Self-reported Adherence Research Articles

Socioeconomic status and adherence to COVID-19 preventative measures in Australia: A national cohort study.

The uptake of recommended preventative measures is a critical concern for protecting the public against COVID-19 outbreaks and future pandemics. However, it is unclear to what extent COVID-19 preventative measures were followed in Australia. This study aims to determine adherence level to COVID-19 preventative measures in 2021, and whether these were associated with socioeconomic status (SES). This was a national cross-sectional study using data from the Household Income and Labour Dynamics in Australia (HILDA) survey. This study included 15 457 community-dwelling adults (18 years or older) who participated in the 2021 wave of HILDA survey. SES was assessed by the Socio-Economic Index For Areas (SEIFA) score, split into quintiles. Outcomes included self-reported adherence to COVID-19 preventative measures (mask wearing, keeping distance, staying home; sum score range 3-15) and COVID-19 status (yes/no). Linear and logistic regression were used accordingly to assess the association between SES and the sum score of adherence to COVID-19 measures, and COVID-19 vaccination status. Adherence to COVID-19 preventative measures and uptake of COVID-19 vaccine in Australia in 2021 were moderate (between 60% and 70%). Regression models showed higher SES was associated with a slightly higher score of adherence (β = .08, 95% CI = .04-.12) and a higher likelihood of self-reporting receiving COVID-19 vaccination (OR 1.27, 95% CI = 1.23-1.31). SES was positively associated with the level of adherence to COVID-19 preventative measures and the probability of receiving COVID-19 vaccine. The findings of this study highlight the potential benefits of considering SES, particularly its impact on equity and access, when designing an educational program or awareness campaign in times of crisis. SO WHAT?: The findings of this study highlight the importance of considering SES when designing an educational program or an awareness campaign in times of crisis.

Examining the Accuracy of Self-Reported Antiretroviral Therapy Adherence Using a Visual Analog Scale Among Opioid-Dependent People Living with HIV.

Evidence indicates that regular assessment of antiretroviral therapy (ART) adherence is necessary to promote adherence and achieve viral suppression. Self-reported adherence using a visual analog scale (VAS) has been used extensively to measure ART adherence. However, less is known about the accuracy of the VAS for measuring ART adherence among opioid-dependent people living with HIV. In this study, we aimed to evaluate the accuracy of the VAS in measuring ART adherence in opioid-dependent people living with HIV who are enrolled in a methadone maintenance program (MMP). This study was conducted within a larger randomized controlled trial among opioid-dependent people living with HIV (N = 109) who were enrolled in an inner-city MMP. Self-reported VAS ART adherence data were compared to pharmacy refill data, which is a more objective measure. Self-reported VAS ratings and pharmacy refill behavior were significantly correlated at the 6-month post-intervention mark (r = 0.349, p = 0.006) but not at any other time point (i.e., pre-intervention, post-intervention, 3-months, and 9-months post-intervention). Based on the pharmacy refill data, participants did not consistently adhere to their ART medication but self-reported high adherence on the VAS. The self-report VAS may not be an accurate measure for assessing ART adherence among opioid-dependent persons living with HIV and enrolled in a MMP. Based on our findings, it may be more accurate to use pharmacy refill information or other objective measures to quantify ART adherence over extended periods for this patient population.

An assessment of the content of antenatal care provided by obstetricians in Lebanon: A cross-sectional study.

