Adherence Factors Research Articles

Systematic review and meta-analysis on the effect of depression on ART adherence among women living with HIV.

Depression is a very common psychiatric disorder in worldwide. Globally, Human Immunodeficiency Virus (HIV) is highly prevalent among women, and are disproportionately affected by depression. Antiretroviral Therapy (ART) adherence which could highly be affected by depression is yet to be explored effectively. Depression affects overall poor HIV clinical outcomes, socioeconomic and social interactions. However, it is not well understood specifically how depression affects ART adherence in women living with HIV (WLWHIV). Investigating the effects of depression on ART adherence is critical in order to develop nuanced new evidence to address non-adherence in WLWHIV. To conduct a meta-analysis on the correlation between depression and adherence to antiretroviral therapy among women living with HIV in the globe. Using population, exposed and outcome approach, we searched Scopus, PubMed, EMBASE, Cochrane Library, Psych info, Web of science and google scholar for cohort and cross-sectional studies globally. The search strategy was structured comprising terms associated with antiretroviral therapy and adherence, women living with HIV and depression. We evaluated the paper quality, using the Newcastle-Ottawa Scales (NOS). The fixed effect model was used to analysis the effect of depression on ART adherence. A total of 8 articles comprise 6474 participants were included in this study. There were controversial findings related to the effect of depression to ART adherence. Among three cross-sectional study, one article demonstrating, depression was associated with ART adherence. Of the five cohort studies, four cohort studies reported association. The overall pooled estimated effect of depression on ART adherence was 1.02 [RR = 1.015 with 95% CI (1.004, 1.026)] with a p-value of 0.005. Depression was the risk factor for ART adherence among women living with HIV. It is therefore, necessary for clinician to note this and perform screening for ART adherence. The review protocol was developed with prospero registration: CRD42023415935.

Progress of Research on the Current Status and Influencing Factors of Medication Adherence in Chronic Hepatitis B Patients

Progress of Research on the Current Status and Influencing Factors of Medication Adherence in Chronic Hepatitis B Patients

Medications Adherence and Associated Factors Among Patients with Stroke in Iraq.

Stroke poses significant challenges to affected individuals, their families, and healthcare systems, with adherence to medications being a pivotal determinant of health outcomes. In this study, we aim to evaluate the medication adherence of stroke patients living in Iraq, and explore how patients' demographic and clinical details relate to their adherence levels. Furthermore, we seek to assess the self-care practices used by stroke patients and their adherence to them. We carried out a cross-sectional correlational study conducted from November 2022 to April 2023, stroke patients diagnosed in seven hospitals across Baghdad and Al-Mothanna governorate were recruited, with diagnoses confirmed by physicians and senior neurologists using MRI and/or CT scans. Patients' adherence to medications, demographic data, clinical characteristics, and self-care activities were analyzed using descriptive statistics and regression analyses. Of the 200 participants, mean age was 58.27 years, with males constituting 53.5%. About 40.5% had a hemorrhagic stroke, and 59.5% an ischemic stroke. The mean adherence score was 13.36 (SD= 4.658) out of a possible 28. Factors significantly correlated with medication adherence included age, monthly income, time since having a stroke, and education level. Adherence was also significantly linked to having diabetes mellitus or high blood pressure. The assessment of participants' self-care activities and medication adherence revealed that responses to questions about healthcare habits varied, with "None" being the most common response for most items. Notably, we found no significant association between adherence and factors such as gender, marital status, living place, and smoking status. Medication adherence remains suboptimal among stroke patients in Iraq. Various demographic and clinical factors play a role in influencing adherence. The conformity to medication regimens and factors associated with it among individuals who have suffered a stroke in Iraq is vital.

