Economic Evaluations of Digital Health Interventions for Patients With Heart Failure: Systematic Review.

BACKGROUND: Digital health interventions (DHIs) have shown promising results in enhancing the management of heart failure (HF). Although health care interventions are increasingly being delivered digitally, with growing evidence on the potential cost-effectiveness of adopting them, there has been little effort to collate and synthesize the findings. OBJECTIVE: This study's objective was to systematically review the economic evaluations that assess the adoption of DHIs in the management and treatment of HF. METHODS: A systematic review was conducted using 3 electronic databases: PubMed, EBSCOhost, and Scopus. Articles reporting full economic evaluations of DHIs for patients with HF published up to July 2023 were eligible for inclusion. Study characteristics, design (both trial based and model based), input parameters, and main results were extracted from full-text articles. Data synthesis was conducted based on the technologies used for delivering DHIs in the management of patients with HF, and the findings were analyzed narratively. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed for this systematic review. The reporting quality of the included studies was evaluated using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) guidelines. RESULTS: Overall, 27 economic evaluations were included in the review. The economic evaluations were based on models (13/27, 48%), trials (13/27, 48%), or a combination approach (1/27, 4%). The devices evaluated included noninvasive remote monitoring devices (eg, home telemonitoring using digital tablets or specific medical devices that enable transmission of physiological data), telephone support, mobile apps and wearables, remote monitoring follow-up in patients with implantable medical devices, and videoconferencing systems. Most of the studies (24/27, 89%) used cost-utility analysis. The majority of the studies (25/27, 93%) were conducted in high-income countries, particularly European countries (16/27, 59%) such as the United Kingdom and the Netherlands. Mobile apps and wearables, remote monitoring follow-up in patients with implantable medical devices, and videoconferencing systems yielded cost-effective results or even emerged as dominant strategies. However, conflicting results were observed, particularly in noninvasive remote monitoring devices and telephone support. In 15% (4/27) of the studies, these DHIs were found to be less costly and more effective than the comparators (ie, dominant), while 33% (9/27) reported them to be more costly but more effective with incremental cost-effectiveness ratios below the respective willingness-to-pay thresholds (ie, cost-effective). Furthermore, in 11% (3/27) of the studies, noninvasive remote monitoring devices and telephone support were either above the willingness-to-pay thresholds or more costly than, yet as effective as, the comparators (ie, not cost-effective). In terms of reporting quality, the studies were classified as good (20/27, 74%), moderate (6/27, 22%), or excellent (1/27, 4%). CONCLUSIONS: Despite the conflicting results, the main findings indicated that, overall, DHIs were more cost-effective than non-DHI alternatives. TRIAL REGISTRATION: PROSPERO CRD42023388241; https://tinyurl.com/2p9axpmc.

Genetic Markers Associated with Postpartum Depression: A Review.

Postpartum depression (PPD) is a common illness in mothers after childbirth. PPD negatively affect the mother's quality of life and the bond with the infant, which can interfere with the infant's emotional, social, and cognitive development. PPD is caused by various biological and psychosocial factors. The aim of this review is to summarize the latest evidence of the associations between genetic polymorphisms and PPD. PubMed and Scopus were used as the literature search databases for this review. The keywords used were postpartum depression, postnatal depression, genetic, and polymorphism. Twenty-seven articles were reviewed after screening and applying the inclusion criteria. As results, the serotonin gene (5-HTTLPR) and oxytocin genes (OXTR) have the most significant associations with PPD among other genes. Further research on PPD biomarkers should be conducted to diagnose and treat PPD patients.

Potential Application of Marine Algae and Their Bioactive Metabolites in Brain Disease Treatment: Pharmacognosy and Pharmacology Insights for Therapeutic Advances.

Seaweeds, also known as edible marine algae, are an abundant source of phytosterols, carotenoids, and polysaccharides, among other bioactive substances. Studies conducted in the past few decades have demonstrated that substances derived from seaweed may be able to pass through the blood-brain barrier and act as neuroprotectants. According to preliminary clinical research, seaweed may also help prevent or lessen the symptoms of cerebrovascular illnesses by reducing mental fatigue, preventing endothelial damage to the vascular wall of brain vessels, and regulating internal pressure. They have the ability to control neurotransmitter levels, lessen neuroinflammation, lessen oxidative stress, and prevent the development of amyloid plaques. This review aims to understand the application potential of marine algae and their influence on brain development, highlighting the nutritional value of this "superfood" and providing current knowledge on the molecular mechanisms in the brain associated with their dietary introduction.

