scholarly journals Office, Central, and Ambulatory Blood Pressure for Predicting First Stroke in Older Adults: A Community-Based Cohort Study

Hypertension ◽  
2021 ◽  
Author(s):  
Kenji Matsumoto ◽  
Zhezhen Jin ◽  
Shunichi Homma ◽  
Mitchell S.V. Elkind ◽  
Joseph E. Schwartz ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Risk Model ◽  
Population Based ◽  
Applanation Tonometry ◽  
Competing Risk ◽  
Community Based ◽  
Older Population ◽  
Competing Risk Model ◽  
The Impact

Hypertension is the most prevalent modifiable risk factor for stroke. Office blood pressure (BP) measurements may have limitations in defining the impact of hypertension on stroke. Our aim was to compare the stroke risk for office, central, and ambulatory BP measurements in a predominantly older population-based prospective cohort. Participants in the CABL study (Cardiovascular Abnormalities and Brain Lesions; n=816; mean age, 70.8±9.0 years; 39.8% men) underwent applanation tonometry of the radial artery for central BP and 24-hour ambulatory BP monitoring. During a follow-up of 9.6±3.1 years, stroke occurred in 76 participants (9.3%). Among office BP variables, only diastolic BP was associated with stroke in multivariable competing risk model ( P =0.016). None of the central BP variables showed a significant association with stroke. Conversely, all ambulatory systolic and diastolic BP variables were significantly associated with stroke after adjustment for clinical confounders (all P <0.005). In an additional multivariable competing risk model including both ambulatory systolic and diastolic BP values obtained at the same time of the day, diastolic BP was more strongly associated with stroke than systolic BP in 24-hour, daytime, and nighttime periods (all P <0.05). Therefore, in a predominantly older population-based cohort, office diastolic BP was weakly associated with incident stroke; no central BP variable was prognostic of stroke. However, all ambulatory systolic and diastolic BP values were significantly associated with stroke in multivariable competing risk analyses. Moreover, ambulatory diastolic BP was a stronger predictor of stroke than ambulatory systolic BP.

scholarly journals Examining the impact of a community-based exercise intervention on cardiorespiratory fitness, cardiovascular health, strength, flexibility and physical activity among adults living with HIV: A three-phased intervention study

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257639
Author(s):  
Kelly K. O’Brien ◽  
Aileen M. Davis ◽  
Soo Chan Carusone ◽  
Lisa Avery ◽  
Ada Tang ◽  
...  
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Cardiovascular Health ◽  
Intervention Study ◽  
Phase 1 ◽  
Community Based ◽  
Phase 3 ◽  
Living With Hiv ◽  
The Impact

Purpose Our aim was to examine the impact of a community-based exercise (CBE) intervention on cardiorespiratory fitness, cardiovascular health, strength, flexibility, and physical activity outcomes among adults living with HIV. Methods We conducted a longitudinal intervention study with community-dwelling adults living with HIV in Toronto, Canada. We measured cardiopulmonary fitness (V̇O2peak (primary outcome), heart rate, blood pressure), strength (grip strength, vertical jump, back extension, push-ups, curl ups), flexibility (sit and reach test), and self-reported physical activity bimonthly across three phases. Phase 1 included baseline monitoring (8 months); Phase 2 included the CBE Intervention (6 months): participants were asked to exercise (aerobic, strength, balance and flexibility training) for 90 minutes, 3 times/week, with weekly supervised coaching at a community-based fitness centre; and Phase 3 included follow-up (8 months) where participants were expected to continue with thrice weekly exercise independently. We used segmented regression (adjusted for baseline age and sex) to assess the change in trend (slope) among phases. Our main estimates of effect were the estimated change in slope, relative to baseline values, over the 6 month CBE intervention. Results Of the 108 participants who initiated Phase 1, 80 (74%) started and 67/80 (84%) completed the intervention and 52/67 (77%) completed the study. Most participants were males (87%), with median age of 51 years (interquartile range (IQR): 45, 59). Participants reported a median of 4 concurrent health conditions in addition to HIV (IQR: 2,7). Participants attended a median of 18/25 (72%) weekly supervised sessions. Change in V̇O2peak attributed to the six-month Phase 2 CBE intervention was 0.56 ml/kg/min (95% Confidence Interval (CI): -1.27, 2.39). Significant effects of the intervention were observed for systolic blood pressure (-5.18 mmHg; 95% CI: -9.66, -0.71), push-ups (2.30 additional push-ups; 95% CI: 0.69, 3.91), curl ups (2.89 additional curl ups; 95% CI: 0.61, 5.17), and sit and reach test (1.74 cm; 95% CI: 0.21, 3.28). More participants engaged in self-reported strength (p<0.001) and flexibility (p = 0.02) physical activity at the end of intervention. During Phase 3 follow-up, there was a significant reduction in trend of benefits observed during the intervention phase for systolic blood pressure (1.52 mmHg/month; 95% CI: 0.67, 2.37) and sit and reach test (-0.42 cm/month; 95% CI: -0.68, -0.16). Conclusion Adults living with HIV who engaged in this six-month CBE intervention demonstrated inconclusive results in relation to V̇O2peak, and potential improvements in other outcomes of cardiovascular health, strength, flexibility and self-reported physical activity. Future research should consider features tailored to promote uptake and sustained engagement in independent exercise among adults living with HIV. ClinicalTrials.gov Identifier NCT02794415. https://clinicaltrials.gov/ct2/show/record/NCT02794415.

