High Adherence Group Research Articles

Medication non-adherence in acute coronary syndrome patients in Duhok, Iraqi Kurdistan

Background: Adherence to long-term secondary preventive therapies is vital for improving outcomes in patients recovering from acute coronary syndrome (ACS). This study aims to quantify the extent of non-adherence to these therapies in Iraq and identify the main factors contributing to this issue, addressing a research gap in the Eastern Mediterranean region. Methods: This cross-sectional study was conducted from June 2023 to March 2024 in Cardiology Ward of Azadi Teaching Hospital and the Duhok Heart Center, Duhok, Kurdistan Region of Iraq, enrolling 400 patients diagnosed with (ACS). The Adherence in Chronic Diseases Scale (ACDS) was utilized to categorize patients into high, intermediate, or low adherence groups. The study questionnaire comprised three sections including clinicodemographic data, adherence assessment based on the ACDS, and patient-reported reasons for non-adherence. Results: The study revealed that the mean age of the participants was 65.78 ± 11.8 years. Within the sample, 24% reported low adherence, 39% reported medium adherence, and only 37% exhibited high adherence. Significant associations were observed between low adherence and older age (P = 0.026), lower education levels (P = 0.0051), and the presence of endocrine disorders (P = 0.029). Conversely, higher adherence was found among patients taking 3–5 different medication classes (P = 0.0003) and those who underwent coronary interventions (P = 0.014). The primary reason for non-adherence was forgetfulness (89.5%). Conclusion: The study concludes that a substantial portion of ACS patients in Iraq show low adherence to secondary preventive therapies. To increase adherence among patients with ACS, strategies should be developed to improve medication adherence and promote healthy behaviors simultaneously, Forgetfulness and lack of follow-up are the primary reasons for non-adherence.

The Relationship Between a Mediterranean Diet and Frailty in Older Adults: NHANES 2007-2017.

Frailty is a geriatric syndrome of significant public health concern that causes vulnerability to physiologic stressors and an increased risk of mortality and hospitalizations. Dietary intake and quality are contributing factors to the development of frailty. The Mediterranean diet is known to be one of the healthiest eating patterns with promising health impacts for prevention. We evaluated the association between Mediterranean diet patterns and frailty status. We conducted a cross-sectional study using National Health and Nutrition Examination Survey data from 2007 to 2017. We included 7300 participants aged > 60 years who completed the first day of a 24 h diet recall and had full covariate data. We constructed an alternate Mediterranean diet (aMED) score based on the quantity of specific food-group intake and categorized participants to low-, moderate-, and high-adherence groups (aMED adherence scores of 0-2, 3-4, and 5-9, respectively). Using a modified Fried Frailty phenotype (weakness, low physical activity, exhaustion, slow walking speed, and weight loss), participants were categorized as robust (met no criteria), pre-frail (met one or two criteria), and frail (met three or more criteria). Logistic regression evaluated the association of frailty (prefrail/robust as referent) and aMED adherence. Included participants were mainly female (54.5%) and non-Hispanic White (80.0%). The mean (SD) aMED score was 3.6 (1.6) with 45% of participants falling into moderate aMED adherence (26% low adherence, 30% high adherence). Frailty prevalence among participants was 7.1%, with most participants classified as robust (51.0%) or pre-frail (41.9%). Fully adjusted models showed significantly reduced odds of frailty with moderate-adherence and high-adherence groups (odds ratio (95%CI) of 0.71 (0.55, 0.92) and 0.52 (0.36, 0.75), respectively). Mediterranean diet adherence is associated with decreased odds of frailty in older adults. These findings suggest that adherence to a Mediterranean diet may play a critical role in mitigating frailty and its associated conditions. Future research should include longitudinal and interventional studies that can definitively determine the effect of a Mediterranean diet on frailty and what food components provide the greatest benefit.

Effects of exercise on patients with vascular cognitive impairment based on ACSM recommendations: a systematic review of randomized controlled trials.

