Factors associated with weight gain during COVID-19 pandemic: A global study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has resulted in changes in lifestyle habits and experiences of mental health outcomes, some of which were possibly related to weight gain, leading to an increase in the prevalence of obesity, which is associated with the development of several severe diseases. Concerns regarding weight gain and its impact on health outcomes are prevalent worldwide, with obesity being one of the highest causes of mortality in current society. METHODS: A self-reported questionnaire collected data from participants aged 18 years of age and above from 26 countries and regions worldwide. Post-hoc multiple logistic regression analyses have been done to evaluate the association between demographic and socioeconomic factors, and the perspectives that were identified to be associated with weight gain. RESULTS: Participants belonging to a younger age group; with a higher level of education; living in an urban area; living with family members; employed full-time; and had obesity were found to be more vulnerable to weight gain. After adjusting for socio-demographic factors, participants who were quarantined; exercised less prior to the pandemic; consumed unhealthy foods; and reported negative thoughts such as helplessness and the perceived risk of COVID-19, were more likely to experience weight gain; while negative thoughts such as having no means of control over the COVID-19 pandemic and the consequences of the COVID-19 pandemic will have great personal effect were associated with females, students, and people living in the rural area. CONCLUSIONS: Weight gain risk during the pandemic was significantly associated with certain socio-demographic and COVID-19 related factors. To improve public health outcomes, future research should conduct a longitudinal evaluation on the effects of COVID-19 experiences upon health choices. Streamlined mental support should also be provided to the vulnerable groups which were prone to negative thoughts that were associated with weight gain.

Resilience level and its association with maladaptive coping behaviours in the COVID-19 pandemic: a global survey of the general populations.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has induced a significant global concern on mental health. However few studies have measured the ability of individuals to "withstand setbacks, adapt positively, and bounce back from adversity" on a global scale. We aimed to examine the level of resilience, its determinants, and its association with maladaptive coping behaviours during the pandemic. METHODS: The Association of Pacific Rim Universities (APRU) conducted a global survey involving 26 countries by online, self-administered questionnaire (October 2020-December 2021). It was piloted-tested and validated by an expert panel of epidemiologists and primary care professionals. We collected data on socio-demographics, socioeconomic status, clinical information, lifestyle habits, and resilience levels measured by the Brief Resilience Scale (BRS) among adults aged ≥ 18 years. We examined factors associated with low resilience level, and evaluated whether low resilience was correlated with engagement of maladaptive coping behaviours. RESULTS: From 1,762 surveys, the prevalence of low resilience level (BRS score 1.00-2.99) was 36.4% (America/Europe) and 24.1% (Asia Pacific). Young age (18-29 years; adjusted odds ratio [aOR] = 0.31-0.58 in older age groups), female gender (aOR = 1.72, 95% C.I. = 1.34-2.20), poorer financial situation in the past 6 months (aOR = 2.32, 95% C.I. = 1.62-3.34), the presence of one (aOR = 1.56, 95% C.I. = 1.19-2.04) and more than two (aOR = 2.32, 95% C.I. = 1.59-3.39) medical conditions were associated with low resilience level. Individuals with low resilience were significantly more likely to consume substantially more alcohol than usual (aOR = 3.84, 95% C.I. = 1.62-9.08), take considerably more drugs (aOR = 12.1, 95% C.I. = 2.72-54.3), buy supplements believed to be good for treating COVID-19 (aOR = 3.34, 95% C.I. = 1.56-7.16), exercise less than before the pandemic (aOR = 1.76, 95% C.I. = 1.09-2.85), consume more unhealthy food than before the pandemic (aOR = 2.84, 95% C.I. = 1.72-4.67), self-isolate to stay away from others to avoid infection (aOR = 1.83, 95% C.I. = 1.09-3.08), have an excessive urge to disinfect hands for avoidance of disease (aOR = 3.08, 95% C.I. = 1.90-4.99) and transmission (aOR = 2.54, 95% C.I. = 1.57-4.10). CONCLUSIONS: We found an association between low resilience and maladaptive coping behaviours in the COVID-19 pandemic. The risk factors identified for low resilience in this study were also conditions known to be related to globalization-related economic and social inequalities. Our findings could inform design of population-based, resilience-enhancing intervention programmes.

