Health Behaviors Of Patients Research Articles

A survey of comorbidity and health behaviors of diabetic patients in an area of Beijing

Objective By investigating the prevalence of comorbidity and health behaviors among diabetes patients in Beijing, to provide reference for effective health management of diabetic patients. Methods Based on a cross-sectional survey of 10 334 diabetic patients managed by a community health information center in Beijing from 2012 to 2014, the data of 10 334 diabetic patients were analyzed systematically. The common diseases investigated included cardiovascular and cerebrovascular diseases, orthopedic diseases, chronic respiratory/pulmonary diseases, tumors, chronic kidney diseases and other chronic diseases disease. At the same time, the health behaviors of diabetic patients were investigated, including diet behavior, exercise, work intensity, traffic mode, smoking and sleeping. Results ⑴ There were 521 patients with simple diabetes and 9 813 patients with comorbidity. The prevalence of comorbidity was 94.96%. ⑵ There were 6 279 patients with one kind of comorbidity, accounting for 63.99%; 2 726 patients with two kinds of comorbidity, accounting for 27.78%; 808 patients with two or more kinds of comorbidity, accounting for 8.23%; among them, there were 6 153 patients with cardiovascular and cerebrovascular comorbidi-ty, accounting for 62.70%. ⑶ There were significant differences in diet taste preference, whether they often eat unhealthy food, whether the dietary structure is reasonable, intake of tofu and bean products, average daily vegetable, average daily fruit, average daily egg, average daily fish and meat, reduced food intake, regular exercise, exercise mode, duration of each exercise, comprehensive classification of physical activity, other physical exercise, comprehensive score of exercise, working hours per week, walking time to work or shopping, cycling time to work or shopping, transportation for going to work or shopping, walking out in good weather, smoking, sleep difficulties between simple diabetes and comorbidity patients (P<0.05). Conclusions The incidence of diabetic comorbidity is high, among which cardiovascular and cerebrovascular diseases are the most common. There are some differences in diet behavior, exercise, work, transportation and sleep between simple diabetes and comorbidity patients, which may be the cause of comorbidity. Key words: Diabetes mellitus; Comorbidity; Prevalence; Health behavior

Religion and Health Behaviors in Primary Care Patients.

BackgroundFew studies have investigated the association between religion and health behaviors in Korea, where various religions coexist. The present study aimed to investigate the association between religion and health behaviors among primary care patients in Korea.MethodsWe analyzed data from the Family Cohort Study in Primary Care. Among the 1,040 participants in the cohort, 973 of those who had reported their religion were included in the analysis. Participants completed standardized questionnaires that included religious status and lifestyle factors, such as physical activity, smoking status, drinking status, and dietary habits. The association between religion and health behaviors was analyzed using multivariate logistic regression models.ResultsAmong the 973 participants, 345 (35.5%) were Christian, 153 (15.7%) were Roman Catholic, 308 (31.7%) were Buddhist, and 163 (16.8%) did not have any religion. Compared with those without a religion, the odds ratio (OR) for vigorous physical activity (OR, 1.52; 95% confidence interval [CI], 1.01–2.28) increased, and that for binge drinking (OR, 0.67; 95% CI, 0.46–0.78) and problematic drinking (OR, 0.59; 95% CI, 0.35–0.99) decreased among participants with a religion. Compared with those without a religion, Catholics were more likely to engage in vigorous physical activity (OR, 2.20; 95% CI, 1.31–3.67), whereas Christians were less likely to engage in heavy (OR, 0.50; 95% CI, 0.30–0.84), binge (OR, 0.35; 95% CI, 0.22–0.54), and problematic drinking (OR, 0.46; 95% CI, 0.25–0.86). Smoking, meal regularity, and breakfast consumption were not associated with religion.ConclusionThe status of drinking and physical activities were different according to religion. As religion is one of the psychosocial characteristics of patients, knowing patients’ religion can be helpful for primary physicians.

