Different Levels Of Adherence Research Articles

Estimating the Cost of the Spanish Sustainable Food Basket through the Reference Budgets Approach

Reference budgets (RB) are illustrative priced baskets containing the minimum goods and services necessary for well-described types of families to have adequate social participation. Cross-country comparable food RB with the minimum cost were previously developed in 26 EU countries. However, sustainability was not considered. The aim of this paper is to present the development of healthy and sustainable food baskets for Spanish adults. This work follows the steps proposed in previous European projects to build RB: (1) revision of guidelines on healthy and sustainable eating and expert consultations, (2) translation into a concrete list of foods, (3) pricing. The results indicate that a sustainable diet can be cheaper than current recommendations when only the dietary content is considered, representing monthly savings of about EUR 7.27. This is mainly explained by the shift towards more plant-based proteins. Adding constraints on origin, packaging and seasonality increases the overall cost of the food basket by EUR 12.22/month compared with current recommendations. The Spanish Sustainable Food Reference Budget illustrates the cost of applying different criteria to improve dietary sustainability in the Spanish context, and can be useful to support the ecological transition, since providing different levels of adherence to a sustainable dietary pattern can ease its access across socioeconomic groups.

Dynamics of inhaled corticosteroid use are associated with asthma attacks

Inhaled corticosteroids (ICS) suppress eosinophilic airway inflammation in asthma, but patients may not adhere to prescribed use. Mean adherence—averaging total doses taken over prescribed—fails to capture many aspects of adherence. Patients with difficult-to-treat asthma underwent electronic monitoring of ICS, with data collected over 50 days. These were used to calculate entropy (H) a measure of irregular inhaler use over this period, defined in terms of transitional probabilities between different levels of adherence, further partitioned into increasing (Hinc) or decreasing (Hdec) adherence. Mean adherence, time between actuations (Gapmax), and cumulative time- and dose-based variability (area-under-the-curve) were measured. Associations between adherence metrics and 6-month asthma status and attacks were assessed. Only H and Hdec were associated with poor baseline status and 6-month outcomes: H and Hdec correlated negatively with baseline quality of life (H:Spearman rS = − 0·330, p = 0·019, Hdec:rS = − 0·385, p = 0·006) and symptom control (H:rS = − 0·288, p = 0·041, Hdec: rS = − 0·351, p = 0·012). H was associated with subsequent asthma attacks requiring hospitalisation (Wilcoxon Z-statistic = − 2.34, p = 0·019), and Hdec with subsequent asthma attacks of other severities. Significant associations were maintained in multivariable analyses, except when adjusted for blood eosinophils. Entropy analysis may provide insight into adherence behavior, and guide assessment and improvement of adherence in uncontrolled asthma.

Plant-Based Dietary Patterns and Cardiometabolic Risk: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

Abstract Objectives Plant-based diets defined by limited animal food consumption have been extensively associated with cardiometabolic health benefits in Western nations. Diet indices are increasingly used to distinguish the protective characteristics of a plant-based diet at different levels of adherence. We aimed to synthesize evidence on the association between adherence to plant-based diet indices and cardiometabolic risk. A plant-based diet index (PDI) is hypothesized to be inversely associated with type 2 diabetes (T2D) and cardiovascular disease (CVD) with a stronger association with the healthful index (hPDI) that emphasizes higher quality plant-based foods. Methods We systematically searched MEDLINE, EMBASE and CINAHL databases through January 2021. Prospective cohort studies assessing the association of plant-based diet indices with T2D and CVD in adults were included and appraised for risk of bias and quality (NutriGrade). We followed the PRISMA-P, Cochrane and MOOSE guidelines. Random and fixed-effects meta-analyses were conducted to pool risk ratios (RR) of extreme quantiles. Dose-response meta-analyses were conducted after harmonizing all diet index scores. I2-values of 30–60%, 50–90%, and 75–100% denoted moderate, substantial, and considerable heterogeneity respectively. Results We included a total of 10 studies from 5927 retrievals. Across 6 studies there were 22 135 cases of T2D over 4 817 308 person-years. Across 7 studies there were 15 077 cases of CVD over 6 117 016 person-years. The PDI was associated with a lower risk of T2D (RR = 0.82, 95% CI [0.75, 0.91], I2 = 55.4%), and CVD (RR = 0.88, 95% CI [0.8, 0.96], I2 = 16.2%). The hPDI had a stronger inverse association with T2D (RR = 0.73, 95% CI [0.68, 0.77], I2 = 84.3%) and CVD (RR = 0.8, 95% CI [0.77, 0.88], I2 = 55.9%). All dose-response relationships were linear (except hPDI with CVD). All studies had acceptable risk of bias and the quality of evidence was moderate. Conclusions Adherence to a plant-based diet was inversely associated with T2D and CVD with a stronger association for a healthful plant-based diet pattern. Since highest quantiles of the index still included moderate meat consumption, linear dose-responses emphasized potential benefits on risk of T2D and CVD with any incremental progression towards a plant-based diet. Funding Sources Nora Martin Fellowship, Ontario Graduate Scholarship.