Determinants of medication adherence and impact of mobile telephony, pillbox interventions on compliance and glycemic control among patients with type 2 diabetes

Abstract Background: Medication adherence has been linked to improved glycemic control, fewer complications from diabetes, fewer hospitalizations, reduced health care expenses, and a decreased mortality rate. The medication adherence pattern, reason, and factors associated with poor medication adherence among patients living with type 2 diabetes mellitus were determined, and the impact of two interventions to improve medication adherence was assessed. Materials and Methods: The medication adherence patterns of 240 people living with diabetes were determined using the Morisky Green Levine Medication Adherence Scale-4 and categorized into low, medium, and high adherence patterns. Patients with poor medication adherence (low and medium pattern) scores were randomized into short message service (SMS) and pillbox interventions, and the impact of Interventions on compliance and glycemic control was determined. Results: Results demonstrate that 3% of patients living with type 2 diabetes have low, 43% medium, and 54% have high medication adherence patterns. The most common reason cited for non-adherence was (88%) followed by lack of finance (5%) and multiple medications (4%). A positive association of injectable dosage forms, number of drugs, and treatment modalities with adherence was found. SMS and pillbox intervention improved medication adherence among individuals with diabetes who had poor adherence, which translated into good glycemic control. Conclusions: The improvement in drug compliance and glycemic control was found to be equivocal among the SMS and pillbox intervention groups. The inclusion of interventions into the institutional education program and counseling by health care workers will motivate patients to adopt these interventions to improve drug compliance and glycemic control.

A cross-sectional study of the factors influencing adherence to antiretroviral therapy among adults with human immunodeficiency virus infection in a tertiary care hospital in Puducherry, India.

Combating human immunodeficiency virus/acquired immunodeficiency syndrome epidemic has been possible due to advances in prevention strategies and Antiretroviral therapy (ART). Optimal adherence to ART is a major factor in achieving the desired immunological, virological, and patient well-being outcomes. Several socio-demographic, patient, treatment, and health-care system-related factors influence nonadherent behavior to ART. This study was planned to assess (1) ART adherence level, (2) factors and reasons associated with nonadherence, and (3) impact of suboptimal adherence on treatment outcomes. This was a cross-sectional analytical study of 300 patients in a tertiary care hospital in Puducherry, India. Random sampling was used to collect data from patient treatment cards and a predesigned structured questionnaire. The pill count method was used to calculate adherence level. Nonadherence was chosen as a dependent variable and factors affecting adherence were chosen as independent variables. Test for significance was carried out by Chi-square test and Fisher's exact test. Optimal adherence was seen in 68.3%. Factors significantly associated with nonadherence were lower education level, high prior CD4 count, irregular follow-up, missing doses in the past, and being late for pharmacy pill refills. Adherence was positively associated with mean increase in CD4 count over 6 months. In our study, the adherence rate is suboptimal which can lead to failure of ART. Nonadherence was associated with a decrease in CD4 count overtime. Most of the factors significantly affecting ART adherence were patient behavior related. These factors can be used for target intervention during reinforcement adherence counseling.

Association between medication adherence and blood pressure control and factors associated with antihypertensive medication adherence in the Melaka Tengah District: A cross-sectional survey.

The burden of cardiovascular disease and early morbidity and mortality is exacerbated by hypertension. According to the 2019 National Health and Morbidity Survey, 30% of adults in Malaysia aged over 18 years had hypertension. Our study aimed to investigate the association between medication adherence and blood pressure control and the factors associated with antihypertensive medication adherence. This cross-sectional study was conducted among adult patients with hypertension who had been under treatment at public primary health clinics in the Melaka Tengah District. A self-administered questionnaire was used, and blood pressure was measured. Descriptive and multivariate logistic regression analyses were conducted using the Statistical Package for the Social Sciences (version 28). A total of 1531 patients were recruited in this study. Among them, 74.1% had good antihypertensive medication adherence, and 51.4% had their blood pressure controlled. Medication adherence was significantly associated with blood pressure control (P<0.005). The multivariate analysis showed that the determinants for antihypertensive medication non-adherence were Malay ethnicity, secondary education, farther distance from the clinic, experience of side effects of antihypertensive medications, concern about long-term side effects and usage of alternative medicine (P<0.05). Taking multiple antihypertensive medications was the only factor associated with uncontrolled blood pressure (P<0.05). Addressing issues on medication adherence is important to ensure blood pressure control. The factors associated with non-adherence should be closely monitored to improve blood pressure control and prevent adverse health outcomes. Single-pill combination antihypertensive medications are encouraged to reduce pill burden and improve blood pressure control.

