Fear Of Possible Side Effects Research Articles

Vaccinations in Selected Immune-Related Diseases Treated with Biological Drugs and JAK Inhibitors-Literature Review and Statement of Experts from Polish Dermatological Society.

The growing use of biological drugs in immune-mediated chronic diseases has undoubtedly revolutionized their treatment. Yet, the topic of vaccinations in this group of patients still raises many concerns and implies many therapeutic problems that require discussion and standardization of management. The aim of this literature review is to present current knowledge regarding safety and efficacy of vaccinations in dermatological and rheumatological patients treated with biological drugs and JAK inhibitors. Additionally, this article provides recommendation from experts of the Polish Dermatological Society about proper use of vaccinations during therapy with biologics. Generally, all live attenuated vaccines are contraindicated during immunosuppressive/immunomodulatory therapy. If there is need, they should be administered long enough prior to the therapy or after cessation. Yet, inactivated vaccines mostly can be safely used, but the problem in this case is the effectiveness of the vaccination. Most studies report that the immune response in patients on biologics after administration of different inactivated vaccines is similar to or even better than in the control group. Thus, the importance of vaccination among patients on biologics must be emphasized to reduce omissions and the fear of possible side effects or insufficient post-vaccination response.

A Comparison of the Awareness, Attitude, and Uptake of COVID-19, Hepatitis B Virus, and Yellow Fever Vaccines Between Rural and Urban Respondents in Edo State, Nigeria.

Despite the target set by WHO, Africa still falls short when it comes to individuals' use of COVID-19 vaccines. There is a similar pattern of low vaccine usage for the hepatitis B virus (HBV) and yellow fever (YF). The objective of our study is to compare the awareness, attitude, and uptake of vaccine-preventable diseases (VPD), COVID-19, HBV, and YF, between a rural and an urban community in Nigeria. The study was a descriptive cross-sectional study carried out between January 2022 and December 2022 in a rural community, Okada, and an urban community, Benin, in Edo State, Nigeria. A total of 283 rural participants and 483 urban participants were interviewed. SPSS Statistics version 26 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.) was used for data collection and analysis. The significant value was set at P<0.05. A major percentage of both populations, 98.3% urban and 90.1% rural, reported being aware of COVID-19 vaccines (indicated by P<0.001). There was a similar pattern with HBV vaccine awareness. However, awareness of YF vaccines was more common in the rural (63.3%) community than in the urban (55.0%) community. A complete dose uptake of COVID-19 vaccines was reported by 7.7% of the rural and 2.2% of the urban respondents. The major reason for the refusal of vaccine uptake was the fear of possible side effects. The study showed that vaccine uptake for COVID-19, HBV, and YF is low despite seemingly good awareness of these vaccines. The number one reason for any vaccine refusal is the possibility of experiencing side effects.

The Acceptance of a COVID-19 Vaccine Among Parents: Are They Willing to Vaccinate Their Children?

AIM: The aim of this study was to evaluate the willingness of parents to allow their children to receive a COVID-19 vaccine and the factors affecting the decision.&#x0D; METHODS: This study was conducted as a prospective, cross-sectional and descriptive survey study. A survey consisting of questions about the COVID-19 vaccination was conducted with parents.&#x0D; RESULTS: The study included 592 parents, 180 (30.4%) male, and the mean age was 34.14 ± 7.42 years. There were 257 (43.4%) parents would vaccinate their children. A high level of education of parents (p=0,022), a high monthly income of the family (p=0,006), and male gender (p=0,002) were associated with high willingness to vaccinate their children. Two hundred twenty two parents stated that their decision may change depending on whether the vaccine is of domestic or foreign origin, and 215 (96.85%) of them stated that they would prefer domestic vaccines. The most frequent reasons for vaccine hesitancy or refusal to their children were: fear of possible side effects and it being a foreign vaccine. &#x0D; CONCLUSION: The hesitancy or refusal of parents to vaccinate their children with the COVID-19 vaccine is high. Public health authorities should inform the public about the importance of vaccination and domestic vaccine production should be encouraged

Acceptability and applicability of biometric iris scanning for the identification and follow up of highly mobile research participants living in fishing communities along the shores of Lake Victoria in Kenya, Tanzania, and Uganda

