From Supervised to Unsupervised Exercise: Factors Associated with Exercise Adherence

Getting older adults to initiate and maintain long-term exercise is an important public health mandate. This study is an analysis of a clinical trial of 112 sedentary adults, age 65–90 years, randomly assigned to 1 of 2 exercise interventions. We examined predictors and patterns of adherence of the 6-month home-based component of the trial. Telephone follow-up and diaries were used to assess adherence. Adherence to weekend exercise during the supervised phase of the program was the strongest predictor of subsequent home-based adherence. Adherence appeared stable throughout the intervention, indicating that adherence or nonadherence was established from the outset. The authors conclude that nonadherence can be identified early in the behavioral-change process. Future studies should focus on developing strategies for adults with chronic illnesses, depressive symptoms, and functional limitations who are nonadherent early on as they initiate and attempt to maintain exercise.

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AB1351-HPR A HAND EXERCISES MHEALTH APP FOR PATIENTS WITH RHEUMATOID ARTHRITIS: DEVELOPMENT, DESIGN AND USABILITY STUDY IN TURKEY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.5496 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1963.2-1964

Author(s):

E. Tonga ◽

C. Srikesavan ◽

E. Williamson ◽

S. Lamb

Keyword(s):

Rheumatoid Arthritis ◽

Focus Group ◽

Phase 1 ◽

Hand Function ◽

Exercise Adherence ◽

Smartphone Application ◽

Home Based ◽

User Centered

Background:The Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) programme has been shown to provide long term improvement in hand function for patients with rheumatoid arthritis (RA) affecting their hands. In Turkey, limited number of physiotherapists work in rheumatology departments so there is an opportunity to use the digital technologies for exercise prescription and follow up to improve access to treatment.Growing research evidence supports the effectiveness of mHealth interventions for improving exercise adherence and motivation.To our knowledge,there is no hand exercises mHealth program for patients with rheumatoid arthritis designed by experts with the user-centered method.Objectives:The aim of our study is to develop and design a smartphone application for structured hand exercise program for patients with RA in Turkey and to test its usability.Methods:We used a qualitative user-centered design approach with 2 phases.PHASE 1:we conducted focus group meetings to discuss the content, feature and design of app to produce a prototype version of smartphone software for RA hand training program.The Focus Group consisted of two physiotherapists and three hand therapists working in the field in different rheumatology or hand rehabilitation clinics,two software-computer engineers, and three patients with RA who had previously participated in hand therapy. The focus group met 4 times during phase 1. PHASE 2:we investigated the usability of prototype version of the rheumatoid hand exercise smartphone app software. All focus group members (n=10) and 6 patients used the app for one week.All users filled the usability questionnaire and provided written feedback on the app. Revisions were made and the revised version was tested. We put the revised app in digital markets in Turkish and English.Results:The major themes identified from the Focus Group discussions during phase 1 were (a)Login techniques (b)self-monitoring (c)exercises types/frequency/diary, (d) patient education, (e)behavioral change and encouragement (f)exercise adherence. Patients and therapist all agreed the login needed to be easy. Patients wanted to be able to monitor their pain levels and hand function in the app. Patients thought the SARAH exercise were suitable for the app. A patient said:‘SARAH exercises is beneficial for my hand and tendon gliding exercise,I will be happy to see these exercises in app’. Patients wanted exercise reminders using push up notifications to encourage exercise were proposed and included.A patient commented ‘in themorning and after work, motivational push up messages could be beneficial for exercise habit.”During the phase 2,we identified a need for education on how to use digital app, ways to provide patient follow up to monitor adherence, the need to allow patients to select the amount of notifications. This feedback was incorporated into the final version.Conclusion:mHealth applications represent an easily accessible bridge between patients and health professionals for home-based programs. Using a user-centered approach ensured that we developed an application that met the needs of therapists and patients. Physiotherapists are using the app in rheumatology clinics in Turkey and long-term usability and feasibility studies are ongoing.References:[1]Argent R, Patient Involvement With Home-Based Exercise Programs: Can Connected Health Interventions Influence Adherence? JMIR Mhealth Uhealth 2018.[2]Lamb SE, Strengthening and Stretching for Rheumatoid Arthritis of the Hand Trial (SARAH).Lancet. 2015,385(9966).[3]Azevedo R, Smartphone application for rheumatoid arthritis self-management: cross-sectional study revealed the usefulness, willingness to use and patients’ needs.Rheumatol Int.2015, 35(10).Disclosure of Interests:None declared

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A Low Level of Darunavir Resistance–Associated Mutation Emergence in Patients With Virological Failure During Long-term Use of Darunavir in People With HIV. The ANRS CO3 Aquitaine Cohort

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa567 ◽

2020 ◽

Vol 7 (12) ◽

Author(s):

Hélène Chaussade ◽

Camille Tumiotto ◽

Fabien Le Marec ◽

Olivier Leleux ◽

Lucile Lefèvre ◽

...

