Long-term Adherence Research Articles

Long-Term Efficacy of a Mobile Mental Wellness Program: Prospective Single-Arm Study.

Rising rates of psychological distress (symptoms of depression, anxiety, and stress) among adults in the United States necessitate effective mental wellness interventions. Despite the prevalence of smartphone app-based programs, research on their efficacy is limited, with only 14% showing clinically validated evidence. Our study evaluates Noom Mood, a commercially available smartphone-based app that uses cognitive behavioral therapy and mindfulness-based programming. In this study, we address gaps in the existing literature by examining postintervention outcomes and the broader impact on mental wellness. Noom Mood is a smartphone-based mental wellness program designed to be used by the general population. This prospective study evaluates the efficacy and postintervention outcomes of Noom Mood. We aim to address the rising psychological distress among adults in the United States. A 1-arm study design was used, with participants having access to the Noom Mood program for 16 weeks (N=273). Surveys were conducted at baseline, week 4, week 8, week 12, week 16, and week 32 (16 weeks' postprogram follow-up). This study assessed a range of mental health outcomes, including anxiety symptoms, depressive symptoms, perceived stress, well-being, quality of life, coping, emotion regulation, sleep, and workplace productivity (absenteeism or presenteeism). The mean age of participants was 40.5 (SD 11.7) years. Statistically significant improvements in anxiety symptoms, depressive symptoms, and perceived stress were observed by week 4 and maintained through the 16-week intervention and the 32-week follow-up. The largest changes were observed in the first 4 weeks (29% lower, 25% lower, and 15% lower for anxiety symptoms, depressive symptoms, and perceived stress, respectively), and only small improvements were observed afterward. Reductions in clinically relevant anxiety (7-item generalized anxiety disorder scale) and depression (8-item Patient Health Questionnaire depression scale) criteria were also maintained from program initiation through the 16-week intervention and the 32-week follow-up. Work productivity also showed statistically significant results, with participants gaining 2.57 productive work days from baseline at 16 weeks, and remaining relatively stable (2.23 productive work days gained) at follow-up (32 weeks). Additionally, effects across all coping, sleep disturbance (23% lower at 32 weeks), and emotion dysregulation variables exhibited positive and significant trends at all time points (15% higher, 23% lower, and 25% higher respectively at 32 weeks). This study contributes insights into the promising positive impact of Noom Mood on mental health and well-being outcomes, extending beyond the intervention phase. Though more rigorous studies are necessary to understand the mechanism of action at play, this exploratory study addresses critical gaps in the literature, highlighting the potential of smartphone-based mental wellness programs to lessen barriers to mental health support and improve diverse dimensions of well-being. Future research should explore the scalability, feasibility, and long-term adherence of such interventions across diverse populations.

Evaluation of longer- vs short-term use of patiromer on health care resource utilization in the patiromer longer-term use evaluation (VALUE) study.

Studies suggest that continuous long-term use of patiromer by patients with hyperkalemia is associated with less health care resource utilization compared with not using potassium binders. To retrospectively evaluate health care resource utilization and costs with longer-term adherent vs short-term use of patiromer. Time-restricted extracts from Optum's de-identified Clinformatics® Data Mart Database (CDM; January 2016-May 2019) and Symphony Health (SHA; January 2016-September 2018) deidentified databases were analyzed. Both include participants enrolled in commercial and privatized public insurance programs (SHA includes some government programs). Both integrate health care claims data from medical and pharmacy claims. Patients aged 18 years or older with hyperkalemia and an index patiromer prescription were selected. Patiromer use was identified as short-term (<2 months) and any fill quantity or adherent longer-term with claims for at least 2 consecutive months and fill quantities of at least 80% of the total days. Groups were matched on multiple categorical covariates to control for demographic variables, baseline characteristics, and markers of disease severity. Random sampling without replacement was performed 50 times to identify 50 sets of patients matched from the short-term cohort to the longer-term cohort. Health care costs/charges and encounters were compared for a 6-month post-index period using t-tests. Of the CDM patients, 1,267 (40.2%) vs 1,887 (59.8%) and of the SHA patients, 2,234 (35.1%) vs 4,132 (64.9%) experienced longer-term vs short-term patiromer use, respectively. Patient sampling selected 242 and 485 patient-matched pairs from CDM and SHA databases, respectively. At 6 months post-index in longer-term vs short-term patiromer groups (P < 0.0001 for all differences shown), respective mean medical and prescription costs/charges were $42,000 vs $54,311 (-$12,311) and $6,816 vs $4,786 (+$2,030), respectively, for CDM patients and $75,147 vs $84,414 (-$9,267) and $4,689 vs $3,736 (+$953) for SHA patients. In the CDM database, medical costs were lower for longer-term vs short-term cohorts for end-stage renal disease services charges ($10,342 vs $14,976 [-$4,634]), inpatient charges ($15,789 vs $21,473 [-$5,684]), and office visit charges ($10,152 vs $13,152 [-$3,000]). Patient out-of-pocket costs ($658 vs $420 [+$238]) and total prescription charges ($6,158 vs $4,366 [+$1,792]) were higher for the longer-term cohort of CDM patients, with similar findings in the SHA dataset. Adherent, longer-term use of patiromer is associated with significantly lower medical costs offsetting higher prescription costs, driven by the largest changes in inpatient and clinic services at CDM and SHA, respectively. This illustrates an economic value of longer-term adherence to patiromer.

