.4 months (7.0, 18.1 [Kd]), and 15.6 months (9.9, NA [KdD]), respectively. Median OS was 38.9 months (31.5, 53.9 [KRd]), 24.2 months (17.3, 36.8 [Kd]), and not reached (KdD). Overall, the CARO study impressively demonstrates efficacy and safety of KRd, Kd, and KdD regimen in real-world.

Engaging survivor and oncologist stakeholders to develop a patient-reported outcome assessment to use as a component of survivorship care.

Incorporating patient-reported outcomes (PROs) into survivorship care may improve the comprehensiveness of follow-up. The objective was to engage stakeholders to develop a PRO assessment of survivors' symptoms and concerns for use during breast cancer follow-up. We convened patient and oncologist stakeholder advisory groups to develop an initial PRO assessment including survivorship domains of importance, measurement instruments, and clinically significant thresholds, and revise the assessment based on feedback from community focus groups and two rounds of iterative pilot testing with survivors. Stakeholders identified key domains and measurement instruments, including recurrence symptoms, treatment side effects, adherence, mental health, and sexual health. Ninety-four survivors completed the PRO assessment in the initial pilot test (median age 62years, median 2years from diagnosis). Most (89/93) reported questions were easy to understand. The level of missingness was low. The most common threshold-level symptoms/concerns were hot flashes (46%), fatigue (35%), back pain (31%), joint pain (31%), and anxiety (30%). The PRO assessment was revised to clarify symptom causality and desire to discuss with a provider. In a follow-up pilot study with 20 survivors, the most common symptoms were chest/breast discomfort (50%) and anxiety (25%). We leveraged stakeholder input to develop a comprehensive PRO assessment to use to assess breast cancer survivors' well-being. Our PRO assessment is acceptable to survivors. Future research will focus on the integration of the PRO assessment into clinical care.

Evaluating Biomarkers for Diagnosis and Treatment Monitoring in Gaucher Disease

Aim/Objective: The primary goal of this study is to explore the impact of consistent treatment on key disease marker, Lyso-Gb1. Additionally, this research aims to evaluate the influence of splenectomy on Lyso-gb1 concentrations within the patient group. Materials and Methods: 37 patients diagnosed with GD were categorized based on treatment compliance into three groups: 28 in the regular treatment group, who consistently followed their treatment; 6 in the irregular treatment group, with inconsistent treatment adherence; and 3 in the untreated group. A control group of 33 healthy individuals without GD was also included. Enzyme replacement therapy was utilized as the treatment regimen. The analysis of Lyso-Gb1 levels was performed using liquid chromatography coupled with tandem mass spectrometry, ensuring high precision in measurement. Results: Lyso-Gb1 levels were significantly higher in GD patients compared to the healthy control group (p

Effects of Tai Chi and Qigong in Depressive and Anxiety Symptoms in Cancer Patients: An Overview of Systematic Reviews

Abstract Depressive and anxiety symptoms are prevalent among cancer patients, significantly impacting their quality of life and treatment adherence, which can lower survival rates. Addressing these symptoms with evidence-based interventions is crucial. Tai Chi and Qigong (TCQ) are popular complementary therapies that have shown potential in improving mental health in various populations, including cancer patients. However, systematic reviews (SRs) and meta-analyses have reported inconsistent findings regarding TCQ’s effectiveness in alleviating depressive and anxiety symptoms in cancer patients. An overview of these reviews can help synthesize outcomes, evaluate methodological quality, and clarify these discrepancies. The objective of this study was to identify and summarize the existing evidence regarding the effectiveness of TCQ in improving depressive and anxiety symptoms in cancer patients. Six electronic databases were searched from inception to July 2024. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Assessing the Methodological Quality of Systematic Reviews 2 was used to assess the methodological quality of the included SRs. In total, 894 studies were retrieved and assessed. Of these, 10 SRs were included, of which 9 SRs reported depressive symptoms and 8 SRs anxiety symptoms. Of these SRs, 5 out of 9 (56%) demonstrated significant improvement in depressive symptoms for TCQ with standardized mean differences (SMDs) ranging from −0.27 to −0.70, while 6 out of 8 (75%) demonstrated significant improvement in anxiety symptoms with SMDs ranging from −0.29 to −0.71. For quality appraisal, 1 SR was rated as high confidence, 3 SRs as moderate confidence, 2 SRs low confidence, and 4 SRs critically low confidence. After excluding 4 SRs with critically low confidence, 4 out of 5 (80%) of SRs demonstrated a significant effect of TCQ in improving depressive symptoms with SMDs ranging from −0.32 to −0.70, and all 6 SRs demonstrated significant improvement in anxiety symptoms with SMDs ranging from −0.29 to −0.71. TCQ can be effective in alleviating depressive and anxiety symptoms in cancer patients. Healthcare providers should consider incorporating TCQ into cancer care. More randomized controlled trials on various cancer sites (e.g., female genitals, lungs, brain, skin, and pancreas), cancer stages (e.g., Stage IV), and non-Chinese populations with longer follow-ups should be conducted.

