Minimal Adherence Research Articles

Suicidal Behavior in Nepali motion pictures of three decades (1990-2020): A content analysis.

Assessment of the depiction of suicidal behavior in motion pictures would reveal the social representation of suicide that would foster suicide prevention in a country. We aimed to assess how suicidality has been depicted in Nepali movies by scrutinizing their contents against the sociodemographic checklist and WHO media guidelines for suicidal reporting. This is a narrative quantitative analysis of suicidal behavior portrayals in the Nepali motion pictures that are publicly and freely accessible. Overall, out of the 573 scrutinized movies, we found ten movies consisting of 11 characters (i.e., the prevalence is 1.75%) showing suicidal behavior. The majority of suicidal behavior was seen in males 6 (54.5%), and the majority of attempters were students 3 (27.3%) or homemakers 2 (18.2%). Suicidal behavior was mostly observed in unmarried people 6 (54.5%). Hanging was the most prevalent method (45.5%), and home (36.4%) and public places (36.4%) were equally the most frequent places of attempt. The consequential risk factors for the attempts were found to be marital problems/premarital affairs (50%), followed by unfulfilled demand/conflict (30%). While all 11 items depicted the method and place of the attempt, two also depicted the complete scene of the attempt. One item used language that normalized suicide as a constructive solution to the problem. None of the pictures publicized any mental health messages or educated the public about suicide prevention. The minimal adherence of the Nepali motion pictures on the depictions of suicidality with WHO media guidelines indicates urgent need to create awareness among the Nepali film fraternity.

Knowledge Attitude and Practice of Pregnant Women Towards Physical Exercise in Agege Local Government Area of Lagos State, Nigeria

Introduction: Pregnancy is a good time to develop a healthy lifestyle in pregnant women which includes physical exercise. The objective of this study was to assess the knowledge, attitude and practice of physical exercise among pregnant women in Agege local government area in Lagos state, Nigeria. Methodology: A cross-sectional survey method was used; 400 pregnant women were recruited into the study using convenience sampling technique. A structured and validated questionnaire was designed to assess knowledge, attitude and practice of pregnant women towards physical exercise was used to collect data. All the results were tested at 0.05 level of confidence. Results: The result showed that 36% of the pregnant women were between the age of 21-25 years and more than 35% were between 15-20 years, more than (71%) of the women have heard about physical exercise. Nevertheless, only 52% of the pregnant women engaged in physical exercise. Most (54.0%) of them actually prefer domestic activities over real physical exercise. The result suggests that women’s knowledge concerning physical exercise during pregnancy is reasonable and their attitude is positive; however, a large number do not practice physical exercise. Antenatal program may be tailored into introducing guided physical exercise and introduce pregnant women into guided models of fitting exercises for each trimester. Conclusion: Physical exercise in pregnancy is important to aid bodily movement produced by skeletal muscles that results in energy expenditure. Exercise is a subset of physical activity that is planned, structured, and repetitive and has as objective to improve or maintain physical fitness. Physical activity and exercise promote health and longevity, and minimal adherence to current physical activity guidelines is associated with a significant 20-30% reduction in risk of all-cause mortality. Pregnancy leads to a reduced level of physical activity for most women, the activity level is often further reduced throughout pregnancy, and the pre-pregnancy exercise level is usually not regained six months after childbirth