Keyword(s):

Protease Inhibitor ◽

Virological Failure ◽

Resistance Test ◽

Resistance Testing ◽

Factors Associated ◽

Viral Loads ◽

Hiv Resistance ◽

Baseline Characteristics

Abstract Background Ritonavir-boosted darunavir (DRV/r) is a protease inhibitor (PI) indicated for the treatment of naïve and pretreated HIV-infected patients since 2007. Our study aims to describe DRV/r-treated patients experiencing virological failure (VF) documented with HIV resistance testing. Methods Data from patients belonging to the ANRS CO3 Aquitaine Cohort treated with a regimen including DRV/r between February 2007 and December 2015 were analyzed. Baseline characteristics of patients experiencing VF (defined by 2 consecutive plasma viral loads >50 copies/mL) were compared with those without VF. We then described factors associated with VF as emergence of IAS DRV resistance–associated mutations (RAMs). Results Among the 1458 patients treated at least once with a DRV/r-based regimen, 270 (18.5%) patients experienced VF during follow-up, including 240 with at least 1 genotype resistance test (GRT). DRV RAMs were detected in 29 patients (12%). Among them, 25/29 patients had ≥2 DRV RAMs before DRV/r initiation, all of whom had experienced VF during previous PI treatments. For 18/29, DRV/r was maintained after VF, and controlled viremia was restored after modification of DRV-associated antiretroviral molecules or increased DRV dose. Finally, only 6/29 patients selected new DRV RAMs after DRV/r initiation. All of these experienced previous VFs while on other PIs. Conclusions These results highlight the efficacy and robustness of DRV/r, as the emergence of DRV RAMs appeared in <0.4% of patients receiving a DRV/r-based regimen in our large cohort.

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Cancer incidence and factors associated with malignancies in coeliac disease during long‐term follow‐up

GastroHep ◽

10.1002/ygh2.446 ◽

2021 ◽

Vol 3 (2) ◽

pp. 107-115

Author(s):

Inka Koskinen ◽

Kaisa Hervonen ◽

Eero Pukkala ◽

Timo Reunala ◽

Katri Kaukinen ◽

...

Keyword(s):

Coeliac Disease ◽

Cancer Incidence ◽

Factors Associated ◽

Long Term Follow Up

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Exercise-Based Interventions to Enhance Long-Term Sustainability of Physical Activity in Older Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16142527 ◽

2019 ◽

Vol 16 (14) ◽

pp. 2527 ◽

Cited By ~ 13

Author(s):

Sansano-Nadal ◽

Giné-Garriga ◽

Brach ◽

Wert ◽

Jerez-Roig ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Active Control ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Community Dwelling ◽

Exercise Interventions ◽

Mean Differences

Exercise is a form of physical activity (PA). PA is an important marker of health and quality of life in older adults. The purpose of this study was to conduct a systematic review of the literature to assess the effect of exercise-based interventions on an at least six-month follow up PA measure, and to describe the specific strategies implemented during the intervention to strengthen the sustainability of PA in community-dwelling 65+ year-old adults. We registered and conducted a systematic review and meta-analysis (PROSPERO: CRD42017070892) of randomized clinical trials (RCT). We searched three electronic databases during January 2018 to identify RCT assessing any type of exercise-based intervention. Studies had to report a pre-, post-, and at least 6-month post-intervention follow-up. To be included, at least one PA outcome had to be assessed. The effect of exercise-based interventions was assessed compared to active (e.g., a low-intensity type of exercise, such as stretching or toning activities) and non-active (e.g., usual care) control interventions at several time points. Secondary analyses were conducted, restricted to studies that reported specific strategies to enhance the sustainability of PA. The intervention effect was measured on self-reported and objective measures of time spent in PA, by means of standardized mean differences. Standardized mean differences of PA level were pooled. Pooled estimates of effect were computed with the DerSimonian–Laird method, applying a random effects model. The risk of bias was also assessed. We included 12 studies, comparing 18 exercise intervention groups to four active and nine non-active control groups. Nine studies reported specific strategies to enhance the long-term sustainability of PA. The strategies were mostly related to the self-efficacy, self-control, and behavior capability principles based on the social cognitive theory. Exercise interventions compared to active control showed inconclusive and heterogeneous results. When compared to non-active control, exercise interventions improved PA time at the six-months follow up (standardized mean difference (SMD) 0.30; 95%CI 0.15 to 0.44; four studies; 724 participants; I2 0%), but not at the one- or two-years follow-ups. No data were available on the mid- and long-term effect of adding strategies to enhance the sustainability of PA. Exercise interventions have small clinical benefits on PA levels in community-dwelling older adults, with a decline in the observed improvement after six months of the intervention cessation.

