Understanding the secondary system of therapeutic alliance in autism interventions from the perspectives of parents and caregivers

This study utilized a sequential explanatory mixed-methods design in understanding the secondary system of therapeutic alliance from the perspectives of parents and caregivers of children with autism. In the quantitative phase, data from the accomplished questionnaires of 124 parent–caregiver dyads were collected and analyzed. Four factors extracted from the literature: treatment attitude, treatment compliance, level of stress, and perceived autism severity were examined as possible predictors of parent–therapist alliance, caregiver–therapist alliance, and parent–caregiver alliance. In the qualitative phase, eight parent–caregiver dyads (who both scored high in their alliance with therapist, alliance with each other, treatment attitude, treatment compliance, and level of stress) were interviewed to probe on their experiences of alliance-building, parenting, and caregiving. The integration of both quantitative and qualitative data led to the formulation of a conceptual framework that explains how the factors influence the secondary system of therapeutic alliance. These findings emphasize that tapping into the personal experiences of parents and caregivers can help in identifying what they value in a working, therapeutic relationship. Moreover, communication, skills training, and feedback among therapists, parents, and caregivers are essential to enhance positive attitude toward treatment, promote compliance to treatment recommendations, and address sources of personal stress. Nevertheless, this study calls for future studies to build into the factors associated with the systemic therapeutic alliance and to implement intervention programs that may target issues relating to attitude toward treatment, compliance to treatment, and experience of parental and caregiver stress.

Translating Games Into Effective Health Results Using Digital Tools

The use of gamification in the health context, especially to trigger behavior change, has assumed a particular relevance. However, the scientific evidence that supports the effectiveness of gamified methodologies has constituted a barrier to the implementation of projects. This chapter draws on a review of this theme, identifying barriers and opportunities for using gamification mechanisms. Results show that digital games are often considered as more enjoyable, engaging, and interesting solutions that are able to increase access, autonomy, self-efficacy, compliance to treatment, and knowledge acquisition. However, most studies reported a high risk of bias due to small-sized samples, short follow-up times, and lack of randomized control trials or more robust study designs. Therefore, future research should target older adults, ensure longer periods of follow-up, bigger samples, and include randomized control trials. Involvement of patients and health professionals is also a key component to ensure a more effective and regulated delivery of such solutions within the healthcare system.

Psychosocial, Internal and External Factors of Treatment Compliance of Schizophrenic Patients: A Literature Review

Compliance to treatment is one of the important and essential components of healing and schizophrenia patient’s quality of life. Treatment compliance can be improved by identifying internal and external factors from the patient. This review aims to identify Psychosocial, Internal and External Factors of Treatment Compliance of Schizophrenic Patients. The systematic research for articles begins by identifying research articles in four databases, from Scopus, Science Direct, Sage and Proquest in 2019 – 2021 using predetermined keywords. Articles were selected using PRISMA methode, and based on the inclusion and exclusion criteria that set out. Twenty-five articles analyzed in this lyteratur review were all quantitative studies. The results of the research review show that psychosocial, internal factors and external factors are components of supporting compliance to treatment for schizophrenic patients

Reversible supraventricular tachycardia complicating diabetic ketoacidosis in an adult patient: A case report

Diabetic ketoacidosis (DKA) is a commonly encountered serious acute metabolic complication of diabetes mellitus (DM) in adolescents and young adults. It is traditionally associated with poorly treated or newly diagnosed type 1 DM, however, in the setting of type 2 DM, inadequate insulin treatment, non-compliance to treatment, newly diagnosed DM, acute illnesses, drugs, and extreme stress can precipitate DKA. We report the case of a 42-year-old known diabetic of 7 years duration with a family history of DM who presented with a two-week history of difficulty in breathing, polyuria, and vomiting. On further examination, pulse rate was 220 beats per minute, respiratory rate 40 cycles per minute, temperature 38.4’C. Random blood sugar was 18.1mmol/l with ketonuria ++. Severe acidosis and mild hypokalemia were noted with her electrocardiogram (ECG) showing supraventricular tachycardia. She was managed and discharged in stable condition with a normal ECG after 20 days on admission to continue basal and pre-meal insulin at home. Adequate diabetic education was conducted and follow-up with endocrinology and cardiology units was advised.

