Long-term Adherence Research Articles

Utilization of Gerontechnology Smart Pill Boxes Combination of Color and Sound to Improve Compliance in Taking Medication in The Elderly: a Review

Physiological changes in the elderly result in changes in the pharmacokinetics and pharmacodynamics of drugs in geriatric patients, requiring the use of several drugs taken simultaneously, this is called polypharmacy. Therefore, there is a potential for inappropriate drug use and a 2- to 3-fold increased risk of unwanted drug reactions (ADR) in this age group. A safe medication system needs to be developed and maintained to ensure that patients receive good medication care. Pillbox is a tool that serves to put medicine in place with the hope that long-term medication adherence can be met in elderly patients, so the use of pillboxes will be more useful to improve medication adherence to patients. Developing the innovation “MARI: smart pillbox” by combining color and sound can facilitate and help remind patients to take medicine, monitor treatment, and send compliance reports to Health services to be an excellent alternative that can be applied to elderly patients to improve medication compliance and avoid medication errors in elderly patient.

Nasal Corticosteroid Delivery Methods in Chronic Rhinosinusitis With Polyps: A Systematic Review.

This systematic review evaluates and compares the efficacy and safety of different intranasal corticosteroid delivery methods for treating chronic rhinosinusitis with nasal polyps (CRSwNP). Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and Web of Science were systematically searched from January 1, 1980 to January 9, 2024. Two independent reviewers searched 4 databases for English-language, prospective randomized controlled trials (RCT), comparing different delivery methods of corticosteroids for the treatment of CRSwNP. Studies were excluded for specific reasons (wrong comparisons, wrong intervention, wrong patient population, and wrong route of administration). The data search identified 2282 studies. After removing duplicates, 1503 studies were screened by title and abstract, with 1479 excluded for not meeting criteria. Eighteen full-text articles were assessed for eligibility, and 5 RCTs were included in the review. Both short- and long-term treatments with nebulizer, aerosol spray, and nasal drop methods demonstrated similar efficacy to oral corticosteroids (OCS) but with a better safety profile. Long-term use of aqueous sprays showed clinical improvement but was less effective than other non-aqueous delivery methods. Non-aqueous delivery methods, including nebulizers, aerosol sprays, and nasal drops offer a safe alternative to OCS without systemic side effects. Patients using aqueous formulations should be advised on the importance of long-term adherence to achieve symptom improvement.

Association between Mediterranean diet adherence and Parkinson's disease: a systematic review and meta-analysis.

Parkinson's disease (PD) is a chronic neurodegenerative disorder, and past research suggests that adherence to the Mediterranean diet (MD) may influence the risk of PD. However, there are varying conclusions among different studies regarding the correlation between long-term adherence to the MD and the occurrence of PD. This meta-analysis aimed to investigate the association between MD adherence and PD incidence. This meta-analysis was registered on PROSPERO (CRD42024520410). We searched PubMed, Embase, Web of Science, and Cochrane databases to identify observational studies, including prospective cohorts, case-control, and cross-sectional studies, up to February 2024. Studies reported on MD adherence were included, with MD adherence categorized through a quantifying score or index. The pool odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for the highest versus the lowest categories of MD score in relation to PD risk, using random-effects models. Additionally, bias assessment, heterogeneity assessment, sensitivity analysis, and subgroup analysis were performed. A total of 12 studies were included in the meta-analysis. The overall effect size of PD risk was as follows: compared to the lowest adherence to the MD, the highest adherence to MD showed a significant negative correlation with the incidence of PD, with an overall OR of 0.75 (95% CI: 0.66, 0.84). Specifically, in studies diagnosing PD, the overall OR was 0.83 (95% CI: 0.74, 0.94), while in studies diagnosing prodromal Parkinson's disease (pPD), the overall OR was 0.67 (95%CI: 0.59, 0.76). For individuals aged <60 years, the overall OR was 0.70 (95%CI: 0.62, 0.78), whereas, for those aged ≥60 years, the overall OR was 0.86 (95%CI: 0.74, 0.99). The evidence from this meta-analysis demonstrates a significant negative correlation between adherence to MD patterns and the risk of PD, suggesting that the MD may serve as a protective factor for PD. This dietary pattern may be particularly beneficial in reducing the risk of pPD.

