Factors associated with medication adherence among people with type 2 diabetes in Indonesia: A multicenter cross-sectional study using structural equation modeling.

Adherence to oral chemotherapy in pediatric oncology: A scoping review of challenges and strategies.

"It was red, it was inflamed": A qualitative study of patient perspectives on musculoskeletal ultrasound in rheumatoid arthritis care.

Methamphetamine use as an independent risk factor for intracerebral hemorrhage in hypertensive patients: A case-control study.

Factors associated with inhaler therapy adherence using a multidimensional adherence model in patients with chronic obstructive pulmonary disease.

Implementation of therapeutic adherence in adult patients diagnosed with the Human Immunodeficiency Virus: A systematic review.

Development and fit-for-purpose validation of human scalp hair analysis using UHPLC-MS/MS for determining exposure to CFTR modulators.

Depression is a common mental health comorbidity among patients with sickle cell disease (SCD) and is associated with increased health care utilization, increased costs, and poorer quality of life. Although depression and antidepressant adherence have been shown to be associated with medication adherence in other chronic conditions, research examining these associations in SCD is lacking. To determine whether comorbid depression and antidepressant medication adherence are associated with adherence to SCD disease-modifying therapies (DMTs) among Texas Medicaid patients with SCD. This retrospective study analyzed Texas Medicaid claims data (01/2016 to 08/2023) for individuals who had at least 3 medical claims for SCD, had at least 1 prescription claim for an SCD DMT, were aged 8 to 63years, and were continuously enrolled for 6 months before and 12 months after the index date (first claim for an SCD DMT). In addition to the above, patients with depression had at least 1 medical claim for a depressive disorder, and those with treatment had at least 1 prescription claim for a selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor. Adherence was measured using proportion of days covered (PDC). Descriptive and inferential statistics were used to describe and compare demographic and clinical characteristics and medication adherence between patients with SCD with or without comorbid depression. Multivariable logistic regression was used to determine the association between comorbid depression, antidepressant adherence, and SCD DMT adherence. Among 1,005 patients with SCD (22.9 ± 11.7years), 35.3% had comorbid depression. Mean PDC for each SCD DMT was 38.7 ± 26.7% (hydroxyurea), 37.5 ± 29.5% (L-glutamine), 33.9 ± 30.4% (crizanlizumab), and 60.9 ± 34.1% (voxelotor). Overall SCD DMT adherence was 11.7% (PDC ≥ 80%) and 17.2% (PDC ≥ 70%), and significantly lower among patients with comorbid depression compared with those without comorbid depression (7.6% vs 14.0%; P = 0.0026). Among patients with SCD and comorbid depression with treatment, mean adherence to selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors was 43.2 ± 29.1% and 42.3 ± 30.8%. Overall mean adherence to antidepressants was 43.3 ± 29.8%, and 20.5% (PDC ≥ 80%) and 23.5% (PDC ≥ 70%) of patients were adherent. After adjusting for covariates, the multivariable logistic regression model showed that compared with antidepressant-nonadherent patients, antidepressant-adherent patients had higher odds (adjusted odds ratio = 16.70; 95% CI = 3.97-70.31) of being adherent to SCD DMTs (PDC ≥ 70%) among patients with SCD and comorbid depression events. More than one-third of patients with SCD had depression, and depression was associated with lower SCD DMT adherence. Antidepressant-adherent patients had higher odds of being adherent to SCD DMTs. Providers should regularly screen for depression and initiate and encourage antidepressant adherence, as this may potentially improve adherence to SCD DMTs. Given the known association between medication adherence and health outcomes, improving adherence to SCD DMTs may improve the health outcomes in this population.

