Non-Adherence in Adult Male Patients with Community-Acquired Pneumonia: Relative Forgiveness of Amoxicillin versus Respiratory Fluoroquinolones.

The consequences of non-adherence to treatment (NAT) on antimicrobial efficacy may depend on drug forgiveness-a property that should account for pharmacokinetics (PK) and pharmacodynamics (PD) as well as interindividual variability. In this simulation study, relative forgiveness (RF) in NAT, defined as the probability of a successful PK/PD target (PTA) attained under perfect adherence compared to imperfect adherence, was evaluated for amoxicillin (AMOX) (oral 1000 mg/8 h) and two respiratory fluoroquinolones-levofloxacin (LFX) (oral 750 mg/24 h) and moxifloxacin (MOX) (oral 400 mg/24 h)-in virtual outpatients with community-acquired pneumonia for S. pneumoniae. Several NAT scenarios (delay in dose intake and a missed dose) were considered. PK characteristics of virtual patients, including variability in creatinine clearance (70-131 mL/min) and S. pneumoniae susceptibility variability associated with geographical location, were simulated in NAT. In this regard, in regions of low MIC delays from 1 h to 7 h or omission of dose ingestion would not have negative consequences on the efficacy of AMOX because of its good RF associated with the AMOX PK and PD properties; RF of LFX 750 mg or MOX 400 mg/24 h regimen vs. AMOX 1000 mg/8 h is one. However, in regions of elevated MIC for S. pneumoniae AMOX loses its RF, LFX and MOX vs. AMOX, showing higher RF (>1) depending on the CLCR of patients. These results illustrate the importance of considering the RF of antimicrobial drugs in NAT and provide a framework for further studying its implications for clinical success rates.

Intervención multidisciplinaria en pacientes con diabetes mellitus tipo 2 en comunidades rurales: un estudio piloto / Multidisciplinary intervention in patients with type 2 diabetes mellitus in rural communities: a pilot study

Resumen Objetivo: Evaluar los efectos de una intervención multidisciplinaria, para mejorar la adhesión al tratamiento en diabetes mellitus tipo 2 (DM2) de comunidades rurales. Materiales y Métodos: Participaron 26 pacientes (15 mujeres) con DM2 (M edad = 60 DT = 12) de dos comunidades rurales del noroeste de México. Se aplicaron los inventarios de Depresión y Ansiedad de Beck y el Inventario de Calidad de Vida y Salud. Se midió la glucosa en el ayuno y la hemoglobina glicosilada antes y después de la intervención. Resultados: La intervención mostró una disminución en depresión y ansiedad, así como una mejor calidad de vida. También se detectó una disminución de la glucosa en ayuno. Se calculó la prueba t de Student para examinar las diferencias en las variables señaladas tomadas en dos momentos, antes de iniciar el programa y al finalizar el programa. Se observaron menores niveles de sintomatología depresiva, ansiedad y mayores niveles de calidad de vida al finalizar el programa. Además, el nivel de glucosa en sangre descendió de manera significativa. Conclusiones: Se analizaron las implicaciones de intervenciones de este tipo en comunidades rurales, detectándose la necesidad de implementar políticas públicas que permitan mejorar condiciones en población vulnerable.

Abstract Objective: To evaluate the effects of a multidisciplinary intervention in patients with type 2 Diabetes Mellitus from rural communities. Materials and methods: Twenty-six patients (15 women and 11 men) with DM2 from two rural communities in northwestern Mexico participated. The average age was 60 years. The Beck Depression and Anxiety Inventory and Inventario de Calidad de Vida y Salud were applied, in addition to fasting glucose and glycosylated hemoglobin before and after the intervention. Results: Statistically significant pretest-postest changes were detected in depression and anxiety (p=.006 y p=.002 respectively). by Student's t for related samples and the size of the median and large effect by Cohen's d in the psychological variables. In fasting blood glucose changes were detected between the first and last sessions. However in glycosylated hemoglobin only 6 patients decreased their levels. Conclusions: Future studies involving community members to support the behavioral change of patients with DM2 are proposed.

Impact of adherence to Mediterranean diet and/or drug treatment on glycaemic control in type 2 diabetes mellitus patients: DM2-CUMCYL study.