Salivary Protein Profile and Food Intake: A Dietary Pattern Analysis.

Saliva research has gained interest due to its potential as a source of biomarkers. One of the factors inducing changes in saliva, in the short term, is food intake, and evidence exist about changes in salivary proteome induced by some food components. Since this topic of research is in its early stages, it was hypothesized that saliva protein composition could be associated with different levels of adherence to dietary patterns that contain higher amounts of plant products. The aim of the present study was to test this hypothesis, in adults, by comparing salivary protein electrophoretic profiles of individuals with different diet characteristics, particularly dietary patterns (DP) that exhibit different proportions of animal and plant-based products. Dietary habits were assessed in 122 adults (61 from each sex, with ages ranging from 20 to 59 years) using Food Frequency Questionnaires. To identify the dietary patterns, a principal component analysis was used. Individual's non-stimulated saliva was evaluated for flow rate, pH, protein concentration, α-amylase activity, and electrophoretic protein profiles. Seven dietary patterns (DP) were identified. Salivary amylase enzymatic activity was positively associated with animal-based and starchy foods DP, and with plant-based fatty foods without wine DP. At the same time, protein bands containing amylase and type S cystatins were positively associated with the cheese/yoghurt and wine DP. Our results support the association of salivary proteomics and different dietary patterns and highlight the need of considering food consumption habits in studies using saliva, since this is a factor associated with variations in the composition of this fluid.

Effect of Timing of and Adherence to Social Distancing Measures on COVID-19 Burden in the United States : A Simulation Modeling Approach.

Across the United States, various social distancing measures were implemented to control the spread of coronavirus disease 2019 (COVID-19). However, the effectiveness of such measures for specific regions with varying population demographic characteristics and different levels of adherence to social distancing is uncertain. To determine the effect of social distancing measures in unique regions. An agent-based simulation model. Agent-based model applied to Dane County, Wisconsin; the Milwaukee metropolitan (metro) area; and New York City (NYC). Synthetic population at different ages. Different times for implementing and easing social distancing measures at different levels of adherence. The model represented the social network and interactions among persons in a region, considering population demographic characteristics, limited testing availability, "imported" infections, asymptomatic disease transmission, and age-specific adherence to social distancing measures. The primary outcome was the total number of confirmed COVID-19 cases. The timing of and adherence to social distancing had a major effect on COVID-19 occurrence. In NYC, implementing social distancing measures 1 week earlier would have reduced the total number of confirmed cases from 203261 to 41366 as of 31 May 2020, whereas a 1-week delay could have increased the number of confirmed cases to 1407600. A delay in implementation had a differential effect on the number of cases in the Milwaukee metro area versus Dane County, indicating that the effect of social distancing measures varies even within the same state. The effect of weather conditions on transmission dynamics was not considered. The timing of implementing and easing social distancing measures has major effects on the number of COVID-19 cases. National Institute of Allergy and Infectious Diseases.

Prognosis of Patients with Colorectal Cancer with Diabetes According to Medication Adherence: A Population-Based Cohort Study.