BackgroundThe decision between home-based (HC) and institutional care (IC) for Alzheimer's disease (AD) is critical for patients, families, and healthcare systems, yet evidence on long-term trade-offs remains insufficient.ObjectiveThis study comprehensively compare the 5-year clinical, economic, and family-related outcomes between HC and IC for AD patients.MethodsWe conducted a prospective-retrospective cohort study involving 252 AD patients (HC = 124; IC = 128) and their families. Outcomes included cognitive and functional status (using Mini-Mental State Examination and Barthel index), neuropsychiatric symptoms (Neuropsychiatric Inventory), medication adherence (Medication Possession Ratio and Morisky Medication Adherence Scale), healthcare costs, and family impact (Depression, Anxiety and Stress Scales and General Health Questionnaire).ResultsAnalysis revealed a critical dichotomy: HC showed better early cognitive preservation but later accelerated decline, contrasting with IC's stable trajectory. IC demonstrated superior control of harmful behaviors and prevention of consequential events, while HC was associated with more significant medical complications. Medication adherence was sustainably higher in IC but progressively deteriorated in HC. Economically, HC's lower initial direct costs were offset by substantial indirect costs, while IC incurred higher but predictable direct expenditures. Crucially, the psychological and health impact on family progressed substantially in HC but remained low and stable in IC.ConclusionsNo single care model was universally superior. The HC versus IC decision involves strategic trade-offs across clinical, economic, and family domains. These findings advocate for personalized, dynamic care models that facilitate timely transitions, guided by patient needs and family capacity, to optimize long-term outcomes for both patients and their families.

Diabetes mellitus poses a significant public health challenge in Sub-Saharan Africa (SSA), exacerbated by healthcare limitations, socioeconomic disparities and sociocultural factors affecting disease management. Medication adherence is critical for glycaemic control but remains suboptimal in this region. This review synthesises evidence on adherence to antidiabetic medications in SSA, identifies key determinants and suggests strategies to improve adherence. A systematic review was conducted following PRISMA 2020 guidelines by searching PubMed, Scopus, Web of Science and African Journals Online for studies published between January 2015 and May 2025. Studies involving diabetic patients in SSA and assessing medication adherence were included. Data were extracted using a standardized form, and methodological quality was assessed using the Newcastle-Ottawa Scale. Twenty-six studies with over 6500 participants from 10 SSA countries were included. Adherence rates varied from 13.9% to 84.5%, with most settings reporting moderate to low adherence. Key determinants of non-adherence included socioeconomic barriers, therapy-related factors, health system limitations, and sociocultural influences. Effective interventions need to be culturally sensitive and address these multidimensional barriers. Future research should focus on longitudinal and interventional designs.

Supervised In-Person versus Home-Based Exercise in Peripheral Artery Disease: A Pilot Comparative Study.

From dispensing to caring: Enhancing patient-provider relationships through parallel chart writing in a pharmacist-managed clinic.

Non-adherence to cardiovascular disease (CVD) treatments leads to suboptimal health outcomes and increased healthcare and societal costs. We assessed the long-term effects of adherence to CVD and diabetes medications using population data and microsimulation modelling. We developed a CVD microsimulation model using individual participant data from the SIDIAP database (2012-2021) for 152,117 adults who received new prescriptions for antihypertensive, lipid-lowering, oral glucose-lowering or antiplatelet treatments in Catalonia between January 2012 and December 2013. Model inputs included demographic and clinical characteristics, medication adherence and cardiovascular events. Costs (€, 2025) and treatment effects were sourced from the literature, and utilities were estimated using national population-based surveys. Model validity was assessed by comparing simulated and observed cumulative incidences over 8 years. The model simulated life-years (LYs), quality-adjusted life-years (QALYs) and healthcare and societal costs under three scenarios: non-adherent, observed adherence and full adherence. We estimated the maximum per-patient cost at which adherence-enhancing interventions would remain cost-effective. Simulated cumulative incidences of cardiovascular events and all-cause death closely matched observed data. Improved adherence increased survival by 0.19-0.58 years and QALYs by 0.25-0.70, while increasing lifetime healthcare costs by €2,431-€8,093 per patient. The additional cost per QALY ranged from €8,946 to €12,614 per QALY, indicating that improving adherence is likely to be a cost-effective if achieved at additional cost of up to €4,041 to €10,098 per patient. Long-term extrapolation of real-world data using microsimulation modelling shows that optimising adherence to CVD and diabetes medications can enhance health outcomes cost-effectively.