Care-educational game for men who have sex with men and live with HIV and Aids

Objective: To describe the construction of a board game-type care-educational technology for the health education of men who have sex with men and live with the Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome, within the scope of Primary Health Care. Methods: Methodological study, developed from a participatory perspective in four stages: development of a scoping review; theorization and construction of the technology; appraisal; and final design. Results: The game “HIVIVENDO E APRENDENDO” was constructed considering the integrative perspective of care for the target population, addressing in its content aspects about the infection and the disease, welcoming, treatment adherence, related stigmas and prejudices, citizenship, and quality of life. Conclusion: With the developed care-educational technology, it is intended that, after the validation phase, it can become a facilitating tool for promoting health education for both professionals and users in Primary Health Care.

Impulsivity and Cognitive Functioning in Inpatients with Concurrent Disorders: A Comparative Study with Healthy Controls and Evaluation of Treatment-Related Changes: Impulsivité et fonctionnement cognitif chez les patients hospitalisés présentant des troubles concomitants : étude comparative avec des témoins sains et évaluation des changements liés au traitement.

This study investigated impulsivity and working memory among CD inpatients across treatment and compared to controls. Patients (N = 56, Mage = 38.2, SD = 11.7, 17F) and healthy controls (N = 50, Mage = 31.9, SD = 10.0, 25F) completed a battery of self-report questionnaires and behavioural tasks assessing working memory and impulsivity (response inhibition, delay discounting, reflection, decision-making). Patients were assessed within 2 weeks of admission (baseline) and at 6 months (follow-up). Controls completed a single session at baseline. Patient demographics, diagnostic status, and treatment outcome (discharge with or without medical advice) were retrieved from medical records. Group differences in demographics were probed for inclusion as covariates. At baseline, patients had greater self-reported impulsivity on the UPPS-P (negative and positive urgency) and BIS (motor and non-planning), and greater delay discounting than controls. Among patients, there was no association between treatment adherence and working memory, self-report, or behavioural impulsivity, and no change in behavioural impulsivity was observed from baseline to follow-up. This is the first study to assess impulsivity and working memory in the context of CD treatment. Patients exhibited greater impulsivity on choice-based and various self-report measures. The absence of treatment-related changes in impulsivity and working memory outcomes suggests that conventional treatments may be neglecting to target potentially key areas of functioning. Further research is needed to examine how treatment affects impulsivity and related functions in individuals with CD, and their impact on clinical outcomes.