Exercise is considered to be an effective method for functional recovery in patients with vascular cognitive impairment (VCI), but there is a paucity of research on exercise dosage. There has been no meta-analysis of the effects of exercise therapy for vascular cognitive impairment based on the American College of Sports Medicine (ACSM) exercise prescription for a seemingly healthy population. We therefore conducted a study to analyze the effects of various exercise therapies on cognitive functioning, physical functioning, and ability to perform activities of daily living in patients diagnosed with vascular cognitive impairment. Four electronic databases, namely PubMed, Embase, Web of Science, and Cochrane, were systematically searched for studies examining the effects of exercise on patients with VCI. The exercise interventions were categorized into an ACSM high adherence group versus an ACSM low or indeterminate adherence group, following the recommendations for exercise testing and prescribing for seemingly healthy populations developed by ACSM. Meta-analyses were conducted using a random effects model to compare results among subgroups. The study encompassed 14 trials involving 1333 subjects. Among these, 8 studies adhered highly to ACSM recommendations, while 6 studies demonstrated low or uncertain adherence. Subgroup analyses revealed differing effects: in the high adherence group, SMDs for cognitive functioning, living ability, and physical functioning were 0.53 (95% CI 0.13-0.94), 0.53 (95% CI 0.11-0.94), and 0.66 (95% CI 0.45-0.87), respectively. Conversely, in the low or indeterminate adherence group, SMDs for cognitive functioning, living ability, and physical functioning were 0.09 (95% CI -0.13 to 0.32), -0.11 (95% CI -0.57 to 0.34), and 0.65 (95% CI -0.04 to 1.35). We performed subgroup analyses by type of vascular cognitive impairment, and meta-analyses showed positive SMDs of 0.59 (95% CI 0.22-0.97) and 0.68 (95% CI 0.47-0.90) for exercise on cognitive impairment after stroke in terms of cognitive function and physical function, respectively. The results suggest that exercise interventions exhibiting high adherence to ACSM guidelines yield more favorable outcomes concerning cognitive functioning, physical functioning, and daily living abilities among patients with VCI compared to interventions with low or uncertain adherence to ACSM recommendations.

Association between the EAT-Lancet Diet, Incidence of Cardiovascular Events, and All-Cause Mortality: Results from a Swiss Cohort.

An unhealthy diet is a major contributor to several noncommunicable diseases, including cardiovascular diseases, the leading cause of death worldwide. Additionally, our food system has significant impacts on the environment. The EAT-Lancet Commission has recommended a healthy diet that preserves global environmental resources. This prospective study aimed to evaluate the associations between adherence to the EAT-Lancet diet and the incidence of cardiovascular events and all-cause mortality in a Swiss cohort. We analyzed data from the CoLaus/PsyCoLaus cohort study (N = 3866). Dietary intake was assessed using a semiquantitative food frequency questionnaire. The EAT-Lancet adherence score was calculated based on the recommended intake and reference intervals of 12 food components, ranging from 0 to 39 points. Participants were categorized into low-adherence, medium- adherence, and high-adherence groups according to score tertiles. We used Cox Proportional Hazards regressions to assess the association among diet adherence, incident cardiovascular events, and all-cause mortality. During a mean follow-up of 7.9 y (SD: ±2.0 y), 294 individuals (7.6%) from our initial sample experienced a first cardiovascular event, and 264 (6.8%) died. Compared with the low-adherence group, the adjusted hazard ratios for all-cause mortality were 0.88 (95% CI: 0.66, 1.17) and 0.70 (95% CI: 0.49, 0.98) for the medium-adherence and high-adherence groups, respectively (P-trend = 0.04). We observed no association between adherence groups and cardiovascular events. In a Swiss cohort, high adherence to the EAT-Lancet diet is associated with a potential 30% lower risk of overall mortality. However, EAT-Lancet diet is not associated with cardiovascular events.

Impact of Mediterranean Diet Adherence on the Incidence of New-Onset Hypertension in Adults With Obesity in Korea: A Nationwide Cohort Study.

This study investigated the association between adherence to the Mediterranean diet (MD) and new-onset hypertension (HTN) in a cohort of community-dwelling, middle-aged, older Korean individuals with obesity. We used data from the Korean Genome and Epidemiology Study, a population-based prospective cohort study. The Korean version of the MD Adherence Screener was used to evaluate compliance with the MD. The primary endpoint was the incidence of new-onset HTN. Cox proportional hazard models were used to estimate the hazard ratio (HR) and 95% confidence interval for HTN incidence with increasing MD adherence. Data from 1995 participants with obesity without HTN at baseline were analyzed. After adjusting for confounders, participants with moderate (Group 2) and high adherence (Group 3) to the MD had HRs for new-onset HTN of 0.72 (0.57-0.90) and 0.73 (0.56-0.95), respectively, compared with those with low adherence (Group 1). Sex and age differences were associated with MD adherence and HTN incidence. The association between MD adherence and HTN incidence was only significant in males and in participants aged 40-64years. There was no significant association between MD adherence and new-onset HTN in females or those aged ≥ 65years. In conclusion, this study found a significant association between adherence to the MD and a reduction in new-onset HTN in Korean adults with obesity. Considering its value and sustainability, the adoption of the MD may contribute to the prevention of new-onset HTN in populations with obesity.

Mediterranean Diet and Olive Oil Redox Interactions on Lactate Dehydrogenase Mediated by Gut Oscillibacter in Patients with Long-COVID-19 Syndrome.