Diabetes mellitus is known to have a negative effect on colorectal cancer survival due to hyperinsulinemia or hyperglycemia, and medications such as metformin, which targets insulin resistance and hyperinsulinemia, have a preventive effect on the risk of death. The aim of this study was to compare the risk of death among patients with colorectal cancer with diabetes with different levels of adherence to oral antidiabetics. National Health Information Database was used, which has all claims data for those who are registered for national health insurance in Korea, from 2002 to 2016, for conducting a retrospective cohort study. Newly diagnosed patients with colorectal cancer among diabetics were followed up from the date of diagnosis until death or December 31, 2016. The medication adherence was calculated as the proportion of days covered (PDC). The HR and 95% confidence interval (CI) for death were estimated using the low-adherence patients as a reference. A total of 33,841 diabetic patients with newly diagnosed colorectal cancer were followed for an average of 4.7 years. Patients with colorectal cancer with good adherence (PDC ≥ 80%) showed a reduced risk of death [HR (95% CI), 0.82 (0.78-0.86)] compared with those with poor adherence (PDC < 80%). A reduced risk of death was observed for all cancer subsites. The maintenance of good medication adherence for diabetes mellitus was related to a favorable prognosis of colorectal cancer. This study provides evidence that patients with colorectal cancer who are adherent to their diabetes medication will have better survival than patients who are not adherent.

Mandatory Social Distancing Associated With Increased Doubling Time: An Example Using Hyperlocal Data

Mandatory social distancing has been shown in both observational and modeling studies to decrease the spread of infectious diseases such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).1 It has been widely implemented in the U.S. during the SARS-CoV-2 pandemic, but this implementation occurred at different times and with different levels of adherence. The state of Georgia has 159 relatively small counties, making it possible to assess the impact of different distancing policies in neighboring counties.

Cinacalcet adherence in dialysis patients with secondary hyperparathyroidism in Lombardy Region: clinical implications and costs

BackgroundPatients on dialysis often have secondary hyperparathyroidism (SHPT), a disorder associated with renal osteodystrophy, progressive vascular calcification, cardiovascular disease, and death. The objective of this retrospective observational study was to evaluate, in dialysis patients with SHPT, the impact of different levels of adherence to cinacalcet therapy on hospitalisations and direct healthcare costs charged to the Lombardy Regional Health Service (Italy).MethodsData recorded in the administrative databases on all citizens undergoing dialysis between 1 January 2011 and 31 December 2011 were selected. For the aim of this study, patients with SHPT already on dialysis in the first 6 months of 2009 who had been treated with cinacalcet for at least 365 days were selected and retrospectively analysed through to end of 2012. Healthcare resource utilisation, cinacalcet adherence, and costs for medication, hospitalisations, and diagnostic/therapeutic procedures were estimated.ResultsA total of 994 patients were identified (mean age 63.0 years, females 43.5%). The first patient tertile had an adherence to cinacalcet of <64.1%, whereas the third had an adherence of over 91.5%. Patients in the third adherence tertile experienced fewer all-causes hospitalisations than those in the first tertile (−19.2%; p=0.01423), fractures (−37.1%; p=0.59422), cardiovascular disease (−23.8%; p=0.04025), and sepsis (−32.3%; p=0.01386). The increase in costs for cinacalcet-adherent patients is almost completely offset by the reduction in costs for hospitalisations.ConclusionsThe results of the analysis suggest that there may be some correlation between a high level of cinacalcet adherence and a decrease in hospitalisations.

The optimal drug adherence to maximize the efficacy and safety of non-vitamin K antagonist oral anticoagulant in real-world atrial fibrillation patients.