Quality and timely antenatal care is a vital component of pregnancy care for the well-being of mothers and babies. The aim of this study of to assess self-reported obstetricians' adherence to national and international antenatal care guidelines in Lebanon. This cross-sectional study approached all obstetricians registered with the Lebanese Society of Obstetrics and Gynecology and the Lebanese Order of Physicians to participate in an online and telephone-based survey. The study tool included all of the items from the World Health Organization and national guidelines for antenatal care. Obstetricians' self-reported adherence was assessed across five modules including dietary interventions, dietary supplements, antenatal care assessment, fetal growth assessment, and antenatal care preventive measures. A total of 134 obstetricians completed the survey. Overall, adherence was high for most antenatal care guidelines except for providing nutrition services to undernourished pregnant women, screening for intimate partner violence, and providing tetanus vaccines. The number of recommended antenatal care visits (≥8 vs. <8 visits) was higher among obstetricians in Mount Lebanon or Beirut compared to other areas in Lebanon (72.7%vs.48.6%; p-value <0.01). Provision of tetanus or diphtheria, tetanus, and pertussis (DTP) vaccination was lower for obstetricians who provide care for women who pay out-of-pocket compared to obstetricians who provide care to women who use other payment methods (25.3%vs.45.7%; p-value = 0.024). Group B streptococcus screening test and the provision of at least five ultrasounds were higher among obstetricians who provide care in private clinics or clinics in private hospitals compared to clinics in public hospitals or primary healthcare centers (88.8%vs.66.7%; p-value = 0.023) and (83.6%vs.55.6%; p-value = 0.011), respectively. Reinforcing the adherence to all antenatal care guidelines by continuous monitoring of health facilities is crucial for best practice. Subsidies for essential services may be required for those who are unable to afford components of antenatal care.

Multiple recommended health behaviors among medical students in Western Canada: a descriptive study of self-reported knowledge, adherence, barriers, and time use

BackgroundGeneral medical practitioners are responsible for promoting and prescribing lifestyle modification and serve as role models for healthy behaviors. We aimed to assess self-reported knowledge, adherence, barriers and time spent on all recommended health behaviors among medical students.MethodsA cross-sectional online survey of eight behavioral domains among undergraduate medical students in The University of British Columbia, Canada, was analysed using descriptive statistics and visual display.ResultsBetween March and April 2023, 137 medical students participated in the survey (74% female). Over 80% had knowledge of five health behavior recommendations, but lacked knowledge of specific dietary recommendations in particular. Over 60% reported meeting guideline-recommended levels for tobacco, weekly alcohol, daily alcohol (females only), and physical activity (males only). Large gaps existed between knowledge and adherence for physical activity, sleep, sedentariness, screen time, and dietary recommendations. Sex differences in knowledge and adherence to recommended health behaviors were identified. Time spent on wellness focused on sleep (47–49 h/week), diet (9.6 h/week), exercise (5.8 h/week), and hobbies (6.1 h/week). Forgetting recommendations (69% of females, 71% of males), and lack of time (72% of females, 52% of males) were principal barriers to knowledge and adherence.ConclusionMost medical students in Western Canada reported not meeting multiple recommended health behaviors. Time was the largest barrier to adherence and free time was spent on sleep. Medical education may require protected time and dedicated content for health behaviors to ensure future physicians can be role models of health promotion for patients.

Disease burden among patients with Arginase 1 deficiency and their caregivers: A multinational, cross-sectional survey.

Arginase 1 deficiency (ARG1-D) is an ultrarare, metabolic disease which may cause spastic paraplegia, cognitive deficiency, seizures, and ultimately severe disability. The aim of this study was to assess disease burden in ARG1-D by performing a cross-sectional survey of patients with ARG1-D and their caregivers in four European countries (France, Portugal, Spain, and the United Kingdom). Patients were enrolled at participating clinics and data were collected using a web-based questionnaire. The findings indicate that there is a significant share of patients who experience severe cognitive and mobility impairment but also that there is a considerable variance in symptom severity among patients. Disease management was mostly in line with treatment guidelines and self-reported adherence to treatment was reported to be high among a majority although following diet restrictions was perceived as difficult. However, despite this, since a large share of patients experienced severe cognitive and mobility impairment an unmet need among this patient population is suggested. The introduction of disease-modifying therapies and early identification and diagnosis may help alleviate the disease burden associated with ARG1-D in the future.