AIMS: This study aimed to analyse the association between adherence to treatment and glycaemic control in people with type 2 diabetes mellitus. METHODS: Multicentre, cross-sectional study in patients with type 2 diabetes mellitus recruited by primary care professionals in Castilla y León (Spain). Sociodemographic and clinical characteristics were reflected in self-reported questionnaire, which included the Morisky-Green Medication Adherence Scale and the 14-point Mediterranean Diet Adherence Screener. Medication non-adherence and poor glycaemic control were analysed by bivariable and multivariable analyses. RESULTS: Of 3536 included patients, the 33.8% reported non-adherence to pharmacological treatment, and the 33.7% had poor glycaemic control (HbA1c ≥58 mmol/mol [7.5%]); 50.6% of patients reported moderate-high adherence to the Mediterranean diet (≥9 points). The multivariable logistic regression model showed that educational level (OR 0.73; 95% CI 0.61-0.87; p < 0.001) and sedentarism (OR 1.64; 95% CI 1.36-1.98; p < 0.001) were associate with low adherence. Younger age, rural residence, smoking, time since diagnosis (OR 1.04; 95% CI 1.03-1.05; p < 0.001) and polypharmacy were associated with poor glycaemic control. CONCLUSION: Lower educational level and sedentarism were associated with low adherence. Younger age, rural residence, smoking, time since diagnosis and polypharmacy, increased risk of poor glycaemic control.

Consumo de substâncias psicoativas em pacientes com tuberculose: adesão ao tratamento e interface com Intervenção Breve / Psychoactive substance use in patients with tuberculosis: treatment adherence and interface with Brief Interventions / Consumo de sustancias psicoactivas en pacientes con tuberculosis: adhesión al tratamiento e interfaz con Intervención Breve

Enquadramento: O consumo de substâncias psicoativas associado à tuberculose estabelece uma urgente questão de saúde pública. Objetivo: Caracterizar o perfil e o consumo das substâncias psicoativas dos pacientes em tratamento da tuberculose e analisar a relação entre as variáveis de saúde, o consumo e a adesão ao tratamento, na perspetiva da Intervenção Breve (IB). Metodologia: Estudo descritivo correlacional, com 114 pacientes, utilizando o Self-Reporting Questionnaire e o Alcohol Smoking and Substance Involvement Screening Test, no período de 2016 a 2017. Resultados: Os fumadores que consumiam álcool (p = 0,058) e aqueles que relataram não ter doenças crónicas (p = 0,024) apresentaram necessidade de receber IB. O consumo de cannabis destacou-se entre os fumadores (p = 0,009). Relativamente à frequência da adesão ao tratamento, 40% faziam uso de tabaco, 21,1% uso de álcool, 10,5% uso de cannabis e 13,7% de cocaína. Conclusão: Verificou-se a vulnerabilidade desta população em relação ao consumo de substâncias psicoativas quanto à adesão ao tratamento.

Background: Psychoactive substance use associated with tuberculosis is an urgent public health issue in the contemporary world. Objective: To characterize the profile and psychoactive substance use of patients undergoing tuberculosis treatment and to analyze the association between health-related variables, consumption, and treatment adherence, from the perspective of Brief Interventions (BI). Methodology: Descriptive correlational epidemiological study, with 114 patients, from 2016 to 2017. The Self-Reporting Questionnaire and the Alcohol, Smoking and Substance Involvement Screening Test were used. Results: Smokers who drank alcohol (p = 0.058) and those who reported not having chronic diseases (p = 0.024) had a need to receive BI. Cannabis use was more frequent among smokers (p = 0.009). As for the frequency of treatment adherence, 40% of participants smoked, 21.1% drank alcohol, 10.5% used cannabis, and 13.7% used cocaine. Conclusion: These results demonstrated the vulnerability of this population to psychoactive substance use based on treatment adherence.

Introducción: El consumo de sustancias psicoactivas asociadas al tuberculosis constituye un problema urgente de salud pública en el mundo contemporáneo. Objetivo: Caracterizar el perfil y el consumo de sustancias psicoactivas de los pacientes sometidos a un tratamiento contra la tuberculosis y analizar la relación entre las variables de salud, consumo y adhesión al tratamiento, desde la perspectiva de la Intervención Breve (IB). Metodología: Se llevó a cabo un estudio epidemiológico descriptivo correlativo, con 114 pacientes, mediante el Self-Reporting Questionnaire y el Alcohol Smoking and Substance Involvement Screening Test, de 2016 a 2017. Resultados: Los fumadores que consumían alcohol (p = 0,058) y los que informaron que no tenían enfermedades crónicas (p = 0,024), presentaron la necesidad de recibir IB. El consumo de cannabis fue más frecuente entre los fumadores (p = 0,009). En cuanto a la frecuencia de la adhesión al tratamiento, el 40% consumía tabaco, el 21,1% alcohol, el 10,5% cannabis y el 13,7% cocaína. Conclusión: Los resultados demostraron la vulnerabilidad de esta población en relación con el consumo de sustancias psicoactivas en cuanto a la adhesión al tratamiento.

