Factors Associated With Pharmacological and Non-pharmacological Treatments Adherence in Patients With Borderline Personality Disorder in Iran

BackgroundBorderline personality disorder is a major mental illness characterized by a sustained relationship instability, impulsive behavior and intense affects. Adherence is a complex behavior, from minor refusals of treatment to inappropriate use of health services or even abandonment of treatment, which can be affected by various factors. Therefore, the present study aimed to investigate the factors affecting pharmacological and non-pharmacological adherence in patients with borderline personality disorder referred to an outpatient referral clinic in Tehran, Iran.MethodsThe study was a retrospective cohort. The files of patients with borderline personality disorder referred to the outpatient clinic of the Tehran Psychiatric Institute were reviewed as the first step. In the next step, we contacted the patients and asked them to fill out the questionnaires. Data were collected using the Drug Attitude Inventory (DAI) questionnaire and a researcher made questionnaire to determine the attitude of patients toward pharmacological and non-pharmacological treatment and therapeutic adherence. After collecting data, patients’ therapeutic acceptance was divided into three groups: poor, partial, good compliance. The data were analyzed by SPSS software version-22.Results Ninety-four patients were involved in the study and fifty four of them were women. In terms of psychotherapy adherence, patients with higher education and hospital admission history have better compliance. Medication attitudes were negative in 54 patients (57.4%), while 40.4% of them stated that psychotherapy or counselling did not help their condition and showed a negative attitude toward non-pharmacological treatment. Additionally, psychotherapy good adherence of the patients (44.7%) was higher than medication good adherence (31.9%). The most common reasons for discontinuation of treatment were medication side effects (53.1%), dissatisfaction with the therapist (40.3%) and then fear of medication dependence (40%). The results showed no relationship between other demographic factors and treatment adherence.ConclusionsResults of the current study show that attitude toward psychotherapy is more positive than pharmacotherapy. In addition, according to the results, working on changeable factors such as patients’ fear of dependence to medication, dissatisfaction with the therapist, and medication side effects may improve patients' treatment adherence.

Isoniazid preventive therapy in child household contacts of adults with active TB in Bamako, Mali

BACKGROUND and OBJECTIVE: Isoniazid preventive therapy (IPT) is known to reduce the risk of developing active TB in about 59% in children aged 15 years. We assessed adherence, completion and adverse events among children who were household contacts of a newly diagnosed adult with smear-positive TB in Bamako, Mali.METHODS: Children aged <15 years living in the same house with an adult smear-positive index case were enrolled in the study in the Bamako Region after consent was obtained from the parent or legal guardian. Adherence was assessed based on the number of tablets consumed during 6 months.RESULTS: A total of 260 children aged <15 years were identified as household contacts of 207 adult patients with smear-positive TB during the study period. Among all child contacts, 130/260 (50.0%) were aged 0–4 years and were eligible for IPT; 128/130 (98.5%) were started on IPT and 83/128 (64.8%) completed with good adherence at the end of the 6 months, and without any significant adverse events.CONCLUSION: We successfully implemented IPT with good acceptance, but low completion rate. The Mali National TB Program and partners should expand this strategy to reach more children in Bamako and the whole country and create greater awareness in the population.

Improving Adherence to Myofunctional Therapy in the Treatment of Sleep-Disordered Breathing