Quality of life and adherence to healthy lifestyle factors among breast cancer survivors in Cyprus

Abstract Breast cancer is a prevalent disease for women globally, with rising survival rates highlighting the need to address the breast cancer survivors’ (BCS) quality of Life (QoL). Furthermore, adherence to a healthy lifestyle is associated with decreased mortality in BCS. Mapping the Lifestyle Medicine pillars and the World Cancer Research Fund/American Institute for Cancer Research recommendations identifies 7 healthy lifestyle components: weight management, physical activity, healthy eating, restorative sleep, avoidance of risky substances, positive social connections and stress management. This study examines adherence to these healthy lifestyle components and QoL among BCS. A cross-sectional study conducted in 2022-23 recruited primary adult BCS from the Bank of Cyprus Oncology Centre. Participants completed a survey assessing self-reported QoL and adherence to the aforementioned 7 healthy lifestyle components, through validated questionnaires. Out of 349 BCS approached, 272 were included in the final analysis. Mean age and time since main treatment completion were 51 (SD: 7.4) and 3.6 (SD: 2.5) years respectively. Amongst study participants 58% were classified as bad sleepers, 53.3% were overweight or obese, 23% were stressed, 78% reported to have moderate/high physical activity, and 60% adhered to the Mediterranean diet. Regarding substance use, 16% were current smokers, and 18% were hazardous drinkers. Median score for social support was 75 (IQR: 53-97; max score=100) and for QoL was 67 (IQR: 50-97; max score:100). BCS in Cyprus generally exhibit moderate adherence to the Mediterranean diet, engage in fairly active lifestyles and enjoy high levels of social support and QoL. On the other hand, a substantial proportion smoke or drink, are overweight or obese, are stressed and have poor sleep quality. Targeted interventions to increase the adherence of breast cancer survivors to the 7 healthy lifestyle components are required. Key messages • Overall variability exists in the adherence to healthy lifestyle components among BCS in Cyprus. • This population can benefit from intervention targeting sleep, stress and weight management.

The state of pandemic preparedness in four European countries

Abstract One of the lessons learned from the COVID-19 pandemic is that monitoring determinants and behaviour can improve policy and communication strategies. To improve countries’ capacity to respond in a hot phase of a pandemic and build a resilient society, suitable monitoring in a cold phase of various behaviours and determinants that could become important in future pandemics is key. In March 2024 we launched the first round of the Pandemic Preparedness and Behaviour (PPb) survey in four European member states: Spain, Slovenia, Ireland and The Netherlands (N = ∼1000 per country). In this presentation we start by showing key findings. For example, we found that overall, approximately one third of participants believe their government is prepared if a new pandemic would occur next month. Next, we discuss similarities. For example, we find that in all four countries, perceived preparedness of self is higher than perceived preparedness of one’s government. We also address key differences, such as distinct patterns in perceived risk of a highly contagious outbreak in the next 5 years (whereas in Spain 26% perceives of participants an outbreak as probable, this is 43% in Slovenia) or differences in self-reported adherence to hygiene behaviours (i.e. handwashing after coughing or sneezing in elbow is markedly higher in the Slovenian sample than in the Netherlands). Next, we explore which determinants of these patterns are generalisable, and which are specific to two of the four countries: Spain and Slovenia. We follow up by comparing insights for policy and practice in their given contexts, as well as lessons learned with respect to use and development of the monitor. We conclude that monitoring individual behaviours and its determinants helps to develop joint efforts in developing effective public health policies across Europe regarding pandemic preparedness.

Association between Thai language proficiency and adherence to COVID-19 protective behaviors (CPB) among Myanmar migrant workers in Southern Thailand.