To investigate the association between adherence to non-vitamin K antagonist oral anticoagulant (NOAC) and clinical outcomes and to determine the optimal cut-off level of NOAC adherence among patients with atrial fibrillation (AF). Using the Korean National Health Insurance Service database, we identified 96197 patients with non-valvular AF who initiated NOAC or warfarin in 2013-16. We compared clinical outcomes between adherent [proportion of days covered (PDC) ≥80%] vs. non-adherent (PDC <80%) NOAC users, and further with warfarin users. We assessed the outcomes according to different levels of adherence. The proportion of adherent NOAC users was 64.0%. Compared with non-adherent NOAC users, adherent NOAC users were at lower risks of ischaemic stroke/systemic embolism (SE) [adjusted hazard ratio (aHR) 0.73, 95% confidence interval (CI) 0.69-0.79], and myocardial infarction (aHR 0.82, 95% CI 0.72-0.93), whereas there was no significant risk alteration for major bleeding (aHR 1.01, 95% CI 0.91-1.11). Compared with warfarin, non-adherent NOAC use failed to have better efficacy against ischaemic stroke/SE (aHR 0.99, 95% CI 0.93-1.05) and rather had increased risk of myocardial infarction (aHR 1.13, 95% CI 1.03-1.25). In NOAC users, the risks of adverse outcomes decreased according to gradual increase of adherence rates with the lowest risks in ≥90%, except for major bleeding in which there were no significant associations. In an adherence level-dependent fashion, adherent use of NOAC showed better clinical outcomes without increasing bleeding risk. Maintaining ≥90% of adherence optimizes effectiveness of NOAC therapy without compromising its safety.

Model predictive control for dose guidance in long acting insulin treatment of type 2 diabetes

Approximately 90% of the people with diabetes have type 2 diabetes (T2D), and more than half of the diabetes patients on insulin fail to reach the treatment targets. The reasons include fear of hypoglycemia, complexity of treatment, and work load related to treatment intensification. This paper proposes a model predictive control (MPC) based dose guidance algorithm to identify an individual’s optimal dosing of long acting insulin. We present a model for simulating the effect of long acting insulin on fasting glucose in T2D. We do this by adapting previous models such that slow and non-linear dynamics are identifiable from clinical data. For dose guidance, we use MPC with a novel approach to sub-frequency actuation, to increase safety between input samples. To test the controller, we simulate scenarios with biological variations and different levels of adherence to treatment. The results are compared to a standard of care (SOC) method in insulin dose adjustments.

When Is Forgetting Not Forgetting? A Discursive Analysis of Differences in Forgetting Talk Between Adults With Cystic Fibrosis With Different Levels of Adherence to Nebulizer Treatments.

Forgetting is often cited as a reason why people struggle to adhere to treatments for chronic conditions. Interventions have tried to improve forgetting behavior using reminders. We used a discursive psychological approach to explore differences in how high and low adherers constructed forgetting their nebulizer treatments for cystic fibrosis. Interviews were conducted with 18 adults from a cystic fibrosis center in the United Kingdom. High adherers constructed forgetting treatments as occasional lapses in automaticity and temporary lapses in memory that they found easy to repair. Low adherers utilized forgetting to normalize more consistent nonadherence to treatments. However, it is important to contextualize forgetting as a discursive resource that helped these participants to negotiate moral discourses around adherence to treatment that reminder interventions cannot address; we therefore recommend a more behavioral, patient-focused, theory-driven approach to intervention development.

Adherence to Home-Based Rehabilitation in Older Adults With Diabetes After Hip Fracture.

Adherence to rehabilitation is beneficial to patients with hip fracture. However, the relationships between different levels of adherence and postoperative recovery among older adults after hip fracture have not been addressed thoroughly in the literature. The aims of this study were to explore the trajectories of adherence to home-based rehabilitation during the 12-month period after hospital discharge and to examine the effects of adhering to prescribed home-based rehabilitation on postoperative recovery of physical functions. We employed a secondary data analysis, and 88 hip-fractured older adults with diabetes were recruited. The Chinese Barthel Index was used to measure daily physical functions, a goniometer was used to measure range of motion, and the MicroFET2 dynamometer was used to measure muscle power. Adherence was measured as the rate of adherence to the suggested frequency of home-based rehabilitation activities. Adherence to home-based rehabilitation decreased over time. The high-adherence group was more likely to recover prefracture physical functions than was the low-adherence group, and the high-adherence group had better self-care abilities, greater range of motion for ankle extension, and higher muscular strength on both adduction and abduction than did the low-adherence group. The results of our study suggest that patients adhere to more than 50% of prescribed rehabilitation. Future studies should continue to explore interventions to enhance rehabilitation adherence after hospital discharge.