Myofunctional therapy (MT) is used to treat sleep-disordered breathing. However, MT has low adherence—only ~10% in most studies. We describe our experiences with MT delivered through a mobile health app named Airway Gym®, which is used by patients who have rejected continuous positive airway pressure and other therapies. We compared ear, nose, and throat examination findings, Friedman stage, tongue-tie presence, tongue strength measured using the Iowa oral performance instrument (IOPI), and full polysomnography before and after the 3 months of therapy. Participants were taught how to perform the exercises using the app at the start. Telemedicine allowed physicians to record adherence to and accuracy of the exercise performance. Fifty-four patients were enrolled; 35 (64.8%) were adherent and performed exercises for 15 min/day on five days/week. We found significant changes (p < 0.05) in the apnoea–hypopnoea index (AHI; 32.97 ± 1.8 to 21.9 ± 14.5 events/h); IOPI score (44.4 ± 11.08 to 49.66 ± 10.2); and minimum O2 saturation (80.91% ± 6.1% to 85.09% ± 5.3%). IOPI scores correlated significantly with AHI after the therapy (Pearson r = 0.4; p = 0.01). The 19 patients who did not adhere to the protocol showed no changes. MT based on telemedicine had good adherence, and its effect on AHI correlated with IOPI and improvement in tongue-tie.

Active TB infection and its associated factors among HIV-1 infected patients at Jimma medical center, Southwest Ethiopia

Background Human immune deficiency virus (HIV) increases the susceptibility to primary infection or reinfection and the risk of tuberculosis (TB) reactivation for patients with latent TB. There was no current report on the rate of active TB infection among HIV-1 infected patients in our teaching and referral hospital. Therefore, this study was aimed to determine the prevalence and factors associated with active TB infection among HIV-1 infected patients. Methods Hospital-based retrospective cross-sectional study was conducted at the Anti-Retroviral Therapy (ART) chronic follow-up clinic. Systematic random sampling was used to include the patients. A structured questionnaire was used to collect data. Data were analyzed using SPSS version 25. Descriptive statistics were used to describe the findings and multivariate logistic regression was performed to identify factors associated with active TB infection. Result 150 HIV-1 infected patients (female 54.7%) were included. The median (interquartile range, IQR) age of the patients was 33.5 (25.7, 40.0) years. Twenty-six (17.3%) of the patients had developed active TB infection, which was independently associated with the WHO clinical stage III and IV (AOR: 9.67, 95% confidence interval (CI); 2.21–42.37), p = 0.003). The use of isoniazid preventive therapy (IPT) (AOR: 0.123, 95CI; 0.034–0.44, p = 0.001) and having good adherence to ART medications (AOR: 0.076, 95CI; 0.007–0.80, p = 0.032) was associated with the reduced risk of active TB infection among HIV-1 infected patients. Conclusions Advanced WHO clinical stages increased the risk of active TB infection, while the use of IPT and good adherence to ART medications reduced the risk of active TB infection. Therefore, patients with advanced WHO clinical stage should be screened for TB infection, and starting IPT for the candidate patients should be strengthened to reduce the burden of active TB incidence. ART medication adherence should also be supported.

Beneficial Effects of Slow-Release Large Neutral Amino Acids after a Phenylalanine Oral Load in Patients with Phenylketonuria

The mainstay of phenylketonuria treatment is a low protein diet, supplemented with phenylalanine (Phe)-free protein substitutes and micronutrients. Adhering to this diet is challenging, and even patients with good metabolic control who follow the dietary prescriptions in everyday life ignore the recommendations occasionally. The present study explores the ability of slow-release large neutral amino acids (srLNAAs) to prevent Phe increase following a Phe dietary load. Fourteen phenylketonuric patients aged ≥13 years were enrolled in a 6-week protocol. Oral acute Phe loads of 250 and 500 mg were added to the evening meal together with srLNAAs (0.5 gr/kg). Phe and tyrosine were dosed before dinner, 2h-after dinner, and after the overnight fast. After oral Phe loads, mean plasma Phe remained stable and below 600 µmol/L. No Phe peaks were registered. Tyrosine levels significantly increased, and Phe/Tyrosine ratio decreased. No adverse events were registered. In conclusion, a single oral administration of srLNAAs at the dose of 0.5 gr/kg is effective in maintaining stable plasma Phe during acute oral loads with Phe-containing food and may be added to the dietetic scheme in situations in which patients with generally good adherence to diet foresee a higher than prescribed Phe intake due to their commitments.