Long-term green-Mediterranean diet may favor fasting morning cortisol stress hormone; the DIRECT-PLUS clinical trial.

Fasting morning cortisol (FMC) stress hormone levels, are suggested to reflect increased cardiometabolic risk. Acute response to weight loss diet could elevate FMC. Richer Polyphenols and lower carbohydrates diets could favor FMC levels. We aimed to explore the effect of long-term high polyphenol Mediterranean diet (green-MED) on FMC and its relation to metabolic health. We randomized 294 participants into one of three dietary interventions for 18-months: healthy dietary guidelines (HDG), Mediterranean (MED) diet, and Green-MED diet. Both MED diets were similarly hypocaloric and lower in carbohydrates and included walnuts (28 g/day). The high-polyphenols/low-meat Green-MED group further included green tea (3-4 cups/day) and a Wolffia-globosa Mankai plant 1-cup green shakeFMC was obtained between 07:00-07:30AM at baseline, six, and eighteen-months. Participants (age=51.1years, 88% men) had a mean BMI of 31.3kg/m2, FMC=304.07nmol\L, and glycated-hemoglobin-A1c (HbA1c)=5.5%; 11% had type 2 diabetes and 38% were prediabetes. Baseline FMC was higher among men (308.6 ± 90.05nmol\L) than women (269.6± 83.9nmol\L;p=0.02). Higher baseline FMC was directly associated with age, dysglycemia, MRI-assessed visceral adiposity, fasting plasma glucose (FPG), high-sensitivity C-reactive-protein (hsCRP), testosterone, Progesterone and TSH levels (p ≤ 0.05 for all). The 18-month retention was 89%. After 6 months, there were no significant changes in FMC among all intervention groups. However, after 18-months, both MED groups significantly reduced FMC (MED=-1.6%[-21.45 nmol/L]; Green-MED=-1.8%[-26.67 nmol/L]; p<0.05 vs. baseline), as opposed to HDG dieters (+4%[-12 nmol/L], p=0.28 vs. baseline), whereas Green-MED diet FMC change was significant as compared to HDG diet group (p=0.048 multivariable models). Overall, 18-month decrease in FMC levels was associated with favorable changes in FPG, HbA1c, hsCRP, TSH, testosterone and MRI-assessed hepatosteatosis, and with unfavorable changes of HDLc (p<0.05 for all, weight loss adjusted, multivariable models). Long-term adherence to MED diets, and mainly green-MED/high polyphenols diet, may lower FMC, stress hormone, levels,. Lifestyle-induced FMC decrease may have potential benefits related to cardiometabolic health, irrespective of weight loss. ClinicalTrials.gov, identifier NCT03020186.

Treatment patterns and adherence to lipid-lowering drugs during 8 years of follow-up after a cardiovascular event

Abstract Introduction In previous research using nationwide prescription data we demonstrated that a considerable proportion of statin users in Norway had treatment gaps or discontinuation in treatment, with 20% of patients having gaps exceeding 180 days. Yet, evidence for treatment practice and long-term adherence to lipid lowering drugs among patients with atherosclerotic cardiovascular disease is limited. Purpose To investigate long-term treatment patterns and adherence to lipid lowering drugs following hospitalization for an acute cardiovascular event. Secondary, to investigate the association between patient characteristics and adherence. Methods Consecutive patients admitted to two hospitals in Norway with acute myocardial infarction or angina undergoing revascularization from 2011-2014 (N=1094) were included in this study. Data on clinical and psychosocial factors were linked to prescription registry data from 2010 to the date of death or end-of follow-up (2020). We evaluated treatment adherence from time of hospital admission to end of follow-up by estimating proportion of days covered (PDC) and gaps in statin treatment. Risk of gaps in statin treatment of &amp;gt;180 days were evaluated across different patient subgroups. Treatment practice after hospital discharge was assessed by the proportion of patients with atorvastatin 40/80 mg or rosuvastatin 20/40 mg, and the proportion of patients with a subsequent ezetimibe prescription. Results Median age was 63 years (SD 9.6) at time of hospital admission. 96% of the patients were discharged with a statin at the index event. During a median of 8 years (SD 2.5) of follow-up, 16% had a gap in their statin treatment exceeding 180 days, and 22% had a PDC &amp;lt; 0.8. LDL-cholesterol target achievement at follow-up was poor and psychosocial distress was prevalent (Table 1). The proportion of patients with gaps ≥180 days was quite similar in all patient subgroups, however somewhat more prevalent among patients who reported statin side-effects (Figure 1). Less than two out of three patients were prescribed high intensity statin therapy during follow-up, while 25% received additional treatment with ezetimibe (Figure 1). Mean number of milligrams redeemed during follow-up was 43 for atorvastatin, 36 for simvastatin and 18 for rosuvastatin. Conclusion In this study of patients hospitalized for an atherosclerotic cardiovascular event, long-term follow-up over 8 years showed that a considerable proportion of patients have poor statin adherence, with gaps in treatment exceeding 180 days. Furthermore, many patients are treated with suboptimal statin therapy, and only 1 out of 4 patients were prescribed ezetimibe. There is a considerable potential for improving long-term adherence and optimizing lipid lowering therapy in secondary prevention.Patient characteristics (N=1094)Proportion of patients with gap&amp;gt;180 days