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Opioid prescriptions in patients with osteoarthritis: a population-based cohort study

Rheumatology ◽

10.1093/rheumatology/kez646 ◽

2020 ◽

Vol 59 (9) ◽

pp. 2462-2470 ◽

Cited By ~ 2

Author(s):

Jacoline J van den Driest ◽

Dieuwke Schiphof ◽

Marcel de Wilde ◽

Patrick J E Bindels ◽

Johan van der Lei ◽

...

Keyword(s):

Cohort Study ◽

Patient Characteristics ◽

Population Based ◽

Prescription Rate ◽

Factors Associated ◽

Prescription Rates ◽

Care Information ◽

Information Database

Abstract Objectives To examine the incidence, prevalence and trends for opioid prescriptions in patients with OA. Furthermore, types of opioids prescribed and long-term prescription rates were examined. Finally, the patient characteristics associated with the prescription of opioids were assessed. Methods A population-based cohort study was conducted using the Integrated Primary Care Information database. Incidence and prevalence of opioid prescriptions were calculated for the period 2008–2017. Logistic regression was used to assess which patient characteristics were associated with opioid prescriptions. Results In total, 157 904 OA patients were included. The overall prescription rate remained fairly stable, at around 100 incident and 170 prevalent prescriptions per 1000 person years. However, the incident prescription rate for oxycodone increased from 7.1 to 40.7 per 1000 person years and for fentanyl from 4.2 to 7.4 per 1000 person years. The incident prescription rate for paracetamol/codeine decreased from 63.0 to 13.3 per 1000 person years. Per follow-up year, long-term use was found in 3% of the patients with incident OA. Finally, factors associated with more prescriptions were increasing age, OA in ≥2 joint groups [odds ratio (OR) 1.56; 95% CI: 1.51, 1.65] and the presence of other musculoskeletal disorders (OR 4.91; 95% CI: 4.76, 5.05). Men were less likely to be prescribed opioids (OR 0.78; 95% CI: 0.76, 0.80). Conclusion Prescription rates for opioids remained stable, but types of opioids prescribed changed. Oxycodone and fentanyl were increasingly prescribed, while prescriptions of paracetamol/codeine decreased. Since the benefit of opioids for OA pain is questionable and side effects are common, opioids should be prescribed with caution.

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Incidence and Risk Factors of Chronic Pulmonary Aspergillosis Development during Long-Term Follow-Up after Lung Cancer Surgery

Journal of Fungi ◽

10.3390/jof6040271 ◽

2020 ◽

Vol 6 (4) ◽

pp. 271

Author(s):

Sun Shin ◽

Bo-Guen Kim ◽

Jiyeon Kang ◽

Sang-Won Um ◽

Hojoong Kim ◽

...

Keyword(s):

Lung Cancer ◽

Cumulative Incidence ◽

Lung Cancer Surgery ◽

Cancer Surgery ◽

Pulmonary Aspergillosis ◽

Factors Associated ◽

Long Term Follow Up ◽

Chronic Pulmonary Aspergillosis

Lung resection surgery for non-small-cell lung cancer (NSCLC) is reportedly a risk factor for developing chronic pulmonary aspergillosis (CPA). However, limited data are available regarding the development of CPA during long-term follow-up after lung cancer surgery. This study aimed to investigate the cumulative incidence and clinical factors associated with CPA development after lung cancer surgery. We retrospectively analyzed 3423 patients with NSCLC who (1) underwent surgical resection and (2) did not have CPA at the time of surgery between January 2010 and December 2013. The diagnosis of CPA was based on clinical symptoms, serological or microbiological evidences, compatible radiological findings, and exclusion of alternative diagnoses. The cumulative incidence of CPA and overall survival (OS) were estimated using the Kaplan–Meier method, and a multivariable Cox proportional hazard analysis was performed to identify factors associated with CPA development. Patients were followed-up for a median of 5.83 years with a 72.3% 5-year OS rate. Fifty-six patients developed CPA at a median of 2.68 years after surgery, with cumulative incidences of 0.4%, 1.1%, 1.6%, and 3.5% at 1, 3, 5, and 10 years, respectively. Lower body mass index (BMI), smoking, underlying interstitial lung disease, thoracotomy, development of postoperative pulmonary complications 30 days after surgery, and treatment with both chemotherapy and radiotherapy were independently associated with CPA development. The cumulative incidence of CPA after surgery was 3.5% at 10 years and showed a steadily increasing trend during long-term follow-up. Therefore, increased awareness regarding CPA development is needed especially in patients with risk factors.