The effect of life skills training on reducing domestic violence and improving treatment adherence in women with diabetes experiencing intimate partner violence: a randomized clinical trial based on the theory of self-efficacy

BackgroundIntimate partner violence (IPV) is a global health problem and the cause of chronic diseases, such as diabetes. It has a negative effect on adherence to treatment, decreases self-efficacy beliefs, and intensifies stress in women. Therefore, this study aimed to investigate the effect of life skills training based on the self-efficacy theory on IPV and adherence to treatment in women with type 2 diabetes.MethodsThis trial was conducted using a pretest-posttest design and follow-up after one month. The samples included 100 women selected by convenience sampling with random block allocation with type 2 diabetes and IPV. The intervention consisted of 8 sessions over one month of life skills training based on self-efficacy theory. Participants completed questionnaires at pre-test, post-test and follow-up, including a demographic information form and questionnaires on IPV and treatment adherence. Considered statistically significant at P < 0. 05.ResultsThe mean changes in IPV scores from the pre-test to the post-test were − 8.38 ± 4.06 and − 0.06 ± 3.09 in the intervention and control groups, respectively. Also, the reduction in the intervention group was significantly more than in the control group (P < 0.001; 95%CI=-9.75; -6.89). The mean changes in IPV scores from post-test to follow-up were − 1.36 ± 3.47 and 1.50 ± 4.14 in intervention and control groups, respectively, indicating a statistically significant difference between the two groups (P < 0.001; 95%CI=-4.38; -1.34). The mean changes in adherence scores from the pre-test to the post-test were 11.40 ± 4.23 and 0.68 ± 3.49 in the intervention and control groups, respectively. The increase was significantly higher in the intervention group than in the control group (P < 0.001; 95%CI = 9.18; 12.26). The mean changes in adherence scores from post-test to follow-up were 2.68 ± 5.06 and − 0.86 ± 2.43 in the intervention and control groups, respectively. The difference between the two groups was statistically significant (P < 0.001; 95%CI = 1.95; 5.12).ConclusionLife skills training based on self-efficacy theory reduced IPV and improved treatment compliance in women with diabetes under IPV. It is recommended that this training be taught to other patients with chronic conditions as a means of violence prevention and treatment adherence.Trial registrationThe trial was registered with the Iranian Registry of Clinical Trials (IRCT) on 13 October 2022 and can be found on the Iranian Registry of Clinical Trials platform. IRCT registration number: IRCT20090522001930N6.

A community-based analysis of security practices regarding over-the-counter skincare products in nationwide retail drug stores.

Access to over-the-counter (OTC) skincare products is critical for managing a wide range of dermatologic conditions, yet recent trends in urban retail stores may jeopardize this accessibility and exacerbate healthcare disparities. However, the emerging trend of securing skincare products behind security glass in urban retail environments poses significant risks to healthcare equity and accessibility. Herein, we aim to quantify the prevalence of skincare products behind security glass in pharmacies within a 25-mile radius of Times Square, New York City. An observational, cross-sectional study was conducted, selecting 50 pharmacies from a total of 389 identified in the target radius. Digital photographs of skincare product aisles were taken, and the percentage of products secured behind glass was calculated for various categories and brands. The study found significant disparities in the availability of skincare products, with significantly higher percentages of products behind security glass in pharmacies located in urban areas compared to suburban regions. Among the four brands analyzed, Olay, L'Oréal, La Roche-Posay, and Vichy, there was no significant difference in the proportion of products behind security glass. Barriers to accessing skincare products, such as physical restrictions, time constraints, stigma, and privacy issues, may hinder individuals from obtaining necessary treatments, leading to potential delays in care and poorer health outcomes. Our study underscores the urgent need for dermatologists and healthcare policymakers to advocate for alternative security measures that do not compromise product accessibility. Facilitating easier access to OTC skincare products could dramatically improve treatment adherence and patient outcomes, particularly in urban settings where disparities are most pronounced.

Gamification and its Potential for Better Engagement in the Management of Heart Failure or Quality of Care Registries: A Viewpoint.