Long-term aspirin adherence and risk of cardiovascular events and death after myocardial infarction: A nationwide cohort study

Abstract Background Aspirin is mandatory in the acute phase after myocardial infarction (MI); however, the efficacy of aspirin for long-term secondary prevention is less established and may have changed with the addition of modern therapies and diagnostics methods. Purpose To investigate the effectiveness of adherence to long term aspirin therapy at different timepoints following MI. Methods Using Danish nationwide registries, we included patients ≥40 years with a first time MI undergoing percutaneous coronary intervention from 2004 through 2017, who were alive, not treated with anticoagulants, and had stayed adherent to aspirin at one year after the index event (Figure 1). We evaluated adherence to aspirin therapy as proportion of days covered (PDC) ≤80% and &amp;gt;80% at four landmarks (2, 4, 6, and 8 years after MI, respectively). At each landmark, patients were excluded from the analysis if they had suffered a recurrent MI or stroke, died, emigrated or were on anticoagulant or P2Y12-inhibitor therapy. The absolute and relative risks of a composite of death, recurrent MI, or ischemic stroke at 2 years from each landmark were calculated through multivariable logistic regression analysis with average treatment effect modelling standardized to the distribution of age, sex, diabetes, hypertension, hypercholesterolemia, chronic kidney disease, cancer, peptic ulcer, former bleeding, and chronic obstructive pulmonary disease (as a proxy for smoking). Non-CVD death was used as a neutral comparator. Results A total of 40,114 individuals were included in the analysis. Suboptimal adherence to aspirin (PDC≤80%) increased from 10% at first landmark 2 years after MI to 19% at fourth landmark 8 years after MI (Figure 1). The standardized absolute risk of death, recurrent MI, or ischemic stroke was highest at the first landmark 2 years after MI for both PDC-groups (PDC&amp;gt;80%: 8.34%, 95% confidence interval [CI]: 8.04-8.63% and PDC≤80%: 10.75%, 95% CI: 9.80-11.69%) (Figure 2). The standardized relative risk of the composite endpoint was significantly higher for patients with PDC≤80% at all landmarks. A trend towards a diminished protective effect of long-term aspirin therapy appeared from 4 years after the index MI and onwards, decreasing from 1.40 (95% CI: 1.26-1.53) at second landmark 4 years after MI to 1.20 (95% CI: 1.04-1.35) at fourth landmark 8 years after MI. Overall, we found no difference in the relative risk of non-CV death between PDC-groups. Conclusion Suboptimal adherence to long-term aspirin therapy following MI was associated with an increased risk of recurrent MI, ischemic stroke, or death, but the relative risk appeared to decrease slightly over time from 4 years after the index MI and onwards.Figure 1Figure 2

Sex aspects of guideline-directed therapy in young ST- elevation myocardial infarction patients

Abstract Background Young women are at specific risk for a poor outcome after ST- elevation myocardial infarction (STEMI). We aimed to investigate sex- and age-specific differences in adherence to a guideline-directed drug therapy for secondary prophylaxis and to assess its effect on overall survival. Methods Administrative health insurance data (≈26 million members) was screened for patients 18- &amp;lt; 60 years with STEMI from 01/2008 to 12/2018. Patient demographics, details on in-hospital treatment, long-term adherence to guideline-directed drug therapy and the effect on mortality was assessed. Results 59,401 patients &amp;lt;60 years (19.3 % women, median age 53 (IQR 48 - 56) were treated in-hospital with STEMI. Overall, adherence to a guideline-directed heart failure therapy decreased over time. 180 days post STEMI, 80.3 % of women and 82.9 % of men &amp;lt;60 were on complete secondary prophylaxis with ACE/AT1 blockers, beta blockers, statins and a platelet activation inhibitor. Five years after the event, however, only 36.6 % of women and 40.9 % of men were under complete therapy. Similarly with a lower drug adherence, women showed a poorer outcome after STEMI with a 90-day mortality of 7.9 % compared to 6.4 % in men as well as a poorer overall survival (p&amp;lt;0.001). After adjustment for patients’ risk factors, there was a clear association between guideline directed therapy and overall survival. The positive association increased with the number of drugs taken. Moreover, sex-specific differences were specifically evident, if all four drugs were prescribed. The effect on overall survival of one heart failure drug was marginal and not sex-specific with a HR of 0.88 (95% CI 0.76-1.02) in women versus HR 0.91 (95% CI 0.84 - 0.99) in men (pint =0.707). Under complete guideline directed therapy, however, HR for overall survival was 0.22 (95% CI 0.19-0.26) in women versus HR 0.31 (95% CI 0.28 - 0.33) in men (pint &amp;lt;0.001). Conclusion Long-term adherence to an optimal guideline-directed drug therapy after STEMI is generally low with specifically women &amp;lt;60 years lacking a consistent therapy. The lack of consistent therapy is one aspect explaining the poor outcome after STEMI in younger women. Our data show, that women specifically benefit from a consistent secondary prophylaxis. As the underutilization of heart failure drugs is contributory to the unfavorable outcome in young female and male patients, systematic approaches and education of healthcare providers are needed to ensure the long-term use of heart failure drugs specifically in this patient cohort at risk.Kaplan-Meier estimatesCox regression analysis