Mobile Apps for Health Behavior Change in Physical Activity, Diet, Drug and Alcohol Use, and Mental Health: Systematic Review

BackgroundWith a growing focus on patient interaction with health management, mobile apps are increasingly used to deliver behavioral health interventions. The large variation in these mobile health apps—their target patient group, health behavior, and behavioral change strategies—has resulted in a large but incohesive body of literature.ObjectiveThis systematic review aimed to assess the effectiveness of mobile apps in improving health behaviors and outcomes and to examine the inclusion and effectiveness of behavior change techniques (BCTs) in mobile health apps.MethodsPubMed, EMBASE, CINAHL, and Web of Science were systematically searched for articles published between 2014 and 2019 that evaluated mobile apps for health behavior change. Two authors independently screened and selected studies according to the eligibility criteria. Data were extracted and the risk of bias was assessed by one reviewer and validated by a second reviewer.ResultsA total of 52 randomized controlled trials met the inclusion criteria and were included in the analysis—37 studies focused on physical activity, diet, or a combination of both, 11 on drug and alcohol use, and 4 on mental health. Participant perceptions were generally positive—only one app was rated as less helpful and satisfactory than the control—and the studies that measured engagement and usability found relatively high study completion rates (mean 83%; n=18, N=39) and ease-of-use ratings (3 significantly better than control, 9/15 rated >70%). However, there was little evidence of changed behavior or health outcomes.ConclusionsThere was no strong evidence in support of the effectiveness of mobile apps in improving health behaviors or outcomes because few studies found significant differences between the app and control groups. Further research is needed to identify the BCTs that are most effective at promoting behavior change. Improved reporting is necessary to accurately evaluate the mobile health app effectiveness and risk of bias.

건강신념모델 기반 중재연구가 당뇨환자의 건강행위와 생리적지표에 미치는 효과를 중심으로 한 체계적 문헌고찰

건강신념모델 기반 중재연구가 당뇨환자의 건강행위와 생리적지표에 미치는 효과를 중심으로 한 체계적 문헌고찰

Oral health and dental behaviour of patients with left ventricular assist device: a cross-sectional study.

AimsThe aim of this cross‐sectional study was the assessment of dental behaviour, oral health, as well as oral health‐related quality of life of patients with left ventricular assist device (LVAD).Methods and resultsPatients (128) with LVAD were recruited from the University Department for Cardiac Surgery at Heart Center, Leipzig, Germany. A healthy control group (HC, n = 113) was included. Dental behaviour was assessed with a standardized questionnaire, and to evaluate oral health‐related quality of life, the German short form of oral health impact profile was applied. The presence of decayed, missing, and filled teeth; dental treatment need; periodontitis severity; and periodontal treatment need were assessed. These findings were correlated to disease‐related and device‐related factors. The minority of patients used aids for interdental hygiene (16.4%). For the LVAD patients, a German short form of oral health impact profile sum score of 4.96 ± 8.67 [0.5; 0–6] was assessed. The LVAD group suffered from more missing teeth (11.91 ± 9.13 vs. 3.70 ± 3.77; P < 0.01) than HC. More severe periodontitis was found in LVAD group (LVAD = 41.4% and HC = 27.4%; P < 0.01). Periodontal treatment need was high in both groups, without a significant difference (LVAD = 84.4% vs. HC = 86.7%; P = 0.71). LVAD therapy as bridge to transplantation was correlated with periodontal treatment need (odds ratio = 11.48 [1.27; 103.86]; P = 0.03). Further correlations between treatment need and disease specific factors were not detected.ConclusionsPatients with LVAD suffer from a high periodontal treatment need and a lack in oral behaviour. Interdisciplinary special care concepts appear recommendable to improve oral health in LVAD patients.

Self-Care Behaviors in Diabetic Type 2 Patients in the countryside of Tabriz, Iran: Application of the Extended Theory of Reasoned Action (ETRA).

