Factors Associated with Medication Adherence to Long-Acting Injectable Antipsychotics: Results from the STAR Network Depot Study.

INTRODUCTION: Long-acting injectable (LAI) antipsychotics are prescribed to people with severe psychiatric disorders who show poor adherence to oral medication. The present paper examined factors potentially associated with medication adherence to LAI treatment. METHODS: The STAR (Servizi Territoriali Associati per la Ricerca) Network Depot Study was a multicenter, observational, prospective study that enrolled 461 subjects initiating a LAI from 32 Italian centers. After 6 and 12 months of treatment, we evaluated differences between participants with high (≥5 points) and low (<5 points) medication adherence using Kemp's 7-point scale in sociodemographic, clinical, psychopathological, and drug-related variables. Factors that differed significantly between the two groups were entered for multivariate logistic regression. RESULTS: Six months after enrollment, participants with high medication adherence were younger, living with other people, had lower Brief Psychiatric Rating Scale (BPRS) total scores, lower adverse events, and a more positive attitude toward medication than participants with low adherence. Multivariate regression confirmed lower BPRS resistance and activation scores, absence of adverse events, and positive attitude toward medication as factors significantly associated with good adherence. After 12 months, all BPRS subscales were significantly lower in the high adherence group, which also showed a more positive attitude toward medication. BPRS resistance and attitude toward medication were confirmed as factors associated with medication adherence. DISCUSSION: Our findings suggest that adherence to LAI is principally related to attitude toward medication and traits of suspiciousness/hostility. Quality of patient-clinician relationship and tailored psychoeducational strategies may positively affect adherence in people undergoing psychopharmacological treatment, including LAI.

Apixaban in low-weight patients with cancer-associated thrombosis: A cross sectional study of drug levels.

INTRODUCTION: Apixaban, a direct factor Xa inhibitor, has been shown to be at least as safe and probably more effective than dalteparin for the treatment of cancer-associated thrombosis (CAT) as reported in the ADAM-VTE and Caravaggio studies, which included a low percentage of underweight patients. Lower-weight-based dosing is supported by cancer-specific studies such as half-dose edoxaban in the Hokusai-VTE cancer trial in individuals weighing <60 kg. OBJECTIVE: To examine apixaban plasma trough levels in low-weight individuals with CAT, stably anticoagulated with full or half-dose apixaban. METHODS: This was a cross-sectional study of 61 routinely treated patients with active cancer and venous thromboembolism comparing three groups: patients weighing >60 kg treated with apixaban 5 mg twice daily, patients weighing ≤60 kg also receiving apixaban 5 mg twice daily, and patients weighing ≤60 kg given half-dose apixaban (2.5 mg twice daily). Apixaban plasma steady-state trough levels were determined on a single occasion. RESULTS: Mean apixaban plasma trough levels were similar for patients weighing >60 kg on full-dose apixaban to those weighing ≤60 kg taking 2.5 mg twice daily (mean, 109 ng/dL; 95% confidence interval [CI], 74-145; standard deviation [SD]: 77.6; and mean,101 ng/dL, 95% CI, 67-135; SD: 80, respectively). Mean values for low-weight patients (≤60 kg) on the full 5 mg twice-daily dosing tended to be higher (mean, 136 ng/dL; 95%CI, 70-201; SD:114), without statistical significance (P = .22). CONCLUSIONS: This study supports the rationale for studying weight-based adjustments in apixaban dosing in prospective studies evaluating safety and efficacy of dose reduction in low-weight patients with cancer.

Cognitive impairment in late life bipolar disorder: Risk factors and clinical outcomes.

BACKGROUND: Late Life Bipolar Disorder (LLBD) is associated with a high prevalence of cognitive impairments, but few studies have examined their risk factors and clinical correlates METHODS: Participants with bipolar disorder older than 60 (n = 86) were recruited from psychiatric outpatient and inpatients units. Patients were assessed with various instruments, including the Clinical Dementia Rating scale, the Montreal Cognitive Assessment and the Cumulative Illness Rating Scale. The distribution of disorder-specific and general risk factors was compared between patients with LLBD plus cognitive impairments (mild cognitive impairment or dementia) and those with LLBD but no cognitive impairment. Analyses were first conducted at the bivariate level, then using multiple regression. The association with disability, aggressive behavior and suicidal ideation was also explored. RESULTS: Cognitive impairments in LLBD were associated with a diagnosis of type 1 bipolar disorder (OR = 6.40, 95%CI: 1.84 - 22.31, p = 0.004), fewer years of education (OR = 0.79, 95%CI: 0.69 - 0.91, p = 0.001) and higher severity of physical diseases (OR 26.54, 95%CI: 2.07 - 340.37, p = 0.01). Moreover, cognitive impairments were associated with an increased likelihood of disability and recent aggressive behavior, but not suicidal ideation. LIMITATIONS: retrospective design, conflation of MCI and dementia, not all subjects were in euthymia CONCLUSIONS: In LLBD, the presence of cognitive impairments was associated with a diagnosis of type I bipolar disorder, lower education and more severe physical comorbidities. In turn, MCI or dementia were associated with increased disability and aggressive behavior. These findings may aid the identification of patients at risk for cognitive deterioration in everyday clinical practice.