The association between host country language proficiency and disease prevention among migrants is underexplored. The objective of this study is to assess the extent to which self-reported command of the Thai language is associated with adherence to COVID-19 protective behaviors (CPB) among Myanmar migrant workers in Thailand. We distributed a self-administered structured questionnaire in Burmese language to 1,050 Myanmar migrant workers in Southern Thailand from September 2022 to January 2023. The questionnaire included background characteristics, self-reported Thai language proficiency based on the Common European Framework Reference (CEFR), and self-reported CPB adherence at residence and workplace. We analyzed data using descriptive statistics and multivariate linear regression analysis. Although slightly less than half of the participants reported CEFR A1 level or higher in Thai speaking and listening skills, less than 10 percent did so for reading and writing skills. Workplace COVID-19 preventive adherence scores were initially found to be significantly associated with A1 level or higher speaking and listening skills. However, after adjusting for confounders, these associations were not statistically significant (Speaking skill's Adjusted Beta = 0.713, 95% CI = -0.011, 1.437; Listening skill's Adjusted Beta = -0.367, 95% CI = -1.087, 0.353). No significant associations were found between any language skill domain and residence COVID-19 preventive adherence scores for both unadjusted and adjusted analysis. The study findings may have implications for relevant stakeholders in migrant services, migrant health, and infectious disease control. However, information biases, language barriers, and lack of generalizability should be considered as caveats in the interpretation of the study findings.

A Stepped-Wedge, Cluster-Randomized, Multisite Study of Text Messaging Plus Peer Navigation to Improve Adherence and Viral Suppression Among Youth on Antiretroviral Therapy.

To address the need for improved virologic suppression among youth living with HIV (YLH) on antiretroviral treatment (ART), we evaluated peer navigation plus TXTXT daily text message ART reminders. YLH aged 15-24 on ART for at least 3 months at six research sites in four Nigerian cities. Using a stepped-wedge design, Cluster 1 was non-randomized, while Clusters 2 and 3 were randomized to sequences of routine care (control period) and 48 weeks of the combination intervention (intervention period). The primary endpoint was viral suppression (HIV-1 RNA <200 copies/mL) at week 48 of the intervention. Secondary endpoints included adherence measured by self-report (90% considered adherent). Post-hoc analysis assessed virologic control at <50 copies/mL and <1000 copies/mL. Generalized estimating equations determined the difference between intervention and control periods in the intention-to-treat population. We enrolled 558 YLH and followed 541 over time, mean age 18 years, 53.8% female, 71.7% perinatally infected, and 38.6% virologically non-suppressed at enrollment. For the primary endpoint, the intervention periods displayed a small, non-significant increase in viral suppression < 200 copies/mL (OR = 1.16 [0.88, 1.54], p = 0.297). There was a significant effect of the combination intervention on virologic control <1000 copies/mL (OR = 1.42 [1.03, 1.94], p = 0.030). Self-reported adherence also improved (OR = 2.07 [1.46, 2.95], p < 0.001). Peer navigation plus daily text message ART reminders demonstrated limited benefit among ART-experienced, predominantly perinatally-infected YLH, with no significant effect on viral suppression below 200 copies/mL despite improvement in self-reported adherence.

Comparing the effects of time-restricted eating on glycaemic control in people with type 2 diabetes with standard dietetic practice: A randomised controlled trial

AimsTo test the efficacy of time-restricted eating (TRE) in comparison to dietitian-led individualised dietary guidance to improve HbA1c in people with Type 2 diabetes mellitus. MethodsIn a parallel groups design, 51 adults (35–65 y) with Type 2 diabetes mellitus and overweight/obesity (HbA1c ≥6.5% (48 mmol/mol), BMI ≥25-≤40 kg/m2) commenced a six-month intervention. Following baseline, participants were randomised to TRE (1000–1900 h) or DIET (individualised dietetic guidance) with four consultations over four months. Changes in HbA1c (primary), body composition, and self-reported adherence (secondary) were analysed using linear mixed models. A non-inferiority margin of 0.3% (4 mmol/mol) HbA1c was set a priori. ResultsForty-three participants (56 ± 8 y, BMI: 33 ± 5 kg/m2, HbA1c: 7.6 ± 0.8%) completed the intervention. HbA1c was reduced (P=0.002; TRE: −0.4% (−5 mmol/mol), DIET: −0.3% (−4 mmol/mol)) with no group or interaction effects; TRE was non-inferior to DIET (−0.11%, 95%CI: −0.50% to 0.28%). Body mass reduced in both groups (TRE: −1.7 kg; DIET: −1.2 kg) via ∼900 kJ/d spontaneous energy reduction (P<0.001). Self-reported adherence was higher in TRE versus DIET (P<0.001). ConclusionsWhen individualised dietary guidance is not available, effective, and/or suitable, TRE may be an alternative dietary strategy to improve glycaemic control in people with Type 2 diabetes mellitus.