Diabetes is a chronic disease that requires a person with diabetes to make a multitude of daily self-management decisions and perform complex care activities. The aim of this study was to explore the determinants of self-care factors among type 2 diabetic patients using the extended theory of reasoned action (ETRA). A cross-sectional study. This study was conducted among 200 patients with type 2 diabetes.To measure self-care behaviors in type 2 diabetic patients, a questionnaire based on the ETRA was used, which included knowledge, subjective norms, attitudes toward the behavior, behavioral intention, and self-efficacy. The overall Structural Equation Modeling (SEM) was applied to identify the determinant structures of behavioral intentions and finally self-care estimated from attitudes, subjective norms and self-efficacy in type 2 diabetic patients. Attitude to self-care behaviors (standardized regression weight=0.322; p<0.001) and self-efficacy (standardized regression weight=0.625; p<0.001) were statistically significant predictors of behavioral intention. Also, of the ETRA variables, only self-efficacy (standardized regression weight=0.482; p=0.001) was significantly predictor of self-care behaviors. Based on our findings, self-efficacy was found effective in improving health behaviors in patients with type 2 diabetes. Therfore, healthcare providers may be considering self-efficacy as an important factor while devoloping educational intervention aiming at improving self-care behaviors among rural farmers type 2 diabetic patients.

The Impact of Online Health Information on Patient Health Behaviours and Making Decisions Concerning Health.

The number of Internet users searching for health-related issues increases significantly every year. The aim of this study was to investigate whether and how the information about health and disease obtained from the Internet by patients influenced them and how different e-health services can affect the patients’ choice of the doctor. The research was based on a national survey conducted among 1000 Polish adults. The study was carried out with the use of the computer-assisted telephone interviews (CATI). The study showed that e-health facilities are increasingly affecting the patient’s choice of doctor. Among the highest rated factors, the possibility of setting the date of appointment online and practice’s own website were indicated. Information on health and disease obtained from the Internet influenced respondents in many areas. Almost half of health Internet users (HI-users) wanted to change their diet and increase healthy physical activity under the influence of health information obtained online. Regarding health decision making, health information obtained from the Internet caused 45% of HI-users to make an appointment to see a doctor, and 40% of them had questions concerning diagnosis and treatment. Information on health and disease obtained from the Internet undoubtedly affects patient behaviour and health decisions they make.

Usage and Scientific Properties of the ADVOCATE Oral Health Care Measures.

Background:Feedback information about the quality of oral health care is important for reflective learning by oral health care professionals and the wider health system. To this end, a list of 48 topics describing oral health and oral health care was recently agreed as part of the EU H2020 ADVOCATE project.Objective:This article reports on the formulation of measures based on the ADVOCATE topics and provides information on usage, reporting, validity, and reliability of the measures.Methods:The AIRE instrument was used to guide the methodological approach adopted. The appropriateness of the measures was tested among 39 general dental practitioners (GDPs) in Denmark, Germany, and the Netherlands. Data were collected from a convenience sample of patients via a questionnaire deployed in an online application in their practice. Feasibility, acceptability, and usefulness of the measures were evaluated through focus group interviews with GDPs. Face validity and test-retest reliability of the measures were assessed.Results:For 46 of the 48 topics, a measure could be defined by constructing a definition and a numerator and denominator. Data collection for all 46 measures was feasible and acceptable for patients using the online questionnaire. The practicalities of using claims data for the purpose of giving feedback to individual and groups of GDPs proved to be challenging in terms of timely access of such data, the granularity of the data, and matching the content of the data with the consented items on quality of oral health care. Face validity was considered appropriate, as the patients found the questionnaire easy to understand. Test-retest reliability was found to be acceptable for 36 of 46 measures.Conclusion:The broad range of the ADVOCATE oral health care measures could make a useful contribution to a more transparent, evidence-based, and patient-centered oral health care system.Knowledge Transfer Statement:This study shows the usage, reliability, and validity of 46 oral health care measures. The measures, which include patient experience and health behaviors, were found to be useful to stimulate discussions about clinical practice. The measures can provide essential information for quality improvement strategies and useful and relevant feedback information for GDPs.