Factors of Adherence to Concurrent Tuberculosis Treatment and Antiretroviral Therapy among HIV-TB Co-Infected Individuals in the East Region, Cameroon in the COVID-19 Era: A Retrospective Cohort Study

Factors of Adherence to Concurrent Tuberculosis Treatment and Antiretroviral Therapy among HIV-TB Co-Infected Individuals in the East Region, Cameroon in the COVID-19 Era: A Retrospective Cohort Study

Factors linked to virological failure in people on a dolutegravir-based regimen in Mamelodi.

Since 2019, the World Health Organization has recommended dolutegravir-containing regimens for HIV in low- and middle-income countries because of its high genetic barriers to resistance, lower drug interactions, fewer side effects, higher viral load (VL) suppression rates and cost-effectiveness compared to efavirenz. This study investigates factors associated with unsuppressed VLs in people living with HIV on tenofovir-lamivudine and dolutegravir (TLD) in South Africa (SA). A cross-sectional study was conducted between October 2023 and February 2024 at Mamelodi Regional Hospital's Ntshembo Clinic. Participants were people living with HIV aged 18 years and older, more than 6 months on TLD, with either suppressed (≤ 50 copies/mL) or unsuppressed (> 50 copies/mL) VLs. Significant associations were found between unsuppressed VL and factors such as sex, marital status, occupation and education level. Male participants were less likely to achieve VL suppression than female participants (odds ratio: 0.45, p = 0.0007). Poor antiretroviral therapy adherence was linked to higher unsuppressed VL (p < 0.05). Newly initiated patients had significantly lower suppression rates (p < 0.05). The use of traditional or herbal and religious products was also linked to unsuppressed VL (p < 0.05). The study highlights the importance of addressing adherence factors to improve VL suppression rates among people living with HIV on TLD. Tailored interventions targeting adherence, especially among newly initiated patients, and addressing the use of traditional or herbal and religious products are warranted to enhance treatment outcomes.

Genomic characterization of a multidrug-resistant uropathogenic &lt;i&gt;Escherichia coli&lt;/i&gt; and evaluation of &lt;i&gt;Echeveria&lt;/i&gt; plant extracts as antibacterials

&lt;abstract&gt; &lt;p&gt;Uropathogenic &lt;italic&gt;Escherichia coli&lt;/italic&gt; (UPEC) is the most common bacterial agent associated with urinary tract infections, threatening public health systems with elevated medical costs and high morbidity rates. The successful establishment of the infection is associated with virulence factors encoded in its genome, in addition to antibacterial resistance genes, which could limit the treatment and resolution of the infection. In this sense, plant extracts from the genus &lt;italic&gt;Echeveria&lt;/italic&gt; have traditionally been used to treat diverse infectious diseases. However, little is known about the effects of these extracts on bacteria and their potential mechanisms of action. This study aims to sequence a multidrug-resistant UPEC isolate (UTI-U7) and assess the multilocus sequence typing (MLST), virulence factors, antimicrobial resistance profile, genes, serotype, and plasmid content. Antimicrobial susceptibility profiling was performed using the Kirby-Bauer disk diffusion. The antibacterial and anti-adherent effects of the methanol extracts (ME) of &lt;italic&gt;Echeveria&lt;/italic&gt; (&lt;italic&gt;E. craigiana&lt;/italic&gt;, &lt;italic&gt;E. kimnachii&lt;/italic&gt;, and &lt;italic&gt;E. subrigida&lt;/italic&gt;) against UTI-U7 were determined. The isolate was characterized as an O25:H4-B2-ST2279-CH40 subclone and had resistant determinants to aminoglycosides, β-lactams, fluoroquinolones/quinolones, amphenicols, and tetracyclines, which matched with the antimicrobial resistance profile. The virulence genes identified encode adherence factors, iron uptake, protectins/serum resistance, and toxins. Identified plasmids belonged to the IncF group (IncFIA, IncFIB, and IncFII), alongside several prophage-like elements. After an extensive genome analysis that confirmed the pathogenic status of UTI-U7 isolate, &lt;italic&gt;Echeveria&lt;/italic&gt; extracts were tested to determine their antibacterial effects; as an extract, &lt;italic&gt;E. subrigida&lt;/italic&gt; (MIC, 5 mg/mL) displayed the best inhibitory effect. However, the adherence between UTI-U7 and HeLa cells was unaffected by the ME of the &lt;italic&gt;E. subrigida&lt;/italic&gt; extract.&lt;/p&gt; &lt;/abstract&gt;