Fact or Fiction-Accelerometry Versus Self-Report in Adherence to Pediatric Concussion Protocols: Prospective Longitudinal Cohort Study.

Concussion, or mild traumatic brain injury, is a growing public health concern, affecting approximately 1.2% of the population annually. Among children aged 1-17 years, concussion had the highest weighted prevalence compared to other injury types, highlighting the importance of addressing this issue among the youth population. This study aimed to assess adherence to Return to Activity (RTA) protocols among youth with concussion and to determine if better adherence affected time to recovery and the rate of reinjury. Children and youth (N=139) aged 5-18 years with concussion were recruited. Self-reported symptoms and protocol stage of recovery were monitored every 48 hours until symptom resolution was achieved. Daily accelerometry was assessed with the ActiGraph. Data were collected to evaluate adherence to the RTA protocol based on physical activity cutoff points corresponding to RTA stages. Participants were evaluated using a battery of physical, cognitive, and behavioral measures at recruitment, upon symptom resolution, and 3 months post symptom resolution. For RTA stage 1, a total of 13% of participants were adherent based on accelerometry, whereas 11% and 34% of participants were adherent for stage 2 and 3, respectively. The median time to symptom resolution was 13 days for participants who were subjectively reported adherent to the RTA protocol and 20 days for those who were subjectively reported as nonadherent (P=.03). No significant agreement was found between self-report of adherence and objective actigraphy adherence to the RTA protocol as well as to other clinical outcomes, such as depression, quality of life, and balance. The rate of reinjury among the entire cohort was 2% (n=3). Overall, adherence to staged protocols post concussion was minimal when assessed with accelerometers, but adherence was higher by self-report. More physical activity restrictions, as specified in the RTA protocol, resulted in lower adherence. Although objective adherence was low, reinjury rate was lower than expected, suggesting a protective effect of being monitored and increased youth awareness of protocols. The results of this study support the move to less restrictive protocols and earlier resumption of daily activities that have since been implemented in more recent protocols.

A Longitudinal Observation of Antenatal Milk Expression in Mothers of Infants with Congenital Anomalies.

Background: For mothers of infants with congenital anomalies, antenatal milk expression (AME), known as hand expression during late pregnancy, allows mothers to contribute to their newborn's care through colostrum collection. However, research is limited by self-report of AME adherence and colostrum volume. Objective: This study examined the ability of participants to adhere to a recommended protocol on AME for any removal and measurement of colostrum during late pregnancy. Materials and Methods: A prospective, longitudinal, observational design was used. Our recommended protocol involved hand expression of 5 minutes per breast for a total of 10 minutes for each AME session twice per 24 hours for any colostrum from 37 0/7 weeks gestation until birth. Women received AME education, completed milk logs, and attempted AME. The study team verified all colostrum volumes. Results: Nineteen women (10 nulliparous) participated, with 13 (68%) carrying infants with major organ system defects and 6 (32%) carrying infants with congenital heart defects. Most participants (52.6%) completed more than half but fewer than all AME sessions. Seven participants (36.8%) fully adhered, completing two AME sessions daily until hospital admission. Eighteen participants (94.7%) could remove milk (80-100% of the time). The 24-hour colostrum volume (median 0.35 mL, interquartile range [IQR] 0.065-0.845) and the total colostrum volume (median 3.99 mL, IQR 1.35-6.82) from AME varied. Conclusions: Among a small group of women of infants with congenital anomalies, adherence to a recommended protocol is feasible but varied by AME session frequency. Most women could collect colostrum for future infant feeding.