Over the past decade, gamification, an umbrella term that refers to tools that engage and motivate participants through the use of game design elements (e.g., challenges and rewards) in a non-gaming context, has emerged as a promising approach in the management of chronic diseases. Specifically, it has been demonstrated to be effective in the education of both patients as well as healthcare professionals on medication adherence, risk reduction, patient self-care, and rehabilitation. There is some evidence suggesting that gamification might have similar benefits for heart failure (HF) patients and their health care professionals. This is of specific interest since HF is a chronic disease associated with a severely compromised long-term prognosis and subsequent high health care resource utilization. However, more robust research is needed to confirm these findings and determine the optimal method, as well as barriers, to the implementation of gamification in the working process of health care professionals or treatment adherence to patients specifically in the setting of HF. This viewpoint explores the literature concerning HF and gamification and aims to identify its various potentials in the management of HF patients.

Quality of life, compliance with treatment, and challenges among patients undergoing cardiac intervention.

Cardiovascular disease is the leading cause of mortality and disability worldwide, with important economic and quality-of-life implications. Effective treatment relies on drug adherence, which is impacted by a variety of factors; noncompliance increases morbidity, mortality, and healthcare costs. This study examines the quality of life, treatment adherence factors, and challenges that cardiac patients encounter during their treatment regimen. A cross-sectional study among 111 cardiac patients through purposive sampling was done at the All India Institute of Medical Sciences Deoghar between January 2023 and April 2024. Data on demographics, clinical characteristics, quality of life, and treatment adherence were gathered and analyzed using descriptive and inferential statistics while adhering to ethical guidelines and participant privacy. The research of 111 cardiac patients (76.6% male, mean age 56.45 years) revealed that the majority had undergone coronary artery bypass grafting surgery (83.8%), with many preferring private hospitals (58.6%). High medication adherence (82.0%) and regular follow-up (71.2%) were noted, although lifestyle improvements such as smoking cessation were less prevalent. Significant concerns in barriers were reported, including financial difficulties (35.1%) and accessibility of prescribed drugs (45.9%). Quality of life was generally reported as high, with most patients reporting no significant problem. This study reveals excellent adherence to medications and regular follow-up among participants. However, significant impediments such as financial constraints and accessibility issues for prescribed drugs continue to have an influence on treatment. Despite these limitations, patients often report a high quality of life, underscoring the complex interplay of medical, economic, and lifestyle aspects in cardiovascular health management.

Trauma-informed practice for genetic counselors: Insights from a workshop evaluation.

Trauma-informed practice (TIP) is an emerging model of care that acknowledges the widespread impact of trauma and emphasizes both physical and psychological safety for consumer and provider. It is being increasingly integrated into models of healthcare delivery, organizational policies, and practices, and has been shown to improve clinical interactions, increase treatment adherence, and improve healthcare outcomes. However, to date, TIP has not yet been systematically integrated into genetic counseling training and practice. In this study, using the RISE2 Genomics reporting standard, we present the outcomes of developing and evaluating a TIP workshop designed and delivered for genetic counselors in New South Wales, Australia. This workshop was the first of its kind and addressed the unique clinical and psychosocial challenges that genetic counselors face, including the risk of vicarious trauma and the high rates of burnout in the profession. The workshop aimed to enhance genetic counselors' understanding of trauma and its effects, provide practical strategies for communication and engagement with trauma-affected individuals, and offer guidance on incorporating TIP into clinical practice. Genetic counselors who participated in the TIP training expressed strong appreciation for the workshop and reported increased awareness of the ubiquity of trauma and the presentation of traumatic responses, and increased self-perceived knowledge and confidence in providing trauma-informed care. Additionally, participants were interested in ongoing TIP professional development and the integration of TIP into models of genetic counseling and professional practice. As the field of genetic counseling continues to evolve, we suggest that integrating TIP into training, professional development, and practice will not only improve client outcomes but also reduce rates of vicarious trauma and burnout among genetic counselors. This study is the first to consider the educational needs and the incorporation of TIP into genetic counseling practice, and in doing so, it paves the way for future research and policy development that integrates TIP into models of genetic counseling.