Adherence to Levothyroxine Treatment Among Patients With Hypothyroidism: A Northeastern Italian Survey.

Background: A significant number of patients show sub-optimal adherence to levothyroxine (LT4) therapy, mainly because they have to postpone their breakfast by at least 30 min. The aim of this observational cross-sectional study was to assess the therapeutic compliance of patients on LT4 treatment and to verify the preference of a lifetime treatment in tablet or liquid form. Patients and Methods: Ambulatory care patients aged 18 years or older, affected by hypothyroidism and on LT4 treatment (in tablet or liquid form) were administered the eight-item Morisky Medication Adherence Scale (MMAS-8). The MMAS-8 questionnaire was supplemented with 3 further items to specifically evaluate preference between tablet and liquid forms of LT4 for lifetime treatment. Results: A total of 320 patients (272 female), median age 47.9 ± 15.6 years (range, 20-78 years), completed the MMAS-8 questionnaire. Eighty-seven percent of the participants were adhering to their treatment for both tablet and liquid LT4 formulations, although significant differences emerged. Patients on LT4 tablets forgot to take their medication more frequently (p < 0.001), felt hassled about sticking to their treatment plan (p < 0.001), and had difficulty remembering to take all their medication(s) (p < 0.001) than those on liquid LT4 treatment. Conclusions: Adherence to LT4 treatment was high for both tablet and liquid formulations. Taking LT4 at breakfast was the most convenient option for most patients.

Validation of the VERITAS-Pro treatment adherence scale in a Spanish sample population with hemophilia.

PURPOSE: We aimed to conduct a validation in Spanish of the Validated Hemophilia Regimen Treatment Adherence Scale - Prophylaxis (VERITAS-Pro) questionnaire for use in patients with hemophilia under prophylactic treatment. PATIENTS AND METHODS: The VERITAS-Pro scale was adapted through a process of back translation from English to Spanish. A bilingual native Spanish translator translated the scale from English to Spanish. Subsequently, a bilingual native English translator translated the scale from Spanish to English. The disagreements were resolved by agreement between the research team and translators. Seventy-three patients with hemophilia, aged 13-62 years, were enrolled in the study. The scale was applied twice (2 months apart) to evaluate the test-retest reliability. RESULTS: Internal consistency reliability was lower on the Spanish VERITAS-Pro than on the English version. Test-retest reliability was high, ranging from 0.83 to 0.92. No significant differences (P>0.05) were found between test and retest scores in subscales of VERITAS-Pro. In general, Spanish patients showed higher rates of nonadherence than American patients in all subscales. CONCLUSION: The Spanish version of the VERITAS-Pro has high levels of consistency and empirical validity. This scale can be administered to assess the degree of adherence of prophylactic treatment in patients with hemophilia.

Treatment refusal among patients with psoriasis.

BACKGROUND: Treatment refusal, which is defined as a patient actively refusing to take treatment despite physician recommendations, has never been evaluated in psoriasis. OBJECTIVE: To investigate refusal of topical treatments by patients living with psoriasis in France. METHODS: Using responses to an internet study, participants who refused topical treatment (n = 50) were compared to those who applied topical treatment (n = 205). Participants undergoing phototherapy, biotherapy, and oral treatment were excluded. Spearman rank correlations completed by Fisher's exact tests and Student's t-tests were performed. RESULTS: Comorbidities, localization of lesions, and symptoms associated with psoriasis were not significant predictors of treatment refusal. Compared to patients who accepted treatment, more patients who refused treatment believed that psoriasis is not manageable (80.0% versus 61.5%; p = 0.01), that psoriasis treatments never work (58.0% versus 27.5%; OR: 2.09 p < 0.0001), and that all creams have the same effects (54.0% versus 31.7%; OR: 1.7, p = 0.003). Among patients who reported seeking medical attention from physicians, more patients in the treatment refusal group reported some level of dissatisfaction with their relationship with their physician than in the treatment acceptance group. LIMITATIONS: The validity of the self-reported treatment refusal could not be evaluated. CONCLUSION: Treatment refusal is an important element to be taken into consideration in the management of psoriasis.