Chronic viral inflammation is associated with oxidative stress and changes in gut microbiota. The Mediterranean diet (MD), with recognized anti-inflammatory and antioxidant properties, modulates gut microorganisms, specifically on the interaction between extra virgin olive oil, a key component of the MD with well-documented antioxidant effects. This study investigated the influence of adherence to MD and antioxidant-rich foods (extra virgin olive oil) on biochemical, inflammatory, and microbiota profiles in patients with chronic inflammation defined as a prolonged inflammatory response due to immune dysregulation following the acute phase of the viral infection. Participants were classified into low (n = 54) and high (n = 134) MD adherence groups (cut-off of 7 points based on previous studies utilizing the same threshold in the assessment of MD adherence). Gut microbiota was sequenced using the 16S technique, and the adherence to MD was assessed using a validated questionnaire for a Spanish population. High adherence to the MD was linked to significant improvements in inflammatory and oxidative stress markers, including reductions in LDL-cholesterol, glucose, and lactate dehydrogenase (LDH) levels, an indicative of redox balance, as well as a significant higher consumption of antioxidant foods. Moreover, gut microbiota analysis revealed distinct compositional shifts and a lower abundance of the Oscillibacter genus in the high adherence group. Notably, a significant interaction was observed between MD adherence and extra virgin olive oil consumption, with Oscillibacter abundance influencing LDH levels, suggesting that the MD antioxidant properties may modulate inflammation through gut microbiota-mediated mechanisms. These findings provide new evidence that adherence to the Mediterranean diet can reduce inflammatory markers in patients with long-COVID-19, a population that has not been extensively studied, while also highlighting the potential role of the bacterial genus Oscillibacter in modulating this effect.

Mediterranean diet score linked to cognitive functioning in women: evidence from the Czech Republic

Abstract Background Evidence suggests that adherence to the Mediterranean diet (MED) may be beneficial in preventing cognitive decline, although findings are inconsistent. We aimed to explore this association in the Czech population of older adults. Methods A total of 6,028 males and females from the Czech arm of the Health Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) study were included in the analysis. Dietary data were collected using a food frequency questionnaire, and MED was calculated based on nine food groups. The MED score ranged from 0 to 16 points and was categorized into three groups: 0-7, 8-10, and 11-16 points. Cognitive function was measured using four tests assessing verbal memory and learning, verbal fluency, and attention, mental speed and concentration, from which single z-scores were computed. The composite score of cognitive function was computed as the mean of z-scores. The cross-sectional associations between MED and composite score of cognitive function were analyzed using multivariate linear regression. Results Females with a dietary score of 8-10 points (Beta=0.05, 95% CI: -0.002; 0.097), and those with a score of 11-16 points (Beta=0.08, 95% CI: 0.016; 0.140) had a higher composite cognitive score than women in lowest adherence group. Looking at specific domains, women in the highest adherence group had significantly better immediate verbal memory (Beta=0.12, 95% CI: 0.031; 0.205) and delayed recall (Beta=0.12, 95% CI: 0.027; 0.212), respectively, than those in the lowest adherence group. There were no associations in males. Conclusions Higher adherence to the MED was associated with better cognitive functioning in verbal memory and composite cognitive score in Czech females. The results suggest that the Mediterranean diet may help to improve cognitive functioning in older women. #NGEU Key messages • Findings suggest that Mediterranean diet may be beneficial in cognitive functioning in older women. • Higher adherence to the Mediterranean diet is connected to better cognitive function particularly in verbal memory domain.

Psychometric evaluation of the Adelphi Adherence Questionnaire (ADAQ©) in adults with osteoarthritis

BackgroundMedication non-adherence is a common issue in chronic illness. The World Health Organization has recognized a need for a valid and reliable method of measuring adherence to understand and mitigate non-adherence. This study aimed to psychometrically evaluate the English version of the Adelphi Adherence Questionnaire (ADAQ©), a questionnaire designed to assess patient-reported medication adherence across multiple therapy areas, in patients with Osteoarthritis (OA).MethodologyData from the Adelphi OA Disease Specific Programme™, a survey of physicians and their consulting adult patients with OA conducted in the United States, November 2020 to March 2021, was used to assess the psychometric properties of the ADAQ. Patients completed the ADAQ, Adherence to Refills and Medication Scale (ARMS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and EQ-5D-3L. The measurement model of the 13-item ADAQ was assessed and refined using latent variable modelling (Multiple Indicator Multiple Cause, confirmatory and exploratory factor analyses, item response theory, Mokken scaling, and bifactor analyses). Correlational analyses (Spearman’s rank and polyserial as appropriate) with ARMS, WOMAC, and EQ-5D-3L scores assessed construct validity. Anchor- and distribution-based analyses were performed to estimate between-group clinically important differences (CID).ResultsOverall, 723 patients were included in this analysis (54.5% female, 69.0% aged ≥ 60). Latent variable modelling indicated a unidimensional reflective model was appropriate, with a bifactor model confirming an 11-item essentially unidimensional score. Items 12 and 13 were excluded from scoring as they measured a different concept. The ADAQ had high internal reliability with omega hierarchical and Cronbach’s alpha coefficients of 0.89 and 0.97, respectively. Convergent validity was supported by moderate correlations with items of the ARMS, and physician-reported adherence and compliance. Mean differences in ADAQ score between high and low adherence groups yielded CID estimates between 0.49 and 1.05 points, with a correlation-weighted average of 0.81 points.ConclusionThis scoring model showed strong construct validity and internal consistency reliability when assessing medication adherence in OA. Future work should focus on confirming validity across a range of disease areas.