Divergent Perceptions of ADHD among Diagnosed Adolescents and Their Parents: An Exploratory Study

AbstractDifferences in the perceptions of illness between patients and caregivers are associated with negative health-related outcomes. However, little is known about the correlates of divergent perceptions of ADHD among diagnosed adolescents and their parents. This study applied the Common-Sense Model of Illness Representations (CSM) to examine how parent perceptions of ADHD, including divergent parent-adolescent perceptions, relate to coping, quality of life (QoL), and treatment adherence, among adolescents with ADHD. Participants were 63 adolescents diagnosed with ADHD (10–18 years, 79.3% male, mean age = 14.28, SD = 2.07) and their parents (78.8% mothers), recruited from clinics and support services. Self-report measures were completed by adolescents and parents in isolation from one another. Results from a series of hierarchical regressions indicated that adolescents held less pessimistic views of the disorder and believed it was less biologically based than did parents. Divergent parent-adolescent perceptions regarding timeline and causes were significantly related to adolescent coping and QoL. Adolescents’ expectation of a shorter duration of ADHD was associated with reduced active coping. Their stronger attribution to insufficient efforts was associated with lower QoL. Although adolescents with a stronger belief in psychosocial causes exhibited poorer active coping and QoL, they exhibited greater active coping when their parents endorsed this belief. Taken together, these findings identify beneficial and detrimental beliefs about ADHD for both diagnosed adolescents and their parents. The results underscore the potential importance of beliefs about psychosocial causes to coping and well-being, as well as the importance of divergent parent-adolescent perceptions.

Effect of Corticosteroid Phobia on Treatment Adherence and Outcome in Women With Lichen Sclerosus: A Prospective Study.

The phenomenon of topical corticosteroid (TC) phobia (TCP) poses a challenge to the adherence of patients requiring prolonged treatments, particularly those with conditions like atopic dermatitis. Nonadherence to treatment significantly contributes to the inadequate control of diseases. This study aimed to evaluate TCP among women suffering from vulvar lichen sclerosus (VLS) and its potential impact on treatment adherence and therapeutic outcomes. This observational, prospective study involved adult patients who received their first histological diagnosis of VLS and underwent a 12-week corticosteroid treatment regimen at our Vulva Unit between June 2022 and September 2023. All participants completed the validated TOPICOP questionnaire, which assesses concerns, worries, and beliefs regarding TC usage. Baseline and 12-week control visit assessments were conducted to evaluate subjective and objective parameters of VLS. Patient adherence to treatment was monitored through diary entries. Among the 50 patients included (with a mean age of 64.9 ± 13.5 years), more than half (58%) had prior experience with TC treatments and 10.3% had used corticosteroids for vulvar symptoms without a precise diagnosis. The median global TOPICOP score was 19.4% (interquartile range = 5.6-36.1), with a corresponding median value of 7.0 (interquartile range = 2.0-13.0). A total of 41 patients (82.2%) adhered to the study treatment, which proved highly effective in alleviating symptoms and improving signs of VLS. Multivariate analysis revealed that neither treatment adherence nor effectiveness were significantly associated with the level of TCP. Among our VLS patients, TCP was relatively low and did not negatively impact treatment adherence to corticosteroids. Moreover, TCP did not influence the effectiveness of TC therapy, as it did not affect adherence.

A meta-analysis of technology-based interventions on treatment adherence and treatment success among TBC patients.

Various technology-based interventions have been designed to improve medication adherence and treatment success. However, research on the most effective mode to address this issue is still limited. Our study evaluated the effectiveness of technology-based interventions in improving treatment adherence, completion, and treatment success among tuberculosis (TBC) patients. We conducted a meta-analysis of randomized controlled trials by searching articles from six databases including PubMed, Science Direct, Cochrane, Jstor, Embase, and Scopus from 2018 to April 2023. Two independent reviewers assessed the study quality using the Cochrane Risk of Bias 2.0 tool. We analysed the data using a random-effects model. We also conducted publication bias and sensitivity analysis. In total, 13 studies were identified and 4,794 participants were included in the meta-analysis. The results indicated that technology-based interventions were effective in improving treatment adherence, completion, and success (Odds Ratio (OR): 2.57, 95% Confident Interval (CI): 1.01-6.50, I2 = 86.6%; OR: 1.77, 95% CI: 0.95-3.28, I2: 82.3%; OR: 1.61, 95% CI: 0.85-3.06, I2: 84%, respectively). We examined the possibility of publication bias in the published studies included in this systematic review. However, no evidence of publication bias was found. From the sensitivity analysis by removing one study randomly, we found that our results are robust. Based on the results, we can conclude that technology-based interventions like MERM, text-based messages, video conferencing, and VOT are effective in increasing treatment adherence and completion in tuberculosis management. Therefore, technology shows immense potential in enhancing patient outcomes.