P-519. Long-acting Injectable PrEP Uptake and Persistence in a Sexual Health Clinic

Abstract Background HIV pre-exposure prophylaxis (PrEP), a powerful tool for HIV prevention, has traditionally been taken as a daily oral medication. Long-acting injectable (LAI) cabotegravir is superior to daily oral PrEP for HIV prevention and was approved for use as LAI-PrEP in 2021. We aimed to evaluate the uptake of LAI-PrEP and six-month LAI-PrEP persistence in a sexual health clinic. Participant characteristics (N=36) LAI: Long acting injectable PrEP: Pre-exposure prophylaxis Methods In February 2023, an LAI-PrEP pilot was implemented in a county sexual health clinic serving a diverse patient population in a designated ending the HIV epidemic in the South. Through state funding, patients at risk of HIV through sexual transmission were eligible to receive initial doses of LAI-PrEP at no cost and same-day initiation was encouraged. We evaluated the first 12 months of implementation. The primary outcome was LAI-PrEP persistence at 6 months. Statistical analyses were performed (SPSS version 29) using chi-square test for categorical variables with a significance level of 0.05. LAI-PrEP – long-acting injectable pre-exposure prophylaxis Results During the 12-month period, 55 people initiated LAI-PrEP, with 36 eligible for the six-month PrEP persistence evaluation. This population was 83% men, 31% Black, 58% Hispanic/Latino, and the median age was 32 (range 20-58) years. 75% received oral PrEP previously. LAI-PrEP six-month persistence rate was 72% (26 of 36). Among the 10 people with LAI-PrEP discontinuation, 1 transitioned to oral PrEP, 2 no longer had an indication for PrEP (change in serodifferent relationship status), and 7 were lost to follow-up. LAI-PrEP persistence differed by race (46% Black vs 88% white, p=0.007) and sexual orientation (37% heterosexual, 89% gay, 67% bisexual, p=0.019). LAI-PrEP – long-acting injectable pre-exposure prophylaxis Conclusion In the first year of LAI-PrEP implementation, LAI-PrEP uptake was favorable in our clinic, especially among priority populations for HIV prevention. Loss to follow-up was the most common reason for discontinuation, but change in PrEP method or loss of PrEP indication accounted for 30% of discontinuations. Nevertheless, the differences in persistence rates suggest a need for targeted interventions to improve long-term adherence in minority and heterosexual groups. Addressing PrEP persistence in these populations is crucial for optimizing the impact of LAI-PrEP in communities with a high burden of new HIV infections. Disclosures All Authors: No reported disclosures

P-558. Long-acting Injectable Cabotegravir/Rilpivirine Plus Subcutaneous Lenacapavir Effective in People with HIV with Viremia and Cabotegravir or Rilpivirine Resistance-Associated Mutations

Abstract Background Long-acting antiretroviral regimens have the potential to achieve virologic suppression in people unable to maintain adherence to daily oral antiretroviral therapy (ART). Long-acting injectable cabotegravir/rilpivirine (LAI CAB/RPV) is currently the only complete long-acting regimen and is recommended by IAS-USA for select patients with viremia. However, resistance-associated mutations (RAMs) among treatment-experienced people with HIV are common, precluding use of LAI CAB/RPV. LAI CAB/RPV plus subcutaneous lenacapavir (LEN) may provide therapeutic options for people with poor long-term adherence and cabotegravir or rilpivirine RAMs.Table 1.NNRTI Mutations by Patient Methods Patients at UMMC’s Adult Special Care Clinic were selected for LAI CAB/RPV plus LEN by a multidisciplinary panel. Criteria for selection included recurrent viremia despite intensive case management strategies, presence of historical or current RAMs to CAB or RPV, and partially- or fully-active cabotegravir based on mutation scores. Patients began therapy with LEN and LAI CAB/RPV on the same day. The prescribed regimen consisted of CAB/RPV 600/900 mg intramuscular at months 0 and 1 followed by every 2 months and LEN 600 mg oral daily x 2 days and 927 mg subcutaneous every six months. No oral lead-in of CAB/RPV was administered, and oral LEN was administered via directly-observed therapy. Results Nine patients were treated with LAI CAB/RPV plus LEN at UMMC. Mean baseline viral load was 36 251 copies/mL. All patients had RPV RAMs. One patient had CAB RAMs (N155H, T977A) conferring low-level resistance to CAB. The follow-up period ranged from 24-36 weeks. All patients maintained viral loads &amp;lt; 200 copies/mL during follow-up. Patients with baseline CD4 &amp;lt; 200 cells/µL demonstrated 208% increase in absolute CD4 count. No treatment-emergent resistance has occurred to date. Conclusion LAI CAB/RPV plus LEN achieved virologic suppression for up to 36 weeks of follow-up in PWH with incomplete adherence to oral ART and mutations to CAB or RPV. Further follow-up and larger sample size will be needed to determine long-term durability of this combination. Additional combinations of long-acting ART are vitally needed to achieve virologic suppression for all. Disclosures All Authors: No reported disclosures