Factors Associated with Vaccination Intention against the COVID-19 Pandemic: A Global Population-Based Study.

Several vaccines have been developed for COVID-19 since the pandemic began. This study aimed to evaluate the factors associated with COVID-19 vaccination intention. A global survey was conducted across 26 countries from October, 2020 to December, 2021 using an online self-administered questionnaire. Demographic information, socio-economic status, and clinical information were collected. A logistic regression examined the associations between vaccine intention and factors such as perceptions and the presence of chronic physical and mental conditions. The sample included 2459 participants, with 384 participants (15.7%) expressing lower COVID-19 vaccination intent. Individuals who identified as female; belonged to an older age group; had a higher level of education; were students; had full health insurance coverage; or had a previous history of influenza vaccination were more willing to receive vaccination. Conversely, those who were working part-time, were self-employed, or were receiving social welfare were less likely to report an intention to get vaccinated. Participants with mental or physical health conditions were more unwilling to receive vaccination, especially those with sickle cell disease, cancer history within the past five years, or mental illness. Stronger vaccination intent was associated with recommendations from the government or family doctors. The presence of chronic conditions was associated with lower vaccine intention. Individuals with health conditions are especially vulnerable to health complications and may experience an increased severity of COVID-19 symptoms. Future research should evaluate the effectiveness of interventions targeting the vaccine perceptions and behaviours of at-risk groups. As such, public awareness campaigns conducted by the government and proactive endorsement from health physicians may help improve COVID-19 vaccination intention.

Global Incidence and mortality of oesophageal cancer and their correlation with socioeconomic indicators temporal patterns and trends in 41 countries.

Oesophageal cancers (adenocarcinomas [AC] and squamous cell carcinomas [SCC]) are characterized by high incidence/mortality in many countries. We aimed to delineate its global incidence and mortality, and studied whether socioeconomic development and its incidence rate were correlated. The age-standardized rates (ASRs) of incidence and mortality of this medical condition in 2012 for 184 nations from the GLOBOCAN database; national databases capturing incidence rates, and the WHO mortality database were examined. Their correlations with two indicators of socioeconomic development were evaluated. Joinpoint regression analysis was used to generate trends. The ratio between the ASR of AC and SCC was strongly correlated with HDI (r = 0.535 [men]; r = 0.661 [women]) and GDP (r = 0.594 [men]; r = 0.550 [women], both p < 0.001). Countries that reported the largest reduction in incidence in male included Poland (Average Annual Percent Change [AAPC] = -7.1, 95%C.I. = -12,-1.9) and Singapore (AAPC = -5.8, 95%C.I. = -9.5,-1.9), whereas for women the greatest decline was seen in Singapore (AAPC = -12.3, 95%C.I. = -17.3,-6.9) and China (AAPC = -5.6, 95%C.I. = -7.6,-3.4). The Philippines (AAPC = 4.3, 95%C.I. = 2,6.6) and Bulgaria (AAPC = 2.8, 95%C.I. = 0.5,5.1) had a significant mortality increase in men; whilst Columbia (AAPC = -6.1, 95%C.I. = -7.5,-4.6) and Slovenia (AAPC = -4.6, 95%C.I. = -7.9,-1.3) reported mortality decline in women. These findings inform individuals at increased risk for primary prevention.

Global temporal patterns of pancreatic cancer and association with socioeconomic development.