HUBUNGAN FAKTOR RISIKO TERHADAP KEPATUHAN PENGOBATAN DIABETES MELLITUS DI PUSKESMAS CIKAMPEK

According to the International Diabetes Federation (IDF) the prevalence of DM was 366 million in 2011, and it's predicted that in 2030 it'll increase to 552 million. In 2020 as many as 1 million people in West Java suffer from DM. With 139 thousand people of whom are residents in Karawang Regency. According to WHO in 2003 only about 50% adherence rate of chronic disease treatment in developed countries. Factors that cause low levels of adherence include running out of medication, forgetting to take medication, knowledge, motivation for treatment, and family support. In addition, age, nutritional status, education level, occupation, and income can also affect medication adherence in DM patients. The purpose of this study was to determine adherence to DM treatment at the Cikampek Health Center and how the relationship between risk factors for adherence to DM treatment. This research is an analytic observational study with a cross-sectional design. The population and sample of this study were all DM patients who underwent treatment methods at the Cikampek Health Center, using total sampling. This research was conducted at the Cikampek Health Center, using MMAS-8 questionnaire and then the data were analyzed using the chi-square test. The results of the study showed that 104 respondents had low adherence to treatment at the Cikampek Health Center, 42.3% had low adherence, and there was no correlation between risk factors and DM treatment adherence.&#x0D; Keywords: Adherence, Diabetes Mellitus, Risk Factor

Related Factors of Antiretroviral Adherence in HIV/AIDS Patients at one of the Community Health Centers in Malang City

Introduction: HIV or Human Immunodeficiency Virus has become a serious global problem due to increased yearly infections. People living with HIV/AIDS (PLHIV) must take antiretrovirals (ARV) to improve their quality of life, so adherence is the main focus of therapy. Objective: This study aims to determine the factors that influence of adherence to ARV treatment in PLWHA at one of the Community Health Centers in Malang City. Methods: This study used an analytic descriptive observational method with a cross-sectional research design. The research sample was PLWHA who fit the inclusion criteria using accidental sampling technique with a minimum sample calculation using the Slovin formula. Data were collected using the Adherence to Refills and Medication Scale (ARMS) questionnaire during the February-March 2021 period at one of the health centers in Malang City. Data were analyzed using multivariate regression to determine factors that influence ARV treatment adherence in PLWHA. Results: This study involved 85 PLHIV patients. A total of 59 people (69.4%) were included in the compliant category on antiretroviral treatment. Multivariate analysis showed that men were 4 times more likely to be disobedient (p=0.022; OR = 4.922; 95% Cl = 1.261 – 19.208), while respondents with school education were less likely to be disobedient p=0.007 ; OR = 0.118; 95% Cl = 0.025 – 0.558). As for age, marital status, and employment status did not have a significant effect on adherence to ARV treatment. Conclusion: Gender is the most dominant factor in influencing adherence where male patients are 4 times more likely to be non-adherent compared to female patients. Keywords: Adherence, AIDS, Antiretroviral, ARV, HIV

Moderating Effects of Authentic Happiness on the Relationship Between Health-seeking Behaviour and Treatment Adherence Among Patients with Hypertension