Encuesta a estudiantes de medicina de Argentina: expectativas respecto al ejercicio de la profesión / Survey to medical studens of Argentina: expectations regarding the practice of the profession

INTRODUCCION: La investigación acerca de las motivaciones y preferencias de los profesionales del sistema de salud tiene escaso desarrollo en Argentina. Sin embargo, cualquier reforma que se quiera proyectar debe tener en cuenta que se trata de un sistema de personas que atienden a personas, y que es el sector en el cual mayor representación tiene los trabajadores que provienen de universidades.OBJETIVO: Describir los factores que influyen en los estudiantes a la hora de realizar la elección para completar su formación, con particular referencia a especialidades críticas en la Argentina: Clínica médica, Medicina general, Medicina comunitaria o familiar, Medicina sanitaria, Salud pública o Epidemiología, Neonatología, Traumatología, Psiquiatría, Anestesiología, Oftalmología y Geriatría.METODOS: Entre mayo de 2010 y mayo de 2011 se aplicó una encuesta estructurada a una muestra de 500 estudiantes de Medicina en el nivel de grado, seleccionados al azar en un muestreo por conglomerados del universo de estudiantes de todas las universidades públicas y privadas e institutos universitarios del país.RESULTADOS: Un alto porcentaje de estudiantes se manifestó dispuesto a completar su formación en especialidades tales como Medicina comunitaria o familiar, por un lado, y Medicina sanitaria, Salud pública o Epidemiología, por el otro. En ambos casos, más de un tercio de los estudiantes afirmó que había una alta probabilidad de que eligiera esas especialidades. También se observó una alta disposición a ejercer la medicina en el sector público, incluso en centros de atención primaria. La disposición a ejercer la profesión en localidades pequeñas y áreas rurales fue significativamente inferior, excepto en los alumnos de menor nivel socioeconómico.CONCLUSIONES: Una política de planificación de recursos humanos orientada a los actuales estudiantes de Medicina podría lograr resultados categóricos en pocos años.

INTRODUCTION: The research about motivations and preferences of health system professionals has scarce development in Argentina. Nevertheless, any reform should keep in mind that it is a system of people caring for people, and the sector with the highest proportion of workers from universities.OBJECTIVE: To describe factors influencing on students when they choose how to complete their education, particularly regarding some critical specialties in Argentina: Clinic, General Medicine, Community or Family Medicine, Public Health or Epidemiology, Neonatology, Traumatology, Psychiatry, Anaesthesiology, Ophthalmology, and Geriatrics.METHODS: Between May 2010 and May 2011, a structured survey was applied to a sample of 500 students of Medicine, randomly selected in a cluster sampling of the universe of all public and private universities as well as university institutes in Argentina.RESULTS: A high percentage of the students was disposed to complete their education in specialties such as Community or Family Medicine, on one hand, and Public Health or Epidemiology, on the other hand. In both cases, more than one third of the students said that it was highly probable that they would choose these specialties. The disposition to work in the public sector or in centers of primary care was also high. The disposition to work in small towns and rural areas was significantly lower, except in studets of low socioeconomic level.CONCLUSIONS: A human resources policy oriented towards students of Medicine is likely to achieve important results within a few years.

