Regular Compliance Research Articles

Standardizing congenital diaphragmatic hernia care in Canada: Implementing national clinical practice guidelines

PurposeWe sought to identify implementation barriers and opportunities to increase utilization of the Canadian Congenital Diaphragmatic Hernia (CDH) Collaborative's clinical practice guideline. MethodsA validated readiness assessment was sent via SurveyMonkey™ to CAPSNet site coordinators and local CDH stakeholders. The survey was open from 11/2018 to 02/2019. Data and responses were analyzed using descriptive statistics (REB 2019-4753). ResultsEighty-six responses were received, of which 65% (n = 56/86) were fully completed. The greatest number of responses came from neonatology (n = 27), pediatric surgery (n = 25), and respiratory therapy (n = 10). Seventy-eight percent (n = 67/86) of respondents were aware of the CDH guideline, and 63% (n = 54/86) used the entire guideline, while 23% (n = 20/86) used only certain sections. Besides recommendations pertaining to fetal intervention and ECLS, interdisciplinary long-term surveillance and prenatal diagnosis were considered most difficult to implement owing to funding limitations. Most respondents (n = 49/56; 87.5%) felt they could implement >75% of the recommendations. Establishing common team goals [i.e., minimize care variations] (n = 33/58;57%), provider buy-in [commitment of all health professionals to the guideline] (n = 28/58;48%), and regular compliance assessment (n = 23/58;40%) would increase uptake. ConclusionThere is national awareness of the CDH guideline. Implementation strategies ensuring common team goals, provider buy-in, and regular compliance assessment should increase guideline uptake/utilization. Consolidating funding for interdisciplinary long-term surveillance and prenatal diagnosis is necessary for any site-specific implementation strategy. Level of evidenceLevel 4 qualitative, survey.

The Effect of Warfarin Administration Time on Anticoagulation Stability (INRange): A Pragmatic Randomized Controlled Trial.

Without supporting evidence, clinicians commonly recommend that warfarin be taken in the evening. We conducted a randomized controlled trial to evaluate the effect of administration time (morning vs evening) on the stability of warfarin's anticoagulant effect. A total of 236 primary care physicians serving 54 western Canadian communities mailed letters of invitation to all their warfarin-using patients. Eligible patients were community-dwelling warfarin users (any indication) with at least 3 months of evening warfarin use and no plans for discontinuation. Participants were randomized (by web-based allocation) to morning vs continued evening warfarin ingestion. We used the Rosendaal method to determine the proportion of time within therapeutic range (TTR) of the international normalized ratio (INR) blood test month 2 to 7 postrandomization vs the 6 months prerandomization. The primary outcome was the percent change in proportion of time outside target INR range (with an a priori minimum clinically important difference of ±20%). All analyses were intention to treat. Between March 8, 2015 and September 30, 2016, we randomized 109 participants to morning and 108 to evening warfarin use. TTR rose from 71.8% to 74.7% in the morning group, and from 72.6% to 75.6% in the evening group, for a change in TTR of 2.9% in the former vs 3.0% in the latter (difference, -0.1%; P = .97; 95% CI for the difference, -6.1% to 5.9%). The difference in percent change in proportion of time outside the therapeutic INR range (obtained via Hodges-Lehmann estimation of the difference in medians) was 4.4% (P = .62; 95% CI for the difference, -17.6% to 27.3%). Administration time has no statistically significant nor clinically important impact on the stability of warfarin's anticoagulant effect. Patients should take warfarin whenever regular compliance would be easiest.