A high adherence level to nutritional recommendations minimizes protein and minerals loss while maximizes visceral fat loss in bariatric surgery patients

BackgroundMetabolic bariatric surgeries are considered the finest and most appropriate treatment option for patients with severe obesity. Besides the surgical procedure, many factors appear to be associated with improved postoperative outcomes such as compliance to the postoperative diet and supplementation, regular physical activity, medical and nutritional follow-up, and modifications in dietary habits. The objectives of this study were to investigate the effect of adherence to postoperative recommendations on anthropometric measurements and body composition and assess the percentage of total weight loss (%TWL) and excess weight loss (%EWL) 3 months postoperative. MethodsFifty-two participants who underwent a Roux-en-Y gastric bypass or sleeve gastrectomy were included. Participants have filled out a preoperative questionnaire. Anthropometric measurements were obtained preoperative and 3 months postoperative using a Body Impedance Analyzer (Inbody 270). The adherence to postoperative recommendations was assessed by the Bariatric Surgery Self-management Questionnaire 3 months postoperative and classified to 3 adherence levels. ResultsMost anthropometric measurements decreased 3 months postoperative in the 3 adherence groups (P ≤ .05). No significant differences were observed between groups in anthropometric measurements and body composition, except for minerals and visceral fat levels. The mineral loss has decreased in both the high and intermediate adherence groups (−.09 ± .22 kg, and −.09 ± .18 kg, respectively). Also, the high adherence group showed less loss in protein amount postoperatively (P = .06). Visceral fat level decreased in the high adherence group (P ≤ .05). ConclusionsAdherence to postoperative behavioral and nutritional recommendations was associated with less protein and mineral loss and enhanced visceral fat reduction postoperatively.

Trajectories of Adherence to Oral Pre-exposure Prophylaxis and Risks of HIV and Sexually Transmitted Infections.

Pre-exposure prophylaxis (PrEP) effectiveness is highly dependent on medication adherence, which is associated with differential HIV risks and possibly sexually transmitted infection (STI). This retrospective cohort study of PrEP users (01/01/2012-12/31/2021) used the MarketScan database of commercially insured enrollees to examine PrEP adherence trajectory groups' associations with HIV and STI acquisition risks. Distinct PrEP adherence trajectories were identified by group-based trajectory modeling among individuals who used oral PrEP. The primary outcome was HIV acquisition incidence, and secondary was STI rate, compared among trajectory groups. Inverse probability treatment weighting time-varying Cox proportional hazards models assessed HIV acquisition, and Poisson regression models assessed STI. Among 23 258 oral PrEP users, 4 distinct PrEP adherence patterns were identified: minimal use (10.5% of the cohort), rapidly declining (25.4%), gradually declining (24.3%), and consistently high (39.8%). Compared with the minimal use group, the gradually declining (adjusted hazard ratio [AHR], 0.53; 95% CI, 0.31-0.90) and consistently high (AHR, 0.50; 95% CI, 0.30-0.84) PrEP adherence groups showed decreased HIV incidence risks. Compared with the minimal use group, the rapidly declining (adjusted incidence rate ratio [AIRR], 1.35; 95% CI, 1.07-1.72), gradually declining (AIRR, 1.73; 95% CI, 1.38-2.18), and consistently high (AIRR, 2.06; 95% CI, 1.64-2.58) groups were associated with increased STI risk. These findings underscore the benefits of continuing and remaining adherent to PrEP and may also inform public health strategies, clinical guidelines, and interventions aimed at maximizing the effectiveness of PrEP in reducing new HIV infections while developing targeted strategies to prevent STIs with PrEP use.

Correlation of mediterranean diet pattern and lifestyle factors with semen quality of men attending fertility clinics: A cross-sectional study