Determinants of health, health behaviours and demographic profile of patients attending an Australian university student-led osteopathy clinic

BackgroundProfiles of health professions practice can inform pre-professional education, provide evidence to assist with interprofessional practice, and inform policy development. An understanding of the profile of patients seeking osteopathy care is emerging. Current research suggests that musculoskeletal presentations predominate with approximately one-third of patients presenting with co-morbid diseases. There is little data on these presentations in Australian osteopathy practice. This study aimed to describe the patient demographics, clinical presentations, health behaviours and determinants of health, including health literacy, of those attending for care at an Australian student-led osteopathy clinic.MethodsA convenience sample design was utilised where consecutive patients presenting for their initial consultation were invited to complete a health information questionnaire during 2016–2017. The questionnaire explored a range of health behaviours and the patient’s health status. Data from the clinical records were also extracted to establish the presenting complaint, duration of the complaint and pertinent demographics. Descriptive statistics were generated for each variable.ResultsData were available for 1617 patients presenting for their initial consultation. The mean age of patients was 33.7 (±13.1) years with 55% (n = 887) identifying as female. Acute presentations predominated (n = 840, 52%), with presentations affecting the spine being the most common (57.8%). Most patients rated their health status as good to very good (75%). Approximately 7.5% of patients were identified as having low health literacy and 55.9% were currently suffering from one or more co-morbid presentations.ConclusionsThe demographic profile and presenting complaints of patients presenting to a student-led osteopathy clinic are largely consistent with other Australian private practice profiles. The current work also identified co-morbid presentations, and positive and negative health behaviours. Osteopaths may play a role in the management of, or referral for, these presentations where health behaviours require change, or management of co-morbid conditions is beyond the scope of practice. The increasing volume of patient profile literature globally suggests that osteopaths can play a substantial role in the management of musculoskeletal complaints. Further, osteopathy may play a role in screening determinants of health, and engage in multidisciplinary care to ensure those patients with co-morbid conditions or adverse health behaviours are managed appropriately.

Effects of a Comprehensive Reminder System Based on the Health Belief Model for Patients Who Have Had a Stroke on Health Behaviors, Blood Pressure, Disability, and Recurrence From Baseline to 6 Months: A Randomized Controlled Trial.

The health behaviors and blood pressure control of patients with hypertension who have had a stroke are unsatisfactory. A protocol of a comprehensive reminder system has been published, and the results of 3 months of implementation have demonstrated improved patient health behaviors and blood pressure control. The continuity of the intervention effect on these variables after 3 months was not clear. The aim of this study was to determine the impact of a comprehensive reminder system intervention on health behaviors, medication adherence, blood pressure, disability, and stroke recurrence in patients with hypertension who have had a stroke from baseline to 6 months after discharge. A multicenter, assessor-blinded, randomized controlled trial was conducted with 174 patients with hypertension who have had a stroke. The intervention consisted of health belief education, a calendar handbook, weekly short message services, and telephone interviews. Data were collected at baseline and at 3 and 6 months after discharge. Repeated-measures analysis of variance and single-effect analysis revealed that, compared with the control group, improvements of health behaviors, medication adherence, blood pressure, and disability of participants in the intervention group were superior. From 3 to 6 months after discharge, these trends remained or continually improved, whereas a downward trend was observed in the control group. There were only 2 stroke recurrences within 6 months, and no statistically significant difference between groups was found. The comprehensive reminder system improved patients' health behaviors and medication adherence and reduced blood pressure and disability; the effect extended to 6 months after discharge.

Изменение образа жизни пациента как задача психологической реабилитации: организация реабилитации как совместной деятельности на личностном и межличностном уровнях

Development of health behavior in patients is an important task of psychological rehabilitation. The models of behavior change and their application in psychological rehabilitation are analyzed. We discuss applications of the PROCEED–PROCEED model to the evaluation of rehabilitation. The value of the model is in the possibility to operationalize and formalize assessment of the effectiveness of the organization of rehabilitation. Based on interdependence theory the importance of achieving consistency of rehabilitation goals and the gradual transformation of expectations is discussed. The effectiveness of rehabilitation and the possibility of patient's behavior change at early stage are associated with the formation of interpersonal relationships that are consistent with the expectations of the patient and his family. The lifestyle changes and active participation of the patient in rehabilitation can only be provided by the transformation of one’s relations with specialists. Subsequently, this interaction has to be reconstructed in the direction of greater participation and responsibility of the patient.

