Good Compliers Research Articles

Personalized Food Avoidance Dietary Approach for Psoriasis and Hypertension: A Case Study and Pilot Trial

Background: The comorbidity, coheritability and common immune pathways of the inflammatory ‘chronic’ (non-communicable) diseases, suggest a shared aetiopathogenic mechanism, with phenotypic localization dependent on genetic predisposition, for example, the arteries in hypertension and the skin in psoriasis. Lifelong observation of psoriasis suggests genetically predisposed toxicity of amphiphilic fats, flavor enhancers, and nonsugar sweeteners. Aim: To conduct trials of personalized dietary intervention to abate the phenotypic expression of psoriasis and hypertension. Materials and Methods: The interventional case study of psoriasis was conducted by means of repetitive dietary challenge and avoidance testing. We then conducted an open trial of personalized nutrition on nine consenting recruits with uncomplicated essential hypertension. They were counseled on which foods to avoid or to take based on the experience gained in psoriasis. Study participants with ‘GOOD’ or ‘FAIR/POOR’ dietary compliance were compared with regard to blood pressure (BP) control, antihypertensive drug treatment requirement (ADTR), and anthropometry. Results: Data from four FAIR/POOR diet compliers and three GOOD compliers, as at 29 weeks of dietary intervention, showed mean systolic home BP values of 128.1 (±6.74) mmHg and 122.3 (±2.03) mmHg, respectively; the mean systolic automated office BP values were 139.8 (±8.80) mmHg and 108.3 (±5.55) mmHg, respectively; as at 39 weeks of dietary intervention, the mean ADTR scores were 4.2 (±2.12) and 1.03 (±0.57), respectively. Using data at baseline and from all available timepoints after dietary intervention, two-way ANOVA confirmed highly significant improvement of BP control (P < 0.0001) and reduction of ADTR score (P = 0.0008) in GOOD compliers. GOOD compliers exhibited significantly more reductions in BMI, abdominal circumference, and triceps skinfold thickness than FAIR/POOR compliers (two-way ANOVA and linear regression: P < 0.05). Conclusion: These results support the case for adverse dietary exposure avoidance to abate the phenotypic expression of chronic disease.

DIET, PSORIASIS AND HYPERTENSION: CONTROLLED CLINICAL TRIAL OF PERSONALIZED FOOD AVOIDANCE DIETARY APPROACH TO STOP HYPERTENSION

Objective: Lifelong observational study of psoriasis (with eschewal of suppressive drug treatments) and dietary dependence of its phenotypic expression. Develop an inductive model of the diet – genome interaction that engenders chronic disease. Test this model by conducting an open controlled trial of Personalized Food Avoidance Dietary Approach to Stop Hypertension (PFADASH). Design and method: Lifelong textual and photographic diary records (cpcpsoriasis.blogspot.com) inspired an inductive model of the diet – genome interaction in which amphiphilic fats promote adverse gene expression effects of flavour enhancers and non-sugar sweeteners. This promotes immune dysfunction and chronic disease. Nine eligible consenting adults with uncomplicated essential hypertension were recruited for an open trial of the PFADASH (‘phase 6’ clinical trial involving withdrawal from postulated egregious dietary exposures). Baseline and monthly assessments included BP, anthropometry, clinical, drug/toxin exposure, ADTR. Quarterly assessments included dietetic, pharmaceutic, exercise, sociological, echocardiogram and laboratory markers of ‘metabolic syndrome’. PFADASH dietary counselors were trained by the Principal Investigator. Detailed Dietary Counselling and Compliance Assessment and Scoring (DCCAS) guidelines were developed. Study participants were counseled on which foods to avoid (PFA) and which to take (DASH). Study participants with ‘GOOD’ dietary compliance were compared with ‘FAIR / POOR’ diet compliers (controls) as regards blood pressure (BP) control, antihypertensive drug treatment requirement (ADTR) and other outcome parameters from the assessments listed above. Results: Comparing four FAIR/POOR diet compliers with three GOOD compliers, differences (95% CI) between mean values were 5.5 (0–11.1) mmHg for home BP, 14.7 (7.9–24.4) mmHg for automated office BP and 1.92 (0.45–3.40) for ADTR score. 2-way ANOVA confirmed improved BP control (p < 0.0001) and reduced ADTR (p = 0.0008) in GOOD compliers. GOOD compliers exhibited more significant improvements in BMI, abdominal circumference and triceps skinfold thickness than FAIR/POOR compliers (using 2-way ANOVA and linear regression, p < 0.05). Conclusions: These results support the postulated diet – genome interaction model i.e. nutritoxi-epigenetic aetiopathogenesis of immune dysfunction and chronic disease. As part of personalized medicine, personalized nutrition should emphasize adverse dietary exposure avoidance, reducing current over-reliance on suppressive drug treatments.