Nutritional composition of commercially-produced 100% orange juice reveals large variability in vascular health bioactive, hesperidin

AbstractIt is well-accepted that fruits contain a wide array of nutrients and bioactive substances which may contribute towards the prevention of chronic disease. Citrus fruits, as well as their juices, are recognised for their rich polyphenol content, specifically the flavanones; hesperidin, naringin and narirutin. Citrus fruits and juices are also rich in vitamin C and provide a source of folate, potassium and provitamin A.Randomised controlled trials have reported significant improvements to vascular function and blood pressure following consumption of 100% orange juice (OJ) with the effects potentially mediated through hesperidin and/or potassium (which has an EU claim for supporting normal blood pressure). Further clinical research may be facilitated by up-to-date information on the composition of OJ.By auditing more than 350 fruit processing companies worldwide, the non-profit organisation SGF International collects authentic OJ samples for regular compliance testing. Samples of unpasteurized OJ from the production line are removed by trained staff immediately post-extraction and frozen at -18°C within a few minutes. The samples are posted in this state to accredited laboratories where key nutrients and bioactives are tested. SGF's Database of Authentic Samples (2018) provides the following data (mg/litre) as sample size, mean, standard deviation, minimum, maximum for hesperidin (231, 520, 175, 109, 1160), L-ascorbic acid (615, 450, 98, 120, 721), potassium (1242, 1758, 204, 1197, 2340), total carotenoids (575, 7, 3, 2, 21) and pectins (1043, 334, 132, 19, 932).On average, there was more hesperidin in OJ than vitamin C, giving an estimated composition of 78 mg hesperidin and 67.5 mg vitamin C per 150 mL serving. Samples from Chinese producers had the greatest variability in hesperidin (109–1160 mg/L) while samples from Argentina, South Africa and Spain had the smallest variability. When OJ from not-from-concentrate (n = 62) and concentrate (n = 169) were compared, mean levels of hesperidin were significantly higher in the not-from-concentrate juice (576 mg/L [sd 228 mg/L] vs. 500 mg/L [sd 146 mg/L]; P = 0.016; Welch's t-test).Vascular benefits in humans have been detected at OJ intakes of 500 ml/day or hesperidin intakes of 290 mg/day (Morand et al. 2011). From a quality assurance perspective, the AIJN sets an acceptable range for hesperidin as 250–700mg/L. Raising the upper cut-off could increase the hesperidin content of commercially-available OJ with potential benefits for vascular health.Morand C et al. (2011) Am J Clin Nutr 93: 73–80.

Compliance to Directly Observed Treatment Short Course (DOTS) Chemotherapy among the Patient of Pulmonary Tuberculosis in Banke District of Nepal

Tubercular infection is still a pervasive public health problem in Nepal despite the massive efforts of National Health Service stakeholders. High bacterial infectivity, transmissibility, increasing drug resistance and non compliance to the therapy have been adding up challenges to prevention and control of tuberculosis. This study was conducted to observe the treatment compliance pattern among new pulmonary sputum smear positive cases of tuberculosis. A cross sectional study was carried out in the year 2009. The 114 new smear positive pulmonary tuberculosis patients registered in the six selected DOTS centres of the Banke Disrtict were randomly selected. Participants were selected from each DOTS centre by probability proportionate sampling methods. Data were analyzed by SPSS (11.0 Version) and P< 0.05 was considered as significant. Overall compliance to DOTS was 86.80 percent; of these, 57.00 percent showed excellent and regular compliance followed by nearly 30 percent good compliance. And 13.20 percent participants were non complaint to DOTS therapy. Positive Family behaviors were positively associated with compliance while alcohol consumption was found to be negatively associated with compliance however; age, sex and income were found to be non significant factors for compliance. Feeling of getting cure even before the course of DOTS therapy (feeling better after 2-3 months regular treatment) and drinking habits were found to be the major causes of non compliance. Supportive family behaviors and avoidance of alcohol consumption may promote the compliance. Excellent treatment compliance in the face of many odds is highly encouraging and the pattern can be useful in treatment despite little non compliances; furthermore compliance can be enhanced by acting on these causes of non compliances.
 Key words: Pulmonary, Tuberculosis, DOTS, Banke, Nepal

The consequence of the first attack of acute rheumatic fever with subclinical carditis