Patterns of Nonadherence to Hydroxyurea in Pediatric Sickle Cell Disease

Background: Sickle cell disease (SCD) affects an estimated 100,000 American children and adults (CDC, 2017). Hydroxyurea is the first-line disease-modifying treatment for SCD. Daily oral hydroxyurea significantly reduces the frequency of pain and serious medical complications associated with SCD, including dactylitis and acute chest syndrome (Wang et al., 2011). However, adherence to hydroxyurea is less than optimal at 74% among pediatric patients, with 20% of children who are prescribed hydroxyurea taking less than 50% of their prescribed doses (Louiselle et al., 2016). Suboptimal hydroxyurea adherence is associated with increased risk for medical complications, diminished quality of life, and higher health care costs and utilization (e.g., Badawy et al., 2017; Thornburg et al., 2010). Factors associated with hydroxyurea nonadherence in pediatric SCD include female sex, older age, more adherence barriers (e.g., difficulty obtaining refills), lower socioeconomic status, and lower parent treatment knowledge. Purpose: This study aims to characterize trajectories of pediatric hydroxyurea adherence to identify subgroups that may be at highest risk for hydroxyurea nonadherence (e.g., sociodemographic factors), critical time periods for adherence support interventions (e.g., adolescence), and minimal adherence thresholds to optimize hydroxyurea efficacy. Methods: Retrospective chart review across two institutions (i.e., Cincinnati Children's Hospital Medical Center and Nemours Children's Hospital, Delaware) are ongoing. Participants will include patients with SCD ages 2 to 21 years who were prescribed hydroxyurea from March 2007 to February 2017. Researchers are extracting the following data from patient electronic medical records (EMRs) to estimate hydroxyurea adherence: hemoglobin F levels (HbF), mean corpuscular volume (MCV), and absolute neutrophil count (ANC). Additional clinical information will be extracted from patient EMRs including demographic information, SCD genotype, SCD complications, acute care utilization, medical and social complexity, and concomitant medication use. Descriptive statistics will be used to summarize demographic and clinical characteristics of the sample. MCV will be the primary measure of hydroxyurea adherence and Hgb F and ANC will be secondary measures. If the final sample size is sufficiently large, we will conduct group-based trajectory modeling (GBTM) to analyze patterns of hydroxyurea adherence changes over time and identify hydroxyurea adherence trajectory subgroups. Multinomial logistic regression analyses will be used to analyze potential predictors of hydroxyurea adherence trajectory subgroup membership. Results: Preliminary results revealed that as of February 2017, 88% of eligible patients (based on age) were prescribed hydroxyurea.Data from the first 30 completed chart reviews indicates that half of the sample was female (sex assigned at birth), all identified as Black or African American, all but two participants had HbSS, and the mean age 13.0 years ( SD=8.0, range=2.47 to 26.81). Average MCV across an average of 21 time points ( SD=14.2, range=5-74) was 94.3 ( SD=11.2, range=58.4-114.2). As of February 2017, 53% of individuals had MCV values at or above 100. Specifically, 60% of 5-9 year olds, 47% of 10-15 year olds, and 46% of 16+ year olds had MCV values at or above 100. Average Hgb F across an average of 21 time points ( SD=15.3, range=3-81) was 22.9 ( SD=9.3, range=2.6-44.8). As of February 2017, 50% of individuals had HbF values at or above 20.0. Specifically, 55% of 5-9 year olds, 32% of 10-15 year olds, and 55% of 16+ year olds had HbF values at or above 20.0. Average ANC (at non-ill visits) across an average of 20.0 time points ( SD=13.6, range=5-71) was 3,965 ( SD=1,227; range=1,600-6,910). As of February 2017, 31% of individuals had ANC values less than 3,000. Specifically, 20% of 5-9 year olds, 34% of 10-15 year olds, and 30% of 16+ year olds had ANC values less than 3,000. Discussion:Results from this study have the potential to help researchers and clinicians better understand patterns and correlates of hydroxyurea adherence in pediatric SCD patients that can be targeted in future interventions.

Optimal adherence threshold to non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation to reduce the risk of thromboembolism and death

Abstract Background Poor adherence to non-vitamin K antagonist oral anticoagulants (NOACs) may raise thromboembolic risks in patients with atrial fibrillation (AF). However, the minimal adherence to maintain the protective effects of NOACs is currently unknown. Purpose To investigate thresholds of NOAC adherence in association with thromboembolic and mortality risks. Methods Using two Belgian nationwide healthcare databases, AF patients ≥45 years old with ≥1 NOAC prescription claim between January 1st, 2013 and January 1st, 2019 were identified. Patients were followed from NOAC initiation until the first occurrence of the investigated outcome, treatment discontinuation (>60-day supply gap), switch to VKAs, death, emigration or end of the study period. Adherence was measured using the proportion of days covered (PDC) after one year of treatment. Inverse probability weighted Cox regression (adjusting for 39 confounding covariates) was used to investigate outcomes (identified using International Classification of Diseases-coded hospital discharge diagnoses and medical procedure codes) between NOAC users with a one-year PDC of 100% (reference group) and NOAC users with lower PDCs. Results A total of 92,111 newly-treated AF patients were included during a mean follow-up of 2.7 ± 1.4 years (250,750 person-years of on-treatment follow-up). The proportions of persistent NOAC users with a PDC of 100%, 95-99%, 90-94%, 85-89%, 80-84% and <80% after one year of treatment were 62.7%, 17.4%, 9.5%, 5.1%, 2.8% and 2.5%, respectively. Compared to NOAC users with a one-year PDC of 100%, significantly higher risks of stroke or systemic embolism were observed among NOAC users with PDCs of 85-89% (adjusted hazard ratio (aHR) 1.35, 95% confidence interval (CI) (1.19-1.54)), 80-84% (aHR 1.31, 95%CI (1.08-1.58)) and <80% (aHR 1.64, 95%CI (1.34-2.01)), while no significant differences were observed among NOAC users with one-year PDCs of 95-99% (aHR 1.02, 95%CI (0.94-1.12)) or 90-94% (aHR 1.06, 95%CI (0.95-1.18)) after multivariable adjustment. Significantly higher risks of all-cause mortality (aHR 1.09, 95%CI (1.01-1.17) and major or clinically relevant non-major bleeding (aHR 1.10, 95%CI (1.04-1.16) were observed with decreasing levels of NOAC adherence, starting from NOAC users with a one-year PDC of 90-94% versus 100%. Findings were similar with once-daily and twice-daily dosed NOACs. Conclusion Lower adherence to NOAC treatment is associated with increased risks of thromboembolism, all-cause mortality and bleeding. For adequate stroke prevention in AF, the optimal adherence threshold to NOAC treatment should be at least 90%, irrespective of the dosing regimen of NOACs.Figure 1

Minimal Adherence Threshold to Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation to Reduce the Risk of Thromboembolism and Death: A Nationwide Cohort Study.