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Variables Affecting Peri-Implant Radiographic Bone Loss-8-23 Years Follow-Up

Applied Sciences ◽

10.3390/app10238591 ◽

2020 ◽

Vol 10 (23) ◽

pp. 8591

Author(s):

Michael Saminsky ◽

Anat Ben Dor ◽

Jacob Horwitz

Keyword(s):

Bone Loss ◽

Goodness Of Fit ◽

Operating Characteristic ◽

Characteristic Curve ◽

Area Under The Curve ◽

Factors Associated ◽

Implant Placement ◽

Dental Records

The aim of this study is to evaluate factors associated with long-term peri-implant bone-loss and to create a statistical model explaining bone-loss. The dental records in a private periodontal practice were screened for implant-patients with a minimal follow-up period of 8 years with periapical radiographs at implant-placement (T0) and last follow-up (Tf). Collected data included demographics, general health, medications, periodontal parameters, implant parameters, bone augmentation procedures, restoration and antagonist data, number of supportive periodontal appointments (SPT), and radiographic bone-loss between T0 and Tf. Bivariate and Mixed Logistic Regression analyses were performed. “Goodness-of-fit” of the model was elaborated with Receiver Operating Characteristic Curve (ROC) analyses. Thirty-seven patients receiving 142 implants were included. Mean clinical follow-up period was 11.7 ± 3.7 years (range 8–23). Most implants 64.4% were SPT-maintained more than twice a year. Patients with osteoporosis and smokers were prone to increased radiographic peri-implant bone-loss. External-hex implants placed without guided bone regeneration (GBR) and implants 10–12 mm long and diameter of 3.7–4 mm showed less peri-implant bone-loss. The model’s Area Under the Curve (AUC) was 76.9% (Standard Error 4.6%, CI 67.8%–86%).

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Factors associated with non-adherence to long-term highly active antiretroviral therapy: a 10 year follow-up analysis with correction for the bias induced by missing data

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkp232 ◽

2009 ◽

Vol 64 (3) ◽

pp. 599-606 ◽

Cited By ~ 63

Author(s):

C. Protopopescu ◽

F. Raffi ◽

P. Roux ◽

J. Reynes ◽

P. Dellamonica ◽

...

Keyword(s):

Missing Data ◽

Antiretroviral Therapy ◽

Highly Active Antiretroviral Therapy ◽

Factors Associated ◽

Highly Active

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Progressive Supranuclear Palsy: A Crucial Co-occurrence in Normal Pressure Hydrocephalus or an Etiology of Hydrocephalic Presentation?

Indian Journal of Neurosurgery ◽

10.1055/s-0040-1708080 ◽

2020 ◽

Vol 9 (03) ◽

pp. 188-192

Author(s):

Halil Onder

Keyword(s):

Progressive Supranuclear Palsy ◽

Normal Pressure Hydrocephalus ◽

Normal Pressure ◽

Short Term ◽

Related Literature ◽

Future Studies ◽

Neuroimaging Data ◽

Long Term Follow Up

AbstractCo-occurrences of neurodegenerative diseases in normal pressure hydrocephalus (NPH) is a remarkable topic of discussion, which has been mentioned in recent studies and it was also emphasized by the International Society for Hydrocephalus and Cerebrospinal Fluid Disorder. In this report, I illustrate two remarkable cases which were initially diagnosed with idiopathic normal pressure hydrocephalus (iNPH) and ventriculoperitoneal (VP) shunt surgery was performed, which yielded significant improvement in the clinic of both patients in the short-term period. However, in the long-term follow-up, both of them deteriorated, and re-evaluation of the neurological examination and neuroimaging data yielded the full clinical picture of progressive supranuclear palsy (PSP). Via the illustration of these cases and related literature data, I rediscuss some related hypotheses about the co-occurrence of these two conditions of hydrocephalus and PSP. I also suggest some distinct discussions to be clarified in future studies.

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