Treatment Adherence in Pediatric Atopic Dermatitis: A Systematic Review.

Adherence to pediatric atopic dermatitis (AD) treatment regimens can be complex and a major challenge to optimizing treatment outcome. We aimed to review factors associated with nonadherence in pediatric AD and propose interventions to improve adherence. PubMed and EMBASE databases were systematically searched for articles from 2000 to February 2023 related to AD and adherence, with an additional update in December 2023. Non-human studies, reviews, commentaries, and meta-analyses were excluded. Articles were sorted into pediatric versus adult study population based on volume. Herein, we examine the results of papers discussing adherence factors related to pediatric patients. A total of 62 studies met inclusion criteria. Thirty-six studies surveyed patients and caregivers (N = 10,268) to identify barriers to treatment adherence. None of the included studies were specific to systemic medications. Barriers includedpoor caregiver quality of life, inadequate AD-related education, topical corticosteroid (TCS) phobia, unclear therapy-related instructions, and dissatisfaction with physician interaction. Five studies solely measured adherence using medication electronic monitoring systems, Morisky medication adherence scale, or self-reported adherence to measure adherencetotopical medications. Twenty-one studies described interventions involving nurse-led or web-based education programs, text message or email reminders, and TCS education. Adherence was improved with caregiver education programs, daily text-message reminders, eczema action plans, TCS potency "traffic light" color system, and frequent follow-up visits. Adherence to pediatric AD treatment poses a multifactorial challenge for caregivers and patients. This study provides an index of strategies to optimize adherence, as it is essential for prevention of long-term sequela associated with AD in children. As the AD treatment landscape rapidly expands, further studies are vital to assess pediatric adherence to new topical, oral, and injectable medications. PROSPERO: CRD42023488557.

Impact of an SMS intervention to support type 2 diabetes self-management: DiabeText clinical trial.

Complications arising from uncontrolled Type 2 Diabetes Mellitus (T2DM) pose a significant burden on individuals' well-being and healthcare resources. Digital interventions may play a key role in mitigating such complications by supporting patients to adequately self-manage their condition. To assess the impact of DiabeText, a new theory-based, patient-centered, mobile health intervention integrated with electronic health records to send tailored short text messages to support T2DM self-management. Pragmatic, Phase III, 12-month, two-arm randomized clinical trial with T2DM primary care patients in Spain. 742 participants with suboptimal glycemic control (HbA1c>7.5) were randomly allocated to a control (usual care) or intervention (DiabeText) group. The DiabeText group received, in addition to usual care, 165 messages focused on healthy lifestyle and medication adherence. glycated hemoglobin (HbA1c). medication possession ratio, quality of life (EQ-5D-5L), diabetes self-efficacy (DSES); and self-reported adherence to medication, Mediterranean diet (MEDAS-14), and physical activity (IPAQ). Over the 12-month period, we observed no significant differences in HbA1c between the intervention and the control groups (Beta=-0.025 (-0.198 to 0.147; p=0.772)). In comparison with the control group, the DiabeText group showed significant (p<0.05) improvements in self-reported medication adherence (OR=1.4; 95%CI: 1.0 to 1.9), DSES (Cohen's d=0.35), and EQ5D-5L (Cohen's d=0.18) scores; but not in the rest of secondary outcomes. DiabeText successfully improved quality of life, diabetes self-management, and self-reported medication adherence in primary care patients with T2DM. Further research is needed to enhance its effects on physiological outcomes.

Longitudinal changes in self-reported medication adherence and beliefs about post-stroke medicines in Sweden: a repeated cross-sectional study

ObjectivesTo explore changes in beliefs about medicines and self-reported medication non-adherence between 3 and 24 months after stroke and to investigate associations between beliefs about medicines and non-adherence at 24...

Suicidality Trajectory, Hopelessness, Resilience, and Self-Efficacy Among Patients With Treatment-Resistant Depression in Vietnam.