Encuesta a médicos jóvenes: disposición a elegir especialidades críticas / Youth doctors survey: willingness to choose critical specialities

INTRODUCCION: Entre mayo de 2010 y mayo de 2011 se aplicó en hospitales públicos y centros de atención primaria de toda la Argentina una encuesta estructurada a una muestra de 300 médicos graduados menores de 35 años de edad, que sirvió para comparar sus opiniones con las de los estudiantes de medicina, relevadas en otra encuesta similar.OBJETIVO: Describir los factores que influyen en los médicos jóvenes al elegir las especialidades para completar su formación, con particular referencia a las especialidades consideradas críticas en Argentina: Clínica Médica, Medicina General, Medicina Comunitaria o Familiar, Medicina Sanitaria, Salud Pública o Epidemiología, Neonatología, Traumatología, Psiquiatría, Anestesiología, Oftalmología y Geriatría. Además, se procuró determinar el grado de adecuación entre las prioridades establecidas por las instituciones rectoras del sistema y las preferencias de los médicos jóvenes respecto a la localidad y al espacio institucional en los que aceptarían ejercer su profesión.METODOS: Se realizó una selección al azar en un muestreo por conglomerados, teniendo en cuenta el universo de profesionales que trabajan en establecimientos asistenciales del subsector público en todo el territorio argentino.RESULTADOS: En comparación con los estudiantes, los médicos ya graduados manifestaron una menor disposición a completar su formación en especialidades tales como Medicina Comunitaria o Familiar, Medicina Sanitaria, Salud Pública o Epidemiología. Sin embargo, un alto porcentaje de médicos afirmó que aún hay una alta probabilidad de que elijan estas especialidades para completar su formación.CONCLUSIONES: Una política adecuada de planificación de recursos humanos, orientada a los médicos jóvenes o incluso a los actuales estudiantes de Medicina, podría lograr en pocos años resultados categóricos a la hora de orientar sus elecciones hacia las necesidades de recursos humanos en el país.

INTRODUCTION: Between May of 2010 and May of 2011, a structured survey was conducted with a sample of 300 doctors younger than 35 years of age working in public hospitals and primary care centers throughout Argentina. It was used to compare their views with those of medical students included in a similar survey.OBJECTIVE: To describe factors influencing the selection of specialties to complete medical education of young doctors, mainly regarding critical specialties in Argentina: Clinical Medicine, General Medicine, Community or Family Medicine, Public Health or Epidemiology, Neonatology, Traumatology, Psychiatry, Anesthesiology, Ophthalmology, and Geriatrics. Besides, the study intended to determine the degree of adequacy between the priorities established by public institutions and the preferences of young doctors, regarding the place and the institutional space where they would exercise the profession.METHODS: The physicians were randomly selected in a conglomerate sample, taking into account the universe of professionals employed at the public subsector thourghout Argentina.RESULTS: In comparison with studets, graduated doctors showed less interest in completing the education through specialties such as Community or Family Medicine, Public Health, or Epidemiology. However, a high percentage of them still said they would probably choose these specialties.CONCLUSIONS: An adequate policy for human resource planning, oriented towards both young doctors and students of medicine, might achieve good results in a few years and match choices to the needs of the country.

Encuesta a estudiantes de medicina de Argentina: expectativas respecto al ejercicio de la profesión / Survey to medical studens of Argentina: expectations regarding the practice of the profession

INTRODUCCION: La investigación acerca de las motivaciones y preferencias de los profesionales del sistema de salud tiene escaso desarrollo en Argentina. Sin embargo, cualquier reforma que se quiera proyectar debe tener en cuenta que se trata de un sistema de personas que atienden a personas, y que es el sector en el cual mayor representación tiene los trabajadores que provienen de universidades.OBJETIVO: Describir los factores que influyen en los estudiantes a la hora de realizar la elección para completar su formación, con particular referencia a especialidades críticas en la Argentina: Clínica médica, Medicina general, Medicina comunitaria o familiar, Medicina sanitaria, Salud pública o Epidemiología, Neonatología, Traumatología, Psiquiatría, Anestesiología, Oftalmología y Geriatría.METODOS: Entre mayo de 2010 y mayo de 2011 se aplicó una encuesta estructurada a una muestra de 500 estudiantes de Medicina en el nivel de grado, seleccionados al azar en un muestreo por conglomerados del universo de estudiantes de todas las universidades públicas y privadas e institutos universitarios del país.RESULTADOS: Un alto porcentaje de estudiantes se manifestó dispuesto a completar su formación en especialidades tales como Medicina comunitaria o familiar, por un lado, y Medicina sanitaria, Salud pública o Epidemiología, por el otro. En ambos casos, más de un tercio de los estudiantes afirmó que había una alta probabilidad de que eligiera esas especialidades. También se observó una alta disposición a ejercer la medicina en el sector público, incluso en centros de atención primaria. La disposición a ejercer la profesión en localidades pequeñas y áreas rurales fue significativamente inferior, excepto en los alumnos de menor nivel socioeconómico.CONCLUSIONES: Una política de planificación de recursos humanos orientada a los actuales estudiantes de Medicina podría lograr resultados categóricos en pocos años.

