Greater Adherence Research Articles

Adherence to a low-fat dietary pattern reduces head and neck cancer risk: evidence from the PLCO trial

PurposeLow-fat dietary (LFD) pattern refers to a dietary structure with reduced fat intake. The aim was to investigate the association between LFD pattern and risk of head and neck cancer (HNC).MethodsData were derived from the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. LFD score was used to assess adherence to an LFD pattern, with higher scores indicating greater adherence. Cox regression was used to evaluate the association between LFD score and risk of HNC and its subtypes. To visualize the trend in risk of HNC and its subtypes with changing LFD score, restricted cubic spline plots were utilized. A series of subgroup analyses were conducted to identify potential confounders. Sensitivity analyses were performed to assess the robustness of the results.ResultsAmong 98,459 participants of PLCO trial, 268 cases with HNC were identified during an average of 8.8 years of follow-up. In the fully adjusted model, participants in the highest compared with the lowest quartiles of LFD score had a lower risk of HNC (HR Q4 vs. Q1: 0.60; 95% CI: 0.40–0.90; P for trend = 0.026) and larynx cancer (HRQ4 vs. Q1: 0.46; 95% CI: 0.22–0.96; P for trend = 0.039). The restricted cubic spline plots demonstrated a linear dose-response relationship between the LFD score and the risk of HNC and its subtypes (all P for nonlinearity > 0.05). The primary association remained robust in the sensitivity analysis.ConclusionOur findings suggest that adherence to an LFD pattern may lower the risk of HNC in the US population.

Patient motivation: A concept analysis.

Patient motivation is crucial in maintaining health-improving activities and helping patients recover from illnesses. Despite extensive research on patient motivation, this concept has not been clearly defined and remains ambiguous. The latest analysis of patient motivation was over two decades ago, thus necessitating the need to reexamine it in more updated literature. This study aims to explore the concept of patient motivation. The eight-step approach of Walker and Avant was used: concept selection, determining analysis aim, identifying concept use, defining attributes, model case identification, borderline and contrary case identification, antecedents and consequences identification, and empirical referent identification. Five databases, CINAHL, Cochrane, Medline, PubMed, ProQuest, and ScienceDirect, were searched for published works between 2014 and 2024 using the keywords "patient" and "motivation." The identified attributes of patient motivation are a psychological drive, a desire to adopt healthy behaviors, and goal-directed action. Antecedents of patient motivation are self-efficacy, provider-patient communication, and social support. Patient motivation leads to consequences, including healthier lifestyles and greater adherence and compliance. The present concept analysis draws upon current literature to suggest the antecedents, attributes, and consequences of patient motivation. Nurses can promote healthier lifestyles and greater adherence and compliance among patients by employing techniques to raise self-efficacy and provide social support while enhancing patient-centered interactions.

Treatment patterns of goserelin 3.6 mg once monthly and 10.8 mg every three months in women with breast cancer: A real-world analysis.

391 Background: Goserelin is a gonadotropin-releasing hormone agonist used for ovarian function suppression in the treatment of pre- and peri-menopausal patients with breast cancer. Goserelin, administered as a subcutaneous implant, is available in doses of 3.6 mg once monthly or 10.8 mg every three months; goserelin 3.6 mg is approved in the US, and both the 3.6 mg and 10.8 mg doses are approved by Health Canada and the European Medicines Agency. A study utilizing US real-world evidence was conducted to characterize treatment patterns of patients treated with goserelin 3.6 mg and/or 10.8 mg. Methods: Electronic health record data of adult patients with a history of breast cancer and with ≥2 prescriptions of goserelin between 1 January 2017 – 31 December 2022 were identified through TriNetX. Index date was the initiation of goserelin administration. Patients were followed until 15 March 2024. Patient demographics, treatment adherence, and healthcare resource utilization (HCRU) were examined and summarized using descriptive analytics. Results: Overall, 3,620 patients were identified: 2,870 treated with goserelin 3.6 mg, 410 with goserelin 10.8 mg, and 340 who switched from goserelin 3.6 mg to 10.8 mg. Peak utilization of goserelin 10.8 mg (36.6%) and peak dosage switching (26.5%) occurred in 2020. Across groups, mean age at index date was 42.2–44.4 years, and patients were white (64.1–67.6%), black (11.8%–13.9%), Asian (8.0%–11.8%), and American Indian and/or Alaskan native (0.3%–2.9%). Of patients with known BMI, BMI mostly ranged between 18.5–24.9 kg/m 2 in all groups. Patients who switched from goserelin 3.6 mg to 10.8 mg had the longest median treatment duration (776 days) (Table). Patients treated with goserelin 10.8 mg remained on treatment for a median of 426 days; 74.4% of these patients were treatment-adherent (Table). In comparison, patients treated with goserelin 3.6 mg had a shorter median treatment duration (226 days) and were less adherent (56.4%) (Table). HCRU during the 12 months after index date was broadly similar across groups. Conclusions: Treatment with goserelin 10.8 mg every three months is associated with greater adherence and longer treatment duration, compared with 3.6 mg once monthly, in patients with a history of breast cancer. Patients who switched from goserelin 3.6 mg to 10.8 mg were treatment-adherent for nearly two years, consistent with clinical recommendations. Goserelin 3.6 mg (n = 2,870) Goserelin 10.8 mg (n = 410) Switched from goserelin 3.6 mg to 10.8 mg (n = 340) Median duration of treatment (days) 264 429 776 Median time to switch (days) — — 218 Patients adherent* to dosing schedule 1,608 (56.4%) 306 (74.4%) — Status as of March 15, 2024 Discontinued goserelin 2,018 (70.8%) 261 (64.3%) 173 (50.9%) Death 88 (3.1%) 10 (2.5%) 3 (0.9%) *Defined as: ≤36 days between prescriptions (3.6 mg) or ≤108 days between prescriptions (10.8 mg).