333 Background: Pediatric cancer patients often experience significant psychological distress due to their diagnosis, treatment side effects, and overall disease burden. Anxiety, depression, acute stress reaction and adjustment disorder are common mental health challenges that negatively impact treatment adherence, well-being, and long-term psychosocial outcomes. Cognitive-behavioral therapy (CBT) has shown positive effects on psychological and health-related outcomes in children with cancer; however, its effectiveness in pediatric cancer patients in Pakistan remains unexplored. Methods: This single-blinded, parallel-group, two-arm randomized controlled trial (RCT) included 80 children (aged 8-14 years) undergoing chemotherapy at the Pediatric Oncology Department of The Children's Hospital, Pakistan Institute of Medical Sciences (PIMS), Islamabad. The intervention group received five weekly, 30-35 minute individual cognitive behavioral therapy (CBT) sessions at the National Autism Center of PIMS, delivered by a consultant psychiatrist trained in CBT, focusing mainly on modifying maladaptive thoughts and promoting behavioral activation, working on coping skills through problem-solving therapy, stress management, anger management, and providing supportive therapy. The control group received usual care. Outcomes were assessed at baseline, post-intervention, and one month after post-intervention using the Revised Child Anxiety and Depression Scale (RCADS) and Pediatric Quality of Life Inventory (PedsQL) 4.0 Core Module. Results: The intervention group showed a significant reduction in anxiety (post-intervention: β = −3.58, 95% CI [−9.04, −4.92], p < 0.001; one-month follow-up: β = −4.26, 95% CI [−9.73, −5.26], p < 0.001) and depression (post-intervention: β = −2.39, 95% CI [−7.64, −1.23], p = 0.001; one-month follow-up: β = −4.12, 95% CI [−7.43, −2.94], p < 0.001), with improvements across generalized anxiety, social anxiety, and major depressive disorder domains. Quality of life (QoL) significantly improved at one-month follow-up (β = 4.07, 95% CI [1.49, 6.18], p = 0.01), particularly in emotional (p = 0.002) and school functioning (p = 0.005). Treatment and medication adherence were higher in the intervention group, with 90 % attending all scheduled chemotherapy sessions compared to 65% in the control group (p = 0.02). Additionally, intervention group experienced reduced sleep disturbances, and improved symptom management, reporting fewer instances of nausea, fatigue, and headaches (p = 0.02). Conclusions: CBT effectively reduces anxiety and depression while enhancing QoL in pediatric cancer patients. These findings support integrating CBT into national standard care protocols for pediatric cancer patients in Pakistan. Future research should explore long-term effects and scalability across diverse healthcare settings.

Diet-related chronic conditions are major contributors to global morbidity and mortality. Effective management of these conditions requires consistent engagement in self-care behaviours such as healthy eating, physical activity, and medication adherence. However, behavioural interventions often lack personalisation, limiting their impact, whereas digital twin (DT) systems, which use digital technologies to generate real-time representations of individuals, offer the potential to support people through adaptive and patient-centred approaches by integrating health data to personalise and optimise self-care strategies. A systematic review was conducted to synthesise and evaluate the use of DT for supporting self-care behaviours among adults with diet-related chronic conditions METHODS: Five electronic databases (PubMed, Web of Science, Embase, CINAHL, and IEEE Xplore) were searched from inception to 31 July 2025. Studies including adults with diet-related chronic conditions, using DT interventions, and reporting changes in self-care maintenance, monitoring, or management were eligible. Of 3,685 records identified, four studies (N=2,662) met the inclusion criteria, all focusing on type 2 diabetes. All four studies used continuous glucose monitoring (CGM), and three additionally used wearable devices and dietary logs integrated with AI-driven DT platforms to provide personalised feedback and recommendations, often alongside human coaching. Two retrospective studies found substantial reductions in antidiabetic medication use, with one reporting a 74% reduction over one year including discontinuation of insulin in 94% of baseline insulin users, and large class‑specific declines, such as sulfonylureas (-99%) and DPP‑4 inhibitors (-88%), with many participants maintaining HbA1c<7% on no therapy or metformin monotherapy, and the other showing that 42.8% of participants eliminated all diabetes medications within 90days while maintaining glycaemic control (via a staged medication‑reduction framework). One randomised controlled trial found that 94% of participants discontinued all T2D medications and 72.7% achieved diabetes remission after one year, accompanied by increased daily steps, improved sleep, and reduced sedentary time (with only 4.7% remaining on metformin alone at one year). Another study found that personalised insulin infusion guided by a DT over 14days reduced insulin doses by 14-29% and increased time in the target glucose range to 86-97% (personal insulin pump data over a 14‑day collection period) CONCLUSIONS: DT-based interventions demonstrated potential to enhance multi-behavioural self-care and clinical outcomes in adults with type 2 diabetes. Evidence is currently limited to diabetes, highlighting the need for studies in other diet-related chronic conditions and standardised assessment of self-care behaviours.