Abstract 14466: Study Protocol: Heart Camp Connect - Promoting Adherence to Exercise in Adults With Heart Failure With Preserved Ejection Fraction

Background: Heart failure with preserved ejection fraction (HFpEF) remains a challenge in cardiovascular care. A chief complaint in adults with HFpEF is fatigue, and regular exercise training is the only treatment shown to routinely improve this symptom. Adherence to exercise recommendations is difficult. We significantly improved 12-month adherence to exercise in adults with persistent HF using an in-person coaching intervention. Secondary analysis of our HFpEF subgroup showed promising long-term exercise adherence. These findings support our recently funded trial to test an intervention delivered in-person vs. virtually to achieve long-term exercise adherence in adults with HFpEF. Aims: We will: 1) Evaluate effects of in-person vs. virtual coaching and enhanced usual care on 12- and 18-month exercise adherence, 2) Determine the optimal minutes of moderate-intensity exercise that yields clinically meaningful change in patient-reported outcomes, 3) Evaluate interventional mechanisms and interim clinical events as mediators of adherence behaviors, and (4) Examine the cost of intervention delivery. Approach: This multi-site, 3-group randomized controlled trial will recruit 300 adults with stable HFpEF to compare an in-person coaching intervention to a virtual coaching, and both to enhanced usual care (UC). After a run-in period, all participants receive a medical fitness center membership (in-person or virtual) for 18 months and are randomized following a 2-2-1 strategy to in-person coaching and exercise (n=120), virtual coaching and exercise (n=120) or UC virtual exercise only (n=60). The primary outcome is adherence to ≥120 minutes of exercise/week measured using a heart rate monitor at 12 months, with a sustainability endpoint at 18 months. Secondary outcomes include health status, physical function and activity, HFpEF symptoms, and inflammatory biomarkers. Data are collected at baseline, 6, 12, and 18 months. Conclusions: Our findings will guide selection of the most efficacious and cost-effective delivery approaches to promote exercise adherence. Identifying active interventional mechanisms and the dose of exercise needed to elicit a response will help to achieve a clinically meaningful change in patient-reported outcomes in HFpEF.

Recreational handball-based training for people with type 2 diabetes: a feasibility trial

Introduction Type 2 diabetes mellitus (T2DM) is recognized as a serious public health concern with a considerable impact on people suffering from the disease and the society. The benefit of physical activity in the prevention and treatment of T2DM are well documented, however, a considerable proportion of individuals with T2DM have an inactive and sedentary lifestyle. Although most people with T2DM are aware of the importance of exercise, many are not interested in joining traditional exercise options, and long-term adherence is poor for those who do. Thus, we aim to investigate the feasibility of recreational handball-based training (HBT) for people diagnosed with T2DM. Methods This single-arm feasibility trial included adults (over 30 years) with a clinical diagnosis of T2DM. They were invited to participate in a 12-week HBT consisting of two weekly 60-minute exercise sessions. The outcome was feasibility, determined by adherence, exercise intensity, adverse events, dropout rate, and metabolic parameters. Results From September to December 2021, 10 people were included in the study. One participant dropped out because of illness and one participant dropped out due to suspected atrial fibrillation. Eight participants concluded the intervention and participated on average 86% (range 14–23) of the HBT sessions exercising with a mean heart rate of 73.4% (standard deviation (SD) 10.2) of individual maximum heart rate. Conclusions HBT for people diagnosed with T2DM was found feasible with a high attendance rate and clinically relevant exercise intensities. However, future randomized controlled trials about the effects of the handball intervention are needed. Trial registration This trial was registered in ClinicalTrials.gov (NCT05015946) on 23/08/2021.

'When I receive ARVs through my group, my heart settles': Participants' perceptions and experiences of Friends for Life Circles for Option B+ in Kampala and Mityana Districts, Uganda.