Experiment in vivo: How COVID-19 Lifestyle Modifications Affect Migraine

Introduction: The coronavirus disease 2019 (COVID-19) pandemic represents a unified lifestyle modification model, which was developed by the globally applied measures. The lockdowns designed the perfect study settings for observing the interaction between migraine and the adopted changes in lifestyle. An experiment in vivo took place unexpectedly to determine how the lockdown lifestyle modifications can influence migraine.Subsection 1: Overall lifestyle modifications during the pandemic: People stay home, and outdoor activities and public contacts are restricted. Sleep is disturbed. Media exposure and prolonged screen use are increased. Working conditions change. In-person consultations and therapies are canceled. The beneficial effects of short-term stress, together with the harmful effects of chronic stress, were observed during the pandemic.Subsection 2: Short-term effects: Substantial lifestyle changes happened, and knowing how vulnerable migraine patients are, one could hypothesize that this would have resulted in severe worsening of headache. Surprisingly, even though the impacts of changing social conditions were significant, some patients (including children) experienced a reduction in their migraine during the first lockdown.Subsection 3: Long-term effects: Unfortunately, headache frequency returned to the basal state during the second pandemic wave. The risk factors that could have led to this worsening are the long-term disruption of sleep and dietary habits, stress, anxiety, depression, non-compliance to treatment, and working during the pandemic.Discussion: Sudden short-term lifestyle changes taking migraine patients out of their usual routine may be beneficial for headache management. It is not necessary to have a natural disaster in place for a drastic lifestyle modification with 6–8-week duration, if we know that this will improve migraine.

527 - Anxiety in older Greek patients undergoing hemodialysis

ABSTRACTIntroduction:A significant proportion of patents under hemodialysis treatment manifest anxiety symptoms, which may affect compliance to treatment and quality of life.The aim of the present study was to investigate anxiety levels of patients under hemodialysis treatment, as well as the relationship between socio-demographic/clinical factors and anxiety.Method:A total of 105 patients with chronic kidney failure under hemodialysis treatment (64 men and 41 women) with a mean age of 72.51 ± 7.55 years were recruited and completed (a) a demographic questionnaire and (b) the State-Trait Anxiety Inventory.Results:58.1% of the participants were male; while the 59.6% of the participants were married and the 60.2% were retired. Our participants exhibited higher state, trait and total anxiety levels compared to general population. There were a statistically significant association between factors, including patients’ functionality, gender, physical exercise, hemodialysis complications, marital status, educational level and anxiety levels. Women exhibited a statistically significant higher state anxiety levels compared to men. Widowed participants, that is, people living alone who had experienced the loss of a beloved one, reported higher state, trait and total anxiety levels. Finally, people with higher education showed lower trait and total anxiety. Individuals who were capable of taking care of themselves reported lower state, trait and total anxiety levels with a statistically significant difference compared to those who needed external help. Additionally, those who physically exercised exhibited statistically significant lower state, trait and total anxiety levels compared to those who didn’t exercise.Conclusions:The conclusions of the present study could be a critical point in determining guidelines that would substantially contribute to the improvement of the psychological state of patients undergoing hemodialysis treatment.