Observancia de las guías internacionales de manejo temprano en sepsis grave y choque séptico / Adherence to international guidelines on early management in severe sepsis and septic shock

Introducción. La observancia completa del tratamiento temprano dirigido por objetivos, disminuye significativamente la mortalidad a 28 días, mientras que la observancia parcial no tiene ningún beneficio. Objetivos. Determinar la observancia de las guías internacionales en sepsis grave y choque séptico, mediante el conjunto de medidas (bundle) de reanimación de las primeras seis horas en pacientes mayores de 16 años de edad, en un centro de referencia de alta complejidad. Materiales y métodos. Se presenta un estudio de cohorte, prospectivo y descriptivo, llevado a cabo durante un período de seis meses, en pacientes con sepsis grave o choque séptico admitidos a los servicios de urgencias, unidades de cuidados intensivos y cuidados especiales. Se midió la observancia del conjunto de medidas mediante ocho intervenciones: 1) medición del lactato sérico, 2) inicio temprano de antibióticos, 3) toma de hemocultivos, 4) infusión de líquidos intravenosos, 5) uso de medicamentos vasopresores, 6) inserción de catéter venoso central, 7) presión venosa central mayor de 8 mm Hg, y 8) saturación venosa central de oxígeno mayor de 70 %. Resultados. Se tamizaron 723 pacientes; 16 % (n=116) cumplieron los criterios de inclusión, 92,2 % (n=107) cumplieron los criterios para sepsis grave y 37,9 % (n=44) para choque séptico. El 62,9 % (n=73) fue subdiagnosticado. La observancia completa de las 8 intervenciones del conjunto de medidas fue de 0 %; de 6 a 7, 19 % (n=22); de 3 a 5, 67,2 % (n=78), y de 0 a 2, 98,3 % (n=114). Conclusión. La completa observancia de las guías internacionales de manejo en sepsis grave y choque séptico en las primeras seis horas es nula y solo se cumple de manera parcial.

Introduction. Complete adherence to early goal-directed therapy has shown a significant reduction in 28-day mortality rate, whereas partial adherence has not shown beneficial effect. Objectives. The effect of adherence to 6 hour sepsis bundle treatment was evaluated on patients with severe sepsis and septic shock. Materials and methods. A prospective cohort study was conducted during a six-month period. The patients were limited to those 16 years or older and included admissions to intensive care units, special care units or emergency departments with severe sepsis or septic shock. The adherence to the 6-hour sepsis bundle was evaluated through 8 interventions as follows: (1) serum lactate measure,( 2) early antibiotic administration, (3) blood culture samples, (4) infusion of intravenous fluids, (5) vasopressor use, (6) central venous catheter, (7) central venous pressure >8 mm Hg, and (8) central venous oxygen saturation >70%. Results. Seven hundred and twenty three patients were screened; 16% (n=116) met the inclusion criteria; 92.2% (n=107) met the criteria for severe sepsis and 37.9% (44) for septic shock; 62.9% (n=73) were subdiagnosed. Complete adherence to the 8 interventions of 6-hour sepsis bundle was 0%; 6 to 7 (19%, n=22), 3 to 5 (67.2%, n=78), and 0 to 2 (98.3%, n=114). Conclusion. Adherence to 6-hour sepsis bundle treatment for severe sepsis and septic shock was not done for the full 8 interventions and only partial accomplishment of the first 4 interventions.

Relación entre adherencia al tratamiento, clima familiar y estilos educativos / Adherence to treatment in cystic fibrosis patients and its asociation with family enviroment and parental rearing style

El objetivo del presente estudio es investigar si existe relación entre el clima familiar, los estilos educativos y la adherencia al tratamiento en pacientes con Fibrosis Quística (FQ). Además, investigar si los diferentes grados de afectación de la FQ influyen en el clima familiar y en los estilos educativos adoptados por los padres. Participantes: 76 pacientes con FQ y sus padres. Las variables evaluadas fueron: el grado de afectación de la FQ, los estilos educativos, el clima familiar y la adherencia al tratamiento. La adherencia al tratamiento fue evaluada a partir de la percepción subjetiva de los pacientes y sus padres y calculada a través de un indicador único construido para el presente estudio. Los resultados indican que no existe relación entre el clima familiar y la adherencia al tratamiento. Sin embargo, la adopción por parte de los padres de estilos educativos más de sobreprotección está relacionada con menores niveles de adherencia. Además, los resultados apuntan que no hay relación entre las variables familiares (clima familiar y estilos educativos) y el grado de afectación de la FQ.(AU)

The main objective of this present study is the investigation about the existence of correlation between the family variables (family environment and parental rearing style) and the adherence in the cystic fibrosis’s treatment by its patients. Another study point is to investigate if the different levels of cystic fibrosis’s affectation have an influence in the family environment and in the parental rearing style chosen by the parents. 76 patients with cystic fibrosis and their parents have taken part of this study. Evaluated variables: level of cystic fibrosis’s affectation, parental rearing style, family environment and the adherence in cystic fibrosis’s treatment. The results indicate that the adherence in cystic fibrosis has no relation with the family environment and show relation with the overprotection subscale. Also, the results show that there is no correlation between family variables and the level of cystic fibrosis’s affectation.(AU)