Innovative intelligent insole system reduces diabetic foot ulcer recurrence at plantar sites: a prospective, randomised, proof-of-concept study

Prevention of diabetic foot ulcer recurrence in high risk patients, using current standard of care methods, remains a challenge. We hypothesised that an innovative intelligent insole system would be effective in reducing diabetic foot ulcer recurrence in such patients. In this prospective, randomised, proof-of-concept study, patients with diabetes, and with peripheral neuropathy and a recent history of plantar foot ulceration were recruited from two multidisciplinary outpatient diabetic foot clinics in the UK, and were randomly assigned to either intervention or control. All patients received an insole system, which measured plantar pressure continuously during daily life. The intervention group received audiovisual alerts via a smartwatch linked to the insole system and offloading instructions when aberrant pressures were detected; the control group did not receive any alerts. The primary outcome was plantar foot ulcer occurrence within 18 months. This trial is registered with ISRCTN, ISRCTN05585501, and is closed to accrual and complete. Between March 18, 2014, and Dec 20, 2016, 90 patients were recruited and consented to the study, and 58 completed the study. At follow-up, ten ulcers from 8638 person-days were recorded in the control group and four ulcers from 11 835 person-days in the intervention group: a 71% reduction in ulcer incidence in the intervention group compared with the control group (incidence rate ratio 0·29, 95% CI, 0·09-0·93; p=0·037). The number of patients who ulcerated was similar between groups (six of 26 [control group] vs four of 32 [intervention group]; p=0·29); however, individual plantar sites ulcerated more often in the control group (ten of 416) than in the intervention group (four of 512; p=0·047). In an exploratory analysis of good compliers (n=40), ulcer incidence was reduced by 86% in the intervention group versus control group (incidence rate ratio 0·14, 95% CI 0·03-0·63; p=0·011). In the exploratory analysis, plantar callus severity (change from baseline to 6 months) was greater in re-ulcerating patients (6·5, IQR 4·0-8·3) than non-re-ulcerating patients (2·0, 0·0-4·8; p=0·040). To our knowledge, this study is the first to show that continuous plantar pressure monitoring and dynamic offloading guidance, provided by an innovative intelligent insole system, can lead to a reduction in diabetic foot ulcer site recurrence. Diabetes UK and Orpyx Medical Technologies.

Determinant Factors of Noncompliance on Treatment Among Hypertensive Patients Attending Outpatient Clinic in Sohag University Hospital

AbstractBackground: Hypertension predominance is expanding quickly. Uncontrolled hypertension or complications related to poor treatment adherence are a difficult challenge for everybody with hypertension, healthcare professionals and medical services frameworks. Hypertension predominance is expanding quickly. An uncontrolled hypertension or complications related to poor treatment adherence are a difficult challenge for everybody with hypertension, healthcare professionals and medical services frameworks. Aim of the work: This study aims to study the determinants of antihypertensive medications noncompliance among hypertensive patients. Methodology: A hospital-based cross-sectional study was conducted on hypertensive patients (N=409) 18 years old and above attending internal medicine outpatient clinic at Sohag University Hospital. Results: show that 57.5% of the participants are males and 49.4% are less than 65 years. It also shows that 51.8% of the patients are smokers, 50.12% of the participants are good compliers while 49.88% of them are poor compliers. Conclusion: Elderly, Illiterate patients and patients with high Perception of the barrier were less compliant.