Evaluation of Adherence to Nevirapine for Prevention of Mother-to-Child Transmission amongst Infants of HIV Positive Mothers in the First 6 Weeks of Life in Lagos Nigeria

Background: Over 90% of infection in children is acquired through mother to child transmission (MTCT). Nevirapine’s efficacy, safety and affordable cost make it the most preferred non-nucleoside reverse transcriptase inhibitor (NNRTI) for paediatric prophylactic use in resource limited settings. There are very few studies on pediatric adherence to antiretroviral prophylaxis, especially in very young infants. The objective of the study was to evaluate the adherence to nevirapine for prevention of mother to child transmission (PMTCT) amongst infants of HIV positive mothers in the first 6 weeks of life. Methods: This was a questionnaire based prospective cross-sectional multicenter study initiated in July 2015 and concluded in December 2017. The study was carried out at the Aids Prevention in Nigeria (APIN/HIV) human immunodeficiency paediatric clinics of the Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos State, 68 Nigerian Army Reference Hospital Yaba (68NARHY) Lagos, Nigeria and the Holy Family Catholic Hospital, Festac Town, Amuwo Odofin, Lagos State. Nevirapine adherence, in infants of 0 - 6 weeks was measured by maternal verbal reports. Results: Eighty-one (81) infants receiving nevirapine within the age of 0 - 6 weeks completed the study. Majority of the infants started treatment at birth (32%) and after 4 weeks (31%). 54% of the 81 respondents do not miss or skip their doses while 46% of respondents skip doses. Majority of the respondents 18 (49%) missed their doses for 24 - 48 hours while 25% missed their doses because they were away from home and 23% ran out of pills. 85.2% took ≥95% of the prescribed medications (good or high adherence ), 8.2% took 80% - 95% of doses (moderate adherence) while 6.2% took 0.05). Conclusions: The adherence rates found in this study are comparable to other studies in developing countries. But these rates are still low for good clinical outcomes. Different levels of adherence were documented with the majority having good or high adherence. Not all of the infants started treatment at birth and Institutional delivery should be encouraged to improve early initiation of prophylaxis. The finding of patients with low adherence rates among the study population calls for intensification of counselling on adherence and should continue to be an integral part of prevention of mother to child transmission. Improved access to antiretroviral agents and improved care delivery systems are important.

The Association Between Adherence to Positive Airway Pressure Therapy and Long-Term Outcomes in Patients With Obesity Hypoventilation Syndrome: A Prospective Observational Study.

To assess the role of different levels of adherence and long-term effects of positive airway pressure (PAP) therapy on gas exchange, sleepiness, quality of life, depressive symptoms, and all-cause mortality in patients with obesity hypoventilation syndrome (OHS). A total of 252 patients with newly diagnosed OHS were followed up for a minimum of 2 years after PAP initiation. PAP adherence (h/night) was monitored. Arterial blood gas samples were taken with patients being alert for more than 4 hours after morning awakening. Subjective daytime sleepiness (Epworth Sleepiness Scale [ESS]), quality of life (Short Form 36 [SF-36]) and patient's depressive symptoms (Beck Depression Inventory [BDI]) were assessed before and at the end of the follow-up period, along with all-cause mortality. At the end of the follow-up period (median duration [25th-75th percentile], 30 [24-52] months), PaO2 increased from baseline (72.7 ± 10.3 versus 63.2 ± 10.6, P < .001) and both PaCO2 and HCO3- decreased (43.0 [39.2-45.0] versus 50.0 [46.7-55.4] and 27.5 ± 3.2 versus 31.4 ± 4.2, respectively, P < .001). In addition, PAP therapy significantly improved ESS (7 [4-9] versus 14 [11-16], P < .001), BDI (8.8 ± 4.9 versus 15.5 ± 7.3, P < .001) and SF-36 (82 [78-87] versus 74 [67-79], P < .001) scores. Over the follow-up period 11 patients died. Patients who used PAP for > 6 h/night had significant improvements (P < .05) in blood gases and SF-36 scores than less adherent patients. Increased hours of use and long-term therapy with PAP are effective in the treatment of patients with OHS. Clinicians should encourage adherence to PAP therapy in order to provide a significant improvement in clinical status and gas exchange in these patients. A commenary on this article appears in this issue on page 1455. Title: PAP Therapy in Patients With Obesity Hypoventilation Syndrome, Registry: ClinicalTrials.gov, Identifier: NCT03449641, URL: https://clinicaltrials.gov/ct2/show/NCT03449641.