P-2184. Antiviral Use among Immigrants with Chronic Hepatitis B (HBV) in Metropolitan-DC

Abstract Background Globally, 296 million people are infected with chronic hepatitis B (HBV) and at risk for cirrhosis and hepatocellular carcinoma. In the Metropolitan-DC area, chronic hepatitis B infection (HBV) is 10 times more common in Asian, African, and Latin American communities (5% prevalence) than non-immigrants communities. Therefore, HBV-related liver disease, including cancer, is a major health disparity for immigrants. Antivirals reduce cancer risk but require long-term adherence. Immigrants face barriers to HBV antiviral adherence, including language, high cost of antivirals, and establishing care for HBV management. We examine antiviral use in a cohort of people with HBV. Methods HOPE is a natural history study at the University of Maryland, Baltimore. HOPE enrolls adults with HBV and includes TEMUL, a sub-study providing free tenofovir alafenamide (TAF) for 2 years. After completing 2 years of TEMUL, participants are transitioned to receiving antivirals through their non-study healthcare providers. We describe antiviral use while on TEMUL and at a 2-year follow-up. Results From May 2017 to March 2024, 92 people received TAF through TEMUL. Eighty-four were foreign-born (78 born in Asia and 6 born in Africa). Most (67%) had mild liver fibrosis at baseline. Eleven were withdrawn (3 lost to follow-up, 3 moved out of state, 5 voluntarily withdrew). Eighty-one completed TEMUL with sustained adherence to TAF. Fifty-eight completed a 2-year follow-up. At follow-up, 36 of 58 (62%) remained on TAF without interruption. Twelve (21%) switched antivirals because of insurance coverage. This caused lapses in antiviral use ranging from 1 month to 2 years in 5 (9%). Ten (17%) stopped antivirals due to loss of health insurance, high copay, and inability to follow-up with a healthcare provider. All 10 were foreign-born, Asian, and non-English speaking. Of these 10, 9 were viremic at follow-up and resumption of antivirals was clinically indicated in all. Conclusion Language and inadequate health insurance coverage hinder antiviral adherence in immigrants with HBV. Foreign-born, non-English speaking patients may be especially vulnerable to lapses in antiviral use. Interventions to improve access to antivirals tailored to this patient group are needed. Disclosures Lydia Tang, MBChB, Arbutus Biopharma: Grant/Research Support|Gilead Sciences: Grant/Research Support

Short- and Long-Term Nutritional Status in Children and Adolescents with Celiac Disease Following a Gluten-Free Diet: A Systematic Review

Background/Objectives: Numerous studies have highlighted the nutritional imbalances that are commonly observed in children and adolescents diagnosed with celiac disease (CD) who follow a gluten-free diet (GFD). However, the development and timeline of these nutritional deficiencies remain unclear. The aim of the present study is to investigate the short-term (≥6 months to &lt;12 months) and long-term (≥12 months) association between adherence to a GFD and nutrient intake as well as micronutrient blood status in children and adolescents aged from 0 to 18 years with CD. Methods: A systematic review was conducted in PubMed and Scopus for observational studies published up to June 2024. Results: A total of 15 studies (case–control, cross-sectional, and prospective studies) with 2004 children and adolescents were included. Their quality was assessed using the ROBINS-E tool. Despite the lack of high-quality data and the heterogeneity of the methods used in the included studies, the results of the cross-sectional/case–control studies show that, in the short term, children and adolescents with CD consumed excessive amounts of protein and carbohydrates compared to controls. After long-term adherence to a GFD, significant changes in the diets of children and adolescents with CD persisted. Fat intake was higher, while protein intake remained excessive compared to controls. Based on prospective studies, vitamin C and iodine intake improved both in the short and long term after adherence to a GFD. However, most other nutrients either remain inadequate or continue to decline, indicating that it is difficult to meet nutrient requirements despite dietary adjustments. Conclusions: Gaps in adherence to dietary recommendations appear to be widespread in children and adolescents with CD, emphasizing the need for improved diet quality and regular monitoring.