Use of Auto-Injector for Methotrexate Subcutaneous Self-Injections: High Satisfaction Level and Good Compliance in SELF-I Study, a Randomized, Open-Label, Parallel Group Study

IntroductionThe objective of the study was to compare compliance and acceptability of a new auto-injector (AI) versus syringe for administration of methotrexate (MTX) in patients with rheumatoid arthritis (RA).MethodsWe conducted a randomized, open-label, parallel group study comparing AI to pre-filled syringe (PFS). Adult patients with RA (ACR/EULAR 2010) receiving MTX (orally or by injection) for at least 3 months were allocated to AI or PFS for 6 months and then were allocated to AI for 6 further months. Two co-primary endpoints were defined at M6: percentage of patients with compliance at least 80%; change in functional capacity assessed by Health Assessment Questionnaire (HAQ). Secondary endpoints included quality of life (RaQoL), RA activity (DAS28), and acceptability. Local safety at injection site was assessed at each visit.ResultsTwo-hundred and sixty-five patients were randomized. The main analysis was conducted on per protocol set (99 AI and 98 PFS). Compliance was 96.2% in AI and 98.9% in PFS. Good complier rates were 89.9% and 94.9%, thus a difference of − 5.0% (− 18.9%; 8.9%). HAQ remained stable in both groups. No difference was found on RaQoL, change in RA activity, and safety profile. Autonomy, acceptability, and patient satisfaction were better with AI, and patients having had the experience of both AI and PFS preferred AI (p < 0.001).ConclusionsAlthough this study did not demonstrate non-inferiority of AI versus PFS, compliance was excellent in the two groups, and AI, which was preferred by patients, is a valuable alternative to PFS for administration of MTX.Trial RegistrationClinicalTrials.gov identifier, NCT02553018.FundingNordic Pharma SAS.

Determinants of Compliance Difficulties among ‘Good Compliers’: Implementation of International Human Rights Rulings in the Czech Republic

The aim of this article is to explore factors that account for compliance difficulties that may eventually result in a variable level of implementation of the rulings of the European Court of Human Rights and the United Nations Human Rights Committee. We do so by focusing on the high-cost rulings requiring complex legislative measures rendered against the Czech Republic, which ranks among the best compliers among Central and Eastern European countries as well as overall. Our study shows that the level of compliance achieved depends on a repeated balancing exercise, in which domestic political actors balance domestic political costs of compliance against international reputational costs of non-compliance. Subsequently, we argue that the lapse of time is critical in understanding the compliance processes as, sometimes, even a short moment of time, when domestic political costs of compliance become lower than international reputational costs of non-compliance, may create a ‘window of opportunity’ for adopting legislation that is necessary for implementing the given rulings of international human rights bodies. Pro-compliance actors then have to take full advantage of such ‘windows of opportunity’. If they fail to do so, this window may close for a long time, if not forever.

A prospective observational study to evaluate the effect of social and personality factors on continuous positive airway pressure (CPAP) compliance in obstructive sleep apnoea syndrome

BackgroundCompliance with CPAP treatment for OSAS is not reliably predicted by the severity of symptoms or physiological variables. We examined a range of factors which could be measured before CPAP initiation to look for predictors of compliance.MethodsThis was a prospective cohort-study of CPAP treatment for OSAS, recording; socio-economic status, education, type D personality and clinician’s prediction of compliance.ResultsWe recruited 265 subjects, of whom 221 were still using CPAP at 6 months; median age 53 years, M: F, 3.4:1, ESS 15 and pre-treatment ODI 21/h. Median compliance at 6 months was 5.6 (3.4– 7.1) hours/night with 73.3% of subjects using CPAP ≥4 h/night. No association was found between compliance and different socio-economic classes for people in work, type D personality, education level, sex, age, baseline ESS or ODI. The clinician’s initial impression could separate groups of good and poor compliers but had little predictive value for individual patients. Compared to subjects who were working, those who were long term unemployed had a lower CPAP usage and were more likely to use CPAP < 4 h a night (OR 4.6; p value 0.011). A high Beck Depression Index and self-reported anxiety also predicted poor compliance.ConclusionsIn our practice there is no significant association between CPAP compliance with socio-economic status, education or personality type. Long term unemployed or depressed individuals may need more intensive support to gain the optimal benefit from CPAP.