Loneliness and Migraine Self-Management: A Cross-Sectional Assessment.

Background: Chronic illness is often comorbid with the psychological state of loneliness. Models of care for patients who experience chronic migraines may often lack an understanding of psychosocial influences of the illness. Addressing the effects of loneliness on the health behaviors of chronic migraine patients may further elucidate gaps in care that exist beyond the biomedical approach to migraine treatment. The primary aim of this study was to assess the relationship between loneliness and behavioral health decisions in chronic migraine patients, specifically patient ability to self-manage, and effectiveness of treatments. Methods: We conducted a cross-sectional survey among patients (n = 500) with migraine and assessed for the experience of loneliness by using the University of California, Los Angeles–Revised (UCLA-R) Three-item Loneliness Scale and the extent of migraine-related disability via the Migraine Disability Assessment (MIDAS). Furthermore, we evaluated patients for their ability to self-manage their migraines, and perceived effectiveness of treatment. Results: Nearly half of our population reported at least one measure of loneliness (230/500, 46.0%). Patients experiencing chronic migraine were statistically more likely to report feeling lonely when compared to patients with episodic migraines (P < .001). Patients who report loneliness had lower odds of feeling ’very satisfied” with their ability to self-manage their migraine symptoms (aOR = 0.34, 95% CI 0.14-0.81) and had lower odds of feeling “very satisfied” with their ability to avoid conditions that cause their headache (aOR = 0.39, 95% CI 0.16-0.91). Conclusions: Loneliness has significant effects on the illness experience of patients with chronic migraines, including their ability to self-manage or be satisfied with their current state of care. Psychosocial models of care that address loneliness among patients with chronic migraine may help improve health outcomes and management.

Factors Affecting Particulate Matter-Related Health Behaviors of Patients with Pulmonary Disease

Factors Affecting Particulate Matter-Related Health Behaviors of Patients with Pulmonary Disease

Factors Affecting Health Behavior of Patients with Stroke: Focusing on Health Literacy of Patients and Family Caregivers

Factors Affecting Health Behavior of Patients with Stroke: Focusing on Health Literacy of Patients and Family Caregivers

Level of health behaviours of HCV infected patients treated with dialysotherapy

Introduction. Hepatitis C virus (HCV) infection is one of the greatest epidemiological risks worldwide (3% infected globally). Dialysis patients are the group at high risk of infections transmitted via blood, are often infected with HCV virus, and suffer from acute or chronic hepatitis. Anti-health behaviours enhance the process of liver fibrosis. The objective of the study was recognition of the level of health behaviours in HCV-infected haemodialysis patients. Materials and Method. The study included 149 adult patients on dialysis infected with HCV, hospitalized in two dialysotherapy centres: the Military Medical Institute and Clinical Hospital in Warsaw. In the study there also participated family members and acquaintances of students of the Higher School in Radom. The study was conducted during the first half of 2017 by a diagnostic survey, using research instrument Health Behaviours Inventory (HBI) according to Z. Juczyński. The questionnaire concerned: eating habits, prophylactic behaviours, everyday health practice, and positive psychological attitude.Results. 73.8% of respondents presented a high level of health behaviours (7–10 sten scores), mediocre - 19.5% (5–6 sten scores), and low – 6.7% (1–4 sten scores). The highest mean value evidencing health promoting life style of the patients was observed with respect to prophylactic behaviours (4.0±0.4), while eating habits and health practices were on the level 3.9±0.4-0.5. The lowest value indicating the least pro-health behaviours concerned positive psychological attitude (3.7±0.4). Conclusions. The overall rate of health behaviours of dialysed HCV patients was high. The dominant category was prophylactic behaviours, whereas the lowest results were obtained with respect to positive psychological attitude. The respondents infected with HCV for longer than 10 years, mainly males, those aged 60-84, with primary vocational education, living in rural areas, and non-active occupationally, had the greatest needs for psychotherapy. It is necessary to provide psychological support for dialysis patients infected with HCV.