Leading the dance: application of social identity leadership theory in dance teaching

ABSTRACT Understanding how motivation works is important for teachers in any domain. The landscape for dance teaching is continuously evolving, and teachers are exploring effective ways to motivate and engage pupils in their dance classes. Knowing what works for pupils and why will influence an individual’s initial choice to take part in dance sessions. Further evolution of these motives will encourage them towards longer-term adherence. In this position paper, we focus on the provision for schools’ and extra-curricular dance classes in education settings, presenting social identity leadership (SIL) as a tool for teachers to consider when motivating pupils to dance. By focusing on this specific context, we situate the SIL model alongside self-determination theory (SDT), theory of reasoned action (TRA) and theory of planned behaviour (TPB) to propose a new leadership-driven approach to motivation and pupil engagement in dance. We discuss applied implications on how the teacher can use SIL to initiate and maintain/enhance pupil involvement in curricular and after-school dance activities. Recommendations for future research are provided in order to optimise both knowledge and application of this important new approach.

Advancements in Anti-Diabetic Therapy: A Review of Enhanced Efficacy and Bioavailability of Voglibose Nanoformulations

The global incidence of type 2 diabetes mellitus (T2DM) is escalating, with projections indicating that 440 million individuals will be affected by 2030. T2DM accounts for 85-95% of all diabetes cases in affluent nations and an even higher proportion in less developed countries. This widespread disease is influenced by numerous factors including cultural shifts, aging populations, urbanization, dietary changes, reduced physical activity, and other unhealthy lifestyle behaviors. Pathophysiologically, T2DM is characterized by insulin resistance, β-cell dysfunction, increased hepatic glucose production, and decreased glucagon-like peptide 1 (GLP-1) levels. Management challenges such as suboptimal medication regimens, poor patient adherence, and inadequate treatment strategies contribute to the prevalence of diabetes-related complications. Alpha-glucosidase inhibitors (α-GIs) like acarbose, voglibose, and miglitol, which primarily act in the gastrointestinal tract to reduce postprandial hyperglycaemia, have been identified as beneficial in managing these issues. Particularly, voglibose has shown superior efficacy and tolerance compared to other α- GIs. Despite their effectiveness, α-GIs are sometimes limited by gastrointestinal side effects, affecting long-term treatment adherence. Recent advancements in nanotechnology offer promising enhancements in the delivery and efficacy of these medications. Nano-formulations, ranging from 10 to 100 nm, can protect drugs from environmental degradation and improve bioavailability by optimizing the dissolution rate and increasing the saturation solubility of poorly soluble drugs. The development of nanoparticle formulations is emerging as a critical strategy to enhance the oral bioavailability of α-GIs, potentially revolutionizing T2DM management by improving drug absorption and minimizing side effects.

Consensus on Safe Initiation and Monitoring of Transanal Irrigation to Optimize Adherence With Therapy.

Transanal irrigation is a well-established minimally invasive therapy that addresses symptoms of both constipation and incontinence. The therapy has been extended from just neurogenic bowel dysfunction patients to those with disorders of brain-gut interaction and postsurgical conditions. To summarized the literature on transanal irrigation and update the contraindication profile. We undertook a literature review of transanal irrigation complications and outcomes. Initiation of therapy as part of a bowel care regime is becoming more common outside specialist centers. In addition, the concept of both high- and low-volume irrigation schedules has entered the treatment paradigm, and it is clear that there is a differing safety profile. We present an update from the previous long list of contraindications. We describe how optimizing long-term adherence depends on these factors in addition to a structured follow-up programme. Transanal irrigation is an increasingly used therapy, with a good safety profile, further improved by the advent of low-volume irrigation options. Key to safe and effective usage of transanal irrigation is careful patient selection allied to tailored initial training of the patient.