BackgroundRecruitment and retention of participants in research studies conducted in fishing communities remain a challenge because of population mobility. Reliable and acceptable methods for identifying and tracking participants taking part in HIV prevention and treatment research are needed. The study aims to assess the acceptability, and technical feasibility of iris scans as a biometric identification method for research participants in fishing communities. MethodsThis was a cross-sectional study conducted in eight fishing communities in Kenya, Tanzania, and Uganda, with follow-up after one month in a randomly selected subset of participants. All consenting participants had their iris scanned and then responded to the survey. Results1,199 participants were recruited. The median age was 33 [Interquartile range (IQR) 24–42] years; 56% were women. The overall acceptability of iris scanning was 99%, and the success rate was 98%. Eighty one percent (n = 949) had a successful scan on first attempt, 116 (10%) on second and 113 (9%) after more than two attempts. A month later, 30% (n = 341) of participants were followed up. The acceptability of repeat iris scanning was 99% (n = 340). All participants who accepted repeat iris scanning had successful scans, with 307 (90%) scans succeeding on first attempt; 25 (7%) on second attempt, and 8 (2%) after several attempts. The main reason for refusing iris scanning was fear of possible side effects of the scan on the eyes or body. ConclusionThe acceptability and applicability of biometric iris scan as a technique for unique identification of research participants is high in fishing communities. However, successful use of the iris scanning technology in research will require education regarding the safety of the procedure.

Israeli parents` views on coronavirus (COVID-19) vaccinations for children: A cross-sectional study

BackgroundParents play the decisive role in children's vaccination. Our study aimed as assessing attitudes of parents toward the COVID-19 vaccine for children aged 5–18 and to define sources of influence on these attitudes, the barriers and reasons for hesitation. MethodsIn this cross-sectional study, 138 Israeli parents of 5–18 aged children completed a self-administered structured questionnaire. FindingsMore than a quarter of parents reported that they did not intend to vaccinate their children. Independent of other demographic characteristics, parents who do not vaccinate their children accordingly to the routine vaccinations have five-fold significant odds not to vaccinate with COVID-19 vaccine (OR = 4.8, 95% CI: 1.8–12.7). Greater social influence was significantly and negatively associated with intentions not to vaccinate a child. Among parents who do not intend to vaccinate their children, the most frequent reasons were fear of possible side effects (92%), vaccine novelty (92%) and lack of belief in its effectiveness (69%). DiscussionThis study found that vaccination in the past as part of routine government immunization programs predict a tendency to vaccinate children during the pandemic. Among the factors associated with the intention not to vaccinate, concerns and uncertainty about the necessity of the vaccine, its side effects and reliability have been emphasized. Application to practiceCultural-religious adjustments should be applied when implementing interventions aiming to promote vaccination in routines and emergencies. Social influence is important in adopting a positive attitude toward vaccines. Public health professionals should incorporate those parents who have vaccinated their children and have a positive attitude toward vaccination.

INVESTIGATION OF AWARENESS OF ROTAVIRUS INFECTION AND VACCINATION IN PARENTS OF INFANTS LESS THAN ONE YEAR-A QUESTIONNAIRE STUDY FROM TURKEY

Introduction: Rotavirus infection is one of the most common causes of infantile diarrhea, with significance in developing countries where it accounts for 15–30% of the mortality rate. Vaccination is an effective way to prevent disease and mortality. Therefore, parents' knowledge about Rotavirus infection and vaccination is critical in increasing vaccination rates. We aimed to investigate parental awareness about Rotavirus infection and vaccine, evaluate attitudes towards Rotavirus vaccination, and determine factors affecting acceptance and hesitations about immunization. Methods: This survey included 1856 participants: parents who had a child aged under one year of age. A self-explanatory questionnaire consisting of 13 questions was composed to determine parental awareness and behavior regarding Rotavirus infection and the vaccine. Results: More than half (n=541, 58.30%) of the parents knew that diarrhea could be a fatal disease, less than half (n=354, 38.15%) knew that RV could cause diarrhea. The parental knowledge rates about the Rotavirus infection and the vaccine were positively correlated with parents' education level and monthly family income. Less than half (41.59%) of the parents were found to have vaccinated their children for Rotavirus infection. Vaccination rates increased in parallel with the increase in income and education level of parents. The primary reasons for nonvaccination were lack of knowledge (44.83%) and the fear of possible side effects (14.94%). Conclusion: The present survey demonstrates that parents' knowledge of rotavirus vaccination is not adequate, and the rate of rotavirus vaccination is even low. The present study underlines that health providers are critical insufficient society awareness and acceptance of Rotavirus immunization.