Background: Hypertension is a chronic health condition that requires consistent management and adherence to treatment. However, there is a dearth of empirical data on the psychological factors influencing treatment adherence among patients with hypertension in Nigeria. Objectives: To determine the moderating effects of authentic happiness on the relationship between health-seeking behaviour and treatment adherence among patients with hypertension. Methods: The study used a cross-sectional study design. Survey tools comprising items of the Authentic Happiness Scale, Health-seeking Behaviour Scale, Hill-bone Compliance High Blood Pressure Therapy Scale were used to obtain data from two hundred and ninety (290) patients who were selected by purposive sampling and met the study eligibility criteria. Results: Increase in health-seeking behaviour and authentic happiness showed significant effects on adherence to treatment [β1 = 0.241, t = 2.92, p = 0.004; β2 = 0.208, t = 4.80, p = 0.01 respectively]. The interaction between health-seeking behaviour and authentic happiness lacked significant effects on treatment adherence [β3 = 0.003, t = 0.032, p = 0.751]. The analysis of conditional effects revealed that the effects of health seeking behaviour on treatment adherence were significantly differentiated when happiness was low [β = 0.263, t = 2.46, p = 0.015], moderate [β = 0.241, t = 2.92, p = 0.004], or high [β = 0.219, t = 2.02, p = 0.044]. Conclusion: Health-seeking behaviour and authentic happiness are potential explanatory factors for adherence to treatment among patients with hypertension.

Effectiveness of the Protection Motivation Theory-based Education Program among People at Risk of Stroke: A Randomized Controlled Trial

Stroke is a serious health issue that causes mortality and disability in the world’s population. People at risk of stroke need to manage the risk factors of stroke and adherence to stroke prevention, which are the key to success in improving clinical outcomes, particularly blood sugar and blood pressure levels. This randomized controlled trial, with a two-arm preand post-test, aimed to investigate the effectiveness of the Protection Motivation Theory-based Education Program on adherence to prevention and clinical outcomes among people at risk of stroke. The sample consisted of 58 adults visiting diabetes and hypertension clinics at a health-promoting hospital in a province in southern Thailand. They were recruited using multi-stage random sampling and randomly assigned into two arms. The experimental arm received the four-week Protection Motivation Theory-based Education Program (n = 29), and the control arm received only usual care (n = 29). Data were collected using a Demographic Data Form, the Morisky Medication Adherence Scale, the Adherence to Preventive Behavior Scale for Thai persons with prehypertension, a mercury sphygmomanometer, and a laboratory test recording form. Data were analyzed using descriptive statistics, Mixed Model ANOVA, and independent t-test. The results showed that after receiving the program, the experimental arm had higher adherence to stroke prevention, lower blood pressure, and lower HbA1C levels than before receiving the program and the control arm after the program completion. The findings indicate the program’s effectiveness in improving adherence to stroke prevention among people at risk of stroke, which results in better clinical outcomes. Thus, nurses can use this program in clinical practice with further testing in other settings with larger groups before it can be widely used.

Integrated Text Messaging (ITM) for people attending cardiac and pulmonary rehabilitation: A multicentre randomised controlled trial

BackgroundPeople living with cardiac and respiratory disease require improved post-hospital support that is readily available and efficient. ObjectivesTo 1) test the effectiveness of an automated, semi-personalised text message support program on clinical and lifestyle outcomes amongst people attending cardiac and pulmonary rehabilitation. Also, 2) to evaluate the program's acceptability and utility using patient-reported outcome and experience measures. MethodsMulticentre randomised controlled trial (3:1, intervention:control) amongst cardiac and pulmonary rehabilitation attendees. Control received usual care (no message program). Intervention also received a 6-month text message lifestyle and support program. Primary outcome was 6-minute walk distance (6MWD). Secondary outcomes included clinical measures, lifestyle, patient-reported outcome and experience measures, medication adherence and rehabilitation attendance. ResultsA total of 316 participants were recruited. They had a mean age of 66.7 (SD 10.1) years. Sixty percent were male (190/316) and 156 were cardiac rehabilitation participants. The cohort's mean baseline 6MWD was higher in the intervention than the control group. At 6 months, 6MWD improved in both groups; it was significantly greater amongst intervention than control participants (unadjusted mean difference of 43.4 m, 95 % CI 4.3 to 82.4; P = 0.0296). After adjustment for baseline values, there was no significant difference between intervention and control groups for 6MWD (adjusted mean difference 2.2 m, -21.2 to 25.6; P = 0·85), medication adherence, or cardiovascular risk factors. At 6-month follow-up, intervention participants reported significantly lower depression scores (adjusted mean difference -1.3, 95 % CI -2.2 to -0.3; P = 0.0124) and CAT scores (adjusted mean difference -3.9, 95 % CI -6.6 to -1.3; P = 0.0038), and significantly lower anxiety (adjusted mean difference -1.1, 95 %CI -2.1 to 0; P = 0.0456). Most participants (86 %) read most of their messages and strongly/agreed that the intervention was easy to understand (99 %) and useful (86 %). ConclusionsAn educational and supportive text message program for cardiac and pulmonary rehabilitation attendees improved anxiety and depression plus program attendance. The program was acceptable to, and useful for, participants and would be suitable for implementation alongside rehabilitation programs. Trial registration numberACTRN12616001167459