Poor adherence to non-vitamin K antagonist oral anticoagulants (NOACs) may raise thromboembolic risks in patients with atrial fibrillation (AF). However, the minimal adherence to maintain the protective effect of NOACs is currently unknown. Therefore, we investigated thresholds of NOAC adherence in association with thromboembolic and mortality risks. Patients with AF initiating NOACs between 2013 and 2019 were identified in Belgian nationwide data. Adherence was measured using the proportion of days covered (PDC) after one year of treatment. Inverse probability of treatment weighted Cox regression was used to investigate outcomes. 92,111 persons were included (250,750 person-years). Compared to NOAC users with a one-year PDC of 100%, significantly higher risks of stroke or systemic embolism were observed among NOAC users with PDCs of 85-89% (adjusted hazard ratio (aHR) 1.35, 95% confidence interval (CI) (1.19-1.54)), 80-84% (aHR 1.31, 95%CI (1.08-1.58)) and < 80% (aHR 1.64, 95%CI (1.34-2.01)), while no significant differences were observed among NOAC users with one-year PDCs of 95-99% (aHR 1.02, 95%CI (0.94-1.12)) or 90-94% (aHR 1.06, 95%CI (0.95-1.18)). Significantly higher risks of all-cause mortality were observed with decreasing levels of NOAC adherence, which were already higher among NOAC users with a one-year PDC of 90-94% versus 100% (aHR 1.09, 95%CI (1.01-1.17)). Findings were similar with once-daily and twice-daily dosed NOACs. Poor adherence to NOACs is associated with increased risks of thromboembolism and all-cause mortality. The minimal adherence threshold should be ≥ 90%, preferably even ≥ 95%.

Metallurgical, erosion, and sensitization performance of TiAlN monolayer and TiAlN/TiN multilayer ceramic coatings on AISI 304 boiler steel

In the present work, TiAlN monolayer and TiAlN/TiN multilayer ceramic coatings were deposited on AISI 304 austenitic stainless steel by plasma arc physical vapor deposition (PAPVD) process. The metallurgical, erosion, and sensitization performance of these coatings were compared with uncoated 304 boiler steel. Metallurgical studies depicted formation of Al and Ti nitrides on monolayer and multilayer coated steel surfaces, which resulted into higher nitriding at the surface and dense coating formation on boiler steel substrate. Multilayer film exhibited comparatively lesser porosity, lower surface roughness, and higher hardness than monolayer coated and uncoated steel. The erosion performance was evaluated at 30° and 90° besides 2 g/min and 3 g/min flow rates of Al2O3 erodent material for coated and uncoated steel substrate. Multilayer coated 304 steel possessed lower erosion wear rate as evaluated through lesser weight loss before and after erosive wear, smaller crater formation, and minimal adherence of erodent material along with lesser Fe content on eroded surface relative to monolayer coated and uncoated steel. Multilayer coated steel thermally aged at 750° for 24 h had least degree of sensitization (DOS) compared to monolayer coated and uncoated aged boiler steel. Although monolayer coated steel performed better than uncoated one in erosion and sensitization performance but multilayer coating performance was best among all coated and uncoated steel used for present study. Thus, it was established that TiAlN/TiN multilayer coating on AISI 304 boiler steel has improved its metallurgical, erosion, and sensitization performance.

Experience With Adaptive Servo-Ventilation Among Veterans in the Post-SERVE-HF Era.

The sleep medicine community has struggled to identify the ideal role for adaptive servo-ventilation (ASV) therapy following a study that found increased mortality in patients with central sleep apnea (CSA) and heart failure with reduced ejection fraction who used ASV therapy. We aimed to identify characteristics of patients who benefit from ASV therapy. We performed a record review of all patients treated with ASV therapy at the Hampton Veterans Affairs Medical Center in Virginia from January 1, 2015, to April 30, 2020. Clinical and polysomnographic characteristics of patients adherent to therapy were compared with those that were not adherent. Our cohort of 31 patients was entirely male with a mean age of 67.2 years, body mass index of 34.0, and Epworth Sleepiness Scale score of 10.9. Primary CSA was initially diagnosed in 3 patients (10%), comorbid obstructive sleep apnea (OSA) and CSA in 9 (29%), and primary OSA in 19 (61%). Seventeen patients (55%) met minimal adherence criteria with ASV therapy. The obstructive apnea-hypopnea index (AHI), as a proportion of the total pretreatment AHI, was higher in adherent patients (81.5%) vs nonadherent patients (46.7%) (P = .02). The median residual AHI was lower in the adherent group, both as absolute values (1.7 vs 4.7 events/h; P = .004) and as a percentage of the pretreatment AHI (3.1% vs 10.2%; P = .002). Patients using ASV devices regularly have a larger component of obstructive sleep-disordered breathing and obtain greater objective benefit from ASV than those that do not. This understanding may help to identify patients that will most benefit from this debated form of therapy.