The Friends for Life Circles (FLC) was a parallel randomized controlled trial testing the efficacy of a group peer support intervention to support long-term adherence to Option B+ in Kampala and Mityana districts in Uganda. We explored FLC participants' experiences and perceptions of the intervention on adherence to Option B+ for PMTCT and potential implications for strengthening the PMTCT program. We collected data from six focus group discussions with lactating women enrolled in the FLC intervention, and from 14 key informant interviews with health workers, district and national level stakeholders, as well as male partners of FLC participants. Data were analysed using a content thematic approach in a continuous and iterative process. Women described the FLC intervention as acceptable and beneficial in enhancing their understanding of HIV and the need for ART. The FLC helped women, especially those newly diagnosed with HIV infection to come to terms with their diagnosis and overcome the fear of death linked to testing HIV positive, and provided opportunities to enhance ART initiation, resumption and adherence. The FLC provided safe spaces for women, to learn about ART, and to receive support from peers including adherence reminders through home visits and 'coded' reminder messages. Receiving ART from support groups protected members from stigma and long lines at health facilities. Fear of stigma, health system challenges, the high cost of caring for animals and lack of money to save in groups were key challenges noted. The FLC support groups were crucial in providing needed support for women to initiate, resume and adhere to lifelong ART for Option B+. It is important that women who test HIV positive and start ART for life receive psychosocial support from peers and health workers to improve chances of preventing HIV transmission from mothers to children.

A Qualitative Study on Parenting Practices to Sustain Adolescent Health Behaviors in American Indian Families.

American Indian (AI) adolescents who practice healthy behaviors of sleep, nutrition, physical activity, and limited screen time can lower their lifetime risk of diet-sensitive disease. Little is known about how AI parenting practices influence the health behaviors of youth. The objective of this qualitative study was to explore how a group of AI parents of youths at risk of disease influenced their youth's health behaviors after a family intervention. A secondary objective was to understand the role of AI parents in supporting and sustaining health behavior change in their youths following the intervention. Semi-structured in-depth interviews were conducted with AI parents (n = 11) and their young adolescents, 10-15 years old (n = 6). Parents reported facilitators to how they enacted healthy lifestyle behaviors, including family togetherness, routines, youth inclusion in cooking, and motivation due to a health condition in the family. Barriers to enacting healthy behaviors included a lack of time, a lack of access to health resources, negative role modeling, and the pervasiveness of screen media. Three major themes about the role of AI parenting emerged inductively from the interview data: "Parenting in nontraditional families", "Living in the American grab-and-go culture", and "Being there and teaching responsibility". The importance of culture in raising youths was emphasized. These findings inform strategies to promote long-term adherence to behavior changes within the intervention. This study contributes to public health conversations regarding approaches for AI youths and families, who are not well represented in previous health behavior research.

Safety and Efficacy of Immune Checkpoint Inhibitors in the Treatment of Hodgkin Lymphoma in People Living with Human Immunodeficiency Virus: A Case Series

Introduction: Immune checkpoint inhibitors (ICI) have changed the landscape of cancer treatment. They work by disrupting the binding of immune checkpoint proteins, such as PD-1, PD-L1, and CTLA-4, which function to prevent over-activation of the immune system. By interrupting this binding, the body's natural immune response against cancer cells is enhanced. Nivolumab and pembrolizumab, two ICIs that target PD-1, are approved for use in relapsed/refractory Hodgkin lymphoma (HL). HIV is associated with higher rates of cancer, including HL. Several studies have demonstrated the safety of ICI in people with HIV (PWH) in many types of cancer. Unfortunately, many cancer clinical trials continue to exclude PWH without consideration of long-term adherence to highly active antiretroviral therapy (HAART), normal CD4+ counts, or undetectable viral loads because of fear regarding increased adverse events (AEs) and poor outcomes. In addition, studies have shown that PWH diagnosed with cancer are less likely to receive any cancer treatment. Here, we present three cases of PWH diagnosed with HL and treated with an ICI and examine their outcomes and ICI-related AEs. In addition, we discuss five matched cases of people without HIV infection diagnosed with HL and treated with an ICI. Methods: A retrospective study was performed for HL patients at an NCI-designated comprehensive cancer center from 2015 to 2022, diagnosed with HIV (confirmed with antibody testing) and treated with an ICI. Three patients met these criteria. HIV-negative matches for the above patients were identified based on diagnosis, treatment, stage, sex, and age. Five patients with HL without HIV infection were identified as appropriate matches based on these criteria. Demographic data and clinical outcomes data were collected from the electronic medical record. The common terminology criteria for adverse events (CTCAE) were used to classify and grade AEs. Due to a small sample size, statistical analyses and comparisons were not performed between PWH and PWOH Results: Demographic data (Table 1) and clinical response/outcome data (Table 2) are shown for all patients. Patients 1, 2, and 3 were HIV positive, while patients 4, 5, 6, 7, and 8 were HIV negative. ICI-related AEs were documented in three patients, one with and two without HIV. Patient 1, who was not compliant with HAART (CD4+ 70, viral load 1.39x10 6), experienced grade 4 myocarditis (confirmed on cardiac MRI) after cycle 2 with nivolumab, with pulseless electrical activity requiring pressor support and mechanical ventilation for four days, along with high-dose steroid taper, IV diuresis, and initiation of guideline-directed medical therapy (GDMT). Nivolumab was discontinued, and the patient was lost to follow-up with reported death three months later, attributed to HL. Patient 7 developed symptomatic grade 2 hypothyroidism on nivolumab after two cycles, requiring levothyroxine, to which the patient responded appropriately. Nivolumab was continued. Patient 8 experienced grade 3 myocarditis (confirmed on cardiac MRI) after cycle 7 of pembrolizumab, with hospitalization for IV diuretics and GDMT initiation. Pembrolizumab was discontinued. Discussion: In conclusion, ICIs are a therapeutic option for the treatment of HL in PWH. This limited case series suggests that PWH on long-term HAART tolerate ICIs well. The patient in our study who was not compliant with HAART experienced grade 4 myocarditis, with death attributed to lymphoma three months later. This may suggest an increased risk of ICI-related AEs and poorer outcomes in patients not on HAART and/or with poorly controlled HIV. However, further studies are required to investigate this risk, as our sample size was too small to draw statistically meaningful conclusions. Interestingly, one patient without HIV infection also experienced ICI-related myocarditis, but of less severe grade (grade 3 versus grade 4) than the patient with HIV. Most patients from both groups had an overall survival (OS) of more than two years, which may suggest that ICIs are not associated with decreased OS in patients with HIV infection. Unfortunately, our study was limited by the sample size, and statistical comparison of patients with and without HIV infection could not be performed. Further research is needed to investigate the tolerance and efficacy of ICIs as therapeutic options in PWH with Hodgkin lymphoma.