ALIGNed on adherence: subanalysis of adherence in immune-mediated inflammatory diseases in the DACH region of the global ALIGN study.

BackgroundNon‐adherence to medication is a challenging problem in daily clinical practice.ObjectiveTo assess reasons for non‐adherence in patients with chronic immune‐mediated inflammatory diseases (IMIDs) in a direct comparison including evaluation of treatment necessity and concerns.MethodsALIGN was a non‐interventional, multicountry, multicentre, self‐administered, cross‐sectional, epidemiologic survey study. Here, we investigate the German, Austrian and Swiss (DACH) cohort. Six hundred thirty‐one patients with different IMIDs (rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, plaque psoriasis, Crohn's disease and ulcerative colitis) under systemic therapies were evaluated concerning adherence, beliefs of necessity and concerns towards treatment in patients with IMIDs.ResultsThe DACH cohort had significantly different levels of adherence depending on the IMID (P < 0.05) and the type of therapy (P < 0.05). Based on the significant influence of concerns on treatment adherence (P < 0.05) and the high belief of treatment necessity, patients could be classified in four attitudinal segments, which were unequally distributed throughout various IMIDs. High concerns had a significant influence on non‐adherence, whereas necessity did not. Older age, female sex, TNFi mono‐, conventional combination and TNFi combination therapy are positively associated with adherence.ConclusionsIn the DACH region, patients are less concerned about medication and believe in the necessity of treatment. Therefore, we suggest adapting the communication in the various patient groups.

Patient Adherence to Scheduled Vital Sign Measurements During Home Telemonitoring: Analysis of the Intervention Arm in a Before and After Trial.