BackgroundWhile numerous studies have examined the impact of individual or combined nutrients on semen quality, research on the correlation between overall dietary patterns and semen quality remains limited. This cross-sectional study investigates the relationship between adherence to the alternative Mediterranean diet (aMED) and semen quality. MethodsA total of 274 men, presenting with both normal and abnormal semen parameters, participated in this study. Dietary data were collected using a 147-item semi-quantitative food frequency questionnaire (FFQ). Participants were divided into three groups based on their adherence to the Mediterranean diet (T1, T2, and T3). Statistical analyses, including ANOVA for numerical data and Chi-square tests for categorical data, were conducted. Multivariable logistic regression models were employed to estimate the association between aMED scores and abnormal semen parameters. ResultsParticipants in the highest adherence group (T3) were younger and had lower BMI compared to those in the other tertiles. Significant differences in sperm parameters were observed across the tertiles. T3 recorded the highest levels of sperm concentration, total sperm count, motility, progressive motility, and normal morphology (57.53 ± 36.16, 213.8 ± 158.9, 73.4 ± 25.9, 61.2 ± 24.6, and 6.42 ± 1.51, respectively), whereas T1 had the lowest values (11.92 ± 22.29, 43.3 ± 73.8, 36.7 ± 33.8, 4.6 ± 5.7, respectively). No significant differences were found in semen volume and viscosity. The regression analysis revealed a significant positive correlation between aMED scores and sperm concentration (B = 1.32, P = 0.001), total sperm count (B = 1.12, P = 0.001), and total motility (B = 0.71, P = 0.001). ConclusionAdherence to a high-quality Mediterranean diet is positively associated with improved semen quality and increased male fertility potential. Promoting healthy dietary patterns may be an effective strategy to enhance sperm motility and overall male reproductive health.

The effects of ACSM-based exercise on breast cancer-related lymphoedema: a systematic review and meta-analysis.

Breast cancer-related lymphedema (BCRL) frequently occurs after axillary lymph node dissection and remains incurable even with lymphaticovenular anastomosis. Exercise interventions have emerged as a potential non-pharmacological management approach. However, standardized exercise recommendations tailored to BCRL patients are lacking. This study evaluated the impact of high and low compliance exercise interventions, aligned with ACSM recommendations, on quality of life (QOL), shoulder range of motion (ROM), and arm volume in BCRL patients. It further aimed to determine the optimal exercise dosage, assessed via the FITT (frequency, intensity, time, type) principle, that maximizes health benefits for BCRL patients. Adhering to the PRISMA guidelines for systematic reviews and meta-analyses, we conducted a comprehensive literature search in various databases, including PubMed, Embase, Cochrane Library, and Web of Science, encompassing the period from the inception of these databases to December 2023. We extracted data on exercise form, frequency, intensity, duration, repetitions, and sets from the identified studies. Subsequently, a meta-analysis and review were conducted. The exercise interventions were evaluated based on ACSM recommendations and categorized as either high or low compliance with ACSM standards. Fixed or random effects models were employed to compare outcomes across study subgroups with comparable results. Additionally, funnel plot analyses, sensitivity analyses, and Egger's and Begg's tests were conducted to evaluate the potential for bias. 15 studies encompassing 863 patients with BCRL were analyzed. Eleven studies exhibited high ACSM compliance, while four demonstrated low ACSM compliance. Regarding QOL, the overall standard mean difference (SMD) was 0.13 (95% CI: -1.07, 1.33). Specifically, the SMD for the high-adherence subgroup was 0.91 (95% CI: 0.33, 1.49; p = 0.002). For ROM, the overall SMD was 1.21 (95% CI: -0.19, 2.61). For arm volume, the overall SMD was -0.06 (95% CI: -0.22, 0.10). QOL results differed significantly in the high-adherence subgroup, whereas no significant effect on ROM or arm volume was observed. The study revealed significant QOL improvements in patients with high ACSM compliance, contrasted with those with low compliance. Conversely, no notable changes in ROM or arm volume were observed. Notably, the high adherence group tended to show better ROM during exercise and stable arm volume. Future research is needed to validate these findings.

National Implementation of CPAP Telemonitoring and a Pay-for-performance Scheme for Homecare Providers in France Leads to Prioritisation of Resources to Individuals with Low Therapy Adherence: The IMPACT-PAP Cohort Study

IntroductionLong-term adherence to continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea remains suboptimal and low adherence increases healthcare costs. This study investigated relationships between CPAP adherence and the intensity of support provided by homecare providers after implementation of telemonitoring and pay-for-performance reimbursement for CPAP in France. MethodsAdults who started CPAP in 2018/2019, used telemonitoring, and had ≥1 year of homecare provider data were eligible. The main objective was to determine associations between CPAP adherence at 1 month (low [<2h/night], intermediate [2 to <4h/night], high [≥4h/night]) and the number/type of homecare provider interactions (home visits, phone calls, mask change) during the first year. ResultsEleven thousand, one hundred sixty-six individuals were included (mean age 59.8±12.7 years, 67% male). The number of homecare provider interactions per person increased significantly as 1-month CPAP usage decreased (7.65±4.3, 6.5±4.0, 5.4±3.4 in low, intermediate and high adherence groups; p<0.01). There was marked improvement in device usage over the first 5–6 months of therapy in the low and intermediate adherence subgroups (p<0.05 after adjustment for age, sex, initial CPAP adherence, and number of interactions). After adjustment for age, sex and 1-month adherence, having 3–4 interactions was significantly associated with better 1-year adherence (odds ratio 1.24, 95% confidence interval 1.05–1.46), while having >7 interactions was significantly associated with worse 1-year adherence. ConclusionsThe telemonitoring/reimbursement scheme in France had a positive impact on CPAP adherence and facilitated a more personalised approach to therapy management, focusing resources on patients with low and intermediate adherence.