Hepatic Safety of Febuxostat and Allopurinol for Gout Patients: A Systematic Review of Randomized Controlled Trial.

Purpose: This study aims to systematically review the hepatic safety of febuxostat and allopurinol in adult gout patients. Methods: We searched for information using the following databases: PubMed, Cochrane Library, and Scopus. The inclusion criteria were to review all randomized controlled trials (RCT) that compared allopurinol and febuxostat for adult gout patients that had an assessment of liver function outcomes. Non-English studies on case reports, case series, reviews, and abstracts only were excluded. We extracted information from the studies to answer the research question, ie, study design, publication year, population, sample size, patient characterization, duration, Jadad score, and liver function outcomes. Results: We screened 512 publications from the databases and identified 11 studies that met the inclusion criteria. Ten out of 11 included studies were double-blind RCTs. In the majority of the included studies, no statistically significant differences were observed in terms of hepatic safety data between febuxostat and allopurinol. However, in studies where allopurinol titration was used, it posed a challenge to maintain blinding. Notably, consistent adverse events related to liver function findings were observed across all reviewed RCTs. These abnormal liver function test results sometimes led to study withdrawal based on the investigators' assessment. Nevertheless, the investigators classified most liver function test elevations as mild to moderate in severity. Conclusion: Our analysis concluded that adult gout patients enrolled in the included RCTs exhibited similar hepatic safety profiles for both febuxostat and allopurinol treatment. Liver function abnormalities were identified in all RCTs included in this systematic review. Consequently, it is important for the product labeling information of both allopurinol and febuxostat to present and describe the current safety data to guide healthcare practitioners when prescribing these medications to patients. Pharmacovigilance and post-marketing pharmacoepidemiology data are essential in establishing the comprehensive safety profile.

Knowledge, attitude, and practice of medication therapy management: a national survey among pharmacists in Indonesia.

Introduction: The use of medication therapy management (MTM) is a proven method for reducing medication errors. MTM services rely heavily on pharmacists as service providers, particularly in community health centers (CHCs). Thus, understanding the knowledge, attitudes, and practices (KAP) of MTM among pharmacists in CHCs is crucial to the strategy for the implementation of MTM program in Indonesia. This study aimed to assess the level of KAP regarding MTM among pharmacists working at CHCs and its associated factors and investigate pharmacists' perceptions of the barriers and facilitators of MTM provision in the future. Methods: A cross-sectional online survey was conducted. The respondents were pharmacists working at CHCs in 28 provinces in Indonesia. Descriptive statistics were used to summarize the responses. Demographic differences were determined using Chi-square and Kruskal-Wallis tests, and associations were identified using multivariable ordinal regression for knowledge and multivariable logistic regression for attitude and practice. Barriers and facilitators were determined from codes and categories of frequency derived from pharmacists' responses to the open-ended questions. Results: Of the 1,132 pharmacists, 74.9% had a high level of knowledge, 53.6% had a positive attitude, and 57.9% had a positive practice toward MTM. Gender, practice settings, province of CHCs, years of practice, and experience in MTM services were factors associated with the KAP level. Respondents perceived that the chronic disease conditions in Indonesia, MTM service features, and current practices were facilitators of MTM provision. The lack of interprofessional collaboration, staff, pharmacist knowledge, patient cooperation, facilities/drug supply/documentation systems, stakeholder support, and patient compliance were the most common barriers to MTM implementation in the future. Conclusion: Most of the pharmacists had high knowledge of MTM; however, only half had positive attitudes and practices toward MTM. Information about factors associated with the KAP level suggests that direct involvement is essential to improve pharmacists' understanding and view of MTM. Pharmacists also perceived barriers to the MTM provision in the future, such as interprofessional and pharmacist-patient relationships. A training program is needed to improve the KAP of MTM and develop skills for collaborating with other healthcare professionals and communicating with patients.

Pharmacists' Knowledge, Attitude, and Practice of Medication Therapy Management: A Systematic Review.