Exploring the Influence of Perceived Social Support on Medication Adherence Among Patients With Chronic Hypertension in 2024: A Cross-Sectional Study From Jeddah, Kingdom of Saudi Arabia.

Background There is no doubt that hypertension is one of the most widespread global health problems, and it is essential to comply with prescribed medications for optimal control. A lack of studies on the effects of perceived social support (PSS) on medication adherence among hypertension patients, especially in Jeddah, Saudi Arabia, made us conduct this study. Methods This was a cross-sectional study that targeted hypertension patients who were visiting primary healthcare centers under the Ministry of Health in Jeddah, Saudi Arabia. The Morisky Green and Levine (MGL) adherence scale and the Multidimensional Scale of Perceived Social Support (MSPSS) were used to assess adherence and perceived social support, respectively. Results The study included 377 hypertensive patients with a mean age of 57 years (SD = 10). The majority were male (n=226, 59.9%) and married (n=261, 69.2%). Educational levels varied, with 148 (39.3%) completing high school and 79 (21%) holding a bachelor's degree or higher. Income distribution showed 166 (44%) earning less than 5,000 SAR and 47 (12.5%) earning over 15,000 SAR. Medication adherence, assessed using the MGL scale, revealed that 121 (32.1%) had low adherence, 206 (54.6%) had moderate adherence, and 50 (13.3%) had high adherence. Perceived social support, measured using the MSPSS scale, indicated that 219 (58.1%) reported high levels of support. A significant association between medication adherence and perceived social support was found (F = 10.293, p < 0.01), with moderate adherers having higher social support scores. Socio-demographic factors influencing adherence included marital status, education level, income, and occupation, with significant associations for each (p < 0.01). Married participants and those with higher education and income levels had greater adherence. Government employees showed the highest moderate adherence while the unemployed and homemakers had lower adherence. No significant associations were found between gender or age and adherence. Conclusion Higher levels of perceived social support,in addition to the influence of socio-demographic factors, are associated with better medication adherence. Targeted interventions addressing these factors could enhance medication adherence and improve health outcomes in this population.

Digital music and movement intervention to improve health and wellbeing in older adults in care homes: a pilot mixed methods study

BackgroundLow physical activity among older adults is related to adverse health outcomes such as depression and loneliness, poor physical function and increased risk of falls. This study was designed to increase physical activity through a digital, group-based, physical activity and music intervention and to examine its effectiveness on social, mental and physical health outcomes.MethodsParticipants were 34 older adults (65 years +) recruited across four care homes in Scotland to a pilot study. Surveys were administered at baseline and post-intervention, comprising measures of fear of falling, depression and anxiety, loneliness, sleep satisfaction and quality of life. A battery of physical function tests and saliva sampling for cortisol and dehydroepiandrosterone hormone analysis were also conducted at each time point. Additionally, process evaluation measures (recruitment, intervention fidelity, attendance, retention rates and safety) were monitored. The intervention comprised 12 weeks of three prescribed digital sessions per week: movement and music (n = 2) and music-only (n = 1), delivered by an activity coordinator in the care home. Post-intervention interviews with staff and participants were conducted to gain qualitative data on the acceptability of the intervention.ResultsAn average of 88% of prescribed sessions were delivered. Pre- to post-intervention intention-to-treat analysis across all participants revealed significant improvements in anxiety, salivary DHEA, fear of falling and loneliness. There were no significant improvements in health-related quality of life, perceived stress, sleep satisfaction or physical function tests, including handgrip strength. Qualitative analysis highlighted benefits of and barriers to the programme.ConclusionsThe digital movement and music intervention was deemed acceptable and delivered with moderate fidelity, justifying progression to a full-scale trial. Although a proper control group would have yielded more confident causal relationships, preliminary psychosocial and biological effects were evident from this trial. To show significant improvements in physical function, it is likely that a bigger sample size providing sufficient power to detect significant changes, greater adherence, longer intervention and/or higher exercise volume may be necessary.Trial registrationThe trial is registered at ClinicalTrials.gov, number NCT05601102 on 01/11/2022.

