Physician and patient preferences for dosing options in migraine prevention.

BACKGROUND: Adherence to a therapy, though a key factor for successful treatment, is low among patients with chronic conditions such as migraine. Dose frequency plays a major role in adherence. This study evaluated the impact of having flexible dosing options on acceptance of and adherence to a new migraine preventive therapy class among adults with migraine. METHODS: In this observational study, two 20-min online surveys were completed: one by physicians currently treating adult patients with migraine and the other by adults with migraine. Both surveys presented the participants with three scenarios: 1) only monthly, 2) only quarterly, and 3) both dosing options of the new medication are available. Physicians estimated the proportion of their migraine patients who would receive the new medication in each scenario. Patients were asked about their dosing preference when either or both options are available. Respondents were asked to rate the likelihood of their acceptance of and adherence to the therapy. RESULTS: 400 physicians and 417 US adults with migraine completed the surveys. The availability of both dosing options yielded a significant increase in the proportion of patients expected to receive the new medication. The overall proportion of patients favoring monthly dosing (35%) was similar to the proportion favoring quarterly dosing (40%). Among those who preferred monthly dosing (n = 147), a greater proportion indicated they are more likely to fill the prescription (77% vs 56%, P < 0.05) and remain adherent (80% vs 57%, P < 0.05) when only monthly is available versus when only quarterly is available. Similarly, among those who preferred quarterly dosing (n = 166), a greater proportion indicated they are likely to fill (63% vs 55%, P < 0.05) and remain adherent (62% vs 54%, P < 0.05) when only quarterly is available compared with when only monthly is available. CONCLUSIONS: Physicians anticipated that the proportion of patients to receive the new medication would increase when both dosing options are available. Patients stated that they are more likely to fill the prescription and adhere to the new therapy when their preferred dosing regimen is available.

Prospective assessment of neuropsychological functioning and mood in US Army National Guard personnel deployed as peacekeepers.

OBJECTIVE: The present study examined the impact of deployment on neuropsychological functioning and mood in Army National Guard personnel. We hypothesized that deployment on a peacekeeping mission, compared to non-deployment, would result in reduced proficiencies in neuropsychological performance and negative mood changes, and that such changes would relate to working in a high-strain job (high demands/low control), in accordance with Karasek's demand-control model. METHODS: This prospective cohort study involved 119 male soldiers (67 participants examined before and after deployment to the Bosnia operational theatre and 52 non-deployed soldiers assessed twice over a comparable period). RESULTS: Unit-level adjusted, multivariate analyses found that deployed soldiers, compared to their non-deployed counterparts, demonstrated reduced proficiency in tasks involving motor speed [unstandardized coefficient B= -3.88, 95% confidence interval (95% CI) -6.38- -1.39; B= -3.84, 95% CI -5.55- -2.14; dominant and non-dominant hand, respectively] and sustained attention (B=0.031, 95% CI 0.009-0.054), along with decreased vigor (B= -2.71, 95% CI -3.63- -1.77). Deployed soldiers also showed improved proficiency in a working-memory task (B= -0.098, 95% CI -0.136- -0.060) with less depression symptomatology (B= -3.19, 95% CI -5.26- -1.13). Work stress levels increased over time in both deployed and non-deployed groups, but observed deployment effects remained significant after accounting for a high-strain job. CONCLUSION: The observed change in performance associated with peacekeeping deployment compared to non-deployment (slowed processing speed, reduced motor speed and reported vigor, together with improved proficiency in a working memory task) suggests an adaptive response to mission occupational stressors. This pattern does not appear to be influenced by working in a high-strain job. Further study is required to examine whether these results reflect transient or permanent changes in functioning.