INTRODUCTION: The research about motivations and preferences of health system professionals has scarce development in Argentina. Nevertheless, any reform should keep in mind that it is a system of people caring for people, and the sector with the highest proportion of workers from universities.OBJECTIVE: To describe factors influencing on students when they choose how to complete their education, particularly regarding some critical specialties in Argentina: Clinic, General Medicine, Community or Family Medicine, Public Health or Epidemiology, Neonatology, Traumatology, Psychiatry, Anaesthesiology, Ophthalmology, and Geriatrics.METHODS: Between May 2010 and May 2011, a structured survey was applied to a sample of 500 students of Medicine, randomly selected in a cluster sampling of the universe of all public and private universities as well as university institutes in Argentina.RESULTS: A high percentage of the students was disposed to complete their education in specialties such as Community or Family Medicine, on one hand, and Public Health or Epidemiology, on the other hand. In both cases, more than one third of the students said that it was highly probable that they would choose these specialties. The disposition to work in the public sector or in centers of primary care was also high. The disposition to work in small towns and rural areas was significantly lower, except in studets of low socioeconomic level.CONCLUSIONS: A human resources policy oriented towards students of Medicine is likely to achieve important results within a few years.

Encuesta a médicos jóvenes: disposición a elegir especialidades críticas / Youth doctors survey: willingness to choose critical specialities

INTRODUCCION: Entre mayo de 2010 y mayo de 2011 se aplicó en hospitales públicos y centros de atención primaria de toda la Argentina una encuesta estructurada a una muestra de 300 médicos graduados menores de 35 años de edad, que sirvió para comparar sus opiniones con las de los estudiantes de medicina, relevadas en otra encuesta similar.OBJETIVO: Describir los factores que influyen en los médicos jóvenes al elegir las especialidades para completar su formación, con particular referencia a las especialidades consideradas críticas en Argentina: Clínica Médica, Medicina General, Medicina Comunitaria o Familiar, Medicina Sanitaria, Salud Pública o Epidemiología, Neonatología, Traumatología, Psiquiatría, Anestesiología, Oftalmología y Geriatría. Además, se procuró determinar el grado de adecuación entre las prioridades establecidas por las instituciones rectoras del sistema y las preferencias de los médicos jóvenes respecto a la localidad y al espacio institucional en los que aceptarían ejercer su profesión.METODOS: Se realizó una selección al azar en un muestreo por conglomerados, teniendo en cuenta el universo de profesionales que trabajan en establecimientos asistenciales del subsector público en todo el territorio argentino.RESULTADOS: En comparación con los estudiantes, los médicos ya graduados manifestaron una menor disposición a completar su formación en especialidades tales como Medicina Comunitaria o Familiar, Medicina Sanitaria, Salud Pública o Epidemiología. Sin embargo, un alto porcentaje de médicos afirmó que aún hay una alta probabilidad de que elijan estas especialidades para completar su formación.CONCLUSIONES: Una política adecuada de planificación de recursos humanos, orientada a los médicos jóvenes o incluso a los actuales estudiantes de Medicina, podría lograr en pocos años resultados categóricos a la hora de orientar sus elecciones hacia las necesidades de recursos humanos en el país.

INTRODUCTION: Between May of 2010 and May of 2011, a structured survey was conducted with a sample of 300 doctors younger than 35 years of age working in public hospitals and primary care centers throughout Argentina. It was used to compare their views with those of medical students included in a similar survey.OBJECTIVE: To describe factors influencing the selection of specialties to complete medical education of young doctors, mainly regarding critical specialties in Argentina: Clinical Medicine, General Medicine, Community or Family Medicine, Public Health or Epidemiology, Neonatology, Traumatology, Psychiatry, Anesthesiology, Ophthalmology, and Geriatrics. Besides, the study intended to determine the degree of adequacy between the priorities established by public institutions and the preferences of young doctors, regarding the place and the institutional space where they would exercise the profession.METHODS: The physicians were randomly selected in a conglomerate sample, taking into account the universe of professionals employed at the public subsector thourghout Argentina.RESULTS: In comparison with studets, graduated doctors showed less interest in completing the education through specialties such as Community or Family Medicine, Public Health, or Epidemiology. However, a high percentage of them still said they would probably choose these specialties.CONCLUSIONS: An adequate policy for human resource planning, oriented towards both young doctors and students of medicine, might achieve good results in a few years and match choices to the needs of the country.