Implementation of the MASK-Air® App for Rhinitis and Asthma in Older Adults: MASK@Puglia Pilot Study

<b><i>Introduction:</i></b> MASK-air® is an app whose aim is to reduce the global burden of allergic rhinitis and asthma. A transfer of innovative practices was performed to disseminate and implement MASK-air® in European regions. The aim of the study was to examine the implementation of the MASK-air® app in older adults of the Puglia TWINNING in order to investigate (i) the rate of acceptance in this population, (ii) the reasons for refusal and (iii) the evaluation of the app after its use. <b><i>Methods:</i></b> All consecutive geriatric patients aged between 65 and 90 years were included by the outpatient clinic of the Bari Geriatric Immunoallergology Unit. After a 1-h training session, older adults used the app for 6 months. A 6-item questionnaire was developed by our unit to evaluate the impact of the app on the management of the disease and its treatment. <b><i>Results:</i></b> Among the 174 recruited patients, 102 accepted to use the app (mean age, SD: 72.4 ± 4.6 years), 6 were lost to follow-up, and 63 had a low education level. The reasons given not to use the app included lack of interest (11%), lack of access to a smartphone or tablet (53%), low computer literacy (28%), and distrust (8%). At follow-up, the overall satisfaction was high (89%), the patient considered MASK-air® “advantageous” (95%), compliance to treatment was improved (81%), and the rate of loss to follow-up had decreased to 6%. <b><i>Conclusion:</i></b> Older adults with a low level of education can use the MASK-air® app after a short training session.

Evaluation of Nutritional Deficiency-5 Years and More Outcomes Post Laparoscopic Sleeve Gastrectomy

IntroductionNowadays one of the most popular surgical method for treatment of obesity is laparoscopic sleeve gastrectomy (LSG). Data regarding long-term nutritional deficiencies following LSG are scare. We aim to assess the prevalence of nutritional deficiencies 5 years post-LSG.MethodsWe retrospectively reviewed the files of 338 patients who had LSG surgery between June 2012 and June 2019 and had preoperative data and had at least 1 year of surgery. Serum iron, ferritin, folic acid, hemoglobin and vitamin B12 levels during annual visits for six years after LSG were compared with preoperative data. Patients with missing data during follow-up were evaluated as dropout and assessments were made on patients with available data.ResultsA total of 338 patients (83% women), with a baseline BMI 46,87±6,17 kg/m2 were included. In baseline, hypoferritinemia was detected in 19.16% for <15 ng/mL cutoff and in 43.11% for <30 ng/ml cutoff value. Serum iron, vitamin B12 and folate deficiencies were exist in 37.62%, 18.64% and 4.14% of the patients, respectively. We compared this prevalances with postoperative datas and found that ferritin deficiency in follow-up visits was significantly more frequent than the baseline (p<0.001), conversely vitamin B12 deficiency was significantly less common (p<0,05).ConclusionDespite the supplement, our results show that the prevalence of patients with hypoferritinemia after LSG is higher than before surgery. This high prevalence may be associated with factors such as insufficient supplementation, insufficient absorption of oral preparations, and insufficient compliance to treatment.