Acceptability of COVID-19 Vaccine Among Hospital Employees in the Department of Paediatrics, Gynaecology and Obstetrics in the University Hospitals of Geneva, Switzerland.

Background and AimsCOVID-19 vaccination has been in the spotlight for almost a year now, both within the scientific community and in the general population. The issue of healthcare workers' (HCWs) hesitancy is particularly salient, given that they are at the forefront of the fight against COVID-19. Not only could unvaccinated HCW spread the disease, but HCWs are also critical messengers in building confidence towards COVID-19 vaccines. The goal of this study was to examine the perception of COVID-19 risk and of its vaccine acceptance among employees (i.e., HCW plus administrative staff) in the Department of Paediatrics, Gynaecology and Obstetrics at the University Hospitals of Geneva, for the purpose of drawing lessons on the determinants of vaccination morale.MethodsWe conducted an anonymous online survey comparing vaccination attitudes among vaccinated and unvaccinated workers in June 2021. It included questions on perception of COVID-19 risks and COVID-19 vaccines. Vaccination was not mandatory in our institution but was strongly recommended.ResultsIn June 2021, 66% of the 1,800 employees of our department had received two doses of COVID-19 vaccine by the time of the survey. Among the employees, 776 participated (43%) to the survey, and among them 684 (88%) had chosen to be vaccinated. Participants working for longer in a hospital, with a chronic disease and a household contact with chronic disease were more likely to be vaccinated. Doctors were twice as likely to be vaccinated than nurses. Among unvaccinated hospital employees, 48 (52%) responded that they would not change their mind. Further, 35 (38%) were not feeling in danger of contracting severe COVID-19, and 32 (35%) had fears about possible side effects of COVID-19 vaccines that they wanted to discuss with a specialist.ConclusionOur study indicates that, while two-third of the employees had been vaccinated, quite many were still hesitant. The unvaccinated explained their choice by not feeling at risk of complicated COVID-19, and because of fear of possible side effects associated with the vaccine. Investments in COVID-19 vaccine education is a critical component for increasing vaccine acceptance among the unvaccinated.

COVID-19 vaccination acceptance among Syrian population: a nationwide cross-sectional study

BackgroundSevere Acute Respiratory Syndrome Coronavirus 2 continues to spread globally and in the absence of an effective treatment, the vaccine remains the best hope for controlling this disease. In this study, we seek to find out the extent to which people in Syria accept the Corona vaccine and what are the factors that affect their decision.MethodsThis cross-sectional study was conducted in Syria during the period from January 3 to March 17, 2021. A structured self-administered questionnaire was distributed in two phases: The first phase included distributing the questionnaire as a Google Form on social media platforms. In the second phase, a paper version of the questionnaire was handed to patients, their companions, and workers in public hospitals. SPSS v.25 and R v.4.1.1 were used to analyze the data. Pearson Chi-square test and Logistic Regression were used to study the associations between categorical groups.ResultsOf 7531 respondents, 3505 (46.5%) were males and 4026 (53.5%) were females. 3124 (41.5%) were 18–24 years old. Healthcare workers were participants’ main sources of information (50.9%), followed by Social Media users (46.3%). 2790 (37%) of the participant are willing to be vaccinated, and 2334 (31%) were uncertain about it. Fear of possible side effects was the main reason for the reluctance to take the vaccine 1615 (62.4%), followed by mistrust of the vaccine formula 1522 (58.8%). 2218 (29.5%) participants think COVID-19 poses a major risk to them personally. Vaccination intention was significantly associated with gender, residence, financial status, educational level, and geographic origin.ConclusionThis study showed very negatively important results. The study participants Vaccination acceptance rate is almost the lowest when compared to its peers. A Lot of efforts should be made to correct misinformation about the vaccine and answer all questions about it, especially with a health system that has been ravaged by war for 10 years.