scholarly journals The 10-year incidence of hypertension across blood pressure categories in a population-based cohort in southwestern Sweden

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ulf Lindblad ◽  
Klara Lundholm ◽  
Jenny Eckner ◽  
Ying Li ◽  
Lennart Råstam ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Lifestyle Modification ◽  
Population Based ◽  
Baseline Blood Pressure ◽  
Swedish Population ◽  
Incident Hypertension ◽  
Pressure Lowering ◽  
Optimal Blood Pressure ◽  
The Impact

Abstract Background To explore the determinants of incident hypertension, and especially the impact of baseline blood pressure categories, in a representative Swedish population. Methods A 10-year longitudinal study of residents aged 30–74. Blood pressures were measured and categorized according to ESH guidelines with optimal blood pressure < 120/80 mmHg, normal 120–129/80–84 mmHg, and high normal 130–139/85–89 mmHg. Incident hypertension was defined as ongoing treatment or three consecutive blood pressure readings ≥ 140/ ≥ 90 mmHg (one or both) at follow-up, while those with ≥ 140 and/or ≥ 90 mmHg at only one or two visits were labelled as unstable. After excluding subjects with hypertension, ongoing blood pressure lowering medication or a previous CVD event at baseline, 1099 remained for further analyses. Results Sixteen (2.6%) subjects with optimal baseline blood pressure had hypertension at follow up. Corresponding numbers for subjects with normal, high normal and unstable blood pressure were 55 (19.4%), 50 (39.1%) and 46 (74.2%), respectively. Compared with subjects in optimal group those in normal, high normal and unstable blood pressure categories had significantly higher risk to develop manifest hypertension with odds ratios OR and (95% CI) of 7.04 (3.89–12.7), 17.1 (8.88–33.0) and 84.2 (37.4–190), respectively, with adjustment for age, BMI and family history for hypertension. The progression to hypertension was also independently predicted by BMI (p < 0.001), however, not by age. Conclusions Subjects with high normal or unstable blood pressure should be identified in clinical practice, evaluated for global hypertension risk and offered personalized advice on lifestyle modification for early prevention of manifest hypertension and cardiovascular disease.

scholarly journals The impact of volume overload on technique failure in incident peritoneal dialysis patients

2019 ◽  
Author(s):  
François Vrtovsnik ◽  
Christian Verger ◽  
Wim Van Biesen ◽  
Stanley Fan ◽  
Sug-Kyun Shin ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Risk Model ◽  
Volume Overload ◽  
Competing Risk ◽  
Related Factors ◽  
Time Points ◽  
Increased Risk ◽  
The Impact ◽  
Technique Failure