Patients with treatment-resistant depression (TRD) have higher rates of suicidal ideation and a higher suicide attempt prevalence than patients with other types of depression. This study was designed to study the suicidality trajectory and relationships between hopelessness, resilient coping, and self-efficacy, respectively, and suicidal ideation and suicide attempts in patients with TRD during hospitalization and at 3 months after discharge. A longitudinal survey of 53 psychiatric inpatients with TRD was conducted. Suicidality, hopelessness, resilient coping, self-reported medication adherence, and self-efficacy were assessed at Weeks 1 and 2 (T0 and T1) after hospitalization and Week 1 and Months 1 and 3 after discharge. Data were analyzed using a Cox regression model. Suicidality varied across the five time points, with a downward trend observed between T0 and T1 (reflecting the initial effects of inpatient treatment) and an upward trend observed across the 3-month follow-up. Antidepressant overdose was the most common method used for suicide. The risk of high suicidal ideation during follow-up was 1.63, 2.63, and 1.14 times higher, respectively, in participants with a high level of hopelessness, low level of resilient coping, and low self-efficacy. Also, having a higher level of hopelessness and being younger in age increased the risk of attempting suicide by 3.07 times and over 6 times, respectively, compared to older participants. Suicidality was shown to fluctuate between the in-hospital treatment phase and the first 3 months following discharge in this sample of patients with TRD. Younger age, feelings of hopelessness, low resilience, and low self-efficacy were the top four factors contributing to postdischarge suicide risk. These findings highlight the need for regular patient monitoring and assessment to identify those with TRD who are at high risk of suicide as well as the importance of focusing on hopelessness, resilience, and self-efficacy as predictors of suicide ideation and attempts. Nurses should help patients with TRD, especially those who are younger, and improve and maintain their hope, resilience, and self-efficacy both during hospitalization and shortly after discharge.

Low-Density Lipoprotein Cholesterol Goal Achievement and Self-Reported Medication Adherence: Insights from the JET-LDL Registry

Low-Density Lipoprotein Cholesterol Goal Achievement and Self-Reported Medication Adherence: Insights from the JET-LDL Registry

Adherence to gluten free diet and problems faced by children with celiac disease and type 1 diabetes mellitus

ABSTRACT Introduction: Celiac disease (CD) in children can be associated with Type 1 Diabetes Mellitus (T1DM) as both share autoimmune etiology. Mainstay of treatment in celiac disease is total avoidance of gluten in diet whereas treatment in child with both the diseases will be Insulin therapy, exercise along with gluten free diet (GFD). There is dearth of literature regarding adherence to GFD and barriers for children with both T1DM and CD. Methods: A questionnaire-based study was done at a tertiary care institute so as to compare the self-reported gluten adherence and the problems faced by children with dual diseases (TIDM and CD) and CD alone. Thirty children of age group 5-14 years each withType 1 DM and CD (T1DMCD group) and celiac disease (CD group) were selected consecutively. A questionnairewas filled by asking questions from either children (above 8 years) or parents (below 8 years) and the results were compiled, compared and further analysed. Results: Baseline demographic parameters were comparable in both the groups. Gluten adherence was found to be worse in T1DMCD group as compared to CD group. Greater number of problems were experienced by children with both TIDM and CD as compared to children with CD alone (P &lt; 0.05). Financial burden more so in T1DMCD group, unawareness about disease and benefits of GFD, less availability and social isolation were found to be the most significant barriers to diet adherence. Conclusion: As these children face dual diseases, they should be made more aware regarding benefits of GFD. Such information is valuable to primary care physicians for better management and rehabilitation of children suffering from these chronic diseases.

Are social protection and food security accelerators for adolescents to achieve the Global AIDS targets?