Towards Sustainable Packaging Using Microbial Cellulose and Sugarcane (Saccharum officinarum L.) Bagasse.

The high consumption of packaging has led to a massive production of waste, especially in the form of nonbiodegradable polymers that are difficult to recycle. Microbial cellulose is considered a biodegradable, low-cost, useful, ecologically correct polymer that may be joined with other biomaterials to obtain novel characteristics and can, therefore, be used as a raw material to produce packaging. Bagasse, a waste rich in plant cellulose, can be reprocessed and used to produce and reinforce other materials. Based on these concepts, the aim of the current research was to design sustainable packaging material composed of bacterial cellulose (BC) and sugarcane bagasse (SCB), employing an innovative shredding and reconstitution method able to avoid biomass waste. This method enabled creating a uniform structure with a 0.10-cm constant thickness, classified as having high grammage. The developed materials, particularly the 0.7 BC/0.3 SCB [70% (w/w) BC plus 30% (w/w) SCB] composite, had considerable tensile strength (up to 46.22 MPa), which was nearly thrice that of SCB alone (17.43 MPa). Additionally, the sorption index of the 0.7 BC/0.3 SCB composite (235.85 ± 31.29 s) was approximately 300-times higher than that of SCB (0.78 ± 0.09 s). The packaging material was also submitted to other analytical tests to determine its physical and chemical characteristics, which indicated that it has excellent flexibility and can be folded 100 times without tearing. Its surface was explored via scanning electron microscopy, which revealed the presence of fibers measuring 83.18 nm in diameter (BC). Greater adherence after the reconstitution process and even a uniform distribution of SCB fibers in the BC matrix were observed, resulting in greater tear resistance than SCB in its pure form. The results demonstrated that the composite formed by BC and SCB is promising as a raw material for sustainable packaging, due to its resistance and uniformity.

Adherence and Opportunity Frequency as Predictors of Communication Outcomes from Pivotal Response Parent Training.

Access to intervention is a barrier for children with autism. As parent-mediated interventions have emerged to address this need, understanding implementation components contributing to child gains is critically important. Existing literature documents relationships between parent treatment adherence and child progress; however, less is understood about components, such as frequency of learning opportunities, which could also affect child outcomes. This study is a secondary analysis of data from a randomized controlled trial evaluating Pivotal Response Treatment group parent training (PRTG) compared to psychoeducation. Linear regression and mediational models were employed to identify potential predictors and mediators of outcome. PRTG produced large increases in adherence and learning opportunities. In general, greater frequency of learning opportunities and adherence predicted better child outcomes. The best-fitting cross-sectional mediational models indicated at least partial mediational effects, whereby increased learning opportunities mediated the relationship between greater adherence and improved child outcomes. This study provides preliminary evidence of how early gains in adherence may support parents to provide more frequent learning opportunities, which, in turn, yield positive effects on child social communication. Future large-scale research, with greater granularity of measurement, is needed to further understand the temporal relationships between these variables.

Assessing the impact of long-acting injectable compared to oral antipsychotic medications on readmission to a state psychiatric hospital.