Is a gluten-free diet enough to treat celiac disease?

Celiac disease is a chronic gluten-induced autoimmune enteropathy in genetically predisposed individuals with specific HLA genotypes carrying the DQ2 (DQA1*0501 and DQB1*0201) or DQ8 (DQA1*0301 and DQB1*0302) alleles. The overall global prevalence of celiac disease is 0.7–1.4%. The increase in the incidence rate is associated with significant consumption of gluten over the last century, which has a peculiar effect on the small intestine mucosa. Atrophic processes in the intestine mucosa contribute to malabsorption and development of gluten-dependent clinical symptoms, however, the manifestation of the disease can occur at any age. The small intestine disease with the development of hyper-regenerative atrophy of the small intestine mucosa is recognized as a systemic disease accompanied by various deficiency conditions both with and without atrophy of the small intestine mucosa. Long-term adherence to a gluten-free diet entails certain deficiency conditions, such as vitamins B, vitamin D, calcium, iron, and folic acid deficiencies, as well as a decrease in body mass index. To ensure adequate nutritional intake, patients with celiac disease require additional resources, namely specialized dietary nutrition products. The issues of understanding the need for enteral nutrition in the management of patients with celiac disease are stressed. The article presents a clinical observation of the nutritional support for a female patient with a typical course of celiac disease, grade 2 protein-energy malnutrition, which demonstrated that the use of specialized food products as additional nutrition can significantly improve the nutritional status and somatometric indicators in a patient with celiac disease on a gluten-free diet.

Healthy grocery delivery in the usual care for adults recovering from an acute coronary event: protocol for a three-arm randomised controlled trial

IntroductionCoronary heart disease is a major contributor to the global burden of disease. Appropriate nutrition is a cornerstone of the prevention and treatment of coronary heart disease; however, barriers including...

Food Compass Score predicts incident cardiovascular disease: The ATTICA cohort study (2002-2022).

The Food Compass Score (FCS) is a novel nutrient profiling system, which evaluates food and diet quality. The present study aimed to prospectively assess the relationship of FCS with short-term (10 years) and long-term (20 years) cardiovascular disease (CVD) incidence and to explore whether this relationship is modified by long-term adherence to a Mediterranean type diet (MTD). Volunteers of the ATTICA cohort study, with complete data for the calculation of FCS and incident CVD were included (n = 759). Development of CVD was determined at 10 and 20 years after baseline. Dietary intake was assessed through a validated food frequency questionnaire. The FCS was calculated for each participant based on the published algorithm. Long-term adherence to a MTD was evaluated through MedDietScore. FCS was inversely associated with CVD incidence (hazard ratio [HR] for 20-year follow-up = 0.97, 95% confidence interval [CI] = 0.95-0.99; HR for 10-year follow-up = 0.98, 95% CI = 0.96-1.01) in the total sample, as well as in those with a high baseline adherence to a MTD (HR for 20-year follow-up = 0.96, 95% CI = 0.93-0.99; HR for 10-year follow-up = 0.98, 95% CI = 0.95-1.02). FCS was also inversely associated with CVD risk in those who went away from the MTD (HR = 0.97, 95% CI = 0.96-0.99). FCS, a novel tool for assessing overall diet quality, was also found to be useful in identifying potential CVD candidates in a long-term period, even in populations with good background dietary habits, such as those following a MTD.

Hearing Aids and Quality of Life: A Psychological Perspective.