Level of health behaviours of HCV infected patients treated with dialysotherapy

Level of health behaviours of HCV infected patients treated with dialysotherapy

Influence of Disease-related Knowledge, Depression, and Family Support on Health Behaviors in Older Patients with Coronary Artery Disease

Purpose The purpose of this study was to identify the degrees and relationships of disease-related knowledge, depression, family support and health behaviors of older patients with coronary artery disease, and the factors influencing their health behaviors. Methods The subjects included 139 older patients with coronary artery disease who visited the outpatient clinic at one general hospital located in metropolitan city B. Data collection was performed from December, 2018 to February, 2019, using a structured self-reported questionnaire. Descriptive statistics, t-test, one-way ANOVA, Pearson correlation coefficients, and multiple linear regression were used to analyze the data. Results Disease-related knowledge (r=-.17, p=.050) and depression (r=-.32, p<.001) had significant negative correlations with health behaviors. While, a significant positive correlation was noted between family support and health behaviors (r=.67, p<.001). In the final multiple regression analysis, medication intake status (β=-.17, p=.009), depression (β=-.15, p=.017) and family support (β=.61, p<.001) significantly influenced health behaviors of the subjects. The explanatory power of the subjects’ medication intake status, disease-related knowledge, depression and family support on health behaviors was 49.0% (F=33.97, p<.001). Conclusion Developing an effective program to improving medication status, depression, and family support is recommended for the enhancement of their health behaviors and ultimately for their recovery and well-being. 주요어: 관상동맥질환, 지식, 우울, ì‚¬íšŒì  지지, 건강행위 Key Words: Coronary artery disease, Knowledge, Depression, Social support, Health behavior

FACTORS INFLUENCING HEALTH BEHAVIORS OF KOREAN OLDER ADULTS WITH CORONARY ARTERY DISEASE

Purpose: The purpose of this study was to examine the effects of disease-related knowledge, depression, and family support on health behaviors of older patients with coronary artery disease. Methods: The subjects were 139 older patients with coronary artery disease who had visited the internal medicine outpatient clinic at one general hospital located in metropolitan city B, Korea. A set of self-reported questionnaire was administered to assess general characteristics, disease-related knowledge, depression, family support, and health behaviors of the subjects. Collected data was analyzed using descriptive statistics, t-tests, one-way ANOVA, Pearson correlation coefficients, and multiple regression. Results: The mean (±SD) age of the subjects was 70.86 (±4.70) years. Health behaviors of the subjects had significant negative correlations with disease-related knowledge (r=-.17, p=.050) and depression (r=-.32, p<.001) while having a significant positive correlation with family support (r=.67, p<.001). In the final multiple regression analysis, factors influencing health behaviors of subjects were medication intake status (β=-.17, p=.009), depression (β=-.15, p=.017) and family support (β=.61, p<.001). The explanatory power of the subjects’ medication intake status, disease-related knowledge, depression and family support on health behaviors was 48.9% (F=33.97, p<.001). Conclusion: Medication intake status, depression, and family support had significant influences on health behaviors of older patients with coronary artery disease. Improvements in medication intake, depression, and family support for older patients with coronary artery disease may be beneficial for their health behaviors, and ultimately, have a positive effect on their recovery from the disease and well-being.

Identifying Frameworks for Validation and Monitoring of Consensual Behavioral Intervention Technologies: Narrative Review.