People living with schizophrenia spectrum disorder (SSD) have a higher death rate which is caused, in part, by poorer adherence to treatment as compared to those with other mental illnesses. Using long-acting injectable antipsychotic (LAI) medications can improve medication adherence and reduce hospitalizations for people living with SSD but are often underutilized. As compared to oral antipsychotic medications provided to patients with SSD at discharge from a psychiatric hospitalization, being provided with an LAI antipsychotic medication may reduce subsequent rehospitalization. Specifically, patients discharged on an atypical or second-generation LAI medication are less likely to be readmitted to the hospital when compared to those discharged on a typical first-generation oral medication. Because LAI antipsychotic medications are often underutilized as treatment options, the study findings suggest that this modality may be considered for patients with SSD when being discharged from a psychiatric hospitalization. Ideally, psychiatric-mental health nurses can educate patients about indications, benefits, and risks of using atypical or second-generation LAI antipsychotic medications during hospitalization and at discharge prevent the risk for future rehospitalizations. INTRODUCTION: People living with schizophrenia spectrum disorder (SSD) have poorer medication adherence compared to those with other mental illnesses. Long-acting injectable antipsychotic (LAI) medication use is associated with greater adherence, reduced re-hospitalizations, and improved recovery outcomes when compared to oral formulations. To compare LAI antipsychotic medication use versus oral formulations on readmission to an inpatient hospital. Medical records (N = 707) from a state psychiatric hospital in the southern region of the United States were reviewed. Controlling for demographic variables, logistic regression analyses were used to examine LAI compared to oral formulations on readmission. Compared to patients discharged with oral antipsychotic medications, those with LAIs had a lower proportion of readmission rates in 6-month and 1-year periods, but not 30-day or 2-year periods. When controlling for demographic variables, those discharged with an atypical LAI had significantly lower odds of being readmitted within the 24-year period compared to those discharged on a typical oral antipsychotic. Compared to orals, LAIs do not increase and may mitigate readmissions to psychiatric hospitalization. Psychiatric-mental health nurses and other professionals may recommend LAIs when indicated for those with SSD.

Validation of a Community-Based Approach Toward Personalized Dementia Risk Reduction: The Kimel Family Centre for Brain Health and Wellness

Background/ObjectivesThe Kimel Family Centre for Brain Health and Wellness is a research-driven community centre testing the efficacy of personalized dementia risk reduction programming on dementia risk and cognition. The objective of this protocol is to validate this approach by following people for two years.Design/SettingParticipants will receive a comprehensive dementia risk assessment, including nonmodifiable and modifiable risk factors, from which they will receive a Personalized Dementia Risk Report and Program Strategy, indicating their health conditions increasing and their risk level in five modifiable risk domains: physical activity, brain-healthy eating, cognitive engagement, social connections, and mental wellbeing. Equipped with this information, participants will enroll in programs within the Centre to address their risk factors. Changes to their dementia risk, cognition, and Personalized Program Strategy will be communicated through re-assessments of risk factors every six months (risk and cognition) and every year (comprehensive assessment).ParticipantsParticipants (n = 450) will be 50 years of age or older, without a diagnosis of dementia, and sufficiently fluent in English to complete the assessments and understand program instructors. One goal is that our participant sample will include people of low income (with fundraising providing free community centre membership), and from various ethnoracial backgrounds.InterventionParticipants will select programs to meet their Personalized Program Strategy. For physical activity, they will gradually work toward the Canadian Society for Exercise Physiology guidelines. For brain-healthy eating, they will learn about the Brain Health Food Guide and food label reading, and then take additional programs. For cognitive engagement and mental wellbeing, they will take at least one hour of relevant programming per week. Social connections will be reinforced throughout all programs. All participants will also have access to the Canadian Consortium on Neurodegeneration’s CAN-THUMBS Up online, educational program on modifiable dementia risk factors, called Brain Health PRO.MeasurementsThe comprehensive assessment includes numerous dementia risk factors, but the primary measures are risk in the five domains, health conditions proximal to those five risk domains, and cognition, and how these are affected by adherence and quality of goal-directed future simulation. We hypothesize a reduced risk in the five domains within six months, improvements in health biomarkers within a year, and maintenance of cognition within two years, with these benefits accruing with greater adherence, but only up to a point, at which benefits will plateau, and greater benefits among participants whose goal-directed simulations are more vivid, personally-relevant, achievable, and positive.ConclusionsThis innovative approach overcomes a number of limitations present in prior multidomain dementia prevention trials. Adapting a preference clinical trial that is embedded in a community centre, where participants have autonomy to choose programs to address their modifiable dementia risk factors, has real-world applicability in the global effort to reduce dementia risk.

Self-Management Programs and the Pursuit of Behavior Change.

