ABSTRACT
Introduction: Injectable medicines are increasingly used to manage risk factors for cardiovascular (CV) events, such as PCSK-9 inhibitors in dyslipidaemia and GLP-1 agonists in diabetes. However, there is a paucity of data around the administrative and clinical practicalities when using these injectables, and limited information on patient and healthcare professionals' perceptions. Purpose(s): To identify the facilitators and barriers on the use of injectable therapies with CV benefits by undertaking interviews with patients, caregivers and healthcare professionals (HCPs). Method(s): Interviews were conducted via telephone and using MS Teams due to Covid-19 restrictions in the United Kingdom (London and Leeds) and Italy (Rome and Milan) in 2021. Coding was undertaken using NVivo and thematic analysis performed. Result(s): A total of 56 patients were interviewed: 30 in the U.K. (mean age 66 yrs, 60% male) and 26 patients in Italy (mean age 63 yrs, 80% male) and 11 caregivers (mean age 59 yrs, 73% female). A total of 38 HCPs were interviewed, 19 in each country and composed of physicians (n=18), pharmacists (n=10), nurses (n=9) and pharmacy technician (n=1). Three distinct themes were identified: (i) Organisational and governance issues - relating to prescribing restrictions and availability of the drugs locally (PCSK9i are initiated and supplied from hospitals) and lack of communication between hospital and primary care setting;(ii) Clinical issues around HCPs' skills and experience - including: Lack of experience with these injectables, lack of time to provide education to patients and caregivers, therapeutic inertia (HCPs not adopting a change in practice despite the evidence or due to bureaucratic restrictions) as well as lack of knowledge on long-term effects, and finally (iii) Patient-related issues - relating to behaviours and beliefs such as reluctance about using injectable therapies, and lack of education about these injectables in terms of indications/clinical benefits for use. Despite some differences in the prescribing of these injectables in the two countries, the analysis captured similar facilitators and barriers. Facilitators included prior use of injectables (e.g. insulin), and the ability to reach a clinical target of lower cholesterol by having just a one shot . HCPs stated that access to rapid pathology tests would aid uptake of injectables with CV benefit as well as having educational tools on these injectables in practice. Conclusion(s): This qualitative study identified barriers to initiation, continuation, and adherence with injectable therapies with CV benefits but also highlighted areas where changes can be made especially around education and support for patients and HCPs.
ABSTRACT
We examinedthe effects of the COVID-19 pandemic on university students’ dietary practices and lifestyles. In this study, the term “dietary practices” refers to people’s choice in food consumption, whereas “lifestyles” refers to their overall habits including both diet and exercise. We followed a quantitative approach through a cross sectional study and collected data from 475 university students in the UAE by means of an online survey. The results of this study indicated that a majority (67%) of the surveyed students seem to have changed their dietary practice for the better and were making healthier life choices. Additionally, it appears that students started leading more active, healthier lifestyles by incorporating exercise in their daily routine. The research concludes with initial suggestions and implications for healthcare practitioners and providing them with information regarding how younger adults in the UAE have behaved during a pandemic. Understanding the results from similar studies will help the health authorities in reshaping policies on nutrition in anticipation of any future pandemics. © 2022 The Author(s). Published by Enviro Research Publishers.
ABSTRACT
The COVID-19 pandemic is affecting global markets through unprecedented circumstances. Fears surrounding such a novel virus have led to dramatic market turbulence and massive tumbles in stock prices. In this article, the authors explore the impact of COVID-19 on a comprehensive sample of 46 emerging countries and assess investors' perceptions toward credit risk. The authors also record the volume of new bond issues in conventional and Islamic bond markets and find that indeed COVID-19 has harshly struck the emerging countries, driving sharp declines in stock market indexes, causing an escalation in volatility levels, and widening the premiums on sovereign credit default swaps. Such upheavals, however, did not yet reach global financial crisis levels. The authors finally examine the reactions of the International Monetary Fund (IMF) local governments, and central banks in response to such a crisis.
ABSTRACT
Background Separate studies suggest that the risks from smoking might vary between high-income (HICs), middle-income (MICs), and low-income (LICs) countries, but this has not yet been systematically examined within a single study using standardised approaches. We examined the variations in risks from smoking across different country income groups and some of their potential reasons. Methods We analysed data from 134 909 participants from 21 countries followed up for a median of 11.3 years in the Prospective Urban Rural Epidemiology (PURE) cohort study;9711 participants with myocardial infarction and 11 362 controls from 52 countries in the INTERHEART case-control study;and 11 580 participants with stroke and 11 331 controls from 32 countries in the INTERSTROKE case-control study. In PURE, all-cause mortality, major cardiovascular disease, cancers, respiratory diseases, and their composite were the primary outcomes for this analysis. Biochemical verification of urinary total nicotine equivalent was done in a substudy of 1000 participants in PURE. Findings In PURE, the adjusted hazard ratio (HR) for the composite outcome in current smokers (vs never smokers) was higher in HICs (HR 1.87, 95% CI 1.65-2.12) than in MICs (1.41, 1.34-1.49) and LICs (1.35, 1 .25-1.46;interaction p<0.0001). Similar patterns were observed for each component of the composite outcome in PURE, myocardial infarction in INTERHEART, and stroke in INTERSTROKE. The median levels of tar, nicotine, and carbon monoxide displayed on the cigarette packs from PURE HICs were higher than those on the packs from MICs. In PURE, the proportion of never smokers reporting high second-hand smoke exposure (>= 1 times/day) was 6.3% in HICs, 23.2% in MICs, and 14.0% in LICs. The adjusted geometric mean total nicotine equivalent was higher among current smokers in HICs (47.2 mu M) than in MICs (31. 1 mu M) and LICs (25.2 mu M;ANCOVA p<0.0001). By contrast, it was higher among never smokers in LICs (18.8 mu M) and MICs (11.3 mu M) than in HICs (5.0 mu M;ANCOVA p=0.0001). Interpretation The variations in risks from smoking between country income groups are probably related to the higher exposure of tobacco-derived toxicants among smokers in HICs and higher rates of high second-hand smoke exposure among never smokers in MICs and LICs. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.