Pancreatic cancer induces a substantial global burden. We examined its global incidence/mortality rates and their correlation with socioeconomic development (Human Development Index [HDI] and Gross Domestic Product [GDP] in 2000 as proxy measures). Data on age-standardized incidence/mortality rates in 2012 were retrieved from the GLOBOCAN database. Temporal patterns in 1998-2007 were assessed for 39 countries according to gender. The Average Annual Percent Change (AAPC) of the incidence/mortality trends was evaluated using joinpoint regression analysis. The age-standardized incidence ranged between 0.8-8.9/100,000. When compared among countries, Brazil (AAPC = 10.4, 95%C.I. = 0.8,21) and France (AAPC = 4.7, 95%C.I. = 3.6,5.9) reported the highest incidence rise in men. The greatest increase in women was reported in Thailand (AAPC = 7, 95%C.I. = 2.1,12.1) and Ecuador (AAPC = 4.3, 95%C.I. = 1.3,7.3). For mortality, the Philippines (APCC = 4.3, 95%C.I. = 2,6.6) and Croatia (AAPC = 2, 95% C.I. = 0,3.9) reported the biggest increase among men. The Philippines (AAPC = 5.8, 95% C.I. 4.5,7.2) and Slovakia (AAPC = 3.1, 95% C.I. 0.9,5.3) showed the most prominent rise among women. Its incidence was positively correlated with HDI (men: r = 0.66; women: r = 0.70) and GDP (men: r = 0.29; women: r = 0.28, all p < 0.05), and similarly for mortality (men: r = 0.67; women: r = 0.72 [HDI]; men: r = 0.23; women: r = 0.28 [GDP]). In summary, the incidence and mortality of pancreatic cancer were rising in many countries, requiring regular surveillance.

The Association between Distal Findings and Proximal Colorectal Neoplasia: A Systematic Review and Meta-Analysis.

OBJECTIVES: Whether screening participants with distal hyperplastic polyps (HPs) detected by flexible sigmoidoscopy (FS) should be followed by subsequent colonoscopy is controversial. We evaluated the association between distal HPs and proximal neoplasia (PN)/advanced proximal neoplasia (APN) in asymptomatic, average-risk patients. METHODS: We searched Ovid Medline, EMBASE, and the Cochrane Library from inception to 30 June 2016 and included all screening studies that examined the relationship between different distal findings and PN/APN. Data were independently extracted by two reviewers with disagreements resolved by a third reviewer. We pooled absolute risks and odds ratios (ORs) with a random effects meta-analysis. Seven subgroup analyses were performed according to study characteristics. Heterogeneity was characterized with the I2 statistics. RESULTS: We analyzed 28 studies (104,961 subjects). When compared with normal distal findings, distal HP was not associated with PN (OR=1.16, 95% confidence interval (CI)=0.89-1.51, P=0.14, I2=40%) or APN (OR=1.09, 95% CI=0.87-1.36, P=0.39, I2=5%), while subjects with distal non-advanced or advanced adenoma had higher odds of PN/APN. Higher odds of PN/APN were observed for more severe distal lesions. Weaker association between distal and proximal findings was noticed in studies with higher quality, larger sample size, population-based design, and more stringent endoscopy quality-control measures. The Egger's regression tests showed all P>0.05. CONCLUSIONS: Distal HP is not associated with PN/APN in asymptomatic screening population when compared with normal distal findings. Hence, the presence of distal HP alone detected by FS does not automatically indicate colonoscopy referral for all screening participants, as other risk factors of PN/APN should be considered.

International incidence and mortality trends of liver cancer: a global profile.