A self-management intervention is a personalized approach to individuals aiming to engage individuals in a behavior change to develop skills to live better with their condition. Self-management involves an iterative process between participants and providers in which goals are formulated and feedback is given. All respiratory societies advocate self-management as part of chronic care because it may improve quality of life and health-care utilization. Self-management is an integral part of pulmonary rehabilitation. Self-management interventions usually involve education and exercise prescription, and that is an asset of current programs; however, recent reports indicate that effective strategies for motivation and a behavior change focus are often missed. A recent systematic review on self-management urges the need for a specific aspect and characteristic of self-management interventions: iterative interactions between participants and health-care professionals competent in using behavior change practices to elicit participants' motivation, confidence, and competence to develop skills to better manage their disease. A recent review of self-care intervention in chronic disease states that the major deficits found in self-care interventions included a lack of attention and/or innovation to the psychological consequences of chronic illness, technology, and behavior change techniques to help patients manage symptoms. There is a need for exploration of mechanisms to explain the relationships between both anxiety and depression, and adherence to treatment in COPD. The latter is particularly appropriate for pulmonary rehabilitation, for which greater adherence is needed. This report aims to introduce basic aspects of behavior change and a proposed roadmap to introduce behavior change into pulmonary rehabilitation and chronic care programs.

Adherence to the Mediterranean diet and 20-year incidence of hypertension: the ATTICA prospective epidemiological study (2002-2022).

Dietary habits are a significant predictor of hypertension (HTN). We aimed to evaluate the long-term association between adherence to the Mediterranean diet and HTN incidence. This was a prospective study among 1415 non-hypertensive adults (44% men, age: 41 ± 13 years) followed up for 20 years. Anthropometric, lifestyle, and clinical parameters were evaluated at baseline. Adherence to the Mediterranean diet was evaluated both at baseline and 10 years through the MedDietScore (range: 0-55, higher values indicate greater adherence). At the 20-year follow-up, 314 new HTN cases were recorded. HTN incidence was 35.5%, 22.5%, and 8.7% in the lowest, middle, and upper tertile of baseline MedDietScore, respectively (p < 0.001). For each 1-point increase in baseline MedDietScore, the 20-year HTN risk decreased by 7% [relative risk (RR): 0.925, 95% confidence interval (CI): 0.906, 0.943], and this effect remained significant after adjustment for age, sex, and baseline lifestyle and clinical confounders, i.e., body mass index, physical activity, smoking, systolic and diastolic blood pressure, family history of HTN, and presence of hypercholesterolemia and diabetes mellitus (RR: 0.973, 95%CI: 0.949, 0.997). In a similar multiadjusted model, compared to subjects who were consistently away from the Mediterranean diet (in the lowest MedDietScore tertile both at baseline and 10 years), only those who were consistently close (in the middle and upper MedDietScore tertiles both at baseline and 10 years) exhibited a 47% lower 20-year HTN risk. A high adherence to the Mediterranean diet, particularly when longitudinally sustained, is associated with lower incidence of HTN.

Effectiveness of an abbreviated version of the automated attention training technique (ATT) for stress reduction in a non-clinical sample—A randomized controlled trial

Stress is one of the leading risk factors for mental health problems. The attention training technique (ATT), developed in the context of metacognitive therapy, is a method for increasing flexible control of attention and might thus reduce the impact of stressful events on mental health. Developed as a 12-min exercise, ATT is primarily used in a clinical context. To ensure low-threshold implementation by the general population in everyday life, we developed an abbreviated 5-min version of the ATT. The present study examined the effectiveness of this abbreviated ATT in reducing stress in a three-armed randomized controlled trial by comparing the abbreviated version (ATTabbr; n = 74) with the long version (ATTlong; n = 67) and a waitlist control group (WCG; n = 77) in a non-clinical sample. The primary outcome was change on the Depression, Anxiety, and Stress Scale (DASS-21). In the intention-to-treat analysis of changes from baseline to follow-up, both the abbreviated ATT version and the long ATT version were superior to the WCG in the reduction of stress (d = 0.67 for the abbreviated version and d = 0.44 for the long version). From post to follow-up, reductions in stress were greater for the abbreviated version than the long version (d = 0.37). We also observed effects of both ATT versions on depression and anxiety but no effect on attention control, perseverative thinking, or quality of life. For the abbreviated version, we found preliminary evidence of a dose-response relationship. Participants with access to the abbreviated version conducted the training twice as often compared with those with access to the long version. These results suggest that the abbreviated version of the ATT is associated with greater adherence and possibly greater effects on stress than the long version. If these results are confirmed, the abbreviated version could be used to reduce stress and increase mental well-being in the general population.