Abstract Background Technique failure in peritoneal dialysis (PD) can be due to patient- and procedure-related factors. With this analysis, we investigated the association of volume overload at the start and during the early phase of PD and technique failure. Methods In this observational, international cohort study with longitudinal follow-up of incident PD patients, technique failure was defined as either transfer to haemodialysis or death, and transplantation was considered as a competing risk. We explored parameters at baseline or within the first 6 months and the association with technique failure between 6 and 18 months, using a competing risk model. Results Out of 1092 patients of the complete cohort, 719 met specific inclusion and exclusion criteria for this analysis. Being volume overloaded, either at baseline or Month 6, or at both time points, was associated with an increased risk of technique failure compared with the patient group that was euvolaemic at both time points. Undergoing treatment at a centre with a high proportion of PD patients was associated with a lower risk of technique failure. Conclusions Volume overload at start of PD and/or at 6 months was associated with a higher risk of technique failure in the subsequent year. The risk was modified by centre characteristics, which varied among regions.

scholarly journals Blood Pressure Control and Recurrent Stroke After Intracerebral Hemorrhage in 2002 to 2018 Versus 1981 to 1986: Population-Based Study

Stroke ◽  
2021 ◽  
Author(s):  
Linxin Li ◽  
Susanna M. Zuurbier ◽  
Wilhelm Kuker ◽  
Charles P. Warlow ◽  
Peter M. Rothwell
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Recurrent Stroke ◽  
Pressure Control ◽  
Population Based ◽  
Stroke Study ◽  
Before And After ◽  
Oxfordshire Community Stroke Project ◽  
The Impact

Background and Purpose: The PROGRESS trial (Perindopril Protection Against Recurrent Stroke Study) conducted in the early 1990s showed that blood pressure (BP) lowering therapy reduced the risks of recurrent stroke by about 50% after spontaneous intracerebral hemorrhage (ICH). However, the ICH subgroup was a minority, and trial cohorts are invariably selective. Therefore, it is unclear whether the impact of BP control on risk of recurrent stroke in ICH observed in PROGRESS would be as great in real-world practice. Methods: We compared BP control (mean BP during study follow-up) and risks of recurrent stroke after first-ever primary ICH in 2 colocated population-based studies before and after the PROGRESS trial (1995–2001) in Oxfordshire: Oxfordshire Community Stroke Project (OCSP; 1981–1986) and OXVASC (Oxford Vascular Study; 2002–2018). Results: Two hundred seventy-seven patients (753 patient-years of follow-up) with first-ever primary ICH were ascertained in OXVASC and OCSP. Baseline systolic BP was comparable between the 2 studies (mean/SD=183.8/36.5 in OXVASC versus 178.1/38.2 in OCSP, P =0.30) but among one hundred thirty-seven 90-day survivors, mean BP during follow-up was substantially lower in OXVASC versus OCSP (135.2/16.4 versus 157.3/17.8, P <0.0001). Risks of recurrent stroke (per 100 patient-years) decreased from 10.3 (95% CI, 4.7–19.5) in OCSP to 3.1 (1.8–4.8) in OXVASC ( P =0.006), predominantly driven by a reduction at younger ages (5-year risk at age <75 years: 35.4% versus 6.9%, P =0.001; hazard ratio, 0.14 [0.04–0.54]). Conclusions: Risks of recurrent stroke after primary ICH have fallen significantly in Oxfordshire over the past 4 decades, coinciding with substantial improvements in BP control during follow-up.

The impact of community-based eHealth self-management intervention among elderly living alone with hypertension

2016 ◽  
Vol 23 (1) ◽  
pp. 167-173 ◽  
Author(s):  
Hyesun Jung ◽  
Jong-Eun Lee
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Measurement ◽  
Intervention Group ◽  
Community Dwelling ◽  
Self Management ◽  
Control Group ◽  
Elderly Persons ◽  
Community Based ◽  
The Impact