Predictors of objective treatment adherence in adolescents with epilepsy: The important role of motivation

ObjectiveAdolescents with epilepsy are at heightened risk for suboptimal anti-seizure medication (ASM) adherence; however, there is a paucity of adherence interventions for this age group. The current study aimed to identify a comprehensive and novel set of predictors of objective, electronically-monitored ASM adherence in adolescents with epilepsy. MethodsParticipants included 104 adolescents (13–17 years old; M = 15.36 ± 1.40), diagnosed with epilepsy and their caregivers. Cross-sectional data were collected from adolescents, caregivers, healthcare providers, and medical chart reviews, including demographics (i.e., age, race/ethnicity, sex, insurance status), the COVID-19 pandemic (i.e., participation before versus during), seizure characteristics (i.e., presence and severity), ASM side effects (Pediatric Epilepsy Side Effects Questionnaire), adherence motivation (1-item 6-point Likert scale item), and adherence barriers (Pediatric Epilepsy Medication Self-Management Questionnaire). Electronically-monitored adherence data was collected via the AdhereTechTM pill bottle or the Vaica SimpleMedTM pillbox over 30 days. ResultsAdolescents demonstrated suboptimal adherence at 78 ± 31.6%, despite high ASM adherence motivation (M = 4.43 ± .94) and minimal adherence barriers (M = 35.64 ± 3.78). Hierarchical multiple regression, which included non-modifiable sociodemographic and medical variables (Block 1) and behaviorally modifiable psychosocial variables (Block 2) was significant, F(12,87) = 3.69, p < .001. Specifically, having private insurance (versus Medicaid or public insurance; t = −2.11, p = .038) and higher adherence motivation (t = 2.91, p = .005) predicted higher objective ASM adherence. ConclusionRoutine assessment of adherence predictors is vital for the promotion of adherence among adolescents with epilepsy. Adolescent adherence motivation may be an important element of multi-component interventions focused on improving ASM adherence in adolescents with epilepsy.

Full-field shingle uplift measurements using StereoDIC: Comparison of single and double sealant three-tab shingle responses when subjected to hurricane velocity winds

For the first time, the vision-based measurement method Stereo Digital Image Correlation (StereoDIC) is applied successfully to quantitatively assess the response of asphalt shingles installed in a model roofing system and subjected to hurricane velocity winds. By mounting a low profile asphalt-shingled plywood roof facsimile without building firmly to a rigid steel frame and supplying sustained winds of 67.1 m/s perpendicular to the leading edge region, StereoDIC measurements were obtained at 1 Hz to measure the full-field uplift displacements for shingles sealed using either single or double sealant strips. By varying the sealant activation process (time and temperature), the effect of installation in winter and summer seasons is also quantified throughout the wind loading process. Results indicate that with lower temperature sealant activation, both single and double sealant shingles sustained catastrophic failure within a short time when the wind speed reached 67.1 m/s, with the double sealant system lasting for about 500 s; visual inspection of the separation surfaces for the low temperature activation showed large specular reflecting regions, indicating either no bonding or minimal adherence. For a higher sealant activation temperature, (a) both single and double sealant shingles remained intact for more than 2 h in 67.1 m/s wind speeds, with no sealant separation observed and (b) displacements for the shingle with double sealant strips were significantly lower than for the single sealant system, confirming the efficacy of a double sealant strip system. As a general observation, StereoDIC measurements clearly show that shingle uplift displacement is not constant across the width of a shingle tab, with the edges of the shingle (tab cutout regions) having significantly larger uplift displacements that may serve as sealant separation initiation sites.

432. An Outbreak of Coronavirus Disease, 2019 (COVID-19) in a Skilled Nursing Facility – California, 2021: Description, Mitigation, Challenges, and Opportunities