Understanding pharmacists' knowledge, attitudes, and practices (KAP) and their perceptions of challenges, barriers, and facilitators towards medication therapy management (MTM) provision are vital in informing the design and implementation of successful service delivery. Thus, this review examined pharmacists' knowledge, attitudes, and practices, and their perceived challenges, barriers, and facilitators to MTM services provision, globally. A systematic search was conducted on 1-31 August 2022 to identify relevant studies on PubMed and EBSCO, supplemented with a bibliographic and a particular hand search. We focused on original research in quantitative survey form with the key concepts of "medication therapy management", "pharmacists", and "knowledge, attitude, practice". We assessed the reporting quality using the Checklist for Reporting of Survey Studies (CROSS). Results are reported narratively and according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. From 237 articles identified, 17 studies met the eligibility criteria. Of the included studies, five reported that pharmacists had a considerable level of knowledge, seven suggested a positive attitude among pharmacists, and five revealed that pharmacists had been practicing some MTM elements. Factors associated with pharmacists' KAP may include age, educational degree, additional qualification, income, years of practice, practice setting, and experience in patient care service. The challenges toward MTM provision were related to the pharmacist-patient and pharmacist-physician relationship. Insufficient time, staff, compensation, and training were the barriers, while patients' willingness to participate and educational background were the facilitators of MTM provision. These findings of studies on KAP could help develop an MTM program and design an intervention to improve program effectiveness. Further research focusing on other quantitative and qualitative studies of KAP is needed to obtain a comprehensive approach to MTM provision.

Knowledge, Attitudes, and Preventative Behavior Toward Tuberculosis in University Students in Indonesia.

Purpose: This study aimed to assess the knowledge, attitudes, and preventative behaviors of university students in Indonesia toward Tuberculosis (TB). Patients and Methods: Participants included students from a university in West Java, Indonesia, who were aged ≥18 years, had access to electronic communication devices and the internet, and agreed to participate in this study. This cross-sectional study invited participants to fill an online questionnaire on Google Forms, and the study was conducted from February to March 2021. Descriptive statistics was used to describe the demographic characteristics of participants. Differences in participants' knowledge, attitudes, and preventative behavior were analyzed using t-test. Spearman correlation coefficient was used to determine the relationships between variables. Characteristics of participants that influenced preventative behavior toward TB were analyzed using linear multiple regression analysis. Results: This study included 524 students. The average knowledge scores out of a possible 11 points of health and non-health students were 7.03 ± 2.36 (out of 11) and 4.98 ± 2.20, respectively. The attitude was 45.40 ± 4.17 (out of 52), 43.75 ± 4.09 respectively, and their average scores out of 44 for preventative behaviors toward TB were 33.08 ± 4.49 and 33.16 ± 4.40, respectively. Female students and students from health faculties demonstrated greater knowledge and better attitudes. Students with a postgraduate academic degree had better knowledge and attitudes and engaged in more preventative behavior. Students who did not smoke had greater knowledge than those who did, and students who had received information about TB engaged in more preventative behavior. Conclusion: Faculty, knowledge of symptoms, preventative examinations, and attitudes toward preventative examinations, treatment, and preventative education, were found to affect TB prevention behavior. These variables should be emphasized in the development of university TB socialization and education programs. The internet and social media should be used in TB education for students.

Dietary Supplementations and Depression.

Depression is a mood disturbance condition that occurs for more than two weeks in a row, leading to suicide. Due to adverse effects of depression, antidepressants and adjunctive therapies, such as dietary supplementation, are used for treatment. Therefore, this review explored and summarized dietary supplements' types, dosages, and effectiveness in preventing and treating depression. A literature search of the PubMed database was conducted in August 2021 to identify studies assessing depression, after which scale measurements based on dietary supplements were identified. From the obtained 221 studies, we selected 63 papers. Results showed PUFA (EPA and DHA combination), vitamin D, and probiotics as the most common supplementation used in clinical studies to reduce depressive symptoms. We also observed that although the total daily PUFA dosage that exhibited beneficial effects was in the range of 0.7-2 g EPA and 0.4-0.8 g DHA daily, with an administration period of three weeks to four months, positive vitamin D-based supplementation effects were observed after administering doses of 2000 IU/day or 50,000 IU/week between 8 weeks and 24 months. Alternatively, microbes from the genus Lactobacillus and Bifidobacterium in the probiotic group with a minimum dose of 108 CFU in various dose forms effectively treated depression. Besides, a depression scale was helpful to assess the effect of an intervention on depression. Hence, PUFA, vitamin D, and probiotics were proposed as adjunctive therapies for depression treatment based on the results from this study.

Barriers to Optimal Tuberculosis Treatment Services at Community Health Centers: A Qualitative Study From a High Prevalent Tuberculosis Country.