Evaluación de la adherencia al tratamiento con calcio y vitamina D en ancianos de una zona básica de salud

Background and objectiveThe vitaminD deficiency is high in the elderly population. Calcium and vitaminD supplements is a frequently used measure in individuals at risk for falls and/or fractures. However, this practice has achieved a low level of compliance. The aim is to assess the adherence to treatment with calcium and vitaminD in elders with hypovitaminosisD in an urban area of Madrid. Patients and methodsIntervention study performed on 438 individuals ≥65years from the ‘Peñagrande Cohort’ with hypovitaminosisD that were treated with calcium and vitaminD. Adherence at 3 and 12months was assessed using the Morisky-Green and counting of prescriptions written. ResultsA total of 413 of the 438 individuals with hypovitaminosisD were analysed (18 patients were not treated because of contraindications, and 7 were considered lost). At 3 and 12months, 63.9% and 47.2%, respectively, were adherents. After a brief educational intervention, 19.3% of individuals without adherence at 3 months became good compliers when measured at one year. Comorbidity was associated with lower rates of adherence to treatment after one year (46.3% versus 35.2%, P=.027). The main cause of non-adherence to calcium was digestive intolerance, and due to oversights for vitaminD. Concordance between adherence assessed by the Morisky test and counting of prescriptions written was high (Kappa index=69.8%). ConclusionsNon-adherence to chronic treatment with calcium and vitaminD is a relevant problem in elderly. It is important to assess adherence and implement health education strategies in clinical practice.

A dissertation on adolescent compliance with oral hygiene instruction during orthodontic treatment

Objectives: To determine the level of compliance with Oral Hygiene Instruction ( OHI) of 12 to 18 years old adolescent patient receiving orthodontic treatment at Dhaka Dental College and Hospital.Materials and Methods : In this descriptive observational study, a total number of 100 patients (37 boys &amp; 63 girls) were selected (with convenient sampling) from Orthodontics and Dentofacial Orthopedics Department in Dhaka Dental College &amp; Hospital. As the number of female patient is higher than that of male patient at Orthodontics and Dentofacial Orthopedics Department in Dhaka Dental College &amp; Hospital and the samples were selected with convenient sampling, the number of female patient was higher in this study.Results: This was an observational study conducted among 100 patients in the department of Orthodontics and Dentofacial Orthopedics, Dhaka Dental College and Hospital. The result of this study indicates that after five month of insertion of orthodontic appliance, 76% patients were good complier with Oral Hygiene instruction (OHI).Conclusion: The insertion of orthodontic appliances can result in changes in the oral environment, such as causing higher concentration of acid-producing bacteria due to the difficulty of performing oral hygiene after the insertion of appliance. Orthodontic appliances can also be associated with white spots, enamel decalcification, periodontal breakdown, and development of carious lesions. Continual plaque build-up may thus jeopardize the continuity of orthodontic treatment and the achievement of successful treatment outcome. So it is very important to give Oral Hygiene Instruction (OHI) at the commencement of orthodontic treatment and close supervision of the patient during treatment.Ban J Orthod &amp; Dentofac Orthop, April 2013; Vol-3, No.2

Long-term efficacy of indicated prevention of depression in non-professional caregivers: randomized controlled trial.

Although depression is a common problem among non-professional caregivers, only one trial has evaluated the efficacy of indicated prevention targeting this population and the long-term efficacy is unknown. The aim of this study was to evaluate the long-term efficacy of a brief intervention for the indicated prevention of depression in a sample of female caregivers. A randomized controlled trial was conducted involving 173 participants (mean age 53.9 years) who were allocated to the intervention (n=89) or the usual-care control group (n=84). Blinded interviewers conducted assessments at 1, 3, 6 and 12 months of follow-up. The main outcome measure was the incidence of major depression and the secondary outcomes were compliance with treatment, depressive symptoms, emotional distress and caregiver burden. At the 12-month follow-up, a lower incidence of depression as evaluated using the Structured Clinical Interview for Axis I Disorders of the DSM-IV was found in the intervention group compared with the control group (10.1% v. 25.0%). The relative risk was 0.40 and statistically significant [χ2=6.68, degrees of freedom=1, p=0.010, 95% confidence interval (CI) 0.20-0.81], and the number needed to treat was 7 (95% CI 4-27). There was a significant delay in the onset of depression in the intervention group (p=0.008). The good complier caregivers had a lower incidence of depression. The intervention effect on depressive symptoms, emotional distress and caregiver burden were maintained for 12 months. This is the first study to demonstrate that a brief problem-solving intervention can prevent the onset of depression among non-professional caregivers over the longer term.