Carbohydrate quality, not quantity, linked to reduced colorectal cancer incidence and mortality in US populations: evidence from a prospective study

BackgroundCarbohydrates have been implicated in colorectal cancer (CRC) risk, but the specific impact of carbohydrate quality and quantity on CRC susceptibility in US populations remains unclear.MethodsWe followed 101,694 participants from Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. The carbohydrate quality index (CQI) and low-carbohydrate diet score (LCDs) were used to evaluate the daily carbohydrate quality and quantity separately, where higher scores indicated greater adherence. Cox proportional hazards regression was used to compute HRs and 95% CIs for incident CRC and related death. Subgroup analyses were conducted to identify potential effect modifiers.ResultsDuring follow-up, we documented 1085 incident cases of CRC, of whom 311 died from CRC. Individuals in the highest compared with the lowest quartiles of CQI had a lower CRC incidence (Q4 vs Q1: HR 0.80, 95% CI 0.67–0.96, Ptrend = 0.012) and mortality (Q4 vs Q1: HR 0.61, 95% CI 0.44–0.86, Ptrend = 0.004). The inverse association between CQI and CRC risk was observed for distal colon and rectum but not for proximal colon cancer. Regarding mortality, this association was only significant for rectum cancer. Subgroup analyses indicated this inverse association of CQI with CRC risk was only observed in participants with lower LCDs. No significant associations were found between LCDs and CRC incidence or mortality.ConclusionsOur findings suggest focusing on higher quality, rather than restricting the quantity, of carbohydrate consumption may be an effective approach to reduce the risk of CRC in the US population, particularly for distal colon and rectal cancers.

Improved medication adherence in COPD patients using tiotropium or tiotropium olodaterol with the HealthPrize digital behavior change program

ABSTRACT Objective To assess the impact of the HealthPrize RespiPoints™ program on treatment adherence and persistence in adults with chronic obstructive pulmonary disease (COPD). Methods In this retrospective cohort study, program participants and nonparticipants receiving tiotropium bromide (TIO) or TIO and olodaterol between 1 January 2015–31 March 2020 were propensity score matched (PSM), from the linked database of the HealthPrize patient list and IQVIA PharMetrics® Plus. Treatment adherence, persistence, healthcare resource utilization, and costs were compared. Multivariable logistic regression models assessed the odds of adherence (≥80% proportion of days covered [PDC]), adjusted risk of discontinuation, and adjusted total healthcare costs. Results Program participants (n = 262) demonstrated a 44% greater adherence during followup than nonparticipants (n = 262) (mean [standard deviation] PDC: 0.72 [0.27] vs 0.50 [0.36], p < 0.0001). Participants had higher odds of adherence vs nonparticipants (adjusted odds ratio: 2.51; 95% confidence interval: 1.72–3.66, p < 0.0001) and a lower percentage of participants discontinued their index medication (19.85% vs 33.59%, p = 0.0004). Fewer participants were hospitalized during follow-up (13.74% vs 17.56%, p = 0.23); adjusted total medical costs were 24% lower (p = 0.08). Higher pharmacy costs partially offset lower healthcare costs. Conclusions Program participants showed improved COPD medication adherence and persistence compared to nonparticipants.

The dietary approaches to stop hypertension (DASH) dietary pattern in childhood in relation to cardiometabolic risk in adolescence and early adulthood in the ALSPAC birth cohort.

To investigate the relationship between the dietary approaches to stop hypertension (DASH)-style dietary patterns in childhood and cardiometabolic risk (CMR) in adolescence/early adulthood. Data were obtained from the Avon Longitudinal Study of Parents and Children (ALSPAC) prospective cohort. Diet diary data collected at 7, 10 and 13 years were used to calculate DASH-style diet scores (DDS). Multivariable linear regression models were used to investigate the associations between the DDS at 7, 10 and 13 years and CMR scores, calculated at 17 and 24 years. The ALSPAC cohort included children born in south-west England in 1991-1992. Children with complete dietary, covariate and cardiometabolic data at 17 (n 1,526) and 24 years (n 1,524). A higher DDS at 7 and 10 years was negatively associated with CMR scores at 17 years (β = -0·64 (95 % CI -1·27, -0·006), Ptrend=0·027 for fifth v. first DDS quintile at 7 years; β = -0·73 (95 % CI -1·35, -0·12) and Ptrend=0·037 for fifth v. first DDS quintile at 10 years) and at 24 years (β = -0·92 (95 % CI -1·49, -0·34) Ptrend = 0·001 for fifth v. first DDS quintile at 7 years; β = -0·60 (95 % CI -1·20, -0·05) Ptrend = 0·092 for fifth v. first DDS quintile at 10 years). No associations were found between the DDS at 13 years and CMR score at 17 and 24 years. Greater adherence with a DASH-style diet during childhood was associated with better cardiometabolic health in adolescence/adulthood in the ALSPAC cohort. The components of the DASH diet could be recommended to improve children's cardiometabolic health.