The Role of Cognition, Affective Symptoms, and Apathy in Treatment Adherence with Noninvasive Home Mechanical Ventilation in Myotonic Dystrophy.

Chronic respiratory failure often occurs in myotonic dystrophy type 1 (DM1) and can be treated with noninvasive home mechanical ventilation (HMV). Treatment adherence with HMV is often suboptimal in patients with DM1, but the reasons for that are not well understood. The aim of this exploratory study was to gain insight in the prevalence of mild cognitive impairment, affective symptoms, and apathy and to investigate their role in HMV treatment adherence in DM1. The Montreal Cognitive Assessment (MoCA), the Hospital Anxiety and Depression Scale (HADS), and the Apathy Evaluation Scale (AES) were used to assess cognition, affective symptoms, and apathy in DM1 patients that use HMV. Patients with low treatment adherence (average daily use HMV <5 h or <80% of the days) were compared with patients with high treatment adherence (average daily use of HMV≥5 h and ≥80% of the days). Sixty patients were included. Abnormal scores were found in 40% of the total group for the MoCA, in 72-77% for the AES, and in 18% for HADS depression. There was no difference between the high treatment adherence group (n = 39) and the low treatment adherence group (n = 21) for the MoCA, AES, and HADS depression. The HADS anxiety was abnormal in 30% of the total group, and was significantly higher in the low treatment adherence group (p = 0.012). Logistic regression analysis revealed that a higher age and a higher BMI were associated with a greater chance of high treatment adherence. This exploratory study showed that cognitive impairment and apathy are frequently present in DM1 patients that use HMV, but they are not associated with treatment adherence. Feelings of anxiety were associated with low treatment adherence. Higher age and higher BMI were associated with high treatment adherence with HMV.

Effects of exercise dose based on the ACSM recommendations on patients with post-stroke cognitive impairment: a systematic review and meta-analyses.

This review aimed to assess the impact of different exercise dosages on cognitive function in individuals with post-stroke cognitive impairment (PSCI). Four electronic databases-Embase, PubMed, Web of Science, and Cochrane Library-were systematically searched from inception to 01 January 2024, focusing on the impact of exercise therapy on cognitive function in individuals with PSCI. Only randomized controlled trials meeting the criteria were included. The exercise therapy dose and adherence were evaluated following the American College of Sports Medicine (ACSM) guidelines, categorized into a high compliance group with ACSM recommendations and a low or uncertain compliance group. A random-effects model compared the effect of ACSM compliance on cognitive function in individuals with PSCI, with the effect size represented by the standardized mean difference (SMD) and a 95% confidence interval (CI). In total, 18 studies meeting the criteria were included, with data from 1,742 participants. The findings suggested a beneficial effect of exercise on cognitive function in individuals with PSCI [SMD = 0.42, 95% CI (0.20, 0.65)]. Ten studies were categorized as the "high adherence group" and eight in the "low or uncertain adherence group" based on the ACSM recommendations. The subgroup analysis revealed that the SMD of the high compliance group was 0.46 (95% CI: 0.10, 0.82) (p = 0.01), while the SMD of the low or uncertain compliance group was 0.38 (95% CI: 0.07, 0.70) (p = 0.02). Our study indicates the beneficial impact of exercise for patients with PSCI over no exercise. Furthermore, high adherence to the exercise dose recommended by ACSM guidelines demonstrated a more substantial improvement in cognitive function than low or uncertain adherence in patients with PSCI. Systematic Review Registration: https:// www.crd.york.ac.uk/prospero/#myprospero, identifier CRD42023487915.

#2420 A comparative analysis of food intake according to the degree of dietary compliance among Korean hemodialysis patients