The impact of cost-sharing schemes on drug compliance in Italy: evidence based on quantile regression

In this article we investigate the causal effect of cost-sharing schemes on compliance with statins in a quantile regression framework. We use the health search CSD-LPD data, a longitudinal observational dataset containing computer-based patient records collected by Italian general practitioners. We exploit a series of natural experiments referring to several introductions of co-payment schemes in some of the Italian regions between 2000 and 2009. We adopt an extended difference-in-differences approach to provide quantile estimates of the impact of co-payments on compliance. We find that (i) introduction of co-payments hurts residents of regions with worse quality and provision of health care; (ii) within these regions, co-payments were particularly harmful for high compliers; (iii) gender, clinical history and geographic residence are important determinants of compliance among poor compliers; (iv) compliance decreases with the potency and dosage of statins, particularly for poor compliers. In the presence of inefficient health-care provision, co-payments are harmful for drug compliance, and this is especially true for patients who are originally good compliers.

Knowledge of the cost of the treatments delivered from the Hospital Pharmacy Department and perception of the health status

To assess the influence of the knowledge of the financial cost of the treatment and perception of the patient of his/her health status and the health care received from the Hospital Pharmacy Department (HPD). During a four-month period, from July to October of 2009, a questionnaire was provided to all the patients coming to the Hospital Pharmacy Department to gather their medications, except for those starting their therapies. The patients returning the completed questionnaire at a next visit were provided with the second part, in which they were informed on the monthly cost of their treatments and some questions from the main questionnaire were asked again. 682 questionnaires were provided, of which 240 (35.3%) were returned completed. 223 patients were given the second part, of which 151 (22.1%) were returned. In general, the patients were satisfied with their treatments (90.4%) and with the care provided at the HPD (95.4%), 69.2% had good knowledge of their treatment, and 59.2% considered themselves as good compliers, and 17.5% did not usually consult with the pharmacist at the HPD. The patient's satisfaction analysis before (7.75; SD: 1.90) and after knowing the treatment cost (7.80; SD: 1.91) did not show statistically significant differences, with the exception of those patients derived from the Infectious Disease Department (p = 0.015) that were less satisfied after knowing the cost. The knowledge on the treatment cost could not be related in general with changes in the attitude of the patients towards their treatments, being necessary the design of more profound studies. Besides, it should be recommended to undertake the improvement actions detected by the patients in order to increase the quality of the pharmacy care delivered.

Telemonitoring for infants at risk of apnoea, bradycardia and hypoxaemia: transmission of data improves the family compliance during home monitoring

We evaluated the compliance of families using telemonitoring and families using conventional home monitoring in infants at risk of apnoea, bradycardia and hypoxaemia. Families who used the telemedicine system could perform the remote data transmission from their home. Families who used the conventional system had to come to the regional centre to download the cardiorespiratory traces captured by the monitor. A total of 175 patients examined at the Regional Centre for Sudden Infant Death Syndrome (SIDS) in Florence were included in the 5-year study. Good compliance was defined as an average daily use of 10 hours or more; insufficient compliance was defined as an average daily use of less than 10 hours. The Centre analysed 612 data downloads, 339 from the telemedicine system and 273 from the conventional system. This represented a total of 105,061 hours of data during 12,862 days of home monitoring. The compliance of families who used the telemedicine system was significantly higher than that of families who used the conventional system. Of the 105 families who used the conventional system, 50 (48%) were good compliers. Of the 70 families who used the telemedicine system, 49 (70%) were good compliers. Telemedicine was associated with a significant improvement in the compliance of families using cardiorespiratory monitors.

The Impact of Cost Sharing Schemes on Drug Compliance: Evidence Based on Quantile Regression

In this work we investigate the causal impact of cost sharing schemes on drug compliance using a Difference-in-Differences approach within a quantile regression framework. We exploit a series of natural experiments occurred in Italy between 2000 and 2010, referring to the introduction of regional co-payment schemes. We find that co-payments have a negative impact on compliance, causing a reallocation of individuals from the upper to the lower tail of the compliance distribution, thus hurting the already narrow group of good compliers. The empirical evidence suggests also that gender, clinical history and geographic residence are important drivers of compliance, particularly within the group of poor compliers.

Challenges to immunization: the experiences of homeless youth.