BackgroundIn a home telemonitoring trial, patient adherence with scheduled vital signs measurements is an important aspect that has not been thoroughly studied and for which data in the literature are limited. Levels of adherence have been reported as varying from approximately 40% to 90%, and in most cases, the adherence rate usually dropped off steadily over time. This drop is more evident in the first few weeks or months after the start. Higher adherence rates have been reported for simple types of monitoring and for shorter periods of intervention. If patients do not follow the intended procedure, poorer results than expected may be achieved. Hence, analyzing factors that can influence patient adherence is of great importance.ObjectiveThe goal of the research was to present findings on patient adherence with scheduled vital signs measurements in the recently completed Commonwealth Scientific and Industrial Research Organisation (CSIRO) national trial of home telemonitoring of patients (mean age 70.5 years, SD 9.3 years) with chronic conditions (chronic obstructive pulmonary disease, coronary artery disease, hypertensive diseases, congestive heart failure, diabetes, or asthma) carried out at 5 locations along the east coast of Australia. We investigated the ability of chronically ill patients to carry out a daily schedule of vital signs measurements as part of a chronic disease management care plan over periods exceeding 6 months (302 days, SD 135 days) and explored different levels of adherence for different measurements as a function of age, gender, and supervisory models.MethodsIn this study, 113 patients forming the test arm of a Before and After Control Intervention (BACI) home telemonitoring trial were analyzed. Patients were required to monitor on a daily basis a range of vital signs determined by their chronic condition and comorbidities. Vital signs included noninvasive blood pressure, pulse oximetry, spirometry, electrocardiogram (ECG), blood glucose level, body temperature, and body weight. Adherence was calculated as the number of days during which at least 1 measurement was taken over all days where measurements were scheduled. Different levels of adherence for different measurements, as a function of age, gender, and supervisory models, were analyzed using linear regression and analysis of covariance for a period of 1 year after the intervention.ResultsPatients were monitored on average for 302 (SD 135) days, although some continued beyond 12 months. The overall adherence rate for all measurements was 64.1% (range 59.4% to 68.8%). The adherence rates of patients monitored in hospital settings relative to those monitored in community settings were significantly higher for spirometry (69.3%, range 60.4% to 78.2%, versus 41.0%, range 33.1% to 49.0%, P<.001), body weight (64.5%, range 55.7% to 73.2%, versus 40.5%, range 32.3% to 48.7%, P<.001), and body temperature (66.8%, range 59.7% to 73.9%, versus 55.2%, range 48.4% to 61.9%, P=.03). Adherence with blood glucose measurements (58.1%, range 46.7% to 69.5%, versus 50.2%, range 42.8% to 57.6%, P=.24) was not significantly different overall. Adherence rates for blood pressure (68.5%, range 62.7% to 74.2%, versus 59.7%, range 52.1% to 67.3%, P=.04), ECG (65.6%, range 59.7% to 71.5%, versus 56.5%, range 48.7% to 64.4%, P=.047), and pulse oximetry (67.0%, range 61.4% to 72.7%, versus 56.4%, range 48.6% to 64.1%, P=.02) were significantly higher in males relative to female subjects. No statistical differences were observed between rates of adherence for the younger patient group (70 years and younger) and older patient group (older than 70 years).ConclusionsPatients with chronic conditions enrolled in the home telemonitoring trial were able to record their vital signs at home at least once every 2 days over prolonged periods of time. Male patients maintained a higher adherence than female patients over time, and patients supervised by hospital-based care coordinators reported higher levels of adherence with their measurement schedule relative to patients supervised in community settings. This was most noticeable for spirometry.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12613000635763; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364030&isReview=true (Archived by WebCite at http://www.webcitation.org/6xPOU3DpR).

Interactions of Modern Aesthetic Materials for Prosthetic Restorations with Oral Mucosa A pilot study

The specific objective of the present study is to assess the interactions between cells from a human gingival epithelial cell line and various aesthetic materials used in modern prosthetic dentistry. For this study six types of dental materials were selected: Cr-Co non-precious metal alloy, ceramics applied on Cr-Co non-precious metal alloy, zirconia, ceramics applied on zirconia, polymethyl methacrylate and pressed ceramics/lithium disilicate. Cells from a human gingival epithelial cell line, Ca9-22 (Health Science Research Resources Bank), were cultured on the chosen surfaces for 3, 5 and 7 days. Cellular proliferation, cell attachment (using Multiplex Arrays Technology) and cytotoxicity (MTT- Assay) were evaluated at distinct predetermined intervals. Measurements performed at each distinct predetermined interval showed no significant difference for cell proliferation and cytotoxicity between the selected surfaces, however the highest levels were registered for the polymethyl methacrylate surface. Different attachment patterns were observed for epithelial cells attached on substrates, such as significantly different levels of adherence of E-Cadherin and N-Cadherin molecules; E-Cadherin adhesion levels indicate that pressed ceramics may be the dental material which, compared to the selected materials, influences the least the homeostasis of oral mucosa.

Mitigating Prenatal Zika Virus Infection in the Americas.