Introduction This study intended to examine the effect of an eHealth self-management (eHSM) intervention on elderly Korean persons who live alone in a community. Methods A quasi-experimental study was designed, and a total of 64 elderly persons (intervention n = 31, control n = 33) with hypertension (a systolic blood pressure measurement of ≥140 and/or a diastolic blood pressure ≥90 mm Hg) or taking anti-hypertensive medication participated. The eHSM intervention consisted of a four-week, in-class educational phase, community-based eHealth monitoring, and monthly telephone counselling for 24 weeks. Results The primary outcome measurement of the study was BP, and secondary outcomes included psycho-behavioural variables. Specifically, the systolic BP among intervention group participants was 133.9 mm Hg at baseline and 122.5 mm Hg after 24 weeks of follow-up. Participants in the intervention group showed greater improvement in self-efficacy, self-care behaviour, and social support than did participants in the control group 24 weeks post-intervention. Discussion The results highlight the clinical efficacy of an eHSM intervention composed of a four-week education program, self-monitoring, and follow-up counselling. The eHSM intervention should be expanded to include community-dwelling elderly persons with hypertension to improve the self-management of hypertension and control of blood pressure.

scholarly journals Use of Statins, Survival and Incidence of Thrombosis Among Older Adults with Polycythemia Vera: A Population-Based Study

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3580-3580
Author(s):  
Nikolai Podoltsev ◽  
Mengxin Zhu ◽  
Rong Wang ◽  
Amer M. Zeidan ◽  
Xiaoyi Wang ◽  
...  
Keyword(s):  
Older Adults ◽  
Overall Survival ◽  
Research Funding ◽  
Jak2 V617f ◽  
Population Based ◽  
Competing Risk ◽  
Rank Test ◽  
Part D ◽  
The Impact

Abstract Introduction: Patients with myeloproliferative neoplasms (MPN) are at increased risk for cardiovascular morbidity and mortality with the highest risk among polycythemia vera (PV) patients. MPN guidelines recommend aggressive management of cardiovascular risk factors which may include statin administration. Statins can induce apoptosis and inhibit JAK2-V617F-dependent cell growth in vitro, as well as inhibit erythropoietin-independent erythroid colony formation of primary cells from patients with MPN. JAK2-V617F mutation is a common somatic event occurring in over 95% of PV patients. There is no published data regarding the impact of statins on the outcomes of PV patients. Methods: Using the Surveillance, Epidemiology, and End Results-Medicare linked database, we assembled a population-based cohort of older adults who were diagnosed with PV during 2007-2013 and fulfilled the following eligibility criteria: 1) aged 66-99 years at diagnosis; 2) had continuous Medicare Parts A and B coverage and not enrolled in health maintenance organizations from 12 months before diagnosis to death or the end of study (12/31/2014), whichever was earlier (i.e., the end of follow up); and 3) continuously enrolled in Medicare Part D from 6 months before diagnosis to end of follow up. Patients were identified as statin users if they had any prescription for statins in Part D claims from their PV diagnosis to the end of follow up. For both statins and hydroxyurea (HU, a common treatment of PV), percentage of days covered (PDC) was defined as the percentage of days from diagnosis to the end of follow-up covered by respective prescriptions. We further classifed statins as lipophilic or hydrophilic. Therapeutic phlebotomy intensity was defined based on the number of phlebotomies per year (>0 but < 3: low intensity, ≥3: high intensity). Log-rank tests were used to compare Kaplan-Meier (K-M) curves between statin users and non-users with regard to overall survival and risk of thrombosis after PV diagnosis. Multivariate Cox proportional hazards models were used to assess the impact of statins use on overall survival. Multivariate competing risk models with death as a competing risk were utilized to evaluate the relationship between statin PDC and thrombosis risk. All multivariate models adjusted for HU PDC, phlebotomy intensity, age, sex, race, state buy-in, influenza vaccination 12 months prior to PV diagnosis (a marker for healthcare access), disability status, modified Elixhauser score for comorbidities, and previous thrombosis. All statistical tests were two-sided and conducted with SAS (Version 9.4). Results: Of the 721 PV patients included in this study (median age = 77 years, interquartile range: 71-83 years), a majority were female (56.7%) and white (91.4%) (Table 1). About 55% of patients used statins, and 72.9% of the 395 users (n=288) started before PV diagnosis. The median statin PDC was 67% among statin users, and most patients (n=361, 91.4%) used only one type of statins (lipophilic: n=295; hydrophilic: n=65). With a median follow-up of 2.75 years, 26.1% (n=103) of statin users and 47.9% (n=156) of statin non-users died; users (median: 6.65 years) had a significantly better overall survival than non-users (median: 3.86 years Log rank test, p<.01) (Figure 1). Adjusting for covariates, every 10% of statin PDC after PV diagnosis was associated with an 18% lower risk of all cause mortality (95% confidence interval [CI]: 0.78-0.86; p<.01). The magnitude of association was very similar for lipophilic and hydrophilic statins. Thrombosis after PV diagnosis was recorded in 257 (35.6%) patients, 177 of whom had arterial thrombosis. One hundred and eighteen (33.4%) statin users and 139 (37.8%) non-users had thrombosis after PV diagnosis. The risk of thrombosis was significantly lower in statin users than in non-users based on Log-rank test (p=.04) (Figure 2) and multivariable competing risk model (every 10% of statin PDC was associated with a 5% lower risk of thrombosis (95% CI: 0.92-0.99; p<.01). Subgroup analyses for lipophilic and hydrophilic statins generated almost identifical results. Sensitivity analyses that only included patients who started using statins after PV diagnosis revealed similar findings pertaining to both survival and thrombosis. Conclusions: In this large population-based cohort study of older adults with PV, use of statins was associated with improved survival and decreased risk of thrombosis. Disclosures Podoltsev: Alexion: Consultancy, Honoraria; Astellas Pharma: Research Funding; Sunesis Pharmaceuticals: Research Funding; Pfizer: Consultancy, Honoraria, Research Funding; Astex Pharmaceuticals: Research Funding; Daiichi Sankyo: Research Funding; Celgene: Research Funding; CTI biopharma: Research Funding; Boehringer Ingelheim: Research Funding; Celator: Research Funding. Zeidan:Pfizer: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Otsuka: Consultancy, Honoraria; Takeda: Honoraria, Speakers Bureau; Celgene: Consultancy, Honoraria; AbbVie: Consultancy, Honoraria; Agios: Consultancy, Honoraria. Davidoff:Celgene: Research Funding. Huntington:Janssen: Consultancy; Bayer: Consultancy; Celgene: Consultancy. Gore:Celgene: Consultancy, Research Funding. Ma:Incyte: Consultancy; Celgene: Consultancy, Research Funding.