Hormone therapy adherence in breast cancer: Predictive factors in Uruguay

Background/Aim: Adjuvant hormone therapy (HT) significantly improves survival in patients with hormone receptor-positive breast cancer, yet adherence to this therapy is critical and tends to decrease over time. This study aims to identify risk factors for suboptimal adherence to adjuvant HT among patients treated at the Hospital de Clínicas and the Hospital Departamental de Soriano, Uruguay, to inform future strategies to improve adherence. Materials and Methods: A retrospective, cross-sectional study was conducted, including 96 breast cancer patients in stages I-III treated with HT for at least three years. Adherence was assessed using the Morisky-Green questionnaire. Statistical analysis was employed to estimate the odds ratios (OR) for non-adherence, with a significance threshold of α=0.05. Results: Out of the 96 patients included, 22.9% demonstrated suboptimal adherence to hormone therapy. Analysis revealed that the use of tamoxifen (adjusted OR of 4.86, p&lt;0.05) and living with others were significant predictors of non-adherence. The aggressiveness of the treatment did not show a statistically significant correlation with adherence. Additionally, the analysis highlighted that sociodemographic characteristics, such as marital status and employment situation, did not directly influence adherence, underscoring the complexity of factors contributing to treatment adherence. Intriguingly, the analysis showed a trend towards greater adherence among postmenopausal patients and those with a history of combined treatment of tamoxifen and aromatase inhibitors, though these results warrant further exploration. Conclusion: Suboptimal adherence to adjuvant HT in breast cancer patients is significantly influenced by the type of hormone therapy prescribed and the patient's social environment. It is necessary to develop personalized interventions that address these factors to improve adherence.

Analyzing knowledge, attitudes, and practices towards COVID-19: The second cross-sectional survey in the Cabo Verdean population

ContextThe emergence and increase of cases of the new coronavirus in Cabo Verde led to the implementation of several infection control measures. However, the success of these measures depends largely on the population's knowledge about the disease and their commitment to fighting it. This study aimed to analyze the knowledge, attitudes, perceptions, and practices of the resident Cabo Verdean population regarding COVID-19. MethodologyA cross-sectional study was carried out among 2754 participants aged 12 and above. The data collection instrument, a questionnaire, was applied in the field by trained surveyors. Descriptive statistics, chi-square tests, Spearman correlation, and simple and multiple regression analyses were performed to assess the sample's determinants of knowledge, attitudes, and practices towards COVID-19. ResultsOf the 2754 study participants, 1331 (48.3%) were male. The mean age of the respondents was 28.5 years (SD = 14.1). The overall knowledge rate was 79%. Logistic regression analysis showed that knowledge was significantly associated with secondary education or higher (p < 0.001), marital status married or de facto partnership (p < 0.001), and residence in the urban area of São Vicente (p = 0.025). The rate of correct answers concerning attitudes was 75.7%, with the majority of respondents agreeing with the measures implemented by the authorities in managing the pandemic (n = 2272; 82.9%). The results show considerable hesitation concerning the vaccine, which is significantly associated with the age group 18 to 30 (p < 0.001). Practices obtained the lowest scores, and physical distancing was one of the preventive measures least complied with. Binary logistic regression revealed a significant association between sex, age, education, and marital status with practices. Knowledge (rho = 0.1436; p < 0.001) and attitudes (rho = 0.1068; p < 0.001) were significantly associated with practices. ConclusionFinancial difficulties seem to hinder compliance with infection control measures. Public health policies may have greater adherence if accompanied by social and economic support strategies. Studies investigating the behavior of infected persons during the infection period may provide helpful information in understanding the mechanisms underlying the virus transmission in the country.

Oral Appliance Therapy for Obstructive Sleep Apnea: Clinical Benefits and Limitations

Obstructive sleep apnea (OSA) is a condition characterized by recurrent upper airway obstruction during sleep. It is associated with a wide range of symptoms and complications. Management includes positive airway pressure (PAP), upper airway surgery, oral appliance therapy, positional therapy, and weight loss. Oral appliance therapy treats OSA through direct expansion of the upper airway or indirectly by preventing its collapse. Its effectiveness in improving apnea-hypopnea index and oxygen desaturation is gaining wider approval and the American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine currently recommend oral appliance as an alternative therapy for those who are unable to PAP therapy. To achieve maximum benefits, it is essential to evaluate factors that can affect treatment outcomes as well as create devices tailored to the individual patient’s dentition and capable of manipulating the degree of mandible advancement. While most are minor and transient, patients should always be warned about the potential adverse effects on mastication and mandibular joint as they can negatively influence treatment compliance. Although PAP shows superior results in improving polysomnography parameters, oral appliance therapy displays comparable health outcomes and greater adherence. Additional studies on establishing patient selection, optimal titration procedure, and measuring objective adherence will further improve oral appliance therapy acceptance.

