ABSTRACT
OBJECTIVES: To compare three methods for evaluating treatment adherence in a 7-day controlled treatment period for malaria in children in Rwanda. METHODS: Fifty-six children (< 5 years) with malaria were recruited at the University Hospital of Butare, Rwanda. Patients were treated with quinine sulfate, taste-masked, pellets during seven days: three days in hospital (in-patient) followed by a four-day out-patient period. Three methods to evaluate medication adherence among patients were compared: manual pill count of returned tablets, patient self-report and electronic pill-box monitoring. These pill-boxes were equipped with a microchip registering date and time of every opening. Medication adherence was defined as the proportion of prescribed doses taken. The inter-dose intervals were analysed as well. RESULTS: Medication adherence data were available for 54 of the 56 patients. Manual pill count and patient self-report yielded a medication adherence of 100% for the in- and out-patient treatment periods. Based on electronic pill-box monitoring, medication adherence during the seven-day treatment period was 90.5 +/- 8.3%. Based on electronic pill-box monitoring inpatient medication adherence (99.3 +/- 2.7%) was markedly higher (p < 0.03) than out-patient adherence (82.7 +/- 14.7%), showing a clear difference between health workers' and consumers' medication adherence. CONCLUSION: Health workers' medication adherence was good. However, a significant lower medication adherence was observed for consumers' adherence in the outpatient setting. This was only detected by electronic pill-box monitoring. Therefore, this latter method is more accurate than the two other methods used in this study.
Subject(s)
Antimalarials/therapeutic use , Drug Packaging/instrumentation , Malaria/drug therapy , Medication Adherence/statistics & numerical data , Quinine/therapeutic use , Administration, Oral , Child, Preschool , Drug Administration Schedule , Female , Humans , Infant , Infant, Newborn , Length of Stay , Male , Rwanda , Treatment OutcomeABSTRACT
The influence of atherosclerosis on distensibility of iliac and superficial femoral arteries was assessed retrospectively in 28 patients using intravascular ultrasound. Distensibility was related to lesion morphology, lesion geometry, percentage area stenosis, effect of balloon angioplasty, hypertension and patient's age. In 10 patients, free lumen area remained unchanged during the cardiac cycle. From the remaining 18 patients, a total of 135 cross-sections underwent qualitative and quantitative analysis. Cross-sections without a lesion were compared with those showing; soft/hard and eccentric/concentric lesions. At normal sites, iliac arteries showed greater distensibility than femoral arteries (6.5 +/- 2.4% vs. 3.5 +/- 0.9%; p < or = 0.05). Hard lesions in iliac arteries were less distensible than lesions; in femoral arteries this difference was less pronounced. Lesion geometry did not influence arterial distensibility. Intravascular ultrasound revealed no difference in distensibility when normal cross-sections were compared with those having a < 50% or a 50% to 90% area stenosis. In contrast, a significant decrease in femoral artery distensibility was found in the presence of > 90% stenosis (0.4%). Comparison of cross-sections before and after balloon angioplasty revealed a marked increase in distensibility of iliac arteries following intervention; in the femoral artery, there was practically no change in distensibility. Hypertension and increasing age proved to have no significant influence on arterial distensibility. This study demonstrates that intravascular ultrasound is potentially a powerful tool to assess arterial distensibility and the influence of atherosclerosis on vascular dynamics.
Subject(s)
Arteriosclerosis/physiopathology , Femoral Artery/physiopathology , Iliac Artery/physiopathology , Ultrasonography, Interventional , Age Factors , Aged , Aged, 80 and over , Angioplasty, Balloon , Arteriosclerosis/diagnostic imaging , Arteriosclerosis/pathology , Arteriosclerosis/therapy , Blood Pressure , Constriction, Pathologic/diagnostic imaging , Constriction, Pathologic/pathology , Constriction, Pathologic/physiopathology , Elasticity , Female , Femoral Artery/diagnostic imaging , Femoral Artery/pathology , Heart Rate , Humans , Hypertension/physiopathology , Iliac Artery/diagnostic imaging , Iliac Artery/pathology , Male , Middle Aged , Retrospective Studies , Signal Processing, Computer-AssistedABSTRACT
Male rats and pregnant and nonpregnant female rats of the Wistar strain were sham-exposed or exposed to static (0.49 T) or to extremely low frequency (50 Hz) magnetic fields (0.018 T) 2 h per day for 20 consecutive days. Measures of irritability, exploratory activity, and locomotion were made in that order before and after the 4th, 10th, and 17th 2-h exposures. A reliable decrease in the irritability of rats after repeated exposure to a static or undulating field was found. No significant effects of treatment conditions on open-field behavior and locomotor activity were observed. Pregnancy had no influence on the behavioral end points. These results indicate that irritability of rats may be used as a simple behavioral indicant of mammalian sensitivity to magnetic fields.