scholarly journals BMI gain and insulin resistance among school-aged children: a population-based longitudinal study in the Brazilian Amazon

2014 ◽  
Vol 112 (11) ◽  
pp. 1905-1910 ◽  
Author(s):  
Barbara H. Lourenço ◽  
Suely G. A. Gimeno ◽  
Marly A. Cardoso ◽  
Keyword(s):  
Insulin Resistance ◽  
Blood Pressure ◽  
Weight Gain ◽  
Diastolic Blood Pressure ◽  
Brazilian Amazon ◽  
Household Wealth ◽  
Population Based ◽  
Model Assessment ◽  
The Impact

Investigation of the determinants of metabolic outcomes associated with non-communicable diseases is increasingly important in developing countries, but such parameters have not been explored extensively during childhood. The present study assessed the impact of weight gain, measured as BMI-for-age Z-scores, on glucose and insulin concentrations, homeostasis model assessment index of insulin resistance (HOMA-IR) values, and systolic and diastolic blood pressure during school years among Amazonian children. A population-based prospective study of 696 children aged >4 to ≤ 10 years with complete anthropometric information at baseline (51 % females and 86 % of mixed race) was carried out; 411 children had data on metabolic parameters after a median follow-up period of 2·0 years (range 1·7–2·6 years). During follow-up, there was a significant increase in the proportion of overweight children (BMI-for-age Z-score >1) from 10·1 to 15·8 % (P= 0·003). In linear regression models adjusted for the child's sex, age, race/ethnicity, baseline household wealth, birth weight and pubertal development stage, for each unit of BMI-for-age Z-score variation during follow-up, an increase of 8·58 (95 % CI 7·68, 9·60) pmol/l in fasting plasma insulin concentrations and 1·47 (95 % CI 1·30, 1·66) in HOMA-IR values was observed. There was no significant impact of weight gain on glucose concentrations and systolic and diastolic blood pressure. In conclusion, we found evidence that an increase in BMI during a 2-year period affected insulin resistance during school years. Considering the significant increase in overweight in this age group, special attention should be paid to monitoring increases in BMI in children from the Brazilian Amazon.