A Machine Learning Model to Predict Patients' Adherence Behavior and a Decision Support System for Patients With Metastatic Breast Cancer: Protocol for a Randomized Controlled Trial.

Adherence to oral anticancer treatments is critical in the disease trajectory of patients with breast cancer. Given the impact of nonadherence on clinical outcomes and the associated economic burden for the health care system, finding ways to increase treatment adherence is particularly relevant. The primary end point is to evaluate the effectiveness of a decision support system (DSS) and a machine learning web application in promoting adherence to oral anticancer treatments among patients with metastatic breast cancer. The secondary end point is to collect a set of new physical, psychological, social, behavioral, and quality of life predictive variables that could be used to refine the preliminary version of the machine learning model to predict patients' adherence behavior. This prospective, randomized controlled study is nested in a large-scale international project named "Enhancing therapy adherence among metastatic breast cancer patients" (Pfizer 65080791), aimed to develop a predictive model of nonadherence and associated DSS and guidelines to foster patients' engagement and therapy adherence. A web-based DSS named TREAT (treatment adherence support) was developed using a patient-driven approach, with 4 sections, that is, Section A: Metastatic Breast Cancer; Section B: Adherence to Cancer Therapies; Section C: Promoting Adherence; and Section D: My Adherence Diary. Moreover, a machine learning-based web application was developed to predict patients' risk factors of adherence to anticancer treatment, specifically pertaining to physical status and comorbid conditions, as well as short and long-term side effects. Overall, 100 patients consecutively admitted at the European Institute of Oncology (IEO) at the Division of Medical Senology will be enrolled; 50 patients with metastatic breast cancer will be exposed to the DSS and machine learning web application for 3 months (experimental group), and 50 patients will not be exposed to the intervention (control group). Each participant will fill a weekly medication diary and a set of standardized self-reports evaluating psychological and quality of life variables (Adherence Attitude Inventory, Beck Depression Inventory-II, Brief Pain Inventory, 13-item Sense of Coherence scale, Brief Italian version of Cancer Behavior Inventory, European Organization for Research and Treatment of Cancer Quality of Life 23-item Breast Cancer-specific Questionnaire, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, 8-item Morisky Medication Adherence Scale, State-Trait Anxiety Inventory forms I and II, Big Five Inventory, and visual analogue scales evaluating risk perception). The 3 assessment time points are T0 (baseline), T1 (1 month), T2 (2 months), and T3 (3 months). This study was approved by the IEO ethics committee (R1786/22-IEO 1907). The recruitment process started in May 2023 and is expected to conclude on December 2023. The contribution of machine learning techniques through risk-predictive models integrated into DSS will enable medication adherence by patients with cancer. ClinicalTrials.gov NCT06161181; https://clinicaltrials.gov/study/NCT06161181. DERR1-10.2196/48852.