BackgroundHomelessness is a critical social issue, both a product of, and contributing to, poor mental and physical health. Over 150,000 young Canadians live on the streets. Homeless youth experience a high incidence of infectious diseases, many of which are vaccine preventable. Early departure from school and limited access to public health services makes them a particularly vulnerable high-risk group. This study explores challenges to obtaining essential vaccines experienced by homeless youth.MethodsA qualitative research study to explore knowledge, attitudes, beliefs, and experiences surrounding immunization of hard-to-reach homeless youth was designed. Participants were recruited for focus groups from Phoenix House and Shelter, a non-profit, community-based organization assisting homeless youth in Halifax, Nova Scotia, Canada. An experienced facilitator guided the recorded discussions. Transcripts of audiotapes were analyzed using a constant comparative method until data revealed a set of exemplars and themes that best captured participants’ knowledge, attitudes, beliefs and experiences surrounding immunization and infectious diseases.ResultsImportant themes emerged from our analysis. Considerable variability in knowledge about immunization and vaccine preventable diseases was found. The homeless youth in the study had limited awareness of meningitis in contrast to a greater knowledge about sexually transmitted infections and influenza, gained during the H1N1/09 public health campaign. They recognized their poverty as a risk for contracting infectious diseases, along with their inability to always employ known strategies to prevent infectious diseases, due to circumstances. They showed considerable insight into the detrimental effects of poor hygiene, sleeping locations and risk behaviour. Interviewed homeless youth regarded themselves as good compliers of health professional advice and offered valuable suggestions to improve immunization in their population.ConclusionsTo provide effective public health interventions, it is necessary to consider the knowledge, attitudes, beliefs, and experiences of hard to reach, high risk groups. Our study shows that homeless youth are interested and capable in discussing immunization. Active targeting of homeless youth for public health immunization programs is needed. Working collaboratively with non-profit organizations that assist homeless youth provides an opportunity to increase their knowledge of infectious risks and to improve immunization strategies in this vulnerable group.

Adherence with immunosuppressive treatment after transplantation: results from the French trial PREDICT

Although immunosuppressive therapy after organ transplantation is paramount for long-term outcomes, patients do not comply with their immunosuppressive treatment as much as might be expected. In this observational study, patients having undergone a kidney or liver transplantation were enrolled. Adherence was evaluated by patients using the compliance evaluation test and by physicians using a visual analogic scale. A linear regression was performed to identify determinants of adherence. Less patients having undergone kidney transplantation (27%) described themselves as good compliers than liver transplanted patients (40%). Discrepancy was noted between the physician and patient assessments. Rates of good adherence were significantly different depending on gender, age at transplantation, retransplantation, and time elapsed since transplantation, in at least one of the groups evaluated (whole cohort, kidney liver transplantation groups). In all three groups, adherence decreased with the number of immunosuppressants prescribed. In the whole cohort, the rate of good adherence was significantly higher in patients taking lower number of immunosuppressive drugs (45% for 1 vs. 24% for 3 immunosuppressants; p = 0.02). In this study, which is the first study of this scale in France, we confirmed that adherence with immunosuppressant treatment was low and that simpler treatment regimens may favor adherence.

Adherence styles of schizophrenia patients identified by a latent class analysis of the Medication Adherence Rating Scale (MARS): A six-month follow-up study

The purpose of this study was to examine patients' response profiles to the Medication Adherence Rating Scale (MARS) and to evaluate the potential of response styles as predictors of the future course of psychotic disorders in terms of rehospitalisation and maintenance of medication. A total of 371 psychiatric in-patients with schizophrenia or schizoaffective disorder who were taking part in a naturalistic long-term study completed a German version of the MARS. A Latent Class Analysis (LCA) was performed. Five latent classes of response styles could be identified: “moderately adherent”, “critical discontinuers”, “good compliers”, “careless and forgetful”, and “compliant sceptics”. Class membership was found to be related to the severity of symptoms, level of functioning, insight into illness, insight into necessity of treatment, treatment satisfaction and medication side effects. At a six-month follow-up appointment, significant differences between the classes persisted. Participants showing a “good compliers” response pattern had a significantly better prognosis in terms of rehospitalisation rate and maintenance of the original medication than “critical discontinuers”. Evaluation of the MARS by studying response profiles provides informative results that reach beyond the results obtained by an evaluation by scores. Patients can be classified into adherence groups that are of predictive value for long-term patient outcome.

Efficacy of a home-based intervention programme on the physical activity level and functional ability of older people using domestic services: a randomised study.