We examined the global incidence and mortality rates of liver cancer, and evaluated the association between incidence/mortality and socioeconomic development (Human Development Index [HDI] and Gross Domestic Product [GDP]) using linear regression analysis. The average annual percent change (AAPC) of the trends was evaluated from join-point regression analysis. The global incidence of liver cancer varied widely by nine-fold, and was negatively correlated with HDI (men: r = -0.232, p = 0.003; women: r = -0.369, p < 0.001) and GDP per capita (men: r = -0.164, p = 0.036; women: r = -0.212, p = 0.007). Its mortality showed a similarly negative correlation with both indices. The greatest incidence rise in men was observed in Poland (AAPC = 17.5, 95% C.I. = 5.6, 30.9) and Brazil (AAPC = 13.2, 95% C.I. = 5.9, 21.0), whereas Germany (AAPC = 6.6, 95% C.I = 2.0, 11.5) and Norway (AAPC = 6.5, 95% C.I. = 3.2, 10.0) had the greatest increase in women. The mortality rates paralleled the incidence rates in most countries. For mortality, Malta (AAPC = 11.5, 95% C.I. = 3.9, 19.8), Australia (AAPC = 6.8, 95% C.I. = 2.2, 11.5) and Norway (APCC = 5.6, 95% C.I. = 2.8, 8.5) reported the biggest increase among men; whilst Australia (AAPC = 13.4, 95% C.I. = 7.8, 19.4) and Singapore (AAPC = 7.7, 95% C.I. = 4.1, 11.5) showed the most prominent rise among women. These epidemiological data identified countries with potentially increasing trends of liver cancer for preventive actions.

Tianma Gouteng Yin Formula for treating primary hypertension.

BACKGROUND: Tianma Gouteng Yin Formula (TGYF) is widely used to treat hypertension-related symptoms in clinical practice in East Asia. It has been shown to have a blood pressure lowering effect, reducing total cholesterol, improving clinical symptoms and quality of life, and preventing the occurrence of stroke in hypertensive patients. Understanding the effect of Tianma Gouteng Yin Formula on blood pressure, quality of life and cardiovascular risk factors could be valuable for the management of high blood pressure. OBJECTIVES: To assess the efficacy and safety of Tianma Gouteng Yin Formula for treating primary hypertension compared to placebo or no treatment. SEARCH METHODS: English databases including Cochrane Central (CCTR), MEDLINE, EMBASE, AMED, CINAHL, IPA, and the Hypertension Group Specialised Register were searched up to July 2011. Chinese databases including Chinese Biomedical Database, TCMonline , Chinese Dissertation Database, CMAC and the Index to Chinese Periodical Literature were searched up to April 2010. SELECTION CRITERIA: Randomised and quasi-randomised controlled trials that compared TGYF with no treatment or placebo for primary hypertension. DATA COLLECTION AND ANALYSIS: No study was identified which met the inclusion criteria for this review. MAIN RESULTS: No study was identified which met the inclusion criteria for this review. AUTHORS' CONCLUSIONS: As no trials could be identified, no conclusions can be made about the role of TGYF in the treatment of primary hypertension. Well-designed randomized controlled studies need to be conducted and published.

Pharmacoepidemiological profiles of oral hypoglycemic agents among 28,773 Chinese patients with diabetes.

AIMS: This study examined the rates of discontinuation of Oral Hypoglycemic Agents (OHAs) in diabetes patients, and to evaluate the associations between discontinuation of OHAs, socioeconomic status and the number of comorbidities. METHODS: A cohort study from January 2004 to June 2007 was conducted and followed up through December 2007. We included all primary care clinics in one large territories of Hong Kong involving 28,773 Chinese diabetes patients. Multivariate regression analyses controlled for age, gender, payment status (fee-payers vs. fee waivers; fee-waivers represented those less able to pay for consultation fees and were regarded as having lower socioeconomic status), service type delivered by the clinics, district of residence, visit type (new vs. follow-up), the number of comorbidities and the drug class (sulphonylureas vs. biguanide vs. combination therapy). RESULTS: 9.9% discontinued their medications within 180 days of their prescriptions. Fee waivers (adjusted odds ratio [AOR] for fee payers=0.81, 95% C.I. 0.73-0.89, p<0.001) and the absence of comorbidities (AOR for ≥one morbidity=0.59-0.62, p<0.001) were associated with medication discontinuation. CONCLUSIONS: Diabetes patients with lower ability to pay and without comorbidities were significantly associated with OHAs discontinuation. They should be the target groups for medication counseling programmes.