Background: Community health centers (CHCs) are a backbone healthcare facility for tuberculosis (TB) services. Identifying barriers amongst TB service providers at the CHC level is required to help them deliver successful TB treatment. Aims: The current study aimed to analyze barriers to successful TB treatment from the perspective of TB service providers at the CHC level in a high prevalent TB country. Methods: A qualitative study was conducted using in-depth interviews and focus group discussions in a province of Indonesia with a high TB prevalence. Two districts representing rural and urban areas were selected to obtain information from TB service providers (i.e., physicians and nurses) at the CHC level. In addition, key informant interviews with TB patients, hospital TB specialists, pharmacists, and activists were conducted. The trustworthiness and credibility of the information were established using information saturation, participant validation, and triangulation approaches. The interviews were also transcribed for the inductive analysis using Atlas.ti 8.4 software. Results: We identified 210 meaning units from 48 participants and classified them into two main themes: organizational capacity and TB program activities. We identified the inadequacy of human resources, facility, and external coordination as the main barriers to organizational capacity. Furthermore, the barriers were identified regarding TB program activities, that is, inadequate TB case finding, diagnosis, drug supply chain and dispensing management, treatment and monitoring, case recording and reporting, and public-private collaboration. Conclusion: Strengthening CHCs in the management of TB is critical to reaching the national and global goals of TB eradication by 2035. These findings can be considered to develop evaluation strategies to improve the successful TB treatment in high prevalent TB countries, especially Indonesia.

Genetic variation of ABCB1 (rs1128503, rs1045642) and CYP2E1 rs3813867 with the duration of tuberculosis therapy: a pilot study among tuberculosis patients in Indonesia.

OBJECTIVE: The risk of contracting tuberculosis (TB) and the efficacy of TB therapy are affected by several factors, including genetic variation among populations. In the Indonesian population, data on the genes involved in drug transport and metabolism of TB therapy are limited. The aim of this study was to identify the genetic profile of the ABCB1 gene (rs1128503 and rs1045642) and CYP2E1 gene (rs3813867) in Indonesians with TB. This study was a cross-sectional study of 50 TB outpatients in Jambi city, Indonesia. Sociodemographic characteristics were obtained from medical records. Whole blood was collected, and genomic DNA was isolated. Single nucleotide polymorphisms were determined using polymerase chain reaction-restriction fragment length polymorphism with HaeIII, MboI, and PstI for rs1128503, rs1045642 (ABCB1), and rs3813867 (CYP2E1), respectively. RESULT: The frequency of alleles of each gene was analyzed by Hardy-Weinberg equilibrium. The genetic profiles of ABCB1 rs1128503 and rs1045642 were varied (CC, CT, TT), while CYP2E1 rs3813867 was present in CC (wild type). The genetic variations of ABCB1 and CYP2E1 may have no significant correlation with the duration of TB therapy. Nevertheless, this study may provide as preliminary results for the genetic profiles of ABCB1 (rs1128503, rs1045642) and CYP2E1 (rs3813867) in the Indonesia population.

Simultaneous Use of Herbal Medicines and Antihypertensive Drugs Among Hypertensive Patients in the Community: A Review.

In various countries, approximately 80% of patients use herbal medicine, both in single form or in combination with antihypertensive drugs, for the treatment of hypertension. Therefore, this research summarized studies on the simultaneous use of herbal medicines and antihypertensive drugs among hypertensive patients in the community. A literature search was conducted on PubMed in April 2020, and the following keywords were used: "herbal medicines" and "antihypertensive patients." In total, 15 of 263 articles were found to be eligible in the initial research. Results showed that studies were performed in different countries worldwide including America and those in Europe, Asia, and Africa between 1960 and 2020. The factors associated with the use of herbal medicines and antihypertensive drugs were age, gender, education level, income, and residence. Herbal medicines and antihypertensive drugs are simultaneously utilized primarily due to their safety and high efficacy. Herbal medicine is frequently recommended by friends or colleagues, herbalists, advertisements, and health workers. Garlic is the most common herbal medicine used along with antihypertensive drugs. The side effects of combination therapy with herbal medicines and prescription drugs for the management of antihypertension include shortness of breath and cough, ulcers, diarrhea, knee cramps, and abdominal discomfort. The lack of communication between patients and health care workers could cause an increase in the simultaneous use of herbal medicines and antihypertensive drugs. Therefore, effective communication among health care workers and appropriate care are important in preventing the side effects and other risks of combined therapy.