Our main objective was to assess whether a home-based program supervised by home helpers (HH) during their normal working hours can prevent excessive sedentariness (mainly maximum walking time and distance) and preserve functional status in elderly people at risk for frailty or disability and using domestic services. A four-month, open label, randomised trial with two groups called "prevention" and "control". In the homes of study participants. The participants were all over 78 years old, lived independently at home, and received the visits of HHs at least once a week. The intervention combined a self-administered exercise program, with 10 g amino-acid supplementation under the supervision of HHs. Main outcome measures included physical activity (the PASE questionnaire), functional tests, nutritional and autonomy scores, and compliance (50% or more was considered satisfactory). Non-parametric methods were used for comparisons between the two groups. A linear regression model was fitted to assess the effect of the intervention on the relative variation of outcomes, adjusted for unbalanced baseline co-variables. One hundred and two persons (prevention n=53, control n=49) with a median age of 85 years were included. Their median Activities of Daily Living and Instrumental Activities of Daily Living (IADL) scores were 6 and 7 respectively. Twenty-three (44%) were good compliers for both interventions. The maximum walking time remained stable while decreasing by 25% in the control group (p=0.0015); and fewer participants had a worsened IADL score in the prevention group (p=0.05). The baseline IADL Score was significantly associated with good compliance to the prevention program (p=0.0011). In good compliers, maximum walking distance and maximum walking time increased by 29.15% (0.0 to 66.7) and 33.3% (-20.0 to 50.0) respectively. This study confirms the feasibility of a prevention program supervised by HHs, and some benefit from the intervention and identifies predictors for better compliance. It will help in the design of prevention trials for elderly people at risk for frailty.

The ARIA guidelines in specialist practice: a nationwide survey

In 2001, the ARIA guidelines were published to assist healthcare practitioners in managing allergic rhinitis (AR) according to the best evidence. Very limited information, however, is avail-able on the impact of these guidelines on clinical practice. All Belgian Otorhinolaryngologists were invited to complete a questionnaire, covering demographic and professional characteristics, knowledge, use and perception of the ARIA guidelines and 4 clinical case scenarios of AR. Of the 258 (44%) Belgian Otorhinolaryngologists who participated, almost 90% had ever heard about ARIA and 64% had followed a lecture specifically dedicated to the ARIA guidelines. Furthermore, 62% stated to always or mostly follow the ARIA treatment algorithms in the daily management of AR patients. In the clinical case section, adherence to the ARIA guidelines raised with increased self-reported knowledge and use of the ARIA guidelines and among participants that considered the guidelines more userfriendly. Of the respondents, 51% were considered as good com-pliers. Younger age was a significant predictor for good compliance. More efforts are required to improve the translation of scientific knowledge into clinical practice and to further identify which factors may influence guideline compliance.

Celiac Disease: Predictors of Compliance With a Gluten‐free Diet in Adolescents and Young Adults

To identify risk as well as protective factors related to compliance with the gluten-free diet in a cohort of teenagers with celiac disease (CD). Two hundred four patients with CD (European Society for Pediatric Gastroenterology, Hepatology, and Nutrition criteria) older than or equal to 13 years and residents of Campania (southern Italy) were enrolled in the study. Patients underwent clinical examination and blood sampling, and were interviewed about school performance, social relationships, family integration, smoking habit, and compliance with a gluten-free diet. Anti-tissue transglutaminase antibodies were assayed with an enzyme-linked immunosorbent assay. One hundred fifty of 204 (73.5%) reported no dietary transgressions, and 54 of 204 (26.5%) reported occasional or frequent transgressions. During the previous month 29 of 54 (53.7%) poor compliers ate from 0.001 to 1 g of gluten per day, 14 (25.9%) from 1 to 5 g, and 11 (20.4%) more than 5 g. The daily intake of gluten was significantly related to anti-tissue transglutaminase antibodies (chi2 = 38.872, P = 0.000). Height was below the third percentile in 19 of 204 (9.3%), and weight was above the 97th percentile in 20 of 204 (9.8%). Diet compliance did not seem to influence the weight and height. One hundred eleven of 150 good compliers (74%) and 31 of 54 (57.4%) poor compliers were asymptomatic. Most patients reported good family relationships (88.7%), social relationships (91.2%), and school integration (88.2%). Alternatively, 54% of patients reported some limitation in their social life. Compliance was good in patients who reported excellent school integration (83%) and social relationships (81%). Optimal school integration significantly contributes to the likelihood of good compliance. A better understanding within the school environment about CD-related issues could improve motivation to adhere to a gluten-free diet.