Predictors of switching from beta-blockers to other anti-hypertensive drugs: a review of records of 19,177 Chinese patients seen in public primary care clinics in the New Territory East, Hong Kong.

BACKGROUND: Beta-blocker drugs are commonly used in family practice and studies showed that they were the most popularly prescribed medications among all antihypertensive agents. This study aimed to identify the factors associated with medication switching from a beta-blocker to another antihypertensive drug among Chinese patients. METHODS: We used a validated database which consisted of the demographic and clinical information of all Chinese patients prescribed a beta-blocker from any public, family practice clinics between 01 Jan 2004 to 30 June 2007 in one large Territory of Hong Kong. The proportion of patients switched from beta-blockers to another antihypertensive agent 180 days within their first prescription was studied, and the factors associated with medication switching were evaluated by using multivariate regression analyses. RESULTS: From 19,177 eligible subjects with a mean age of 59.1 years, 763 (4.0%) were switched from their beta-blockers within 180 days of commencing therapy. A binary logistic regression model used medication switching as the outcome variable and controlled for age, gender, socioeconomic status, clinic setting (general out-patient clinics, family medicine specialist clinic or staff clinics), district of residence, visit type (new vs. follow-up attendance), the number of concomitant co-morbidities, and the calendar year of prescription. It was found that older patients (age 50-59 years: adjusted odds ratio [AOR] 1.38, 95% C.I. 1.12-1.70; p = 0.002; age 60-69 years: AOR 1.63 95% C.I. 1.30-2.04, p < 0.001; age ≥ 70 years: AOR 1.82, 95% C.I. 1.46-2.26, p < 0.001; referent age < 50 years) and new visitors (AOR 0.57, 95% C.I. 0.48-0.68, p < 0.001) were more likely to have their medication switched. CONCLUSIONS: Closer monitoring of the medication taking behavior among the older patients and the new clinic visitors prescribed a beta-blocker is warranted. Future studies should evaluate the reasons of drug switching.

Subjects at risk of discontinuation of lipid-lowering agents: a 6-month cohort study among 12,875 patients in a chinese population.

BACKGROUND: Dyslipidemia is a significant health problem, and persistent use of lipid-lowering agents among dyslipidemic patients is clinically important. However, few studies have evaluated the profiles of medication discontinuation among ethnic Chinese patients. OBJECTIVE: The objective of this study was to evaluate the level of medication adherence among Chinese patients who were prescribed a lipid-lowering drug and to investigate factors that could help physicians identify patients at risk for discontinuing their medication. METHODS: All patients who attended any primary care clinic in 1 territory of Hong Kong and were prescribed at least 1 lipid-lowering agent from January 2004 to June 2007 were included. The incidences of drug discontinuation within 180 days after drug prescriptions were measured, and the factors associated with discontinuation using binary logistic regression analyzes were evaluated. RESULTS: Of the 12,875 eligible patients, the majority were prescribed fibrates (54.4%) and statins (45.1%). Among the patients, 17.0% discontinued their medication. Older patients (adjusted odds ratio [aOR] = 0.72-0.79 for patients >50 years), male subjects (aOR = 0.87; 95% CI, 0.78-0.97; P = 0.009), fee payers (aOR = 0.88; 95% CI, 0.78-0.99; P = 0.029), attendees in family medicine specialist clinics (aOR = 0.82; 95% CI, 0.70-0.96; P = 0.013), residents in rural districts (aOR = 0.52; 95% CI, 0.44-0.60; P < 0.001), follow-up visitors (aOR = 0.60; 95% CI, 0.54-0.66; P < 0.001), patients with comorbidities (aOR = 0.39; 95% CI, 0.35-0.44; P < 0.001 for 1 comorbidity and aOR = 0.28; 95% CI, 0.25-0.33; P < 0.001 for at least 2 comorbidities), and persons who use fibrates (aOR = 0.56; 95% CI, 0.49-0.64; P < 0.001) were significantly less likely to discontinue their medication. CONCLUSIONS: The findings of these associated factors were new for ethnic Chinese patients. These findings could help physicians identify patients who had been prescribed a lipid-lowering agent who were at higher risk of discontinuing their medication. Their medication-taking behavior should be monitored more closely, and future studies should evaluate the reasons of drug discontinuation.