Knowledge of genito-urinary syndrome of menopause among Italian gynecologists: the DIADEM survey

ObjectiveThe objective of this study was to present an updated picture of the knowledge and attitudes of Italian gynecologists with regard to the genitourinary syndrome of menopause (GSM). Study designAn anonymous survey was sent via electronic mail to 3892 gynecologists. The survey consisted of 32 multiple-choice questions divided into four different areas: 1. general demographics of the respondents; 2. knowledge of GSM; 3. most frequently prescribed therapies; and 4. perception of patient compliance and satisfaction with current therapeutic options. Main outcome measuresKnowledge of vulvo-vaginal atrophy (VVA) and attitudes of the gynecologists to its management. ResultsThree hundred and seventy-four out of 3892 invited Italian gynecologists replied to the survey (response rate 9.7 %). Most (84 %) had a good knowledge of GSM and 74 % reported that they investigated it during clinic visits, but most of them underestimated its prevalence. The most frequently prescribed treatment was topical hormonal therapy (60 %), followed by vaginal moisturizers and lubricants (16 %), ospemifene (12 %) and systemic hormone therapy (12 %). According to the clinical experience of respondents, the most effective therapy is local hormonal therapy (36 %), followed by ospemifene (30 %). According to respondents, less than 50 % of patients continue therapy after 12 months, due to the discomfort in vaginal application, the cost of oral therapies and the fear of possible side-effects. ConclusionsWith the limitation of the low response rate, this study suggests that although Italian gynecologists who answered the survey had some knowledge of GSM, they underestimated its prevalence, did not know its most bothersome symptoms and had inadequate knowledge of the efficacy of treatments, patient compliance and satisfaction.

Factors influencing post-partum women’s choice of an implantable contraceptive device in a rural district hospital in South Africa

Background: A single-rod subdermal contraceptive implant containing 68 mg of etonogestrel, ImplanonNXT®, was introduced to the South African healthcare system in 2014. Initially the new device was well received but later uptake tapered off. A need was identified to determine the factors that influence women’s choices with regard to the use of ImplanonNXT® in order to improve its uptake. The aim of this study was to explore the factors that influence women’s choice of ImplanonNXT®.Method: A qualitative study was performed, using semi-structured interviews to explore patients’ knowledge, attitudes and beliefs regarding ImplanonNXT®. Ten patients were interviewed at Knysna Hospital.Findings: There was confusion amongst women about the harms and benefits of using ImplanonNXT® and it became apparent contraceptive counselling during pregnancy greatly affects the choices they make. Other factors that influenced the participants’ choice with regard to contraception included social influences, preference for familiar methods and the side effect profile of the various options. Perceptions of the adverse side effects of the implantable device added to confusion and fear of this method, which influenced women’s ideas about the use of ImplanonNXT®. Poor communication and reluctance from clinic staff to discuss ImplanonNXT® during antenatal visits contributed to poor knowledge about the implantable device and its side effects.Conclusion: Clearer communication during antenatal visits with pregnant women may address some of the fears and beliefs that surround its side effects, workings and efficacy. The fear of possible side effects should be a focus for counselling and education, as it predominantly contributes to women’s confusion and fear of the device. Further research is needed to address this as well as evaluate if interventions such as better counselling and a dedicated team approach can change the attitudes and beliefs of post-partum women towards the ImplanonNXT® device in the South African district health system.

Awareness and attitudes towards clinical trials among Polish oncological patients who had never participated in a clinical trial.