To quantify polypharmacy (≥5 drugs) and hyperpolypharmacy (≥10 drugs) in pacemaker recipients aged ≥65 years and to assess associations with frailty (FRAIL), physical activity (IPAQ), medication adherence (MAT), and healthcare utilization over 6 months. Polypharmacy is common in elderly patients with cardiac devices, but prospective data from European pacemaker clinics on frailty, physical activity, adherence, and prescribing quality are limited. Prospective, single-center observational study in a Portuguese tertiary pacemaker outpatient clinic (n=104). Participants (≥65 years) were assessed at enrolment and at 3 and 6months. FRAIL, IPAQ, and MAT were recorded at each timepoint. Healthcare utilization was defined as emergency department visits and/or hospital admissions. STOPP/START v3 was applied descriptively at 6months. Mean age was 79.1±7.5 years; 69.2% were men. Polypharmacy and hyperpolypharmacy were present in 49.0% and 38.5% at enrolment and 47.5% and 43.4% at 6 months. A higher number of chronic medications was associated with higher FRAIL scores, lower IPAQ scores and more frequent healthcare utilization, whereas MAT scores remained uniformly high. Cardiovascular drugs, diuretics, and proton-pump inhibitors (PPIs) were the most frequently used classes. STOPP/START identified potentially inappropriate medications (notably PPIs and benzodiazepines) and prescribing omissions according to START (notably cardiovascular therapies). Polypharmacy and hyperpolypharmacy are frequent and persistent in elderly pacemaker recipients and are associated with frailty, lower physical activity and higher healthcare utilization. Structured medication review during routine follow-up may help identify PIMs and PPOs and optimize pharmacotherapy.

Cabozantinib is a multi-targeted tyrosine kinase inhibitor that targets Vascular Endothelial Growth Factor Receptor (VEGFR) 2, c-MET, and RET. It exhibits antiangiogenic and antitumorigenic effects and has the potential to treat a variety of malignancies. Palmar-Plantar Erythrodysesthesia (PPE), one of the most common side-effects of tyrosine kinase inhibitors, can have a considerable impact on patients’ quality of life and medication adherence, making it a key therapeutic obstacle in maximising the efficacy of targeted cancer therapy. We describe a rare early-onset bullous type of PPE that developed within 15 days of starting cabozantinib in a 32-year-old woman with papillary renal cell carcinoma. The patient developed severe bullous and hyperpigmented acral lesions, which hampered everyday activities. The response followed a dosage-dependent pattern, with partial improvement and relapse after dose adjustment and full resolution after additional dose reduction and topical treatment. This case emphasises the need to identify unusual and early signs of PPE to provide prompt care while maintaining oncologic therapy