Profiles of discontinuation and switching of thiazide diuretics: a cohort study among 9398 Chinese hypertensive patients.

This study tested the hypothesis that younger, male patients or new clinic visitors, who were prescribed thiazide diuretics were more likely to have drug discontinuation and switching. All adult patients who visited any primary care clinic in one territory of Hong Kong, and who were prescribed a thiazide diuretic from January 2004 to June 2007 were included. The rates of discontinuation and switching, separately, 180 days after thiazide prescriptions were measured. Factors associated with discontinuation and switching were evaluated by multiple regression analyses. Among 9398 patients, 12.5% discontinued and 10.8% switched their prescriptions, whereas prescriptions of other patients remained the same. Younger patients (< 50 years (reference value); adjusted odds ratio (AOR) for 50-59 years=0.74, 95% confidence interval (CI) 0.61-0.90, P=0.002; AOR (60-69 years)=0.57, 95% CI 0.46-0.70, P < 0.001; AOR (≥ 70 years)=0.88, 95% CI 0.73-1.06, P=0.174), male subjects (AOR=1.23, 95% CI 1.07-1.40, P=0.003) and new visitors (AOR (repeat visitors)=0.55, 95% CI 0.47-0.65, P < 0.001) were more likely to be discontinuers. These associations between younger age (< 50 years (reference value); AOR (50-59) years=0.85, 95% CI 0.70-1.04, P=0.112; AOR (60-69 year)=0.79, 95% CI 0.65-0.98, P=0.028; AOR (≥ 70 years)=0.70, 95% CI 0.57-0.85, P < 0.001), male gender (AOR=1.29, 95% CI 1.12-1.48, P < 0.001) and new visitors (AOR (repeat visitors)=0.57, 95% CI 0.48-0.67, P < 0.001) were also significant for medication switching. Clinicians should monitor the medication-taking behavior more closely among patients aged 50-59 years, male subjects and new clinic visitors when thiazide was prescribed.

Adherence to oral hypoglycemic agents in 26,782 Chinese patients: a cohort study.

This study evaluated the factors associated with adherence to oral hypoglycemic agents (OHAs) among Chinese patients. A validated clinical database was used to include all adult patients who were prescribed an OHA in any of the government clinics in a large territory of Hong Kong from January 1, 2004, to June 30, 2007 and made 1 or more subsequent visits for OHA refill. Patients with medication possession ratio (MPR) 0.8 or greater were regarded as medication adherent. One binary logistic regression analysis was performed to test the association between age, gender, visit types (new vs follow-up visits), and MPR while controlling for socioeconomic status, service settings, number of comorbidities, and the medication class prescribed (sulphonylurea vs biguanide vs combination of both). Among 26,782 patients, 89.6% were adherent. Older patients (aged 50-59 years; adjusted odds ratio [AOR] 1.19; 95% confidence interval [CI], 1.06-1.34, P = .004; 60-69 years; AOR 1.37; 95% CI, 1.21-1.55, P < .001; ≥70 years; AOR 1.52; 95% CI, 1.34-1.72, P < .001) and follow-up visitors (AOR 3.89; 95% CI, 3.55-4.27, P < .001) were more likely to be medication adherent. Male subjects were less likely to adhere (AOR 0.84; 95% CI, 0.77-0.91, P < .001). Newer medication adherence-enhancing strategies should be implemented, especially among younger patients, male subjects, and new clinic attendees to secure optimal adherence.

Peri-operative hyperglycemia: a consideration for general surgery?