BackgroundSkilled nursing facility (SNF) residents comprised 11% of all COVID-19 cases in the United States; however, they account for 43% of deaths with case fatality rates (CFR) of 26.0-33.7%. MethodsWe report an outbreak of COVID-19, from June 15 to July 21, 2020 in a 159-bed SNF with a staff of 172 that resulted in an infection rate of 97% in residents and 23% in HCWs (Figure 1). A retroactive review outlined mitigation efforts, discussed challenges, identified risk factors among residents and health care workers (HCW) for acquisition of COVID-19, and reviewed opportunities for improvement (Figure 2). Figure 1. Epi Curve of COVID-19 Outbreak in a Skilled Nursing Facility Figure 2. Timeline of COVID-19 Outbreak in a Skilled Nursing FacilityResultsFactors that contributed to the outbreak: delay in test results had an impact on cohorting; suboptimal adherence to the principles of infection prevention and control (IPC) and minimal adherence monitoring; strict criteria were used to screen for infection; the underappreciated transmissibility of COVID-19 from presymptomatic and asymptomatic persons; symptomatic HCWs who continued to work; the changing guidance on, the suboptimal use of, and an inadequate supply of personal protective equipment; poor indoor air quality due to ventilation challenges; and the important role of community/family/interfacility spread on the outbreak. Whole genome sequencing, performed in 52 samples, identified a common strain that was also found in clusters of 2 other facilities: 1 in the same geographic location, the other in a different geographic location but whose HCWs had the same zip codes as the facility (Figure 3). Certified nursing and restorative nursing assistants had the highest risk of infection with an odds ratio (OR) of 4.02 (confidence interval 1.29-12.55, p value: 0.02) when compared to registered and licensed vocational nurses. The residents’ CFR was 24%. The OR for death was increased by 10.5 (10.20-11.00) for every decade of life as was morbid obesity (BMI > 35) with an OR of 8.50. BMI as a continuous variable increased risk of mortality for every additional unit, OR 1.07 (Tables 1, 2). Whole Genome Sequencing of Isolates from a Skilled Nursing Facility Outbreak Univariate Analysis of Selected Variables Associated with Mortality among Residents at Facility A during COVID-19 Outbreak, June 19 - July 21, 2021 Multivariate Analysis of Factors Associated with Mortality from COVID-19 after Adjusting for Age among Residents (N =124) of Facility A, June 15 - July 21, 2020ConclusionWhile implementation of optimal IPC measures in the pre-COVID-19 vaccination era had no impact on the infections in residents who were likely already infected or exposed at the onset of the outbreak, these measures along with non-pharmacologic strategies were effective in halting the spread among HCWs.Disclosures All Authors: No reported disclosures

Dietary Pattern and Long-Term Effects of Ambient Particulate Matter on Hypertension and Blood Pressure in Chinese Adults

Background: Previous experimental studies have identified specific foods or nutrients that are capable of mitigating adverse health effects induced by air pollution exposure. However, whether the usual dietary pattern can modify the associations between long-term air pollution exposure, hypertension and blood pressure has not yet been assessed. Methods: This cross-sectional study included 61,081 participants aged 30-79 from baseline data of the China Multi-Ethnic Cohort (CMEC). Ambient particulate matter with aerodynamic diameters ≤1 μm, ≤2.5 μm and ≤10 μm (PM1, PM2.5, and PM10) was assessed through a satellite-based random forest approach. The associations between long-term exposure to PM and hypertension were examined by a logistic regression model, and the associations between PM and systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure (PP) were assessed by multivariable linear regression models. The Dietary Approaches to Stop Hypertension (DASH) diet, which is a dietary pattern consisting of 7 food items, was calculated for each participant. Findings: Long-term exposure to ambient PM was associated with an increased risk of hypertension and elevated levels of SBP and PP. The DASH diet modified the associations between PM and hypertension as well as some blood pressure components, as those with a higher DASH score had significantly lower rates of PM-related high blood pressure risk (p value of interaction term < 0.05). For each 10 μg/m3 increase in PM1, PM2.5 and PM10, the participants with minimal adherence to the DASH diet had hypertension risks with ORs (95% CI) of 1.196 (1.084, 1.319), 1.145 (1.09, 1.202) and 1.080 (1.045, 1.117), whereas those with maximal adherence to the DASH diet had lower hypertension risks with ORs (95% CI) of 1.063 (0.953, 1.185), 1.074 (1.017, 1.133) and 1.038 (1.000, 1.077). For specific food items, consuming more fresh fruits, vegetables, dairy and whole grains would reduce the risk of high blood pressure caused by atmospheric particulates. Interpretation: The DASH dietary pattern reduced the hypertension risk induced by long-term exposure to ambient particulate matter. Adequate intake of foods rich in antioxidant compounds may be an effective and wide-reaching intervention to reduce the deleterious impact of air pollution on health. Funding: The National Key Research and Development Program of China (Grant No. 2017YFC0907303), the National Natural Science Foundation of China (Grant No. 81773548) and the China Postdoctoral Science Foundation (Grant No. 2020M683335). Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: Ethical approval was received from the Sichuan University Medical Ethical Review Board.