Abstract Background and Aims Food intake management plays a crucial role in the treatment of hemodialysis (HD) patients. Maintaining a balanced diet involves adequate protein intake, sufficient calorie consumption, and restriction of water, sodium, and potassium intake. This study aims to highlight the significance of balanced dietary management by comparing and analyzing differences in food intake patterns among Korean HD patients based on the levels of dietary adherence. Throughout our analysis, we suggest the importance of balanced food intake management for HD patients. Method The data were collected through a survey conducted among 442 HD patients across 18 university hospitals nationwide. The survey employed the dietary adherence and the food intake frequency questionnaire (FFQ). The collected data were analyzed using SPSS 26.0. The analysis method was K-means cluster analysis to classify the degree of dietary adherence into high-adherence and low-adherence. In addition, cross-analysis and independent samples t-test were utilized to compare differences between the groups in demographic characteristics, general health and nutritional status, laboratory data, and food intake frequency. Results Gender distribution revealed 257 males (59.4%) and 176 females (40.6%). The age distribution was as follows: 50-64 years old, 179 individuals (40.8%); 30-49 years old, 97 individuals (22.1%); 65–74 years old, 97 individuals (22.1%); 75 years and above, 52 individuals (11.8%). BMI determination resulted in the following order: underweight - normal in 207 people (48.8%); obese - severely obese in 123 people (29.0%); and overweight in 94 people (22.2%). Subjective Global Assessment (SGA) indicated that 296 individuals (73.3%) were in good nutritional status, while 108 individuals (26.7%) were in fair nutritional status. The duration of HD was distributed as follows: 135 patients (32.1%) for 1–3 years, 103 patients (24.5%) for 5–10 years, 82 patients (19.5%) for 3–5 years, and 66 patients (15.7%) for 10 years or longer. The subjects were clustered into two groups based on their dietary compliance: high adherence and low adherence. The dietary compliance scores, on a scale of 22 points, were 13.63 ± 1.475 for the high adherence group and 9.15 ± 1.681 for the low adherence group. In the high adherence group, uric acid (p &amp;lt; 0.01), serum creatinine (p &amp;lt; 0.01), intact PTH (p &amp;lt; 0.01), TIBC (p &amp;lt; 0.05), and glucose (p &amp;lt; 0.05) were significantly lower than those parameters in the low adherence group. The frequency of daily food intake was also analyzed according to the dietary adherence. The high adherence group showed significantly higher frequencies in rice(p &amp;lt; 0.001), white fish(p &amp;lt; 0.05), low-potassium vegetables(p &amp;lt; 0.01), mushrooms(p &amp;lt; 0.01), low-fat milk(p &amp;lt; 0.01), liquid yogurt(p &amp;lt; 0.05) compared to the low adherence group. On the other hand, the high adherence group showed lower consumptions of foods, such as gimbap, bibimbap (p &amp;lt; 0.05), noodle soup(p &amp;lt; 0.01), bread(p &amp;lt; 0.05), fruit juice(p &amp;lt; 0.05), and tea(p &amp;lt; 0.01). Conclusion The high-adherence group exhibited significantly satisfactory blood parameters and food intake status, highlighting the pivotal role of dietary compliance. Consequently, adhering to dietary guidelines is essential for ensuring sufficient nutrient intake and overall health among HD patients.

Effect of motor, non-motor clinical features including sleep quality, and prescription pattern on adherence to antiparkinsonian medications in Parkinson’s disease

Objectives: Adherence to antiparkinsonian medications (APMs) may significantly influence Parkinson’s disease (PD) outcome. The present study assesses the role of motor and non-motor features, and prescription patterns on adherence. Materials and Methods: This observational and cross-sectional study included 50 PD patients taking APMs for ≥24 months. Demographic data, PD characteristics, treatment, and follow-up history were collected. Patients following up at least once in six months were considered as regular, else were labeled irregular. Montreal cognitive assessment, patient health questionnaire-4, Pittsburgh sleep quality (SQ) index, Epworth sleepiness scale, global quality of life (GQOL) scale, and Morisky Green Levine medication adherence scale (MGL-MAS) were used to evaluate cognition, depressive and anxiety features, SQ, excessive daytime sleepiness (EDS), quality of life (QOL), and APMs adherence, respectively. Results: Nearly half (46%) of the PD patients reported high adherence (MGL-MAS = 0). Most of the clinical characteristics were comparable between those with medium/low and high adherence, except for a larger proportion of patients in the medium/low adherence group belonging to Hoehn–Yahr stage &gt;2 (P = 0.02). A comparable proportion of patients in both groups reported poor SQ (P = 0.52) and EDS (P = 0.32). In comparison to the high adherence group, a significantly lower median GQOL score was observed in the medium/low adherence group (median [interquartile range] = 65 [50–70] vs. 80 [70–85]; P &lt; 0.001). The APMs prescription and follow-up patterns were comparable between both groups. Conclusion: More than half the PD patients reported medium-to-low adherence. While motor severity and depressive symptoms were associated with medium-to-low adherence, poor SQ was comparable in both groups. Those with medium-to-low adherence reported poor QOL.