BACKGROUND: Intraoperative hyperglycemia in cardiac and neurosurgical patients is significantly associated with morbidity. Little is known about the perioperative glycemic profile or its impact in other surgical populations or in nondiabetic patients. METHODS: A systematic review of blood glucose values during major general surgical procedures reported since 1980 was conducted. Data extracted included blood glucose measures, study sample size, gender distribution, age grouping, study purpose, surgical procedure, anesthetic details, and infusion regime. Excluded studies were those with subjects with diabetes insipidus, insulin-treated diabetes, renal or hepatic failure, adrenal gland tumors or dysfunction, pregnancy, and emergency or trauma surgery. RESULTS: Blood glucose levels rose significantly with the induction of anesthesia (P < .001) in nondiabetic patients. At incision, 2 hours, 4 hours, and 6 hours, 30%, 40%, 38%, and 40% of studies, respectively, reported hyperglycemia. CONCLUSIONS: Factors that confound or protect against significant rises in perioperative glycemic levels in nondiabetic patients were identified. The findings facilitate investigating the impact of hyperglycemia on general surgical outcomes.

Individuals at risk of beta-blocker discontinuation: a cohort study in 19,177 Chinese patients.

PURPOSE: This cohort study evaluated the factors associated with discontinuation of antihypertensive pharmacotherapy among Chinese patients who were prescribed beta-blockers. We tested the hypothesis that patients' age, gender, socioeconomic status, clinical settings and the number of comorbidities were significantly associated with the discontinuation of beta-blockers. METHODS: From a validated clinical database we included all adult patients 18 years or older who were prescribed a beta-blocker in any government primary care clinic in one large territory of Hong Kong during 01 January 2004-30 June 2007. We evaluated the cumulative incidence of drug discontinuation within 180 days of the prescriptions and the factors associated with discontinuation of beta-blockers by multivariable regression analysis. RESULTS: From a total of 19,177 eligible patients (mean age = 59.1 years), 20.8% discontinued their medication. Younger patients [aged <50 years; adjusted odds ratios (aOR) 0.41-0.52 for patients aged >or=50 years; p < 0.001], female gender (aOR 0.87 for males, p = 0.001), fee-waivers (aOR 0.78 for fee-payers, p < 0.001), attendances in family medicine specialist clinics (FMSC) (aOR 1.49, p < 0.001) and staff clinics (aOR 2.32, p < 0.001), residence in more urbanized areas (aOR 0.80 for North District, p < 0.001), new visits (aOR 0.55 for follow-up visits, p < 0.001) and absence of concomitant comorbidities (aOR 0.60 for one comorbidity, p < 0.001; aOR 0.56 for two comorbidities, p = 0.002) were positively associated with drug discontinuation. CONCLUSIONS: Patients who were prescribed beta-blockers with these associated factors should be monitored more closely for antihypertensive drug adherence.

Adherence to combination therapy among ethnic Chinese patients: a cohort study.

Discontinuation of antihypertensive combination therapy imposes a substantial public health burden, but few studies have addressed the factors associated with their discontinuation in Chinese patients. This study evaluated the association between patient age, gender, and number of comorbidities with discontinuation of combination therapies. From clinical databases, we included all adult patients prescribed an antihypertensive fixed-dose combination therapy during January 2004 to June 2007 in any government primary care clinics in one large Territory of Hong Kong. We studied the factors associated with drug discontinuation within 180 days after the first prescription date by multivariable regression analysis, controlling for age, gender, socioeconomic status, service setting, district of residence, visit types (new vs. follow-up), and the number of comorbidities. From 29 253 eligible patients, 7.1% discontinued their antihypertensive prescriptions. Younger (<50 years; adjusted odds ratios [aOR]: 0.78, 95% confidence interval [CI]: 0.66-0.92 for patients aged 50-59 years, P=0.003; aOR: 0.71, 95% CI: 0.60-0.84 for patients aged 60-69 years, P<0.001) and male patients (aOR: 1.19, 95% CI: 1.08-1.31, P<0.001) were more likely to have drug discontinuation. Patients with one (aOR: 0.64, 95% CI: 0.57-0.73, P<0.001) and at least two (aOR: 0.68, 95% CI: 0.54-0.87, P=0.002) comorbidities were less likely to have their medications discontinued. Combination therapies in Chinese patients had a low discontinuation rate when compared with Caucasian patients. Discontinuation was more likely among younger, male patients and those without concomitant comorbidities, in which more meticulous monitoring of their adherence patterns was needed.