Participation in a clinical trial significantly shortens waiting time associated with receiving specialist care. Furthermore, it may be the case that, through clinical trials, subjects can access medicines that are not typically available in Poland. The aim of this study was to determine the opinions of oncological patients about clinical trials. The research has been carried out during the years 2014-2016. A proprietary questionnaire consisting of 10 closed, single and multiple choice questions about awareness and perceptions of clinical trials, and 5 questions concerning demographic information was used. A group of 256 patients with cancer (54% women, 46% men), aged 21-77 years, was surveyed. Respondents were statistically more likely to decide to participate in a clinical trial as oncological patients than the healthy volunteers (Pearson's χ2 test p = 0.00006). The desire to qualify for clinical trials in no way depends on the knowledge of side effects (Pearson's χ2 test p = 0.16796). Our study found that the patients' awareness about clinical trials varied. However, a positive attitude towards research was visible. The main identified barriers to clinical trial participation were fear of possible side effects. Most patients regarded clinical trials as useful, and considered that they are conducted to introduce new treatment/new drug.

Patient-reported barriers to osteoporosis therapy.

SummaryWe investigated reasons for non-treatment of osteoporosis and discontinuation of osteoporosis therapy. Barriers to treatment include patients’ preference for alternative treatments and a fear of possible side effects. Side effects are a common reason for treatment discontinuation, and they may be associated with a lack of willingness to restart treatment.Purpose/introductionOsteoporosis patients commonly cite treatment-related side effects, or the fear thereof, as a reason for discontinuing or not initiating anti-osteoporosis medications. The purpose of this study was to investigate, from the patient’s perspective, reasons for (i) non-treatment of osteoporosis and (ii) discontinuation of osteoporosis therapy.MethodsThis was an internet-based survey of postmenopausal women in the USA who self-reported having been diagnosed with osteoporosis. Respondents were recruited from consumer research panels and received nominal compensation.ResultsWithin the surveyed population (N = 1407), 581 patients were currently being treated, 503 had never been treated, and 323 had previously been treated. Among patients never treated for osteoporosis, the highest ranking reasons for non-treatment were the use of alternative treatments such as over-the-counter vitamins/supplements (57.5 % of respondents) and fear of side effects (43.9 %). Among previously treated patients, frequent reasons for discontinuation included the direction of the physician (41.2 % of respondents), concerns about long-term safety (30.3 %), and the experience of side effects (29.8 %). When asked about their willingness to restart their osteoporosis medication, previously treated patients who were not willing (N = 104) to restart had a higher frequency of experiencing side effects (44.2 versus 20.5 % of those willing; P < 0.001).ConclusionsFrom the osteoporosis patient’s perspective, barriers to prescription treatment include a preference for alternative, non-prescription treatments and a fear of possible side effects. Side effects are one of the most common reasons for discontinuing osteoporosis medications, and they appear to be associated with a lack of willingness to restart treatment.Electronic supplementary materialThe online version of this article (doi:10.1007/s11657-016-0272-5) contains supplementary material, which is available to authorized users.

Nutraceuticals in Acute and Prophylactic Treatment of Migraine.

People who suffer from headaches often prefer nutraceutical treatment over traditional pharmacological approaches, due to fear of possible side effects, drug dependence, or addiction. Since treatment with nutraceuticals does not require a doctor's prescription, many patients rely on their own judgment as to when and which one to take, often without consultation or guidance from their physician. Some physicians could provide information about potential efficacy and side effects of various products, but many are not familiar with the nutraceuticals. Widespread skepticism persists among doctors about the effectiveness of these treatments. This is largely due to the lack of rigorous clinical studies. However, even when incontrovertible scientific evidence exists, many physicians remain distrustful of the evidence. The following review summarizes randomized controlled trials of some of the most commonly used non-pharmacological treatments, including magnesium, coenzyme Q10, riboflavin (vitamin B2), petasites, and feverfew (Table 1).

EMSAM (deprenyl patch): how a promising antidepressant was underutilized.