Age, sex, antihypertensive drugs and the Mediterranean diet on hypertension-related biomarkers: Impact on carotid structure and blood lipids in an Argentinian cross-sectional study

BackgroundCardiovascular risk is modifiable by changes in lifestyle and pharmacological management, with hypertension being a common pathology worldwide. Its treatment must address multiple metabolic targets. Based on the hypothesis that certain antihypertensive medications, such as the commonly used enalapril and losartan, and dietary habits improve hypertension-related changes in carotid structure and cardiometabolic variables, this work aimed to associate these drugs, as well as the Mediterranean diet adherence and non-modifiable biological factors, with changes in carotid intima-media thickness [cIMT] and blood lipids. MethodsSociodemographic, clinical, biochemical and lifestyle data were collected in a cross-sectional study of 313 subjects under survey due to cardiovascular risk factors, aged 34–83 years (Cordoba, Argentina). Generalised structural equation models were used for analysis. ResultsA higher cIMT with age and male sex was confirmed. Women had lower triacylglycerols and saturated fatty acids in serum but higher circulating levels of LDL-C, HDL-C and total cholesterol than men. Also, a higher adherence to the Mediterranean diet was associated with lower triacylglycerols, but higher levels of HDL-C cholesterol and ω-3 polyunsaturated fatty acids (ω-3 PUFAs) in serum. A greater adherence to the Mediterranean diet did not affect cIMT. Enalapril was associated with increased serum ω-3 PUFAs levels, but it did not affect other lipid fractions. Moreover, enalapril may control cIMT, whereas losartan may not. ConclusionsOur data demonstrate that the Mediterranean diet and enalapril are associated with a cardioprotective circulating lipid profile in hypertension. Concerning this, enalapril potentially promotes serum ω-3 PUFAs levels beyond its classical antihypertensive effect, which encourages future clinical studies to confirm it.

Structures of the P. aeruginosa FleQ-FleN master regulators reveal large-scale conformational switching in motility and biofilm control.

Pseudomonas aeruginosa can cause a wide array of chronic and acute infections associated with its ability to rapidly switch between planktonic, biofilm, and dispersed lifestyles, each with a specific arsenal for bacterial survival and virulence. At the cellular level, many of the physiological transitions are orchestrated by the intracellular second messenger c-di-GMP and its receptor-effector FleQ. A bacterial enhancer binding protein, FleQ acts as a master regulator of both flagellar motility and adherence factor secretion and uses remarkably different transcription activation mechanisms depending on its dinucleotide loading state, adenosine triphosphatase (ATPase) activity, interactions with polymerase sigma (σ) factors, and complexation with a second ATPase, FleN. How the FleQ-FleN tandem can exert diverse effects through recognition of a conserved FleQ binding consensus has remained enigmatic. Here, we provide cryogenic electron microscopy (cryo-EM) structures of both c-di-GMP-bound and c-di-GMP-free FleQ-FleN complexes which deepen our understanding of the proteins' (di)nucleotide-dependent conformational switching and fine-tuned roles in gene expression regulation.

Family conflict: Risk factor for low adherence in adolescents with type 1 diabetes in Greek families

Introduction: Type 1 Diabetes Melitus (T1DM) treatment is demanding, due to daily blood glucose monitoring, certain diet plan, specific exercise program, multiple daily insulin injections, and management of episodes of hypo- or hyperglycemia. Family conflict may play a significant role in the adherence of adolescents with type 1 diabetes. Purpose: To evaluate Greek families’ conflicts and determine their relationship with T1DM adolescents’ adherence. Methods: A cross-sectional study was conducted from October 2021 to June 2022. Due to COVID-19 restriction, all the interviews were conducted through online survey. Three questionnaires were distributed to the adolescents. Pediatric Quality of Life Inventory tool, Diabetes Self-Management Profile and Collaborative Parent Involvement Scale for Youths Questionnaire. PeDsQL was distributed to their parents as well. Results: 59 adolescents (N=21) aged 10-19 years and their parents (N=38) participated. The mean values of PedsQL for all five factors ranged from 55.7 (Worry subcategory) to 77.8 (Treatment adherence), showing an overall moderate QoL. According to the mean values, parents’ perspectives PedsQL for all five factors ranged from 38.6 (Worry subcategory) to 77 (Treatment adherence), showing an overall moderate QoL. Mean DSMP score indicated a high level of adherence of children with diabetes mellitus to their treatment, whilst mean cooperation score indicated a high level of cooperation between parents and adolescents with T1DM and low level of FC. Bivariate analysis revealed that less FC was related to better treatment adherence in adolescents. Conclusions: T1DM management remains challenging, particularly as children grow older and move into adolescence. The family can play a significant role in T1DM management. Diabetes multidisciplinary teams should evaluate and understand family members' interactions detecting inter-family problems such as high frequency of FC. Provision of family support can improve communication between adolescents and parents and may reduce FC resulting in better T1DM treatment adherence and outcomes.