Intermittent Preventive Treatment and Malaria of Parturient Women in Southeastern Gabon.

Background: Evaluating malaria control strategies for pregnant women is essential. The objective of this study was to determine the factors influencing the frequency of prenatal consultations (PNC), the adherence to intermittent preventive treatment with sulfadoxine-pyrimethamine (IPT-SP) and its impact on the health of parturient women and their newborn babies living in semi-urban and rural areas of southeastern Gabon.Methods: This transversal study was performed at the Centre Hospitalier Régional Paul Moukambi de Koula-Moutou (CHRPMK). Information regarding age, frequency of prenatal consultations, obstetric history, use of malaria control measures, use of IPT-SP, malaria diagnostic of parturient women and their newborns, were collected with a questionnaire and from birth registers from January 1st 2018 to December 31st 2019.Results: In total, 2174 parturient women were included in the study. The mean age was 26.2 ± 6.99 years and 81.4% of parturient women attended at least four CPN. The proper attendance of PNC (at least 4 prenatal consultations) was linked with age (p< 0.001) and profession (aOR= 1.72 [1.27 - 2.37]; p< 0.001). The coverage rate of IPT-SP was 90% with a good adherence rate (at least three doses of IPT-SP) of 58.87%. The good adherence rate to IPT-SP was linked to profession (aOR= 1.65 [1.20 - 2.29]; p< 0.01) and age (p< 0.001). The mean weight of newborns was higher for babies whose mothers had received three doses of IPT-SP (p< 0,001) but the APGAR score was not influenced by the use of IPT-SP by the mother (p= 0.47). The prevalence of plasmodial infection was 3.10% (IC95%= [1.21 - 5]) and Plasmodium falciparum was responsible for 100% of infections. The prevalence of plasmodial infection was the same for all age groups (p> 0.06). No link was found between plasmodial infection, gravidity (p> 0.06) and domestic control measures (p≥ 0.05). A low birth weight was statistically linked to the mother’s plasmodial infection (OR= 9.42 [2.55 – 34.75]; p< 0.01). Furthermore, plasmodial infection was statistically linked to premature birth (OR= 69.25 [8.52 – 562.69]; p< 0.001).Conclusions: We observed a good attendance of women to prenatal counselling services in southeastern Gabon, though the adherence of IPT-SP is insufficient.

Characterization of long-term oral anticoagulant adherence trajectories among patients with atrial fibrillation: a retrospective observational study

Background Medication taking is a dynamic behaviour that changes over time. Conventional adherence summary measures (e.g. proportion days covered) used in the OAC adherence studies conducted so far, however, are insensitive to the fluid nature of adherence. For example, identical PDC values can be calculated for patients with initial good adherence followed by poor adherence, and for those with periodic non-adherence throughout the course of therapy. Purpose The objective of this study was to characterize atrial fibrillation (AF) patients' long-term unique oral anticoagulant (OAC) adherence trajectories. Methods Using linked, population-based administrative data containing physician billings, hospitalization and prescription records of 4.8 million British Columbians (1996–2019), incident adult cases of AF were identified. Only patients who had prescription refill data available for five years were included in the analysis. The primary measure of OAC adherence was the proportion of days covered (PDC) over consecutive 90-day rolling windows. We modelled continuous 90-day PDC values over time. The time variable was number of years since OAC initiation. Group-Based Trajectory Modelling (GBTM) was used to identify patients' unique longitudinal adherence trajectories. To determine the best model, a relative comparison was done between models using Bayesian information criteria (BIC), and the Akaike information criterion (AIC). Results The study cohort was 19,749 AF patients [mean age 70.6y (SD 10.64), 56% male, mean CHA2DS2-VASc score 2.77 (SD 1.39]. The model that best fit our data identified four distinct OAC adherence trajectories (Figure). These were “consistent good adherence” (n=14,631 patients, 74.1% of the cohort), “rapid decline and discontinuation” (n=2327, 11.8%), “rapid decline with recovery” (n=1973, 9.99%), and “slow decline and discontinuation” (n=819, 4.2%). Our results show that there is heterogeneity among non-adherers. PDC dropped significantly in the first year after therapy initiation for those with “rapid decline and discontinuation” trajectory. Patients exhibiting “rapid decline with recovery” also displayed a rapid decline in adherence in the first year but showed improvements around the third year. Those in the “slow decline and discontinuation” trajectory displayed slow decline in adherence over first three years which eventually led to permanent discontinuation of therapy. Conclusion In this retrospective study we distinguished between the different kinds of non-adherence in terms of timing and rate. While a majority of our cohort adhered to their medications, we identified three unique trajectories displaying declining adherence over time at varying rates. Our results emphasize the importance of early intervention and have direct implications for improving the design of adherence interventions. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health Research grant