Interactions between drug treatment adherence, blood pressure targets, and depression in hypertensive individuals receiving care in the Family Health Strategy

The study analyzes interactions between drug treatment adherence, blood pressure targets, and depression in a probabilistic sample of hypertensive individuals treated in the Family Health Strategy in Governador Valadares, Minas Gerais State, Brazil. This is a cross-sectional study with 641 hypertensive individuals 40 years or older, residing in the urban area of Governador Valadares. Structured scripts were used to collect data in home interviews, with a focus on the following indicators: Medication Assessment Questionnaire (MAQ), Beck Depression Inventory (BDI), and blood pressure measurement. Due to the simultaneity of the target events (depression, blood pressure target, and adherence), we applied a system of recursive and simultaneous nonlinear equations. The results suggest that the odds of meeting the blood pressure target increase significantly with adherence to treatment; they also suggest that individuals that meet the blood pressure target show 2.6 higher odds of treatment adherence. Adherence has a protective effect against depression: individuals with minimal adherence show 8.4 higher odds of developing depressive symptoms when compared to those with maximum adherence. Drug treatment adherence is related simultaneously to blood pressure control and lower levels of depression. Promoting drug treatment adherence is essential for ensuring that individuals remain normotensive, with the potential for reducing levels of depression. These positive externalities can reduce pressure on the health system, with simultaneous gains in quality of life for hypertensive individuals.

Intervention through Short Messaging System (SMS) and phone call alerts reduced HbA1C levels in ~47% type-2 diabetics-results of a pilot study.

PurposeDespite extensive research and newer methods of interventions, the incidence and prevalence of diabetes is increasing at an alarming rate. Currently, according to world health organization (WHO) statistics, 422 million individuals are suffering from diabetes worldwide. In India, recent estimates have reported a significant increase in the number of diabetics in the last decade. Poor dietary habits, minimal adherence to treatment regimens, lack of timely education are some of the contributing factors for increasing incidence and huge economic burden; which can be handled by life style behavior modifications backed up by hand holding through continuous education. Prior studies have demonstrated the efficacy of various self-management tools and educational programs in better disease management behaviors among individuals with diabetes. Among various self-management tools, educating the individuals and alerting them using mobile phone calls and short messaging system (SMS) are widely accepted due to (a) the increasing mobile phone users and (b) availability of short messaging systems in local languages in the recent years. Therefore, a pilot study was conducted to determine the benefit of educating patients through phone calls and SMS in the self-management of diabetes.ObjectivesThe objective of the study is to determine the feasibility and utility of SMS and phone call-based interventions in the management of diabetes by comparing the HbA1c values.MethodologyThe study was conducted for a period of 14 months from December 2017 till Feb 2019. Out of 380 individuals initially enrolled into the study, 120 had completed the 14-months period. Diabetes education through SMS and phone calls was provided on regular basis, and HbA1C levels at baseline, 8-months and 14-months quantified. In addition, feedback on patients’ satisfaction and utility of the SMS / Phone calls was collected using questionnaires.ResultsData from our study demonstrated that after 8-months of intervention through phone calls, a significant increase in the number of individuals with HbA1c in the range of 5.1 to 7.0 was observed (from 27 individuals at base line to 37 individuals after 8-months intervention). Much more significant improvement in the number of individuals with lower HbA1c was observed at 14-months of intervention, indicating the benefit of regular phone call-based system in managing diabetes. A Chi square (χ2) test was performed to examine if the frequencies in the cells varied at baseline and at 8 and 14 months.ConclusionChronic diseases like diabetes needs awareness and education to patients in adopting disease self-management practices. As mobile phone users are increasing in number, providing diabetes management education through mobile phone intervention could be a viable strategy for controlling diabetes.

A Systematic Review of the Ethics of Punishment-Based Procedures for Young Children With Disabilities

Punishment-based procedures are used to reduce challenging behavior in both special education and applied behavior analytic practices. Although commonly effective, these interventions are associated with an increased level of risk, making their use controversial. However, no research has specifically analyzed the extent to which researchers comply with the ethical standards of the professional organizations for special educators and behavior analysts (i.e., Council for Exceptional Children [CEC] and the Behavior Analyst Certification Board [BACB], respectively) when implementing punishment-based procedures. This might be especially important for young children with disabilities, who are a highly vulnerable population. We systematically analyzed the use of punishment-based procedures with this population to determine (a) characteristics of included children and treatments and (b) the degree to which researchers adhered to ethical standards during implementation. Results indicated a variety of punishment-based procedures have been used with this population and have generally resulted in decreased challenging behavior; these results were demonstrated across age, diagnosis, target behavior, and treatment type. However, researchers demonstrated minimal adherence to ethical standards, with no improvements over time. This indicates a need for improved ethical rigor of researchers implementing punishment-based interventions. Recommendations include (a) the creation and validation of an ethics code to assess the degree to which researchers demonstrate ethical practices, and (b) the development of tools to help practitioners recognize the ethical implications of punishment-based interventions and choose/implement appropriate interventions for behavioral interventions.

