Self-reported adherence by MARS-CZ reflects LDL cholesterol goal achievement among statin users: validation study in the Czech Republic.

RATIONALE, AIMS AND OBJECTIVES: Measuring self-reported adherence may contribute to minimizing the risk of therapy failure. Hence, the main aim of the study was to assess the psychometric properties of the Czech version of Medication Adherence Report Scale (MARS-CZ) and its appropriateness for use in long-term statin therapy where goal levels of low-density lipoprotein cholesterol (LDL-c) should be achieved. METHODS: Anonymous structured interview was performed to determine self-reported adherence by MARS-CZ in outpatients chronically treated with statins. At the same time, medication records were reviewed for inclusion of patients into groups of those who achieved and do not achieved LDL-c goal according to cardiovascular risk level. Reliability and validity of MARS-CZ were tested as well as the relationship between adherence and LDL-c goal achievement was examined. RESULTS: A total of 136 (86.6%) patients completed the interview; mean age was 66.1 years; 49.3% were male. The mean score of MARS-CZ was 24.4 and showed positive skewing. Satisfactory internal consistency (Cronbach's α=0.54), strong test-retest reliability (r=0.83, P<0.001; intra-class correlation=0.63, 95% confidence interval: 0.35-0.81) and positive correlation with eight-item Morisky Medication Adherence Scale (r=0.62, P<0.001) were indicated. Low validity values were found between MARS-CZ and 12-item Short Form Health Survey mental and physical subscales. MARS-CZ score significantly correlated with LDL-c goal achievement (P<0.05) when all patients who achieved LDL-c goal (35%) reported high adherence to statin. MARS-CZ score also correlated with cardiovascular risk level and doctor's judgments on adjusting treatment targets for each patient. CONCLUSION: This study proved MARS-CZ as an acceptable self-reported adherence measure. In routine clinical practice, MARS-CZ could be helpful to reveal medication non-adherence before the alteration of drug regimen and thereby contributing to enhancement of statin therapy management.

Cytochrome P450 enzyme regulation by glucocorticoids and consequences in terms of drug interaction.

INTRODUCTION: Due to their multiple effects, glucocorticoids (GCs) have versatile medical uses. They can regulate many xenobiotic-metabolizing enzymes of the cytochrome P450 (CYP) superfamily, and thus, influence pharmacotherapy. AREAS COVERED: The aim of this paper is to summarize the molecular effects of GCs on CYP as well as the available clinical evidence on drug-drug interactions (DDIs) between GCs and other drugs in which GCs influence the metabolism of other medicines through modifying CYP activity. We used the factographic database DRUGDEX® along with bibliographic searches. EXPERT OPINION: Most of the literature reported CYP3A4 induction by GCs, but this was not proved in all research. As the conclusions on these DDIs are conflicting, there are several issues to be considered like the dosage of GCs, the length of GCs treatment and concomitant therapy, all of which can have an additive inducing effect. Further, in designing a DDI study, crossover studies are preferred. A literature search of the abovementioned information resources provided dissimilar results.

Information and awareness concerning ibuprofen as an ingredient in over the counter analgesics: a questionnaire-based survey of residents of retirement communities.

Convenient access to a large variety of OTC medicines presents patients with the opportunity for the self-treatment of many health problems. Yet this also brings on other health risks, especially to the elderly. A pointed lack of information about the safety of NSAIDs has been found among lay people, but no study in the Czech Republic so far has focused on the preferences of the residents' of retirement homes for particular NSAID pain relievers and these patients' level of knowledge regarding use and safety issues. We undertook a cross-sectional study in 9 retirement communities. A self-developed questionnaire was used to gather data on the preferences of seniors for particular NSAIDs and on their knowledge about ibuprofen. Two hundred elderly people participated in the research, 77% of the sample being female. The mean age was 83 +/- 7 years. Ibuprofen was the preferred NSAID analgesic among participants. 64% of respondents indicated that they suffered from pain nearly every day. The best known indication of ibuprofen was analgesic (56.7%) and younger and more educated participants had better knowledge in general about indications. A similar percentage (57.8%) was not aware of any adverse effects of ibuprofen, and 16% believed it had no adverse effects at all. Knowledge of drug interaction was very low--most of participants (84%) were not aware of any interactions. 58% of respondents indicated that they relied on the advice of a physician about pain relievers. Despite the fact that many of the elderly individuals surveyed suffer from pain nearly every day and ibuprofen is their preferred choice among NSAIDs, their knowledge about use and safety of ibuprofen is inadequate.

Chronically Ill Czech Patients' Beliefs About Medicines: The Psychometric Properties and Factor Structure of the BMQ-CZ.

The main objective of this study was to assess the factor structure and psychometric properties of the Czech translation of the Beliefs about Medicines Questionnaire (BMQ-CZ). It was hypothesized that the 4-factor structure of the BMQ-CZ would be confirmed and that psychometric properties would be verified by using positive or negative correlations with self-reported adherence, illness perceptions, and medication statements. A total of 627 people were approached, and 467 agreed to participate. The sample included chronically ill patients as well as patients seeking allopathic and homeopathic care. As a measure of criterion-related validity, the BMQ-CZ was administered along with the translated Czech versions of the Medication Adherence Report Scale (MARS-CZ) and the Brief Illness Perception Questionnaire (Brief IPQ-CZ) and additional assertions. The factor structure, reliability, and validity of the BMQ-CZ were evaluated. The internal consistency of the BMQ-CZ was satisfactory (Cronbach α = .69-.85). A factor analysis supported the BMQ-CZ's 4-factor structure, and the concurrrent validity of the BMQ-CZ was supported by positive correlations with self-reported measures of adherence and beliefs about medicines and disease. The BMQ-CZ demonstrated sufficient psychometric performance as a self-reported measure of medication beliefs among patients with hypertension, diabetes, and rheumatic disease.