Adherence with COVID-19 Preventive Measures and Associated Factors Among Residents of Shashemane, Central Ethiopia

Introduction:Covid 19 pandemic can seriously affect African nations because of the weak health care system, crowding, poor hygiene in the cities, and the random mobility of people. Hospital-based interventions are not a good choice for resource-scarce countries which have shortages of hospital beds, ventilators, and oxygen; rather practicing preventive measures at a community level is the best strategy. There is a shortage of evidence about current public adherence with COVID-19 preventive strategies in Ethiopia, therefore this study helps to target health education messages to groups of populations with poor compliance to specific prevention measures, which also contribute to decreasing the magnitude and duration of the pandemic.Methods:A Community based cross-sectional study was done on 405 participants selected by systematic random sampling in Shashemane. Data was collected using A pretested structured tool comprising socio-demographic characteristics, knowledge, attitude, and adherence with COVID-19 prevention practice. Participants who practiced ≥ 75% of the COVID-19 preventive practices were labeled as having “good adherence”. Bivariate and multivariable logistic regression was used to determine the associated variables. Odds ratios along with 95%CI were estimated to identify associated factors and a level of statistical significance was decided at p -value less than 0.05.Result:The practice of COVID-19 preventive measures was 19.5%, (95% CI: 15–24.5%). Having a favorable attitude (AOR = 5, 95% CI: 3.3–8.41), having good knowledge of the disease (AOR = 3, 95% CI: 2.74– 9.3) and educational status (Diploma and above) (AOR = 5.5, 95% CI: 2– 9.39) were significantly associated factors with the practice of COVID-19 preventive measures.Conclusion:The Adherence to COVID-19 preventive practices was very low, educational status above Diploma, good knowledge, and Favorable attitude were the factors positively and independently associated with good adherence to Covid-19 prevention practices. Behavioral change communication and Strict government law and implementing it are highly required.

Exploiting the Combination of Displacement and Chemical Plating for a Tailored Electroless Deposition of Palladium Films on Copper

Various formulations for electroless deposition, to obtain continuous nanometre-sized and micrometre-sized films of palladium on copper, were compared. We deposited ultrathin films using displacement plating formulations. We obtained continuous films with an equivalent thickness between 6 and 22 nm, measured by exploiting the K-ratio method with SEM-EDS of Pd layers. The Pd films obtained in this step of the work represent a cost-effective catalytic substrate. As a second step, we selected chemical plating as the procedure to obtain palladium films with a thickness in the micrometre range. An ammonia-based Pd chemical plating bath represent one of the most effective chemical plating formulations. To prevent copper substrates from being damaged by ammonia, displacement plating with palladium was also applied as a pre-treatment to make the use of these plating baths a viable way to obtain thicker palladium coatings. Palladium films showing good adherence, compact morphology, and a thickness over 1.5 μm were obtained, proving that the combination of two different electroless techniques was the key to develop a sustainable procedure for micrometre-sized palladium coatings, which could substitute electroplating of Pd in galvanic industry for decorative applications.