Background: Immune mediated damage of RF occurs most prominently in the heart, joints, brain, skin and subcutaneous tissues, however RF leaves no lasting damage to the brain, joint or skin, it is the leading cause of acquired heart disease in children and adolescents worldwide, therefore carditis is the most important manifestation of RF. Echocardiography along with color; Doppler imaging is now worldwide used for early detection of cardiac involvement even in the absence of clinical evidence, which in this case is called subclinical carditis (SCC) and was reported to cause similar consequences to clinically evident carditis.Methods: A retrospective study carried out on 35 patients already diagnosed to have RF and subclinical RHD and attending the cardiology clinic at Alexandria University Children’s Hospital (AUCH) from December 2015 to November 2016. Data collected from patients' files and then appropriately updated during subsequent follow-up visits.Results: 35 children already diagnosed to have RF and subclinical RHD were included in the current study, 22 patients (66.6%) improved completely with no residual cardiac lesion, 10 patients (30.3%) had persistent lesion and one patient (3.1%) had worsened condition.Conclusions: The most important predictors of poor prognosis according to the current study were recurrence and lack of regular compliance to long acting penicillin (LAP). Furthermore the outcome was not influenced by the treatment given in the initial attack.

Cytokine levels in crevicular fluid associated with compliance during periodontal maintenance therapy.

To longitudinally evaluate the effects of compliance during periodontal maintenance therapy (PMT) on cytokines levels and its relation to periodontal status. Ninety-one eligible individuals were selected from a 6-year prospective study with 212 individuals in PMT. From this total, 28 regular compliers (RC) were randomly selected and matched for age and gender with 28 irregular compliers (IC). All participants were non-smokers and non-diabetic. Periodontal parameters and gingival crevicular fluid samples were collected in 5 times: T1 [prior to active periodontal therapy (APT)], T2 (after APT), T3 (2years), T4 (4years), and T5 (6years). Levels of IL-6, IL-10, IL-1β, TNF-α, and MMP-8 were quantified through ELISA. RC presented better clinical periodontal status over time when compared to IC. A significant reduction in the levels of IL-1β, TNF-α, MMP-8, and IL-6 was observed among RC along time (from T1 to T5). Levels of IL-1 were similar among groups. By contrast, levels of IL-6 and TNF-α increased over time in IC individuals. Levels of IL-10 increased among RC and reduced among IC. The inflammatory cytokines IL-1, TNF-α, IL-6, and MMP-8 were correlated with worse clinical parameters among IC, while IL-10 was associated with an improvement in clinical parameters among RC. These results reinforce the role of these cytokines in the pathogenesis of periodontitis, as well as their role as markers to monitoring the progression of the periodontitis. Regular compliance during 6-year period the PMT sustained clinical and immunological benefits obtained after active periodontal therapy.

Dysphonia Plica Ventricularis and Emotional Dysregulation

Dysphonia plica ventricularis(DPV) is a type of functional dysphonia(FD) which can be caused by several reasons. DPV-emotional type is seen secondary to emotional crisis which is equivalent to psychogenic/dissociative dysphonia. Here we describe a case of DPV secondary to emotional dysregulation with an underlying emotionally unstable personality disorder. Crisis intervention and emphasis on regular compliance to treatment has been discussed.