This research assessed the relationship between hearing aid usage and quality of life in individuals with hearing impairment, exploring associated demographic and clinical factors. Data from 500 individuals at a tertiary care facility were collected over a year through medical records and an online questionnaire. Quality of life was gauged using WHOQOL-BREF and HHIE. Multiple linear regression analysed the correlation between hearing aid usage and quality of life, adjusting for age, gender, hearing loss severity, and socioeconomic factors. Descriptive statistics showed varying degrees of hearing impairment, socioeconomic status, hearing aid usage, and quality-of-life scores. Bivariate analyses found significant correlations between hearing impairment level, socioeconomic status, hearing aid usage, and quality of life. Linear regression highlighted a positive relationship between daily hearing aid usage duration and quality-of-life scores, even after adjusting for covariates. Variations in quality-of-life ratings were observed between hearing aid users and non-users, spanning different hearing loss levels and socioeconomic statuses. Subgroup analysis showed a positive correlation between hearing aid use and quality of life across age groups. The study confirms the positive influence of hearing aids on the quality of life in hearing-impaired individuals, emphasizing the benefits of consistent use. Further studies should probe the specific domains and long-term adherence impacts. The online version contains supplementary material available at 10.1007/s12070-023-04297-w.

Cardiovascular Benefits of Resistance Training in Patients With Heart Failure With Reduced Ejection Fraction: A Systematic Review.

Cardiovascular diseases pose a serious problem for health globally. Among these, congestive heart failure is the leading cause of mortality and morbidity worldwide. According to the recent census, heart failure contributes to a huge financial burden annually. Exercise therapy is an integral part of the non-pharmacological management of heart failure. Due to the availability of various types of exercise therapies and rapid advancements in the existing evidence, it is often challenging to prescribe an appropriate exercise program. Although there is unequivocal evidence supporting the cardiovascular benefits of aerobic therapy, the incorporation of resistance training into exercise regimens should also be encouraged due to its effects on muscular endurance and ameliorating skeletal myopathy in heart failure. In this study, we used a systematic literature review (SLR) approach to give an overview of the current literature and highlight the cardiovascular benefits of resistance training, alone or in combination with aerobic training. We reviewed articles from well-recognized journals published between 2013 and 2023, finally narrowing down to nine selected papers for a thorough analysis. The inclusion criteria comprise studies dealing with heart failure with reduced ejection fraction (HFrEF), resistance training alone or in combination with aerobic therapy, and studies available for free in either the PubMed or Google Scholar databases. The systematic review revealed that resistance training in combination with aerobic therapy has greater cardiovascular benefits than either resistance or aerobic therapy alone. A few unique approaches, like periodic intermittent muscular exercise (PRIME) and super circuit training (SCT), have demonstrated an improvement in cardiac and non-cardiac clinical outcomes compared to conventional exercise therapies. Moreover, various factors, like lack of motivation and lack of time, contribute to poor adherence to exercise therapy. Approaches like telerehabilitation and designing exercise regimens with activities that patients enjoy have led to improvements in long-term adherence rates. Nevertheless, further exploration and research by conducting randomized controlled trials on a larger scale is essential to explore the potential of resistance training in the rehabilitation of patients with heart failure with reduced ejection fraction and to develop the most effective exercise therapy.

Portfolio Diet Score and Risk of Cardiovascular Disease: Findings From 3 Prospective Cohort Studies.

The plant-based Portfolio dietary pattern includes recognized cholesterol-lowering foods (ie, plant protein, nuts, viscous fiber, phytosterols, and plant monounsaturated fats) shown to improve several cardiovascular disease (CVD) risk factors in randomized controlled trials. However, there is limited evidence on the role of long-term adherence to the diet and CVD risk. The primary objective was to examine the relationship between the Portfolio Diet Score (PDS) and the risk of total CVD, coronary heart disease (CHD), and stroke. We prospectively followed 73 924 women in the Nurses' Health Study (1984-2016), 92 346 women in the Nurses' Health Study II (1991-2017), and 43 970 men in the Health Professionals Follow-up Study (1986-2016) without CVD or cancer at baseline. Diet was assessed using validated food frequency questionnaires at baseline and every 4 years using a PDS that positively ranks plant protein (legumes), nuts and seeds, viscous fiber sources, phytosterols (mg/day), and plant monounsaturated fat sources, and negatively ranks foods high in saturated fat and cholesterol. During up to 30 years of follow-up, 16 917 incident CVD cases, including 10 666 CHD cases and 6473 strokes, were documented. After multivariable adjustment for lifestyle factors and a modified Alternate Healthy Eating Index (excluding overlapping components), comparing the highest with the lowest quintile, participants with a higher PDS had a lower risk of total CVD (pooled hazard ratio [HR], 0.86 [95% CI, 0.81-0.92]; Ptrend<0.001), CHD (pooled HR, 0.86 [95% CI, 0.80-0.93]; Ptrend=0.0001), and stroke (pooled HR, 0.86 [95% CI, 0.78-0.95]; Ptrend=0.0003). In addition, a 25-percentile higher PDS was associated with a lower risk of total CVD (pooled HR, 0.92 [95% CI, 0.89-0.95]), CHD (pooled HR, 0.92 [95% CI, 0.88-0.95]), and stroke (pooled HR, 0.92 [95% CI, 0.87-0.96]). Results remained consistent across sensitivity and most subgroup analyses, and there was no evidence of departure from linearity for CVD, CHD, or stroke. In a subset of participants, a higher PDS was associated with a more favorable blood lipid and inflammatory profile. The PDS was associated with a lower risk of CVD, including CHD and stroke, and a more favorable blood lipid and inflammatory profile, in 3 large prospective cohorts.