P0267 Proactive Remote Monitoring of Inflammatory Bowel Disease for Improved Outcomes and Flare Prediction

Abstract Background This study evaluated a remote monitoring program for IBD patients, using a mobile app to track disease activity and improve patient-provider communication. The app included disease activity questionnaires, quality of life assessments, and home-based calprotectin tests. we aimed to develop a data-driven, patient-reported care management system for early detection of clinical flares in IBD patients, enabling timely treatment adjustments. Methods A 12-month prospective cohort study included 100 adult IBD patients. Participants completed monthly online questionnaires via the “DATOS” platform, assessing disease activity (PRO2/SCCAI), quality of life (PROMIS-10, SIBDQ), emotional state (DASS-21), and perceived disease control (IBD CONTROL). Home calprotectin tests were performed at baseline, 6 months, and 12 months. Data from 533 monthly observations were used to develop a machine learning model to predict flares. Results Among 100 patients (74% Crohn’s, 26% ulcerative colitis; median age 31 years), 94% were on biological therapy. Adherence to the remote platform declined over time (86% at 0 months, 53% at 6 months, 30% at 12 months). Over the study period, 40 flares, 14 hospitalizations, 6 surgeries, and 31 changes in biological therapy occurred. Patients experiencing a flare had significantly higher fecal calprotectin levels (mean: 901.8 vs. 330.6 mg/kg, p=0.044), as well as increased anxiety, depression, and stress (DASS-21, p&amp;lt;0.05), poorer quality of life (PROMIS-10, p=0.005; SIBDQ, p&amp;lt;0.001), and reduced perceived disease control (IBD-Control, p&amp;lt;0.001). A machine learning model incorporating calprotectin and patient-reported outcomes demonstrated a 0.85 accuracy in predicting flares. Conclusion This study demonstrates the feasibility of a remote monitoring program for IBD patients. Although the program facilitated streamlined patient follow-up, long-term adherence was challenging, highlighting the need for improvements in system usability and patient engagement. The machine-learning model, which combined fecal calprotectin and patient-reported outcomes, showed good accuracy in identifying patients at risk of flares. These findings suggest that remote monitoring, supported by machine learning, could enhance IBD management.

Cluster randomised controlled trial on the effects of long-term home-based exercise for patients with chronic obstructive pulmonary disease with recent exacerbation: research protocol of the COPDtoParis Project

BackgroundChronic obstructive pulmonary disease (COPD) is a highly prevalent respiratory disease associated with significant health decline and economic burdens. Pulmonary rehabilitation is an effective intervention, but securing adherence to exercise...

A Mixed Methods Study of Medication Adherence in Adults with Neurofibromatosis Type 1 (NF1) on a Clinical Trial of Selumetinib.

Oral therapeutic options for plexiform neurofibromas (PNs) in individuals with neurofibromatosis type 1 (NF1) are receiving attention in clinical research. The MEK inhibitor (MEKi) Selumetinib is FDA-approved in children ages 2+ years with inoperable PNs, and shows activity in adults. Prolonged therapy with selumetinib is necessary to maintain tumor reduction. Therefore, investigating long-term adherence is vital to understand patterns of adherence over time and its impact on clinical outcomes. Mixed methods research offers rich information about adherence that can inform future intervention trials, and can assist practitioners in addressing medication adherence concerns. This mixed-method pilot study is the first examination of the feasibility of a technology-based adherence assessment method, the medication events monitoring system (MEMSTM), among individuals with NF1-PN. Adherence was monitored in a small sample of patients (N = 12; mean age = 34.36 years; 58% male) with NF1 and PN across eighteen 28-day treatment cycles. Qualitative data were obtained from individual interviews using inductive and deductive techniques for thematic analysis. The predetermined criterion was met, suggesting that using MEMSTM is feasible despite some challenges with the caps. Depression and overall stress were significantly related to reduced adherence, although these results should be considered hypothesis-generating. Barriers to medication adherence included forgetting and the timing of doses related to eating. Facilitators included consistency, reminders, and social support. This study highlights patient characteristics that may be related to increased risk for nonadherence, as well as challenges with electronic pill caps that should be considered in future clinical trials for NF1-related PN. Results can inform future adherence interventions for adults with NF1 and PNs. Future research with larger samples is needed to fully explore factors related to long-term medication adherence among individuals with NF1.