2557 Improving ClinicalTrials.gov compliance: A coordinated effort for success

OBJECTIVES/SPECIFIC AIMS: ClinicalTrials.gov (CTgov) compliance has received much international attention as a significant regulatory, scientific, and ethical responsibility. Compliance rates for both industry and academia are held up for scrutiny by transparency advocates, but solutions for achieving compliance in academia have proven to be—because of its focus on innovation and multiple disciplines—significantly more complex than those employed by industry. Added challenges for academic medical centers (AMCs) are both increased researcher responsibilities under the new NIH Policy on Clinical Trial Dissemination and system-wide changes to requirements for “clinical trial only” Funding Opportunity Announcements. At Stanford University, a multifaceted approach toward improving CTgov outreach, education, and reporting led to a dramatic turnaround in compliance over 17-month period. METHODS/STUDY POPULATION: Stanford University School of Medicine’s Senior Associate Dean for Research and PI of Stanford’s CTSA applied a 3-part strategy to address unacceptable rates of results reporting. The strategy included (1) regular compliance reports to department chairs, (2) establishment of a central office, Clinical Research Quality (CRQ), to provide consistent training and support, and (3) interdepartmental cooperation across the school and university. Compliance reports, identifying all studies late for results reporting were sent monthly to all department chairs, with heightened focus on departments that conduct the most clinical trials. Senior leadership described the process in executive meetings and set improvement goals. Reports included multiple data points to help departments mobilize resources and identify trends; half-way through the period, soon-to-be late study records were included. CRQ hired 2 fulltime employees tasked with all aspects of managing the CTgov process and designed a portfolio of activities including: (1) a master list of all Stanford studies in the CTgov system; (2) a process for generating and distributing monthly reports; (3) an education program; and (4) support services, including an administrator working group. RESULTS/ANTICIPATED RESULTS: Since December 2015, Stanford has had the second-highest compliance rate improvement out of the 20 schools of medicine that receive the most NIH funding (+ 62%). DISCUSSION/SIGNIFICANCE OF IMPACT: Managing ClinicalTrials.gov compliance requires a high degree of technical knowledge of regulations, NIH policy, and the CTgov system. But without an equally high degree of engagement from senior leadership, results would not have been achieved. Central resources are critical to set policy and establish consistent processes, but without regular and repeated interactions between faculty, a multitude of administrators and staff, more central resources would have been required. By working simultaneously “down from the top” and “up from the bottom,” communication and education expanded rapidly, ineffective efforts were quickly transformed, and what began as an irritating and cumbersome problem became an occasion for collaboration and celebration of increased transparency.

Effect of compliance during periodontal maintenance therapy on levels of bacteria associated with periodontitis: A 6-year prospective study.

It is well established that regular compliance during periodontal maintenance therapy (PMT) maintains the stability of periodontal clinical parameters obtained after active periodontal therapy (APT). However, compliance during PMT has not yet been related to subgingival bacterial levels. Thus, this study followed individuals in PMT over 6 years and longitudinally evaluated the effects of compliance on periodontitis-associated bacterial levels and its relation to periodontal status. From a 6-year prospective cohort study with 212 individuals in PMT, 91 were determined to be eligible. From this total, 28 regular compliers (RC) were randomly selected and matched for age and sex with 28 irregular compliers (IC). Complete periodontal examination and microbiological samples were obtained 5 times: T1 (prior to APT), T2 (after APT), T3 (2 years), T4 (4 years), and T5 (6 years). Total bacteria counts and levels of Actinomyces naeslundii, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola were evaluated through quantitative polymerase chain reaction. RC had less tooth loss and better clinical and microbiological conditions over time when compared with IC. IC had higher total bacterial counts and higher levels of T. denticola. Moreover, among IC, total bacterial counts were positively associated with plaque index and bleeding on probing, while levels of A. naeslundii, T. forsythia, and T. denticola were negatively associated with clinical attachment loss (4 to 5mm) among RC. Compliance positively influenced subgingival microbiota and contributed to stability of periodontal clinical status. Regular visits during PMT sustained microbiological benefits provided by APT over a 6-year period.

A poor country clothing the rich countries: case of garment trade in Bangladesh

The ready-made garment industry of Bangladesh is one of the largest formal manufacturing sectors. It has played a key role in the country’s process of industrialisation, empowerment of women, export oriented development and growth. Workers from poor socio-economic backgrounds are working in the garment industry. Their health, safety and working conditions are very poor and not protected. There is a lack of regular inspection and compliance with local law in buildings and factories. This led to the collapse of the eight story Rana Plaza building in the capital Dhaka on the 24th of April 2013, “killing 1,100 workers and 2,500 injured†2. The main aim of the study is to assess the impact of Rana Plaza Tragedy, where RMG workers make garments for multinational brands of Australia, Europe and USA, and the advantage which took these companies of the absence of labour laws, workplace health and safety standards, building standards, long working hours and low wages in Bangladesh. The study used both primary and secondary data including related case studies. The practical application of the study is to develop formal ethical, labour-law, health and safety standards for a factory worker; construction; institutions and courts for monitoring the supplier’s behaviour onshore and large multinational firms offshore. The study recommends to protect the rights of women workers who are sowing garments for the fashion conscious consumers from the developed countries. Future research will explore inclusive growth for workers and how to stimulate inclusive sustainable business for export led garment industry.