ADVANCE CARE PLANNING FIDELITY TOOL IN THE CONTEXT OF COGNITIVE IMPAIRMENT: THE SHARE TRIAL

Abstract 2. Conducting high-quality advance care planning (ACP) conversations with persons living with ADRD and their family members is inherently challenging. Differing levels of cognitive function, judgment, ability to engage, and care partner involvement adds to the complexity of such ACP conversations, necessitating flexible fidelity monitoring to accommodate contextual factors. This presentation will focus on the process of measuring ACP fidelity. The SHARE ACP fidelity checklist was developed to measure the protocol adherence during ACP meetings, monitor for areas in which ACP facilitators may require re-training or additional support, and to inform analyses of the impact of the overall exposure to the study intervention. The fidelity checklist items are organized into three overarching domains: Meeting Set-Up, ACP Meeting Topics, and Facilitator Communication Skills. For the present study, a fidelity adjudication team from a pool of 7 raters, listened to and independently rated recorded conversations for protocol adherence. Each checklist item is scored ranging from 0 to 2 (0=not done; 1=needs improvement; or 2=effective) with higher scores indicating greater adherence. Fidelity ratings tended to improve over time, suggesting a facilitator experience effect. The goal to achieve an overall fidelity rating of ≥80% was met in 63% of dyad conversations. Based on subscale scores, project targets were most frequently met on the Communication Skills subscale and less frequently accomplished on the Meeting Set Up subscale. Despite some challenges, preliminary assessments of SHARE intervention fidelity appear promising, and evidence suggests the fidelity checklist is both valid and reliable.

Recruitment data of the HAPPCAP‐AD (Human‐APPlication Combined Approach for Prevention of Alzheimer’s Disease): a feasibility study

AbstractBackgroundPhysical inactivity, obesity, type 2 diabetes [T2D], hypertension, smoking, and depression, are six major modifiable risk factors for Alzheimer’s disease (AD). While several multi‐domain intervention studies have been completed, mostly in older adults, targeting one or more modifiable risk factor, results have been inconsistent. We designed novel, “real‐life”, feasibility study of a personalized 18‐months intervention for prevention of cognitive decline in middle‐aged individuals at very high AD risk due the presence of at least two modifiable risk factors plus parental family history of AD. Our aims are to explore: 1) The feasibility of our novel approach; 2) Whether our intervention improves AD risk factors and whether greater adherence is associated with larger improvement; and 3) Whether our intervention improves cognition.MethodStudy’s participants are 40‐65 years old cognitively normal offspring of individuals with AD. Participants must have at least two of the six major modifiable AD risk factors. Recruitment goal was 100 participants. Participants were randomized at a 2:1 ratio to the intervention:control arms of the study. The 18‐months intervention combines a smartphone application (app) with study team guidance through phone‐calls, which include advice for risk factors improvement, interactive follow‐up using an app, and feedback on risk factors management for its modification.ResultSince study was launch in 2019, 500 individuals have completed an online eligibility questionnaire. We have achieved the recruitment goal, and 100 participants have been enrolled, with 67 in the intervention group and 33 in the control group. Groups are well‐matched for baseline demographics and AD risk factors (intervention vs control: age‐ 57.3[SE = 0.64]vs.57.0[SE = 0.99]; sex ‐ [% males]30%vs.33%; years of education‐ 17.7[SE = 0.77] vs.17.0[SE = 0.64]; BMI‐ 30.5[SE = 0.63]vs.29.6[SE = 0.59]; % physical inactivity ‐84vs.82; % T2D‐ 15vs.12; % hypertension‐ 27vs.30; % depression‐ 16vs.15; and MMSE‐ 29[SE = 0.17]vs. 29.2[SE = 0.16]; all p&gt;0.05), except for percentage of smokers which was significantly higher in the intervention arm (12vs.3). Additional analyses will be ready by AAIC 2023.ConclusionResults of this study will provide feasibility data on the adherence to the human‐app approach, characteristics of those who adhere, on whether the approach improves risk factors, and will provide initial data on intervention efficacy for cognition.