The EMSAM patch is a unique monoamine oxidase inhibitor (MAOI) being the only antidepressant utilizing a transdermal delivery system. This was welcomed by clinicians who hoped that EMSAM would be better tolerated than oral MAOIs and non-MAOI antidepressants, as well as being effective for treatment in a wide spectrum of depressed patients including atypical depression, bipolar depression, and refractory depression. Unfortunately, the clinical use of EMSAM has been underutilized and its potential usefulness overlooked. This article suggests that fear of possible side effects, particularly the “cheese reaction” and serotonin syndrome, are some of the main contributors to underutilization by clinicians. These risks have been significantly exaggerated with the 6 mg/day dose not even requiring a special diet. Other contributing factors leading to underutilization are reviewed such as: the lack of studies addressing many important clinical questions; inadequate data analyses; not evaluating the effect of EMSAM on comorbid psychiatric conditions, particularly anxiety disorders; lack of antidepressant comparators versus EMSAM; no dose–response relationship examined; various depressive subtypes and conditions are unexplored, eg, bipolar depression and refractory depression; poor insurance coverage for an expensive medication; as well as minimal marketing efforts and postmarketing studies. On the other hand, many potential advantages of EMSAM are not highlighted enough in the literature and by pharmaceutical companies which might have increased clinical interest and utilization of the antidepressant. For example, the advantages of EMSAM include: avoidance of swallowing issues, as can be seen with oral antidepressants; minimal side effects, probably due to a favorable pharmacokinetic profile; minimal evidence of suicidal behavior, probably relating to the transdermal route of administration; low rates of inducing hypomanic/manic episodes; as well as significant efficacy in “anxious depression” and atypical depression. Recent efforts in conducting some post hoc analyses and presentations on EMSAM may yet stimulate further clinical interest and use of this antidepressant.

OP0151 Cobra-light therapy is clinically non-inferior to original cobra therapy in the treatment of early rheumatoid arthritis

BackgroundEarly, intensive treatment of rheumatoid arthritis (RA) with intensive combinaion therapy (COBRA therapy) considerably lowers disease activity and suppresses radiological progression. Although proven to be very effective, uptake of COBRA...

Immunization Status in Patients with Inflammatory Bowel Diseases and Rheumatologic Disorders Receiving Infliximab Infusions: Results of a Patient Survey in a Tertiary Care Center

Purpose: Patients with Inflammatory Bowel Diseases (IBD) and rheumatological conditions undergoing treatment with immunosuppressive medications are at increased risk for vaccine preventable illnesses. Data suggests that this subset of patients is under immunized. We aimed to assess the status of and attitude toward immunization in patients with IBD and rheumatological disorders undergoing treatment with infliximab at our institution. Methods: A multiple choice closed end questionnaire was handed to patients who presented to Penn State Hershey Medical Center infusion center to receive infliximab infusions. The questionnaire included questions about the patient's immunization history, their insight into vaccination process and the role their primary care providers (PCP) and Gastroenterologist or Rheumatologist played in their vaccination process. Results: 40 patients completed the questionnaire: 18 had IBD (9 ulcerative colitis, 9 Crohn's disease), 19 had a rheumatological condition (11 rheumatoid arthritis, 8 seronegative arthritis) and 3 patients had a combination of IBD and a rheumatological condition. 58% (n=23) were females; average age was 39.2 years. Only 58% (n=23) reported that their Gastroenterologist or Rheumatologist had discussed vaccinations with them. 22.5% (9/40) of the patients did not know that infliximab increases their risk of infection. Only 12.5% (5/40) recognized that the Zoster vaccine is unsafe while 15% thought the injected influenza vaccine was unsafe. 65% (n=26) reported receiving the Tetanus vaccine, 63% (n=25) reported receiving the injected influenza vaccine while only 40% (n=14) reported ever receiving the pneumovax vaccine. Only 10% of vaccines were provided by Gastroenterologists or Rheumatologists while the rest were provided by the PCPs. Major reasons for not being vaccinated were lack of knowledge for need of vaccines in 48% (12/25) and fear of possible side effects in 32% (8/25). 51% (20/39) of patients preferred to receive their vaccinations through their gastroenterologists or rheumatologist, 10% (4/39) preferred to receive their vaccines through their PCPs while the rest, 39% (15/39), did not have a preference. Conclusion: Patients with IBD and rheumatologic disorders have low prevalence of immunization. A large percentage of our Rheumatologists and Gastroenterologists did not discuss vaccination and a very small percentage provided vaccinations to these patients. Patients had poor understanding on the safety of vaccinations and many were under immunized. Efforts to increase the awareness of both the physicians and patients to the safety profile and importance of vaccinations is needed.