Patient compliance and periodontal outcomes.

PubMed, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) were searched until 2014. Reference lists from the articles were examinedStudy selectionTwo authors independently searched for randomised and non-randomised controlled trials and prospective and retrospective cohorts with a mean follow up period of at least five years. Quality of the studies was assessed using the Newcastle-Ottawa scale (NOS) and the data were extracted on a specially designed form. The primary outcome was calculated as risk ratio of tooth loss (RRTL). Risk difference of tooth loss (RDTL) and weighted mean difference of tooth loss rate (WDTLR) were also calculated. One prospective and seven retrospective cohort studies including 1409 participants were included. The pooled RRTL was calculated as 0.56 (CI: 0.38,0.82) P<0.01, while the pooled RDTL was calculated as -0.05 (CI: -0.08, -0.01) p<0.01. Based on the risk difference, the NNT was calculated as 20. Tooth loss rate was significantly lower in the regular compliance group over the five years. To prevent one extraction, 20 teeth have to be maintained with regular compliance for more than five years.

A Matter of Trust: The Cost of HIPAA Non-Compliance

A Matter of Trust: The Cost of HIPAA Non-Compliance

Electronic medication reconciliation and medication errors.

To measure the impact of electronic medication reconciliation implementation on reports of admission medication reconciliation errors (MREs). Quality improvement project with time-series design. A large, urban, tertiary care children's hospital. All admitted patients from 2011 and 2012. Implementation of an electronic medication reconciliation tool for hospital admissions and regular compliance reporting to inpatient units. The tool encourages active reconciliation by displaying the pre-admission medication list and admission medication orders side-by-side. Rate of non-intercepted admission MREs identified via a voluntary reporting system. During the study period, there were 33 070 hospital admissions. The pre-admission medication list was consistently recorded electronically throughout the study period. In the post-intervention period, the use of the electronic medication reconciliation tool increased to 84%. Reports identified 146 admission MREs during the study period, including 95 non-intercepted errors. Pre- to post-intervention, the rate of non-intercepted errors decreased by 53% (P = 0.02). Reported errors were categorized as intercepted potential adverse drug events (ADEs) (35%), non-intercepted potential ADEs (42%), minor ADEs (22%) or moderate ADEs (1%). There were no reported MREs that resulted in major or catastrophic ADEs. We successfully implemented an electronic process for admission medication reconciliation, which was associated with a reduction in reports of non-intercepted admission MREs.

Application of continuing care in patients with generalized anxiety disorder after discharge

Objective : To explore the application of continuing care in patients with generalized anxiety disorder after discharge. Methods : From February 2011 to December 2014, 126 patients with generalized anxiety disorder after discharge were randomly assigned to control group (n=63) and intervention group (n=63). Patients in the intervention group received telephone follow-up and psychological counseling after discharge. When indisposed symptoms appeared, continuing care was conducted with Chinese massage. Results : Self-rating anxiety scale scores were significantly lower in the intervention group than in the control group ( P < 0.05). Scores of medication compliance and regular return visit compliance were significantly higher in the intervention group than in the control group ( P < 0.05). Scores of quality of life were significantly greater in the intervention group than in the control group ( P < 0.05). Conclusion : Continuing care can relieve various indisposed symptoms and mental stress, lessen anxiety, and elevate quality of life in patients after discharge.

PP-094 Status of Regular Drug Use and Compliance to Salt Restrictions at Hypertension Patients

PP-094 Status of Regular Drug Use and Compliance to Salt Restrictions at Hypertension Patients

Analysis of lipid-lowering therapy and factors affecting regularity of statin intake in patients with cardiovascular disease enrolled in the PROFILE registry