Aspects of developing an education programme based on pulmonologists' appraisal related to chronic obstructive pulmonary disease

Introduction: Chronic obstructive pulmonary disease (COPD) is a health burden for the patient and the society. We have sought to find the optimal education content to alleviate this burden. Aim: (1) To create patient education content based on the pulmonologists' opinion; (2) to understand the pulmonologists' attitudes and perceptions; (3) to evaluate the options to improve patient adherence. Method: We have performed 20 interviews with pulmonologists working in inpatient, outpatient and rehabilitation settings. The structure of the interviews has been designed to determine the key elements of a patient education programme and to discover perception and therapeutic attitudes. Results: The average COPD patient is a smoker, male, under-socialized, coughs, has dyspnoea and is older than 40 years. He does not take his illness seriously, and seeks medical attention only in case of worsening of the disease, and improvement in adherence is only present in such cases. The latter phenomenon is frequently transient, and limited to worse periods. Three adherence groups can be defined: marginal good adherence (approx. 10%), the average is around 30-40%, and minimal adherence (60%). Correct inhaler use should be taught in maximum three steps, which should be easily reproduced and explained. Conclusion: The aspects defining the framework of the education programme are the adequate patient profile (tailor-making), on-the-spot education in the pulmonology centre, the relationship between the patient and the doctors, patient attitudes and lifestyle changes (smoking cessation), and choosing the adequate inhaler. Orv Hetil. 2020; 161(3): 95-102.

School–Supervised Use of a Once-Daily Inhaled Corticosteroid Regimen: A Cluster Randomized Trial

To evaluate the efficacy of school-supervised administration of once-daily inhaled corticosteroid to improve asthma control and reduce school absences in a primarily low-income Latino population.Students with asthma in 20 Tucson Unified School District elementary schools were selected to represent a large urban school population of low-income Latino students.The study was a 2-year, cluster-randomized, delayed-intervention trial comparing 9 months of supervised, unblinded, open-label mometasone furoate therapy with usual care. At entry, schools were randomized 1:1 to immediately initiate supervised therapy or delay implementation until year 2. Need for controller therapy was based on in-person evaluation the first year and by telemedicine during the second year. Medication was administered by school health personnel once daily on weekdays; parents were instructed to continue their own home medication during weekends and holidays. The primary outcome was change in Asthma Control Questionnaire (ACQ) score. Secondary outcomes included absences, unscheduled medical visits and hospitalizations, and oral steroid use.Nine hundred ninety-five (11%) of 8916 students reported asthma; 393 (39%) students enrolled, and 332 provided adequate data for analysis. Mean age was 8.1 years. At baseline, only one-fourth had well-controlled asthma. Thirty-nine percent reported controller medication use, and 80% were prescribed controller medication after clinical evaluation. During year 1, the mean ACQ score for students receiving immediate intervention did not significantly differ from those receiving delayed intervention. Medications were administered 98% of the time when students were at school; however, total calendar adherence was 53% due to absences, weekends, and holidays. Average school absences were noted to be 16 and 15 in immediate- and delayed-intervention groups, respectively, with only 4 to 5 of those due to asthma.School-supervised administration of once-daily inhaled corticosteroid did not result in improved asthma control as measured by ACQ, school absences, or health care use when compared with usual care in an urban, low-income, Latino elementary school population. Because of absences, weekends, and school holidays, the regimen achieved 53% calendar adherence despite excellent adherence to school-administered dosing. Further research is needed to clearly define the minimal adherence necessary to result in meaningful improvement in asthma control.There are numerous studies illustrating the benefits of school-supervised asthma therapy; this study provides a real-world application of school-based intervention with humbling but important results. Unique characteristics of the low-income Latino population and minimal research staff involvement may have played a role in outcomes and deserve further study. Of note is the high overall absenteeism rate and low calendar adherence rate. Hence, institution of school medication administration programs alone may not sufficiently impact asthma control without addressing home dosing and other societal determinants of school attendance and overall health.

Navigating Ethical Dilemmas in Mental Health Practice Between Professional Ethics and Islamic Values

Religiously committed mental health practitioners frequently encounter situations in which their perceived or actual religious mandates are at odds with their client’s values, leaving them in an ethical conundrum as to how to reconcile these values with the mandates of their professional ethical codes of conduct. Examples of such conflicts include dealing with cases involving abortion, sexual orientation, gender identity, consensual extramarital affairs, substance and alcohol use, as well as working with clients who display a minimal adherence to basic Islamic rituals and tenets. Precedents to such conflicts have led to serious legal consequences in some cases (DeSantis, 2012; Keeton v. Anderson-Wiley, 2010). Such conflicts are commonplace and particularly important for Muslim mental health professionals operating in the United States and other Western European countries that have secular professional codes of ethics. This paper is a “narrative literature review” that attempts to frame the discussion about value conflicts commonly experienced by Muslim mental health clinicians working within the Islamic legal and ethical discourses in the American context. This is done by analyzing the origins of some of these conflicts as well as providing potential resolutions. First, the relevant mental health philosophies, principles, codes, and definitions are examined. Second, the authors highlight how the Islamic maqāṣid (the higher objectives of Islamic law) and uṣūl (legal maxims), as well as Islamic standard practices, morals, and professional ethics, appear to contribute to the ethical dilemma. Different approaches to conflict resolution and reconciliation between Islamic mandates and ethical dilemmas are presented to help clinicians navigate their professional practice within ethical guidelines while remaining faithful to their religious values.