Genetic aspects of aspirin resistance in patients with cerebrovascular pathology

Введение. Цереброваскулярные заболевания (ЦВЗ) и нарушения мозгового кровообращения (НМК) остаются одной из основных причин смерти во всем мире. Доказана генетическая составляющая возникновения НМК, генетические полиморфизмы могут изменять ответ на фармакологические агенты. Ацетилсалициловая кислота (АСК) — «золотой стандарт» антиагрегантного лечения ЦВЗ. С начала XXI века в мировой науке накопились факты о недостаточном эффекте АСК, в связи с чем возник термин аспиринорезистентность. Цель исследования: оценка вклада гемореологических и генетических факторов в возникновение феномена аспиринорезистентности у пациентов с ЦВЗ. Материалы и методы. В настоящее проспективное рандомизированное контролируемое наблюдательное исследование были включены 186 пациентов с ЦВЗ в возрасте 45–75 лет. Все пациенты получали 75 мг АСК ежедневно. Наряду с комплексным клиническим обследованием, оценкой когнитивного статуса и приверженности к лечению, проводилась лабораторная оценка функции тромбоцитов, развернутый биохимический анализ крови, идентификация полиморфизмов A842G гена циклооксигеназы 1-го типа (ЦОГ-1) (rs 10306114), С50Т ЦОГ-1 (rs3842787) и А1676G ЦОГ-1 (rs1330344). Статистическая обработка выполнена с использованием программ IBM SPSS Statistics. Результаты. Выявлена положительная взаимосвязь между уровнем агрегации тромбоцитов (АТ) с аденозиндифосфатом (АТ-АДФ) и адреналином и (АТ-адр) и пробой АСК in vitro (r = 0,722 и r = 0,689; р < 0,001). Обнаружена отрицательная взаимосвязь между АТ-АДФ и баллом по Монреальской шкале оценки когнитивных функций (англ. Montreal Cognitive Assessment, MoCA) и приверженностью к лечению (r = –0,845; p = 0,001). На основании анализа АТ все обследованные были подразделены на АСК-нечувствительных (группа 1, n = 100) и АСК-чувствительных (группа 2, n = 86). В группе АСК-нечувствительных наблюдалось больше пациентов, несущих хотя бы один аллель G полиморфизма гена ЦОГ-1 rs1330344 по сравнению с пациентами в группе ACK-чувствительных (60,4% против 47,7%; p < 0,01). Наличие rs1330344 часто ассоциировано с сахарным диабетом 2-го типа (отношение шансов = 3,749; 95% доверительный интервал = 1,937–7,254; p = 0,001). Полиморфизм ЦОГ-1 C50T (rs3842787) по данным логистической регрессии связан с АТ-Адр (r = 0,845; р < 0,001). Заключение. Среди причин аспиринорезистентности у пациентов с ЦВЗ следует учитывать генетические аспекты. Background. Cerebrovascular disease (CVD) and stroke remain one of the leading causes of death worldwide. The genetic component of stroke has been proven; genetic polymorphisms can alter the response to pharmacological agents. Acetylsalicylic acid (ASA) is the “gold standard” for antiplatelet treatment of CVD. Since the beginning of the XXI century, the world science has accumulated facts about the insufficient effect of ASA, so the term aspirin resistance appeared. Objectives: to assess hemorheological and genetic factors to the occurrence of the phenomenon of aspirin resistance in patients with CVD. Patients/Methods. This prospective randomized controlled observational study included 186 patients with CVD, aged 45–75 years. All patients received 75 mg ASA daily. Clinical examination, assessment of cognitive status and compliance to treatment, a laboratory assessment of platelet function, a detailed biochemical blood test, identifi cation of A842G polymorphisms of type 1 cyclooxygenase (COX-1) gene (rs 10306114), C50T COX-1 (rs3842787) and A1676G COX-1 (rs3842787) and A1676G COX-1 (rs1330344) were performed. Statistics was carried out using the IBM SPSS Statistics software. Results. The positive correlation was found between platelet aggregation (РА) with adenosine diphosphate (РА-ADP) and adrenaline (РА-Аdr) and an in vitro test with ASA (r = 0.722 and r = 0.689; p < 0.001). A negative correlation was found between РА-ADP and the Montreal Cognitive Assessment (MoCA) score for compliance to treatment (r = –0,845; p = 0,001). Based on the analysis of PA, all examined patients were divided into ASA-insensitive (group 1, n = 100) and ASA-sensitive (group 2, n = 86). In the ASA-insensitive group, there were more patients carrying at least one G allele of the COX-1 gene rs1330344 polymorphism compared with patients in the ACK-sensitive group (60.4% versus 47.7%; p < 0.01). The presence of rs1330344 is often associated with type 2 diabetes mellitus (OR = 3.749; 95% СI = 1.937–7.254; p = 0.001). C50T polymorphism of COX-1 (rs3842787) according to logistic regression is associated with AT-Adr (r = 0.845; p < 0.001). Conclusions. Genetic aspects should be considered among the causes of aspirin resistance in patients with CVD.