ObjectiveThe aim of this study was to analyze the quality of lipid-lowering therapy in a cohort of patients with cardiovascular disease enrolled in a Moscow-based registry, and to analyze the factors affecting the regularity of statin administration in this patient category. MethodsThe present study included all patients who successively sought medical advice in the Preventive Pharmacotherapy Department of the Ministry of Healthcare of the Russian Federation between May 1 and December 31, 2011 (n=274). Each patient was given a specially designed questionnaire in order to assess compliance with the prescribed treatment that included the following questions: (1) if they knew, according to the results of previous exams, that they had elevated cholesterol levels (yes, no, don’t know); (2) what method of hypercholesterolemia correction they used (diet, medication, physical exercise, or other); (3) if they were taking any statins (regularly, no, irregularly); and (4) if yes, what statin preparation and what dose they were taking. Patients’ compliance with statin therapy was assessed on the basis of the responses received and the regularity of statin intake. ResultsThe influence of various factors on regularity of statin intake in patients with cardiovascular disease was assessed by calculating odds ratios (OR) and 95% confidence intervals (CI) for advanced age (>70 years) (OR 0.49); higher statin dose than standard (OR 0.49); hypertension (OR 1.659); history of acute cerebrovascular event (OR 2.019); diabetes (OR 1.023); coronary heart disease (CHD) (OR 4.357); history of myocardial infarction (MI) (OR 4.838); history of coronary angiography/percutaneous coronary intervention (PCI) (OR 5.167). ConclusionsAnalysis of factors with impact on regular compliance with statin therapy showed that the following were most significant: CHD, history of MI, and history of PCI. Previous cerebrovascular events and presence of diabetes did not motivate these patients to take statins on a regular basis.

Analysis of lipid-lowering therapy and factors affecting regularity of statin intake in patients with cardiovascular disease enrolled in the PROFILE registry

ObjectiveThe aim of this study was to analyze the quality of lipid-lowering therapy in a cohort of patients with cardiovascular disease enrolled in a Moscow-based registry, and to analyze the factors affecting the regularity of statin administration in this patient category. MethodsThe present study included all patients who successively sought medical advice in the Preventive Pharmacotherapy Department of the Ministry of Healthcare of the Russian Federation between May 1 and December 31, 2011 (n=274). Each patient was given a specially designed questionnaire in order to assess compliance with the prescribed treatment that included the following questions: (1) if they knew, according to the results of previous exams, that they had elevated cholesterol levels (yes, no, don’t know); (2) what method of hypercholesterolemia correction they used (diet, medication, physical exercise, or other); (3) if they were taking any statins (regularly, no, irregularly); and (4) if yes, what statin preparation and what dose they were taking. Patients’ compliance with statin therapy was assessed on the basis of the responses received and the regularity of statin intake. ResultsThe influence of various factors on regularity of statin intake in patients with cardiovascular disease was assessed by calculating odds ratios (OR) and 95% confidence intervals (CI) for advanced age (>70 years) (OR 0.49); higher statin dose than standard (OR 0.49); hypertension (OR 1.659); history of acute cerebrovascular event (OR 2.019); diabetes (OR 1.023); coronary heart disease (CHD) (OR 4.357); history of myocardial infarction (MI) (OR 4.838); history of coronary angiography/percutaneous coronary intervention (PCI) (OR 5.167). ConclusionsAnalysis of factors with impact on regular compliance with statin therapy showed that the following were most significant: CHD, history of MI, and history of PCI. Previous cerebrovascular events and presence of diabetes did not motivate these patients to take statins on a regular basis.

Role of health education and self-action plan in improving the drug compliance in bronchial asthma.