The Campylobacter jejuni helical to coccoid transition involves changes to peptidoglycan and the ability to elicit an immune response.

Summary Campylobacter jejuni is a prevalent enteric pathogen that changes morphology from helical to coccoid under unfavorable conditions. Bacterial peptidoglycan maintains cell shape. As C. jejuni transformed from helical to coccoid, peptidoglycan dipeptides increased and tri‐ and tetrapeptides decreased. The DL‐carboxypeptidase Pgp1 important for C. jejuni helical morphology and putative N‐acetylmuramoyl‐L‐alanyl amidase AmiA were both involved in the coccoid transition. Mutants in pgp1 and amiA showed reduced coccoid formation, with ∆pgp1∆amiA producing minimal coccoids. Both ∆amiA and ∆amiA∆pgp1 lacked flagella and formed unseparated chains of cells consistent with a role for AmiA in cell separation. All strains accumulated peptidoglycan dipeptides over time, but only strains capable of becoming coccoid displayed tripeptide changes. C. jejuni helical shape and corresponding peptidoglycan structure are important for pathogenesis‐related attributes. Concomitantly, changing to a coccoid morphology resulted in differences in pathogenic properties; coccoid C. jejuni were non‐motile and non‐infectious, with minimal adherence and invasion of epithelial cells and an inability to stimulate IL‐8. Coccoid peptidoglycan exhibited reduced activation of innate immune receptors Nod1 and Nod2 versus helical peptidoglycan. C. jejuni also transitioned to coccoid within epithelial cells, so the inability of the immune system to detect coccoid C. jejuni may be significant in its pathogenesis.

A priori-defined Mediterranean-like dietary pattern predicts cardiovascular events better in north Europe than in Mediterranean countries

BackgroundThe Mediterranean Diet (MD) is a model of healthy eating contributing to a favorable health status, but its clinical usefulness is still debated. The aim of this study was to relate the adherence to MD with the incidence of cardio/cerebro-vascular events (VEs) in north and south European participants of the IMPROVE study. MethodsIMPROVE is an observational, longitudinal, prospective cohort study involving 3703 individuals from five European countries (Finland, Sweden, Netherlands, France and Italy). The study end-point was the incidence of the first combined cardio/cerebro-vascular event occurring during 36-months follow-up. At baseline, a dietary questionnaire about the usual intake during the year preceding enrollment was administered. Based on 7 nutritional items, a MD Score was constructed in which minimal adherence was 0 and maximal adherence was 7. ResultsLatitude was the strongest determinant of MD score (p < 0.001). VEs occurred in 215 participants. The incidence of VEs was the highest in subjects with MD score 0–1, lower in those with score 2–3 and the lowest in those with score ≥ 4. MD score remained significantly associated with subsequent VEs after adjustment for confounders (hazard ratio for one-point increment of the score = 0.75, p < 0.001) and the association was stronger in northern than in southern countries (p = 0.04 for MD Score × latitude interaction). ConclusionsThe MD adherence score based on a simple dietary questionnaire detects changes of risk of VEs. According to our findings north Europeans appear to benefit most from VE-prevention when their diet is altered to the MD diet.

Validation of a short questionnaire to record adherence to the Mediterranean diet: An Italian experience

Background and aimsA greater adherence to the Mediterranean diet has been associated with a reduced risk of major chronic diseases and cancer. The aim of the study was to assess the validity of a new short self-administered 15-item questionnaire (QueMD) to measure adherence to the Mediterranean diet in Italy. Methods and resultsFour-hundred and eighty three participants to cancer-screening programmes at the European Institute of Oncology, Milan (Italy) were invited to join this study. Those interested compiled the QueMD and a validated Food Frequency Questionnaire (FFQ) reporting their usual food consumption during the previous six months. We derived the alternate Mediterranean score (aMED) from both questionnaires with values ranging from 0 (minimal adherence) to 9 (maximal adherence).Complete dietary data were available for 343 individuals (participation rates 71.0%). Spearman correlation coefficient between the responses to the 15 questions of the QueMD and corresponding food intake derived from the FFQ ranged from 0.15 to 0.84. A moderate correlation was found between the aMED scores calculated from the QueMD and the FFQ (intraclass correlation coefficient 0.50; 95% CI, 0.42–0.58), while agreement between the two instruments was only poor to fair for 7 of the 9 single items composing the aMED score, with values ranging from 53.0% for wholegrain products to 79.5% for fruits. ConclusionThis new self-administered 15-item questionnaire could be a useful tool to assess adherence to the Mediterranean diet in the Italian population.