Knowledge, Attitude, and Practice During the COVID-19 Pandemic: A Review.

The World Health Organization declared the novel coronavirus (COVID-19) outbreak a global pandemic on March 11, 2020 due to its rapid spread on a global scale. More than 118,000 cases had been reported in 114 countries, and mortality had reached a total of 4291. Scholars have suggested that the level of panic is correlated with knowledge and attitude among the population. This review presents a summary of knowledge, attitude, and practice during the COVID-19 pandemic among healthcare workers, medical students, and populations in the US, the UK, Italy, Jordan, and China in April 2020. Analysis reveals that the level of the knowledge was positive in general, and optimistic attitudes and good practices are held. Utility of substantial knowledge and positive attitudes and practices hopefully can control the spread of COVID-19.

Inhibitory Activity of Boesenbergia rotunda (L.) Mansf. Rhizome towards the Expression of Akt and NF-KappaB p65 in Acetic Acid-Induced Wistar Rats.

MATERIALS AND METHODS: Forty-eight male Wistar rats were divided into anti-inflammatory mechanism study (n = 18) and acute toxicity study (n = 30). The anti-inflammatory mechanism study employed six groups (n = 3), e.g., the normal control, negative control, positive control (quercetin 20 mg/kg BW), and three doses of BREE (250 mg/kg BW; 500 mg/kg BW; 1000 mg/kg BW). All groups (except the normal control) were inflammatory-induced i.p. using 0.1 mL of 1% of acetic acid. The expression of Akt and NF-kappaB p65 in the stomach and intestine of the rats was examined using Western blot analysis. The acute toxicity study (21 days) was conducted by following the Regulation of Indonesia National Agency of Drug and Food Control No. 7/2014 about In Vivo Nonclinical Toxicity Study using 5 doses of BREE (250 mg/kg BW; 500 mg/kg BW; 1000 mg/kg BW; 2000 mg/kg BW; 4000 mg/kg BW). RESULTS: BREE reduces the infiltration of inflammatory cells in both the stomach and the intestine of acetic acid-induced rats. BREE also alters the expression of Akt and NF-kappaB p65 in the rat's stomach and intestine (p=0.005). The acute toxicity study reveals no lethal effects and behavioral signs of toxicity at all tested doses, which indicates that the LD50 is greater than 4000 mg/kg BW. CONCLUSION: Taken together, BREE could inhibit the expression of Akt and NF-kappaB p65 in the stomach and intestine of acetic acid-induced Wistar rats. This plant could be further explored for its potential as plant-based antistomach ulceration.

Determination of Quercetin and Flavonol Synthase in Boesenbergia rotunda Rhizome.

BACKGROUND AND OBJECTIVE: Flavonols in plants are catalyzed by flavonol synthase (FLS) enzyme. FLS was reported expressed in flowers and fruits, i.e., Dianthus caryophyllus L. (Caryophyllaceae), Petunia hybrida Hort. (Solanaceae), Arabidopsis thaliana L. (Brassicaceae), Citrus unshiu Marc. (Rutaceae). However, none reported about FLS in medicinal plants, particularly those which possess anti-inflammatory activity. This study was aimed to extract and identify FLS in the rhizome of Boesenbergia rotunda (Zingiberaceae) and to determine quercetin in the ethanol extract of the rhizome. MATERIALS AND METHODS: The protein extraction of the rhizome was carried out by employing Laing and Christeller's (2004) and Wang's (2014) methods. The extracted-proteins were separated by using SDS-PAGE, followed by the measurement of FLS intensity by using Gel Analyzer. The FLS-1 of recombinant A. thaliana was employed as the standard. The determination of quercetin in the rhizome was carried out using LC-MS. RESULTS: The FLS occurred as a thick band at 38 kDa with intensity 116-158. The LC chromatogram of the extract indicated a small peak at 7.94 min similar to that of quercetin standard. The MS spectra at 7.94 min indicated that quercetin is present in the B. rotunda rhizome (m/z = 303.0549). The concentration of quercetin in the extract is 0.022% w/v. CONCLUSION: The FLS, an enzyme which plays an important role in producing quercetin, was detected in B. rotunda rhizome planted in Indonesia. As a consequence, quercetin in a small amount, was also quantified in the rhizome of this plant. This report will add a scientific insight of B. rotunda for biological sciences.