BackgroundChanging health behaviors, such as smoking, unhealthy eating, inactivity, and alcohol abuse, may have a greater impact on population health than any curative strategy. One of the suggested strategies is the use of behavioral intervention technologies (BITs). They open up new opportunities in the area of prevention and therapy and have begun to show benefits in the durable change of health behaviors in patients or those at risk. A consensual and international paradigm was adopted by health authorities for drugs 50 years ago. It guides their development from research units to their authorization and surveillance. BITs’ generalization brings into question their upstream evaluation before being placed on the market and their downstream monitoring once on the market; this is especially the case in view of the marketing information provided by manufacturers and the scarcity and methodological limits of scientific studies on these tools.ObjectiveThis study aims to identify and categorize the frameworks for the validation and monitoring of BITs proposed in the literature.MethodsWe conducted a narrative literature review using MEDLINE, PsycINFO, and Web of Science. The review items included the following: name, publication year, name of the creator (ie, first author), country, funding organization, health focus, target group, and design (ie, linear, iterative, evolutive, and/or concurrent). The frameworks were then categorized based on (1) translational research thanks to a continuum of steps and (2) the three paradigms that may have inspired the frameworks: biomedical, engineering, and/or behavioral.ResultsWe identified 46 frameworks besides the classic US Food and Drug Administration (FDA) five-phase drug development model. A total of 57% (26/46) of frameworks were created in the 2010s and 61% (28/46) involved the final user in an early and systematic way. A total of 4% (2/46) of frameworks had a linear-only sequence of their phases, 37% (17/46) had a linear and iterative structure, 33% (15/46) added an evolutive structure, and 24% (11/46) were associated with a parallel process. Only 12 out of 46 (26%) frameworks covered the continuum of steps and 12 (26%) relied on the three paradigms.ConclusionsTo date, 46 frameworks of BIT validation and surveillance coexist, besides the classic FDA five-phase drug development model, without the predominance of one of them or convergence in a consensual model. Their number has increased exponentially in the last three decades. Three dangerous scenarios are possible: (1) anarchic continuous development of BITs that depend on companies amalgamating health benefits and usability (ie, user experience, data security, and ergonomics) and limiting implementation to several countries; (2) the movement toward the type of framework for drug evaluation centered on establishing its effectiveness before marketing authorization to guarantee its safety for users, which is heavy and costly; and (3) the implementation of a framework reliant on big data analysis based on a posteriori research and an autoregulation of a market, but that does not address the safety risk for the health user, as the market will not regulate safety or efficacy issues. This paper recommends convergence toward an international validation and surveillance framework based on the specificities of BITs, not equivalent to medical devices, to guarantee their effectiveness and safety for users.

Control of cardiovascular risk factors and health behaviors in patients post acute coronary syndromes eligible for protein convertase subtilisin/kexin-9 inhibitors

BackgroundWe aimed to examine cardiovascular risk factors and health behaviors in patients with acute coronary syndromes (ACS) according to potential extension of eligibility criteria for protein convertase subtilisin/kexin-9 inhibitors (PCSK9i) to all patients with low-density lipoprotein cholesterol (LDL-c) equal or above 1.8 mmol/l. MethodsIn this prospective cross-sectional study, patients with ACS between 2009 and 2016 and with available LDL-c at one year were considered. We defined three mutually exclusive groups of patients according to eligibility for PCSK9i: “not eligible”, “currently eligible”, and “newly eligible”. We explored the control of cardiovascular risk factors and health behaviors. ResultsOut of 3025 patients who had an ACS one year ago, 1071 (35.4%) were not eligible for PCSK9i, 415 (13.7%) were currently eligible, and 1539 (50.9%) were newly eligible. The proportion of patients with uncontrolled hypertension in the not eligible group was lower than in the group currently eligible (27.6% vs 33.6%, p = 0.02), but similar to the group newly eligible (27.6% vs 28.2%, p = 0.73). The proportion of smokers in the not eligible group was lower than in the group currently eligible (21.2% vs 28.0%, p = 0.02), but similar to the group newly eligible (21.2% vs 22.5%, p = 0.51). ConclusionsMore than half of patients with ACS would be additionally eligible for PCSK9i if prescription is extended from current guidelines to all patients with LDL-c equal or above 1.8 mmol/l. Patients currently eligible for PCSK9i one year after an ACS had a worst control of cardiovascular risk factors than patients potentially newly eligible.