MHealth-assisted expiratory muscle strength training in Parkinson's disease patients: A proof-of-concept study

Background Expiratory muscle strength training (EMST) is acknowledged for its therapeutic benefits in Parkinson's disease (PD), yet long-term adherence remains a challenge. Objective The primary aim of this study was to assess the preliminary effects of EMST coupled with a mobile health app (SpiroGym) on self-efficacy and exercise adherence in PD patients. The secondary aim was to assess the usability of the SpiroGym app. Methods This single-group, multicenter, multinational proof-of-concept study involved 63 PD patients across four tertiary PD centers. Participants were enrolled in either a 1-week (n = 35) or 24-week (n = 28) EMST program coupled with SpiroGym app. Self-efficacy was assessed using the Self-Efficacy for Home Exercise Program scale (SEHEPS) and exercise adherence was monitored by SpiroGym app. Usability was evaluated using the System Usability Scale. Results Post-intervention, significant improvements in SEHEPS were observed in 1-week group (d = 0.48; p = 0.02) and 24-week group (d = 0.57; p = 0.002). Adherence rates in the 24-week PD patient group were high throughout the course of the study. Post-training SEHEPS was found to correlate (rho = 0.55; adjusted p = 0.016) with adherence to EMST during the non-supervised maintenance phase. The SpiroGym app exhibited high usability (&gt;85th percentile score), with no significant differences noted between short-term and long-term use, indicating sustained user satisfaction. Conclusions The results of our study suggest a promising role for SpiroGym app in supporting adherence to home-based EMST in PD patients. Nevertheless, future comparative studies are required to confirm SpiroGym's effectiveness.

Comparative Efficacy of Lebrikizumab, Dupilumab, and Tralokinumab in Maintaining Treatment Response in Atopic Dermatitis at Varying Treatment Continuance Rates

Introduction: Atopic dermatitis (AD) is a chronic inflammatory skin disease with significant impacts on quality of life. Despite the effectiveness of biologics for moderate to severe AD, long-term treatment adherence can be challenging in clinical practice. This study introduces the “durability index” as a novel estimate of the maintenance of therapeutic effect under varying treatment continuance rates. Methods: A population-adjusted indirect comparison of placebo-controlled phase 3 trials of dupilumab 300 mg QW/Q2W (SOLO 1, SOLO 2, and SOLO CONTINUE), tralokinumab 300 mg Q2W (ECZTRA1 and ECZTRA 2), and lebrikizumab 250 mg Q4W (ADvocate1 and ADvocate2) was conducted. In these trials, patients who responded at week 16 (IGA 0/1 or EASI 75) were re-randomized to either continue treatment or switch to treatment withdrawal (placebo) until week 52. The durability index was developed to estimate drug performance at varying treatment continuance rates between 100% to 0% on-treatment. Unanchored simulated treatment comparison (STC) was used to estimate odds ratios (OR) adjusting for baseline covariates. Results: For IGA 0/1, patients receiving lebrikizumab had statistically significantly better odds of maintaining response at week 52 than those on dupilumab for all treatment continuance rates, ranging from 1.730 (p = 0.044) at 100% to 4.690 (p &lt; 0.001) at 0%. ORs comparing lebrikizumab to tralokinumab ranged from 1.787 at 100% continuance to 1.516 at 0%, with significant results favoring continuance rates between 39.5% and 96.9%. For EASI 75, week-52 durability at 100% continuance was non-significantly different between lebrikizumab and dupilumab (OR 0.687, p = 0.183); however, ORs increased in favor of lebrikizumab at lower treatment continuance rates, reaching significance from 64.2% (OR 1.454, p = 0.05) to 0% (OR 3.235, p &lt; 0.001) continuance. ORs comparing lebrikizumab to tralokinumab ranged from 2.132 at 100% to 3.891 at 0% continuance, with significant results favoring lebrikizumab for all treatment continuance rates. ORs comparing dupilumab and tralokinumab showed varying results: tralokinumab was favored for IGA 0/1 at lower continuance rates, while dupilumab was favored for EASI 75 at higher continuance rates. Conclusions: In this indirect comparative analysis, lebrikizumab had treatment response rates that were comparable to or better than dupilumab and tralokinumab, regardless of treatment continuance rates. This finding suggests that lebrikizumab may offer a more effective long-term management option for AD. This analysis was funded by Eli Lilly and Company.