Without effective, scalable interventions, we will fail to achieve the Global AIDS Targets of zero AIDS-related deaths, zero HIV transmission and zero discrimination. This study examines associations of social protection and food security among adolescents living with HIV (ALHIV), with three Global AIDS Targets aligned outcomes: antiretroviral treatment (ART) adherence and viral suppression, HIV transmission risk behaviour and enacted stigma. We conducted three study visits over 2014-2018 with 1046 ALHIV in South Africa's Eastern Cape province. Standardized surveys provided information on receipt of government-provided cash transfers and past-week food security, alongside self-reported ART adherence, sexual debut and condom use, and enacted HIV-related stigma. Viral load (VL) data was obtained through data extraction from patient files and linkage with National Health Laboratory Service test results (2014-2020). We used a multivariable random-effects regression model to estimate associations between receiving government cash transfers and food security and three outcomes: ART adherence and viral suppression, delayed sexual debut or consistent condom use and no enacted stigma. We tested moderation by sex and age and fitted disaggregated models for each outcome. Among the 933 ALHIV completing all three study visits, 55% were female, and the mean age was 13.6 years at baseline. Household receipt of a government cash transfer was associated with improvements on all outcomes: ART adherence and viral suppression (aOR 2.03, 95% CI 1.29-3.19), delayed sexual debut or consistent condom use (aOR 1.62, 95% CI 1.16-2.27) and no enacted stigma(aOR 2.33, 95% CI 1.39-3.89). Food security was associated with improvements on all outcomes: ART adherence and viral suppression (aOR 1.73, 95% CI 1.30-2.30), delayed sexual debut or consistent condom use (aOR 1.30, 95% CI 1.03-1.64) and no enacted stigma (aOR 1.91, 95% CI 1.32-2.76). Receiving both cash transfers and food security increased the probability of ART adherence and VL suppression from 36% to 60%; delayed sexual debut or consistent condom use from 67% to 81%; and no enacted stigma from 84% to 96%. Government-provided cash transfers and food security, individually and in combination, are associated with improved outcomes for ALHIV aligned with Global AIDS Targets. They may be important, and underutilized, accelerators for achieving these targets.

Quality of Life in Japanese People with Type 2 Diabetes Switching from Multiple Daily Insulin Injections to Once-Daily iGlarLixi: SIMPLIFY Japan.

Previous studies have shown that iGlarLixi, a fixed-ratio combination of insulin glargine 100 U/ml and lixisenatide, provides effective glycemic control in people with type 2 diabetes (T2D). The SIMPLIFY Japan study assessed the impact of switching from multiple daily insulin injections (MDI) to once-daily iGlarLixi on health-related quality of life (HRQOL) and glycemic parameters in Japanese people with moderately controlled T2D. This 24-week, prospective, observational cohort study enrolled Japanese adults with T2D who switched from MDI therapy to iGlarLixi. Data were collected at baseline, 12, and 24weeks; changes in Diabetes Therapy-Related Quality of Life (DTR-QOL) questionnaire score, glycated hemoglobin (HbA1c), body weight and self-reported treatment adherence were evaluated; the primary endpoint was change in DTR-QOL at 24weeks. Sixty-six participants were enrolled and 61 were included in the full analysis set. Significant improvements were observed in total DTR-QOL score from baseline to week 24 (mean change + 10.8 points; P < 0.001), with higher scores observed in individual domains related to social/daily activities, treatment satisfaction, and reductions in treatment-related anxiety (P < 0.05). A small HbA1c increase was noted at week 24 (P < 0.001), while this did not appear to adversely affect HRQOL or treatment satisfaction. A significant reduction in body weight was observed at week 12 (mean change - 0.7kg; P = 0.046). Self-reported treatment adherence increased from baseline to week 24, with the proportion of participants who never missed an insulin injection increasing from 55.7 to 77.6%. At week 24, the incidence of hypoglycemia and gastrointestinal adverse events was 18.2 and 27.3%, respectively. Switching from MDI to iGlarLixi therapy in Japanese people with T2D was associated with enhanced HRQOL (despite slight elevation in HbA1c) and improved treatment adherence, with a favorable safety profile. These findings support the beneficial role of iGlarLixi in the management of T2D in real-world Japanese clinical practice. Japan Registry of Clinical Trials (jRCT1041210151).