Background:Considering the prevalence and associated burden of disease due to bronchial asthma, it is mandatory to obtain an optimal control of the disease and to improve outcomes for these patients. But it has been observed that there is very poor adherence to the inhalational therapy which leads to the suboptimal control of the disease.Objectives of the Study:To study the adherence for aerosol therapy in bronchial asthma patients and to assess the impact of health education and self-action plan in improving the compliance to the therapy.Methodology:A prospective study was done in a total of 500 bronchial asthma patients over a period of 2 years. Once included in the study, the patients were followed-up for a total of 12 weeks for calculation of nonadherence to the aerosol therapy. In nonadherent patients, we employed various health education strategies to improve the compliance in these cases.Results:A total of 500 patients of bronchial asthma who were started on aerosol therapy over duration of 2 years were included in the study. At the end of 12 weeks, it was observed that, only 193 patients (38.6%) had regular compliance and 307 patients (61.4%) were noncompliant to aerosol therapy as prescribed for bronchial asthma. Factors that were associated with poor compliance were: Lower educational level status, poor socioeconomic status, cumbersome regimens, dislike of medication, and distant pharmacies. Nondrug factors that reduced the compliance were: Fears about side effects, anger about condition or its treatment, forgetfulness or complacency, and patient's ill attitudes toward health. After employing the various strategies for improving the compliance in these patients, the compliance increased in 176 patients (57.3%) among the earlier defaulted patients, while the remaining 131 patients (42.7%) were found to be noncompliant even after various educational techniques.Conclusion:Noncompliance in asthma management is a fact of life and no single compliance improving strategy probably will be as effective as a good physician-patient relationship. Optimal self-management allowing for optimization of asthma control by adjustment of medications may be conducted by either self-adjustment with the aid of a written action plan or by regular medical review. Individualized written action plans based on peak expiratory flow are equivalent to action plans based on symptoms.

Poor Compliance to Inhaler Therapy in Bronchial Asthma Patients ∼A Prospective Study in General Population

Background: Considering the prevalence and associated burden of disease due to bronchial asthma, it is mandatory to obtain an optimal control of the disease and to improve outcomes for these patients. Asthma control and treatment compliance are widely investigated issues around the world. But it has been observed that there is very poor adherence to the inhalational therapy which leads to the sub-optimal control of the disease. Objectives of the study: To investigate the adherence for anti-asthma inhalational medications in adults with bronchial asthma. Methodology: A prospective study was done in a total of 400 bronchial asthma patients over a period of 2 years. Once included in the study, the patients were followed up for a total of 12 weeks for calculation of non-adherence to the aerosol therapy. Results: A total of 400 patients of bronchial asthma who were started on inhalational therapy were included in the study. At the end of 12 weeks, it was observed that, only 154 patients (38.5%) had regular compliance and 246 patients (61.5%) were non-compliant to aerosol therapy as prescribed for bronchial asthma. Factors that were associated with poor compliance were: lower educational level status, poor socio-economic status, cumbersome regimens, dislike of medication and distant pharmacies. Non-Drug factors that reduced the compliance were: fears about side effects, anger about condition or its treatment, forgetfulness or complacency and patient’s ill attitudes toward health. Conclusion: Noncompliance in asthma management is a fact of life and no single compliance-improving strategy probably will be as effective as a good physician–patient relationship. Optimal self-management allowing for optimization of asthma control by adjustment of medications may be conducted by either self-adjustment with the aid of a written action plan or by regular medical review.

Public health perspectives on noise and cardiovascular disease

Introduction: Emerging research suggests that noise impacts human health beyond simply the auditory system. There have been recent amendments to acceptable noise level thresholds within the occupational setting and new European Union directives for noise in the community from air and road sources. The purpose of this review will be to assess the relationship between noise and cardiovascular disease in different settings. Methods: A literature review was conducted using PubMed on noise and more cardiovascular disease endpoints. All studies published in the English language between 2000-present were included. Studies on noise annoyance were excluded. Results: There is a strong positive association between occupational noise exposure and cardiovascular outcomes. There is a moderate association with noise in the community setting from road sources and a weak association with aircraft noise. The strength of the association across settings is dependent on the outcome type, interaction with age and sex of subjects, and time of measurement. Road source noise had the strongest association with myocardial infarction, notably in women during night exposures. The association with hypertension and road noise, when stratified by sex, was significant in men during night-time exposures and in pregnant older women. Only nighttime aircraft noise was associated with statistically significant findings in adults. All sources of noise demonstrate a dose response relationship, which peaks at different noise thresholds. Occupational noise exposure had the strongest association with noise > 85 dB (A) and duration of exposure. Conclusion: There is sufficient evidence to warrant the precautionary public health principle to reduce noise at the population levels for industry workers through stronger legislation, regular compliance inspections, and health promotion. Where population wide noise legislation has not yet been enacted, noise exposure reduction at the individual level may be beneficial.