Inflammatory rheumatic diseases (IRDs) represent a significant risk factor for cerebrovascular events, independent of traditional cardiovascular risk factors. The elevated risk of stroke in individuals with IRDs arises from chronic systemic inflammation, endothelial dysfunction, accelerated atherosclerosis, prothrombotic effects of antiphospholipid antibodies, and cumulative corticosteroid exposure. Post-stroke rehabilitation in patients with IRDs involves distinct clinical challenges that extend beyond standard neurorehabilitation, including joint involvement, chronic pain, fatigue, and treatment-related limitations. Assessment tools that focus exclusively on neurological recovery are inadequate for this population. Dual-layered protocols that integrate both neurological and rheumatological criteria are required. Although wearable sensors, telemonitoring, and electronic patient-reported outcome measures provide a foundation for continuous monitoring, barriers such as limited digital literacy, insufficient infrastructure, and the absence of IRD-specific content addressing symptom overlap persist. Post-stroke cognitive impairment is frequent and multifactorial in this group, necessitating cognitive assessment approaches tailored to IRD subgroups, as disease-specific manifestations may confound the interpretation of standard screening tools. Physiotherapy, occupational therapy, telerehabilitation, and virtual reality-based interventions may be beneficial when specifically adapted to accommodate joint limitations and pain. While artificial intelligence-based tools hold promise, there remains a need for clinically validated, domain-specific expert platforms. Nurses are integral to this process, providing patient education, monitoring medication adherence, offering psychosocial support, and coordinating remote care. Optimal management of stroke associated with IRDs requires multidisciplinary, technology-enabled, and patient-centered care models that integrate neurology, rheumatology, rehabilitation medicine, and digital health. Given the predominantly indirect nature of current evidence, prospective studies employing validated assessment tools are urgently needed.

Hypertension represents a major contributor to the global cardiovascular (CV) disease burden, yet it remains inadequately controlled largely due to poor treatment adherence. Emerging digital health technologies hold promise for improving blood pressure (BP) management and CV outcomes, but the lack of evidence, unavailability in most countries, and out-of-pocket costs have hindered the widespread use of these technologies in clinical practice. To assess in a randomized controlled trial whether a digital health intervention (DHI) based on the free Elfie solution compared to usual care will reduce systolic blood pressure (SBP) in adults with uncontrolled hypertension (SBP ≥ 140 mmHg). This is a pragmatic, open-label, randomized parallel arm, international, multicenter clinical trial. Adult individuals with hypertension are randomly assigned to usual care or a DHI based on the Elfie solution. Elfie offers a comprehensive set of features designed to enhance self-monitoring, adherence and education, complemented with a gamification feature to boost engagement. The primary outcome is office SBP measured at 6 months. Secondary outcomes include medication adherence, diastolic BP, BP control achievement, hypertension knowledge, self-care, health-related quality of life and process outcomes assessing app usage and engagement. The ELFIE-HYPERTENSION trial is an international multicenter pragmatic randomized clinical trial, investigating the effects of an innovative, free and scalable DHI to improve BP control. If proven effective, this intervention can be easily and widely implemented in the management of hypertension in a variety of clinical settings globally. The trial is registered at the Clinicaltrials.gov (NCT06242483).

This study investigated the role of psychological variables (anxiety, depression, beliefs about medication, satisfaction and frustration of basic psychological needs, and mindfulness skills) on adherence in patients with inflammatory arthritis (IA). 250 patients with IA completed an online questionnaire at baseline (T0) and three months later (T1). Their adherence was assessed at T1 with the General Adherence for Chronic Disease Profile (GACID-P) exploring patients' daily life and medical domains of adherence. Measures carried out at T0 included sociodemographic variables, anxiety and depression, beliefs about medicines, basic psychological needs satisfaction and frustration, and mindfulness skills. Following descriptive analyses and correlations between variables, multiple linear regressions were performed to identify adherence predictors. All significant correlations between psychological variables and the two adherence domains were as expected. Three mindfulness skills (observing, acting with awareness and nonreacting) were found as predictors of both domains. Beliefs about treatment (necessity and overuse) predicted medical adherence, whereas the frustration of the relatedness need with relatives predicted daily life adherence. Mindfulness skills and treatment beliefs are critical psychological factors for improving general adherence in patients with IA. Acceptance and Commitment Therapy (ACT) is proposed as an appropriate integrative approach for improving adherence.