Screening for Pandemic (H1N1) 2009 Virus among Hospital Staff, Spain

Screening for Pandemic (H1N1) 2009 Virus among Hospital Staff, Spain

Re-Assembled Botulinum Neurotoxin Inhibits CNS Functions without Systemic Toxicity

The therapeutic potential of botulinum neurotoxin type A (BoNT/A) has recently been widely recognized. BoNT/A acts to silence synaptic transmission via specific proteolytic cleavage of an essential neuronal protein, SNAP25. The advantages of BoNT/A-mediated synaptic silencing include very long duration, high potency and localized action. However, there is a fear of possible side-effects of BoNT/A due to its diffusible nature which may lead to neuromuscular blockade away from the injection site. We recently developed a “protein-stapling” technology which allows re-assembly of BoNT/A from two separate fragments. This technology allowed, for the first time, safe production of this popular neuronal silencing agent. Here we evaluated the re-assembled toxin in several CNS assays and assessed its systemic effects in an animal model. Our results show that the re-assembled toxin is potent in inhibiting CNS function at 1 nM concentration but surprisingly does not exhibit systemic toxicity after intraperitoneal injection even at 200 ng/kg dose. This shows that the re-assembled toxin represents a uniquely safe tool for neuroscience research and future medical applications.

Adherence to osteoporosis treatments: room for improvement

Osteoporosis is a growing problem worldwide, with the greatest burden resulting from fractures. Currently available are several treatment options that are effective in reducing fracture risk. Patient adherence to these medications is required for benefit to be seen. Yet, similar to other chronic asymptomatic diseases, adherence to osteoporosis therapies is poor. The reasons for suboptimal adherence are multiple but include fear of possible side effects, dosing requirements, and an unwillingness to take a medication for a 'silent' disease. Poor adherence leads to reduced effectiveness, increased morbidity, and increased medical costs. Efforts to improve adherence to osteoporosis treatments are ongoing. The first obstacle in improving adherence to osteoporosis treatments is determining causes of poor adherence. Despite several identifiable causes, improving adherence is difficult. Passive patient education with printed information alone does not appear very effective. Physician-patient interaction, including discussion of bone mineral density results, discussion of osteoporosis medication benefits, and feedback of treatment effects, may be more effective. Improved patient education, better tolerated and less frequently dosed medications, and more healthcare provider-patient interaction may improve adherence and lead to greater fracture reduction.

Shared decision making: Results from an interdisciplinary consulting service for prostate cancer

4756 Background: Locally confined prostate cancer can be treated by various treatment options (radical prostatectomy [RP] or radiotherapy [RT]) with comparable results but different possible side effects. In 2001, we established the first interdisciplinary consulting service for prostate cancer patients in Germany. The aim is to offer a comprehensive and neutral consultation on all treatment options and to make treatment recommendations. Methods: Between 05/01 and 04/03, 362 pts. presented to the consulting service. 2 questionnaires were used. The first one contained epidemiological questions and questions covering information already available on the topic. It also examined fears about the disease / treatment options. The second one was given 2 weeks after the consultation to evaluate the treatment decision and determine the patient's satisfaction with the consultation. Results: 334 cases were assessable. All pts. had already obtained information about the disease / possible treatment options and wished to be involved in the decision-making process. Nearly all of them had a great fear of possible side effects. Such a comprehensive consultation is time-consuming (35 min.) but largely received a very positive assessment in that 66% found it helpful or very helpful. Pts. felt they had been completely informed in 92% of the cases. Only 10% had still failed to make a decision after 2 weeks. 115 pts. had stage T1c, PSA <10 ng/ml and Gleason ≤7. In these cases an equivalent recommendation for RP or RT was given. 43% decided on RP and 43% on RT. Only 16% remained undecided. The histological examination of RP specimens of the pts. who had decided on RP showed a decrease in the rate of extracapsular disease extension (≥T3) from 38 to 20% during the observation period. Conclusions: The change to more cooperation between the different specialities has made the process of deciding on an appropriate treatment much easier for the patient. The consultation enables better selection of individual treatment modalities and their possible side effects from the point of view of both the patients and the attending physicians. In this study, patients choose either RP or RT with equal frequency. No significant financial relationships to disclose.