Real-world experience with TTFields in glioma patients with emphasis on therapy usage.

Tumor Treating Fields (TTFields) has emerged as a significant adjunctive component in the treatment of high-grade gliomas following the EF-14 trial in 2017. The incorporation of TTFields, alongside cyclic temozolomide therapy, has demonstrated improved patient outcomes when the usage exceeds 18 h per day (75% usage). Post-hoc analysis of the EF-14 trial has demonstrated that therapy usage exceeding 90% is associated with an additional benefit, while rates above 50% have also proven effective in literature. Given the cost-intensive nature and mild- to- moderate constraints associated with the therapy, our objective is to generate real-world data on therapy usage through a retrospective analysis at a high-throughput academic center. Between June 2015 and February 2022, a total of 113 high-grade glioma patients received TTFields therapy. Eight patients discontinued TTFields therapy within 2 months with less than 50% usage and were excluded from further analysis. For the remaining patients, the median age was 51 years (range: 20-76 years) and the mean preoperative Karnofsky index was 80%-90%. Most of the patients (75.2%) initiated therapy concurrently with first-line treatment, of whom 27.6% started TTFields therapy concomitant to the first cycle of temozolomide. 15.2% started TTFields therapy in the second-line and 9.5% in the third-line setting. The study cohort had an average therapy duration of 9.3 months with 3.2 break days per month. The mean therapy usage was 65.5% (SD 17.6%). Usage was highest during the first 3 months, with rates of 77.7%, 72.3%, and 71.6%, and then dropped to around 60% in the following 6 months. Linear regression found no predictors of usage, such as age, timing of therapy initiation, and duration or gender. 55% of patients continued TTFields beyond the first recurrence. Interestingly, no drop in usage rates was observed before tumor recurrence was communicated. However, after diagnosis, patients exhibited a significant drop in usage to an average of 52.3%. This high-volume, real-world TTFields usage data reveal that the extent of usage falls short of the intended 75%. It highlights the importance of monitoring and promoting adherence to maximize its potential benefits in managing high-grade glioma patients. Furthermore, strategies to expedite therapy initiation and improve long-term adherence are warranted.

Efficacy of Low-Carbohydrate Diets Versus Low-Fat Diets in Glycemic Control Among Patients With Type 2 Diabetes: A Systematic Review.

This systematic review evaluates the comparative efficacy of low-carbohydrate diets (LCDs) versus low-fat diets (LFDs) in improving glycemic control, weight management, and lipid profiles in individuals with type 2 diabetes mellitus (T2DM) or prediabetes. Seven randomized controlled trials involving diverse populations were included, with dietary interventions ranging from very low-carbohydrate ketogenic (LCK) diets (typically <10% of total caloric intake from carbohydrates, with higher fat and moderate protein) to moderate carbohydrate regimens (30-45% of total calories). LFDs, in contrast, prioritized carbohydrate intake (50-60% of total calories), with reduced fat (<20-30%) and moderate protein (15-20%). Across studies, LCDs consistently demonstrated greater reductions in HbA1c, fasting glucose, and triglycerides, alongside superior weight loss and increased high-density lipoprotein cholesterol compared to LFDs. Additionally, LCDs were associated with significant reductions in diabetes medication use, highlighting their potential to decrease pharmacological dependency and improve metabolic outcomes, including enhanced insulin sensitivity and reduced inflammation. Despite variability in long-term outcomes and adherence, LCDs emerged as a promising alternative to traditional dietary approaches for managing T2DM. Further research is warranted to explore strategies to improve dietary adherence, such as behavioral interventions and technological support, and to evaluate long-term sustainability, including their effects on cardiovascular health and quality of life. These findings underscore the transformative potential of LCDs in diabetes management and highlight the need for personalized dietary approaches.