Because of the risk for Zika virus infection in the Americas and the links between infection and microcephaly, other serious neurologic conditions, and fetal death, health ministries across the region have advised women to delay pregnancy. However, the effectiveness of this policy in reducing prenatal Zika virus infection has yet to be quantified. To evaluate the effectiveness of pregnancy-delay policies on the incidence and prevalence of prenatal Zika virus infection. Vector-borne Zika virus transmission model fitted to epidemiologic data from 2015 to 2016 on Zika virus infection in Colombia. Colombia, August 2015 to July 2017. Population of Colombia, stratified by sex, age, and pregnancy status. Recommendations to delay pregnancy by 3, 6, 9, 12, or 24 months, at different levels of adherence. Weekly and cumulative incidence of prenatal infections and microcephaly cases. With 50% adherence to recommendations to delay pregnancy by 9 to 24 months, the cumulative incidence of prenatal Zika virus infections is likely to decrease by 17% to 44%, whereas recommendations to delay pregnancy by 6 or fewer months are likely to increase prenatal infections by 2% to 7%. This paradoxical exacerbation of prenatal Zika virus exposure is due to an elevated risk for pregnancies to shift toward the peak of the outbreak. Sexual transmission was not explicitly accounted for in the model because of limited data but was implicitly subsumed within the overall transmission rate, which was calibrated to observed incidence. Pregnancy delays can have a substantial effect on reducing cases of microcephaly but risks exacerbating the Zika virus outbreak if the duration is not sufficient. Duration of the delay, population adherence, and the timing of initiation of the intervention must be carefully considered. National Institutes of Health.

Qualificando a adesão à democracia: quão democráticos são os democratas brasileiros?

Resumo O presente artigo busca qualificar a adesão à democracia no Brasil. Ele parte da ideia de que a adesão à democracia é mais bem entendida de um ponto de vista multidimensional. Os indivíduos podem aderir a diferentes princípios subjacentes à democracia, em vez de optarem pela simples adesão ou não a ela. Nosso enfoque são os democratas: queremos saber quão democráticos são os democratas brasileiros. Utilizamos aqui o banco de dados Barômetro das Américas de 2006 a 2012. Os resultados mostram que existem diferentes níveis de adesão à democracia, conforme o princípio democrático em questão. Os brasileiros aderem com maior intensidade à dimensão participativa, em detrimento da procedimental e da representativa. Mostramos, no entanto, que esses princípios podem caminhar de forma mais ou menos independente.

Good adherence to mediterranean diet can prevent gastrointestinal symptoms: A survey from Southern Italy.

AIMTo evaluate how different levels of adherence to a mediterranean diet (MD) correlate with the onset of functional gastrointestinal disorders.METHODSAs many as 1134 subjects (598 M and 536 F; age range 17-83 years) were prospectively investigated in relation to their dietary habits and the presence of functional gastrointestinal symptoms. Patients with relevant chronic organic disease were excluded from the study. The Mediterranean Diet Quality index for children and adolescents (KIDMED) and the Short Mediterranean Diet Questionnaire were administered. All subjects were grouped into five categories according to their ages: 17-24 years; 25-34; 35-49; 50-64; above 64.RESULTSOn the basis of the Rome III criteria, our population consisted of 719 (63.4%) individuals who did not meet the criteria for any functional disorder and were classified as controls (CNT), 172 (13.3%) patients meeting criteria for prevalent irritable bowel syndrome (IBS), and 243 (23.3%) meeting criteria for prevalent functional dyspepsia (FD). A significantly lower adherence score in IBS (0.57 ± 0.23, P < 0.001) and FD (0.56 ± 0.24, P < 0.05) was found compared to CNT (0.62 ± 0.21). Females with FD and IBS exhibited significantly lower adherence scores (respectively 0.58 ± 0.24, P < 0.05 and 0.56 ± 0.22, P < 0.05) whereas males were significantly lower only for FD (0.53 ± 0.25, P < 0.05). Age cluster analyses showed a significantly lower score in the 17-24 years and 25-34 year categories for FD (17-24 years: 0.44 ± 0.21, P < 0.001; 25-34 years: 0.48 ± 0.22, P < 0.05) and IBS (17-24 years: 0.45 ± 0.20, P < 0.05; 24-34 years: 0.44 ± 0.21, P < 0.001) compared to CNT (17-24 years: 0.56 ± 0.21; 25-34 years: 0.69 ± 0.20).CONCLUSIONLow adherence to MD may trigger functional gastrointestinal symptoms, mainly in younger subjects. Moreover, with increasing age, patients tend to adopt dietary regimens closer to MD.