A randomized controlled trial on single-session mindfulness self-compassion interventions for Fibromyalgia Syndrome: evaluating interoceptive awareness, anxiety, and pain

AbstractObjectives: This randomized controlled trial evaluates a single-session Mindfulness Self-Compassion (MSC) intervention for enhancing interoceptive awareness (AI) and alleviating anxiety and reducing pain in Fibromyalgia Syndrome (FMS) patients. The study also examines the intervention’s feasibility and the mediating role of IA in improving clinical outcomes, incorporating nature visuals to address treatment accessibility and adherence. Methods/analysis: Sixty-four FMS patients were randomized into three groups: MSC with audio-only, MSC with audio and nature visuals, or a waitlist control. Validated scales measured interoceptive awareness, anxiety, and pain pre- and post-intervention. ANOVA examined primary outcomes, and mediation analysis explored interoceptive awareness as a mediator. A 7-minute intervention duration was chosen for its balance of effectiveness and feasibility, with nature visuals selected for their calming effects. Findings: Both MSC groups showed significant improvements in IA, anxiety, and pain compared to the control group, with the audio-visual group showing the strongest effects. Enhanced interoceptive awareness significantly mediated anxiety reduction but not pain relief. Nature visuals further reduced anxiety and pain compared to audio-only. Novelty/improvement: This study validates the efficacy of a single-session MSC intervention for FMS, highlighting IA as a crucial mediator of anxiety improvement. Incorporating sensory-rich visual elements enhances therapeutic effects, offering a promising approach for MSC interventions in clinical settings. Future research should explore long-term benefits and optimal dosage of this innovative intervention, addressing the need for accessible, cost-effective FMS treatments.

Effectiveness and prediction of treatment to guided internet-based cognitive behavioural therapy for health anxiety: A cohort study in routine psychiatric care

ObjectiveHealth anxiety, also known as hypochondriasis, is a common psychiatric disorder which leads to considerable distress and is associated with high societal costs. Internet-based cognitive behavioural therapy (ICBT) for health anxiety has demonstrated efficacy in randomized controlled trials (RCTs), but there is limited knowledge regarding its effectiveness in real-world settings. This study aimed to evaluate the clinical effectiveness of guided ICBT for health anxiety in routine psychiatric care, including symptom change, treatment adherence, and potential negative effects. Additionally, we explored predictors of treatment adherence. MethodA longitudinal cohort study of 447 patients enrolled in 12 weeks of ICBT for health anxiety between 2018 and 2020 in an outpatient psychiatric clinic specializing in ICBT. Primary outcome measure was the 14-item Short Health Anxiety Inventory (SHAI-14) and a within-group design with repeated measures was utilized for the primary analysis. ResultsParticipants showed significant improvements from pre- to post-treatment (d = 1.61). At post-treatment, 60 % (95 % CI 58–62) demonstrated statistically reliable change (RCI), and 44 % (95 % CI 42–46) were in remission. On average, participants completed 7 (SD = 4) out of 12 treatment modules. For each additional completed module, the mean reduction was 0.31 (95 % CI 0.10 to 0.54) points on the SHAI-14. ConclusionsGuided ICBT for health anxiety can be effective when delivered within the context of routine psychiatric care. The study suggests that effect sizes are comparable with those in RCTs and higher treatment adherence is associated with better outcomes in health anxiety. ICBT could be used to increase availability to effective therapy for health anxiety.