Facilitator factors to develop a healthy ageing Social Prescribing local system in Portugal—A qualitative case study

Social Prescribing (SP) is an approach which aims of improving health and well-being and connecting patients to community services. Examples of these services include physical activity and cultural activities. Despite its benefits, SP has still not been fully implemented in Portugal. This case study is part of a larger study on Social Prescribing Local System (SPLS) implementation, which comprised a quantitative approach, a pilot study and a qualitative approach, and aims at exploring patients’ and healthcare workers’ perspectives on SP. The study was carried out to understand the motivations of different stakeholders for participating in the pilot project, the anticipated benefits for patients, healthcare professionals, and the health unit, as well as their perceptions and experiences within the scope of the SP project. Data collection was carried out in December 2020 through semi-structured individual interviews and a focus group. A total of seven participants were included, of which one patient, one museum representative and five healthcare professionals. Different common dimensions related to SP emerge, including health and well-being, social interaction and community engagement, accessibility and inclusivity, motivation and adherence, collaboration and coordination, and education and awareness. The patient considered the adequacy of the activity to the patient’s state of health and capabilities, adoption of a phased approach, with a focus on progress, in order to promote long-term adherence as facilitators. For the museum, disseminating its activities to healthcare professionals and patients through different channels such as posters at the health center, social media pages, and training sessions can significantly enhance visibility and engagement, while direct phone contact and digital publications can further promote adherence, ensuring a comprehensive and coordinated approach to patient participation and institutional benefit. Healthcare professionals identified several benefits, including reduction of social isolation and sedentarism, as well as a means of strengthening the therapeutic relationship with patients. The design and implementation of SP programs should be participative and involve all stakeholders participating in the process. Barriers to adherence included time for activity and the associated costs or prerequisites, availability of activities and lack of perceived interest in health.

The Ripple Effect: The Impact of Narrative on Team Culture and Lifelong Exercise Adherence

This case study narratively explores a high school cross-country team in a small U.S. Midwestern town from 1992 to 1999. Results of this study revealed how the team coconstructed discovery and relational nonperformance narratives, with the head coach adopting aligning narrative practices (i.e., newsletters and team journals), which together socially constructed a team culture built on love (i.e., for running, for one’s own self, and for one another). This case study highlights what a discovery and relational narrative are, how they vary from the more dominant performance narrative, and the ways in which these narratives were drawn upon, used, and reproduced over time and ultimately changed the meanings around exercise and sport for the members of this team. The outcomes associated with these narrative practices, and the meanings embedded within them, led to a successful program, greater exercise enjoyment, the development of lifelong friendships and healthy habits, long-term exercise adherence, and a ripple effect of many of the young athletes on this team going on to become future exercise and/or sport leaders (i.e., fitness coaches, personal trainers, and sport coaches) as adults. The long-term implications and implementation recommendations are explored.

Long-Term Benefits of Continuous Glucose Monitoring Combined with Insulin Pump Therapy

Objective: To evaluate the long-term efficacy and safety of continuous glucose monitoring (CGM) combined with insulin pump therapy, focusing on glycemic control, patient adherence, quality of life, and reduction in diabetes-related complications. Methodology: A prospective cohort study was conducted on 100 patients with type 1 or insulin-dependent type 2 diabetes from February 2023 to July 2024 at a Tertiary Care Hospital in Karachi. Participants, aged 18–75 years, used CGM-integrated insulin pump therapy. Key metrics included HbA1c levels, time-in-range (TIR), adherence rates, and quality-of-life scores assessed at baseline and study completion. Statistical analyses were performed using SPSS, with significance set at p &lt; 0.05. Results: The mean HbA1c level decreased to 8.14% (SD: 0.83, p = 0.003), while TIR improved to 67.90% (SD: 12.57, p = 0.001). Adherence rates were high, averaging 89.81% (SD: 5.62, p = 0.02), reflecting strong patient engagement. Quality-of-life scores also increased significantly, with a mean score of 79.74 (SD: 11.28, p = 0.015). No severe adverse events were reported, underscoring the safety of the intervention. Conclusion: CGM combined with insulin pump therapy significantly improves long-term glycemic control, adherence, and quality of life in diabetes management. These findings highlight the clinical and psychosocial benefits of integrating these technologies, particularly in achieving sustainable outcomes. Future research should explore broader population impacts, cost-effectiveness, and advanced technological integration