P067 Patient perceived sleep quality at CPAP titration study as an early indication of short and long-term adherence to CPAP therapy.

Abstract Background Untreated obstructive sleep apnoea is associated with morbidity and diminished quality of life. Despite this, adherence to continuous positive airway pressure (CPAP) remains poor. Few studies have examined which factors from CPAP titration study affect adherence, with a paucity that evaluated perceived sleep quality and adherence. Methods We hypothesise that patients with better perceived sleep quality, at the time of their CPAP titration study will have greater uptake and adherence to CPAP. We aim to: 1. Compare the change in patients’ perceived sleep quality between diagnostic and CPAP titration studies, and future CPAP adherence at 3 and 12 months. 2. Evaluate the association between patients’ perceived sleep quality at the time of their CPAP titration study with future CPAP adherence at 3 and 12 months. 3. Evaluate factors relating to sleep architecture, and sleep disturbance that affect patients’ perceived sleep quality. Sleep studies were obtained prospectively between 2018 and 2019. Patients completed two questionnaires grading sleep quality post study. Progress to Date This study was approved as a quality activity through the Metro North Quality and Safety Unit (ID 3929). Sleep study and questionnaire data were collated and merged with adherence data. Analysis will begin shortly. Intended Outcome and Impact We intend to publish the results of this study in an international sleep journal. Positive findings may improve management of those at risk of poor adherence. Subsequent studies may evaluate the effect of early patient follow up or early motivational interviewing on uptake and adherence to CPAP.

Nanomaterials Drug Delivery System in Herbal Formulation For Antidiabetic Activity: A Review

Diabetes, a chronic metabolic disorder, results in high blood glucose levels due to insufficient insulin production or ineffective insulin utilization. Management entails lifestyle changes, exercise, and medication adherence. Monitoring blood sugar levels, healthy eating, and medication are crucial for controlling diabetes and preventing complications. The illness, currently incurable, necessitates management strategies for regulation. Medical treatments are expensive and require long-term adherence, leading many, especially those from low-income nations, to resort to herbal remedies. However, phytocompounds, though promising, often suffer from limited bioavailability due to poor solubility, permeability, or rapid elimination. Plant nanomedicines offer a promising avenue to address these challenges and alleviate the financial strain on disadvantaged populations. Encapsulated treatments using plant extracts or antidiabetic chemicals at the nanoscale have shown promising results. Our study aims to provide a thorough examination of lipid- and inorganic-based nanoparticulate delivery systems combined with plant extracts or phytocompounds for diabetes management Our analysis will highlight both the advantages and limitations of these systems for future clinical application. Examined studies revealed that nanoparticulate formulations displayed strong antidiabetic effects at lower doses compared to individual plant extracts or phytocompounds. Additionally, nanoparticulate systems have effectively addressed the issue of low bioavailability in herbal medications, showing promise for enhanced therapeutic outcomes.

To be or not to be for a diet? Decision-making algorithm for dietary management of children with atopic dermatitis

The widespread, and not always justified, long-term prescription of a hypoallergenic diet for atopic dermatitis without allergy testing and verification of the diagnosis of food allergy has led to the pendulum swinging in the opposite direction: in recent years, the effectiveness and necessity of an elimination diet in therapy atopic dermatitis is frequently questioned. At the same time, it is generally accepted that in proven food allergy, the targeted elimination diet remains a necessary method in complex therapy.&#x0D; A study was conducted, including a retrospective analysis of 430 case histories and an examination of 130 children with severe atopic dermatitis as part of the prospective part of the study. The analysis of the nutritional status, chemical composition of the diet, body composition, quality of life, eating behavior, as well as compliance of the patients parents was carried out which made it possible to analyze the complex interaction of these indicators with various factors as well as with each other. Risk factors for impaired nutritional status and eating behavior in children with severe atopic dermatitis were early onset of the disease, and long-term adherence to recommendations for limiting or excluding various foods from the diet, especially dairy and/or 4 or more food groups. It was revealed that it is an unbalanced diet, and not elimination itself, is the main factor that reduces the nutritional status of a child. Additional risk factors for impaired nutritional status are the traits of childrens eating behavior caused by the disease itself and adherence to dietary measures, making it difficult to form a complete diet if a diet is necessary and to expand it. As a result, an algorithm was formed, aimed at optimizing the nutritional support of children suffering from atopic dermatitis and food allergy.