Adherence to tuberculosis treatment among patients attending national tuberculosis elimination centre in tertiary care hospital, Bangalore

Background: Annually ten million cases of tuberculosis (TB) and 1.8 million mortalities are recorded. Adherence to TB treatment not only reduces death outcomes but prevents prolonged sickness, transmission to others and development of multi drug resistant TB. This study was aimed at determining the rate of treatment adherence and possible factors influencing adherence to TB treatment in the NTEP Centre at Rajarajeswari medical college and hospital, Bangalore. Methods: It was a cross sectional study design. A validated 8 item Morisky medication adherence scale was used to obtain data from respondents. Adherence to TB treatment was assessed. Chi square test was used to determine the variables that were associated with treatment adherence. Results: Out of 60 patients, majority i.e. 18 (30%) were in the age group 25-34 years, males were more compared to females. Majority i.e. 21 (35%) were studied up to post high school diploma, 31(51.67%) were unemployed, majority i.e. 48 (80.00%) were married, 42 (70.00%) were from nuclear family. Out of 60 patients, majority 54 (90.00%) were Hindus 24 (40.00%) were from lower middle class. Conclusions: The adherence rate for TB treatment in this study was 68.33%. There was no significant association between socio demographic variables, personal habits, health status, current TB status, type of TB, and common symptom with treatment adherence. An intensified health education on the adherence of TB treatment therefore recommended.

Hypertension doctors' awareness and practice of medication adherence in hypertensive patients: a questionnaire-based survey.

Poor adherence to antihypertensive drugs is a major cause of unsatisfactory blood pressure control. Hypertension doctors play an integral role in improving medication adherence in hypertensive patients. Although most existing studies have recognized the status quo and influencing factors of medication adherence, little attention has been paid to hypertension doctors' awareness and practice in hypertension management. Therefore, in this study, we aimed to investigate hypertension doctors' awareness and practice of medication adherence in hypertensive patients. This is a cross-sectional survey. A self-reported questionnaire was developed and sent to hypertension doctors in Hunan province, China, between May 1, 2022 and July 1, 2022. Univariate and generalized linear models were used to identify the factors influencing hypertension doctors' awareness and practice. The correlation between awareness and practice was determined using Spearman's correlation coefficient. In total, 236 valid questionnaires were collected (valid response rate, 73.5%). Of the respondents, 44.1% were chief physicians and 64.4% were females. Approximately half of the respondents were ≥40 years old and had over 14 years of working experience. Most respondents (87.7%) did not have hypertension, but 54.2% had a family history of hypertension. The average awareness and practice scores were 29.8 ± 8.8 and 39.4 ± 7.1, respectively, out of 50, with higher scores indicating higher levels of awareness or practice. More hypertension consultations and more antihypertensive prescriptions issued were associated with better awareness and practice among respondents (ps < 0.05). Respondents with higher education and professional titles had higher awareness (ps < 0.05). Moreover, respondents with 6-13 years of work experience had better practice than those with <5 years of work experience (p = 0.017). There was a significant correlation between hypertension doctors' awareness and practice of medication adherence in hypertensive patients (R = 0.682, p < 0.001). These findings indicate that misconceptions persist in hypertension doctors' awareness and practice of patient medication adherence. Hypertension doctors lack sufficient and correct awareness and practice of medication adherence in hypertensive patients.