Mediterranean diet related to 3-year incidence of cognitive decline: results from a cohort study in Chinese rural elders

ABSTRACT Objective: This study aims to examine the effect of the Mediterranean diet (MeDi) on cognitive decline among the Chinese elderly with a 3-year follow-up. Methods: This study is divided into two waves: wave-1 January 2019 to June 2019 (n = 2313); wave-2 January 2022 to March 2022 (n = 1648). MeDi scores were calculated from the Mediterranean Diet Adherence Screener (MEDAS), with the scoring of low compliance (0–6 points) and high compliance (7–14 points). The Mini-Mental State Examination (MMSE) was used to assess cognitive function. An MMSE score dropping ≥ 2 points from baseline was defined as cognitive decline. The relationships between MeDi score and cognitive decline were analyzed by linear regression models or Binary logistic regression. Results: During the 3-year follow-up, 23.8% of patients exhibited cognitive decline. The study revealed a significant difference in MMSE score changes between low and high MeDi adherence groups (p < 0.001). MeDi score was negatively correlated with cognitive deterioration (β = −0.020, p = 0.026). MeDi score was only negatively associated with cognitive decline in the female subgroup aged ≥65 years (β = −0.034, p = 0.033). The food beans (OR = 0.65, 95%CI:0.51, 0.84), fish (OR = 0.72, 95%CI:0.54, 0.97), and cooked vegetables (OR = 0.68, 95%CI:0.53, 0.84) were protective factors for cognitive decline. Conclusions: This study suggests that greater adherence to the MeDi is linked to a reduced risk of cognitive decline in elderly people. However, this is found only in women who are 65 years old or older. It also found long-term adherence to beans, fish, and vegetables are more effective in improving cognitive function.

Adherence to the EAT-Lancet diet in relation to mortality and exposure to food contaminants in population-based cohorts of Swedish men and women

BackgroundThe EAT-Lancet diet was created to support dietary transition towards sustainable diets. Current evidence indicates that adherence to the EAT-Lancet diet may reduce mortality risk, yet how adherence may impact dietary exposure to food contaminants remains unexplored. We aimed to estimate the association between adherence to the EAT-Lancet diet and i) all-cause, cardiovascular-, and cancer-mortality and ii) predicted dietary exposure to the following food contaminants: cadmium, methylmercury, polychlorinated biphenyls (PCBs), and pesticide residues. MethodsWe used self-reported dietary data from a 96-item food frequency questionnaire of two population-based cohorts – the Cohort of Swedish Men (n = 35,687) and the Swedish Mammography Cohort (n = 32,488). The EAT-Lancet Adherence Index (EAI) was created by scoring consumption of the 14 dietary components included in the EAT-Lancet diet (totalling 0–14 points). Cox proportional hazards regression models were applied to assess the association between EAI and mortality outcomes, presented as multivariable-adjusted hazard ratios (HR) and 95 % confidence intervals (CI). Descriptive statistics were used to characterise predicted exposure to food contaminants, and the correlations between EAI and food contaminants assessed using Spearman’s rank correlation. ResultsIncreased adherence to the EAT-Lancet diet was associated with a lower risk of all-cause mortality (per 3-point increase in EAI: HR = 0.93; CI:0.90,0.97 and HR = 0.91; CI:0.87,0.95 for men and women, respectively) and cardiovascular-mortality (corresponding HR = 0.94; CI:0.88,1.00 and HR = 0.93; CI:0.87,1.00). No clear association was found with cancer-mortality. Increasing EAI was correlated with increased predicted dietary exposure to cadmium, methylmercury, PCBs, and pesticide residues and their median predicted dietary exposures were greater in the high adherence group, compared to the low adherence group. ConclusionHigh adherence to the EAT-Lancet diet is associated with a reduction in risk of all-cause and cardiovascular-mortality, but also increased dietary exposure to food contaminants.

Adherence to prescription proton pump inhibitor therapy amongst individuals diagnosed with Barrett's esophagus.

In the United States, clinical guidelines recommend daily use of proton pump inhibitors (PPIs) amongst individuals diagnosed with Barrett's esophagus to decrease the risk of progression to dysplasia and neoplasia. Prior studies documenting adherence to PPIs in this population have not characterized heterogeneity in adherence patterns. Factors that may relate to adherence are incompletely described. We used administrative claims data from the Merative MarketScan Commercial Claims and Encounters database to conduct a retrospective study of adherence to prescription PPIs. A cohort of individuals diagnosed with incident Barrett's esophagus between 2010 and 2019 was identified. Group-based trajectory models were generated to detect longitudinal adherence subgroups. 79 701 individuals with a new diagnosis of Barrett's esophagus were identified. The best fitting model detected five distinct adherence trajectory groups: consistently high (44% of the population), moderate decline (18%), slow decline (12%), rapid decline (10%), and decline-then-increase (16%). Compared to individuals starting PPIs, those already using PPIs were less likely to have a declining adherence pattern. Other factors associated with membership in a declining adherence group included (but were not limited to): female sex, having a past diagnosis of anxiety or depression, and having one or more emergency department visits in the past year. Using an exploratory method, we detected heterogeneity in adherence to prescription PPIs. Less than half of individuals were classified into the consistently high adherence group, suggesting that many individuals with Barrett's esophagus receive inadequate pharmacologic therapy.