Exercises for prevention of recurrences of low-back pain.

BACKGROUND: Back pain is a common disorder that has a tendency to recur. It is unclear if exercises, either as part of treatment or as a post-treatment programme, can reduce back pain recurrences. OBJECTIVES: To investigate the effectiveness of exercises for preventing new episodes of low-back pain or low-back pain-associated disability. SEARCH STRATEGY: We searched CENTRAL (The Cochrane Library 2009, issue 3), MEDLINE, EMBASE and CINAHL up to July 2009. SELECTION CRITERIA: Inclusion criteria were: participants who had experienced back pain before, an intervention that consisted of exercises without additional specific treatment and outcomes that measured recurrence of back pain or time to recurrence. DATA COLLECTION AND ANALYSIS: Two review authors independently judged if references met the inclusion criteria. The same review authors independently extracted data and judged the risk of bias of the studies. Studies were divided into post-treatment intervention programmes and treatment studies. Study results were pooled with meta-analyses if participants, interventions, controls and outcomes were judged to be sufficiently homogenous. MAIN RESULTS: We included 13 articles reporting on nine studies with nine interventions. Four studies with 407 participants evaluated post-treatment programmes and five studies with 1113 participants evaluated exercise as a treatment modality. Four studies had a low risk of bias, one study a high risk and the remainder an unclear risk of bias.We found moderate quality evidence that post-treatment exercises were more effective than no intervention for reducing the rate of recurrences at one year (Rate Ratio 0.50; 95% Confidence Interval 0.34 to 0.73). There was moderate quality evidence that the number of recurrences was significantly reduced in two studies (Mean Difference -0.35; 95% CI -0.60 to -0.10) at one-half to two years follow-up. There was very low quality evidence that the days on sick leave were reduced by post-treatment exercises (Mean Difference -4.37; 95% CI -7.74 to -0.99) at one-half to two years follow-up.We found conflicting evidence for the effectiveness of exercise treatment in reducing the number of recurrences or the recurrence rate. AUTHORS' CONCLUSIONS: There is moderate quality evidence that post-treatment exercise programmes can prevent recurrences of back pain but conflicting evidence was found for treatment exercise. Studies into the validity of measurement of recurrences and the effectiveness of post-treatment exercise are needed.

Antihypertensive drug adherence among 6408 Chinese patients on angiotensin-converting enzyme inhibitors in Hong Kong: a cohort study.

Few studies have addressed the profile of adherence among ethnic Chinese patients. This study evaluated the factors associated with adherence with angiotensin-converting enzyme inhibitors (ACEIs), an increasingly common antihypertensive drug of choice. The authors included all adult patients who were prescribed an ACEI and paid at least 2 consecutive visits to any primary care clinics of one large territory of Hong Kong from January 2004 to June 2007. The determinants of good adherence to ACEI, as defined by a medication possession ratio > or = 80%, were evaluated by multivariate regression analysis. From 6408 eligible patients, 88.0% were adherent. Patients attending family medicine specialist clinics (adjusted odds ratio [AOR] = 1.46, 95% confidence interval [CI]: 1.12-1.91, P = .005) and follow-up visitors (AOR = 2.98, 95% CI: 2.49-3.55, P < .001) were significantly more likely and attendees of staff clinics (AOR = 0.48, 95% CI: 0.25-0.94, P = .033) were less likely to be adherent to ACEIs. Patients' age, gender, socioeconomic status, district of residence, and the number of comorbidities were not found to be associated with good adherence. Adherence-enhancing strategies should therefore be particularly focused on the new visitors (likely to be drug naive), and future research directions should delineate the best health service setting that could facilitate adherence to ACEIs.