scholarly journals Cancer-Specific Survival Analysis in Patients with Gastric Cancer: Based on Competing Risk Model

2020 ◽  
Author(s):  
Gaopei Zhu ◽  
Yuhang Zhu ◽  
Juan Li ◽  
Weijing Meng ◽  
Xiaoxuan Wang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Survival Analysis ◽  
Risk Model ◽  
Competing Risk ◽  
Tumor Diameter ◽  
Competing Risk Model ◽  
Cancer Data ◽  
Risk Of Death ◽  
All Cause Mortality ◽  
The Impact

Abstract BackgroundCompeting risk events are prone to cause bias in the estimation of all-cause mortality. In order to eliminate the impact of competing events on survival analysis, we constructed a competing risk model. Besides, we attempted to build nomograms to predict gastric cancer-specific mortality (GCSM) and other-cause mortality (OCM).MethodsThe competing risk model was constructed to evaluate all-cause mortality, GCSM and OCM, by using the gastric cancer data from 2004 to 2013 in the Surveillance, Epidemiology, and End Results Program (SEER) dataset. Nomograms were used to predict the risk of individual dying from gastric cancer and other causes based on competing risk model.ResultsA total of 15299 cases were screened out. The 1-year, 5-year, and 8-year survival probabilities were 48.9 %, 22.1 %, and 16.4 % for all-cause mortality, respectively. Univariate and multivariate analyses showed that sex, race, marital status, age at diagnosis, malignant, tumor diameter and TNM staging were all significant prognostic factors of gastric cancer. The GCSM and OCM models showed the risk of death treated by radiotherapy decreased from 0.689 to 0.494 after considering competing risk events. Furthermore, the nomograms showed good accuracy for GCSM prediction of the 1-,5-,8-year, the AUC values of the nomograms were 0.801 [95% CI, 0.793–0.808], 0.820 [95% CI, 0.810–0.829] and 0.823 [95% CI, 0.808–0.844]. The AUC values of the nomograms for predicting 1-, 5-, and 8-year OCM were 0.784 [95% CI, 0.778–0.792], 0.755 [95% CI, 0.748–0.765] and 0.747 [95% CI, 0.739–0.759].ConclusionsOverall, the prognosis of patients with Gastric cancer is poor. The competing risk model could accurately evaluate the probability of dying from gastric cancer and other causes. Nomograms showed relatively good performance and could be considered as convenient individualized predictive tools for predicting GCSM and OCM.

scholarly journals The Effect of Javanese Language Videos with a Community Based Interactive Approach Method as an Educational Instrument for Knowledge, Perception, and Adherence amongst Tuberculosis Patients

Pharmacy ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 86
Author(s):  
Fauna Herawati ◽  
Yuni Megawati ◽  
Aslichah ◽  
Retnosari Andrajati ◽  
Rika Yulia
Keyword(s):  
Intervention Group ◽  
Personal Control ◽  
Control Group ◽  
P Value ◽  
Interactive Approach ◽  
Community Based ◽  
Tuberculosis Patients ◽  
Level Of Knowledge ◽  
The Impact

The long period of tuberculosis treatment causes patients to have a high risk of forgetting or stopping the medication altogether, which increases the risk of oral anti-tuberculosis drug resistance. The patient’s knowledge and perception of the disease affect the patient’s adherence to treatment. This research objective was to determine the impact of educational videos in the local language on the level of knowledge, perception, and adherence of tuberculosis patients in the Regional General Hospital (RSUD) Bangil. This quasi-experimental study design with a one-month follow-up allocated 62 respondents in the intervention group and 60 in the control group. The pre- and post-experiment levels of knowledge and perception were measured with a validated set of questions. Adherence was measured by pill counts. The results showed that the intervention increases the level of knowledge of the intervention group higher than that of the control group (p-value < 0.05) and remained high after one month of follow-up. The perceptions domains that changed after education using Javanese (Ngoko) language videos with the Community Based Interactive Approach (CBIA) method were the timeline, personal control, illness coherence, and emotional representations (p-value < 0.05). More than 95% of respondents in the intervention group take 95% of their pill compared to 58% of respondents in the control group (p-value < 0.05). Utilization of the local languages for design a community-based interactive approach to educate and communicate is important and effective.

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