Medication Adherence in the General Population

Background

Adherence to medication is low in specific populations who need chronic medication. However, adherence to medication is also of interest in a more general fashion, independent of specific populations or side effects of particular drugs. If clinicians and researchers expect patients to show close to full adherence, it is relevant to know how likely the achievement of this goal is. Population based rates can provide an estimate of efforts needed to achieve near complete adherence in patient populations. The objective of the study was to collect normative data for medication nonadherence in the general population.

Methods and Findings

We assessed 2,512 persons (a representative sample of German population). Adherence was measured by Rief Adherence Index. We also assessed current medication intake and side effects. We found that at least 33% of Germans repeatedly fail to follow their doctor''s recommendations regarding pharmacological treatments and only 25% of Germans describe themselves as fully adherent. Nonadherence to medication occurs more often in younger patients with higher socioeconomic status taking short-term medications than in older patients with chronic conditions. Experience with medication side effects was the most prominent predictor of nonadherence.

Conclusions

The major strengths of our study are a representative sample and a novel approach to assess adherence. Nonadherece seems to be commonplace in the general population. Therefore adherence cannot be expected per se but needs special efforts on behalf of prescribers and public health initiatives. Nonadherence to medication should not only be considered as a drug-specific behaviour problem, but as a behaviour pattern that is independent of the prescribed medication.     

Determinants of Medication Adherence to Antihypertensive Medications among a Chinese Population Using Morisky Medication Adherence Scale

Background and Objectives

Poor adherence to medications is one of the major public health challenges. Only one-third of the population reported successful control of blood pressure, mostly caused by poor drug adherence. However, there are relatively few reports studying the adherence levels and their associated factors among Chinese patients. This study aimed to study the adherence profiles and the factors associated with antihypertensive drug adherence among Chinese patients.

Methods

A cross-sectional study was conducted in an outpatient clinic located in the New Territories Region of Hong Kong. Adult patients who were currently taking at least one antihypertensive drug were invited to complete a self-administered questionnaire, consisting of basic socio-demographic profile, self-perceived health status, and self-reported medication adherence. The outcome measure was the Morisky Medication Adherence Scale (MMAS-8). Good adherence was defined as MMAS scores greater than 6 points (out of a total score of 8 points).

Results

From 1114 patients, 725 (65.1%) had good adherence to antihypertensive agents. Binary logistic regression analysis was conducted. Younger age, shorter duration of antihypertensive agents used, job status being employed, and poor or very poor self-perceived health status were negatively associated with drug adherence.

Conclusion

This study reported a high proportion of poor medication adherence among hypertensive subjects. Patients with factors associated with poor adherence should be more closely monitored to optimize their drug taking behavior.     

实行医疗保险总额预付制改革的思考

总额预付制是由医保部门在对医疗机构进行评估后,计算出人均医疗费用,根据服务量和人均医疗费用,测算出医院的年度费用标准,按此费用标准向医院预付定额的医疗费。对上海医保总额预付制的模式、实施成效、存在的问题进行了思考和探讨,对总额预付的运用及改进提出了初步的设想,以此推动医疗保险付费方式改革的持续进展。     

Improvements to the GDB Human Genome Data Base.

Version 6.0 of the Human Genome Data Base introduces a number of significant improvements over previous releases of GDB. The most important of these are revised data representations for genes and genomic maps and a new curatorial model for the database. GDB 6.0 is the first major genomic database to provide read/write access directly to the scientific community, including capabilities for third-party annotation. The revised database can represent all major categories of genetic and physical maps, along with the underlying order and distance information used to construct them. The improved representation permits more sophisticated map queries to be posed and supports the graphical display of maps. In addition the new GDB has a richer model for gene information, better suited for supporting cross-references to databases describing gene function, structure, products, expression and associated phenotypes.     

Using Continuous Data Tracking Technology to Study Exercise Adherence in Pulmonary Rehabilitation

Pulmonary rehabilitation (PR) is an important component in the management of respiratory diseases. The effectiveness of PR is dependent upon adherence to exercise training recommendations. The study of exercise adherence is thus a key step towards the optimization of PR programs. To date, mostly indirect measures, such as rates of participation, completion, and attendance, have been used to determine adherence to PR. The purpose of the present protocol is to describe how continuous data tracking technology can be used to measure adherence to a prescribed aerobic training intensity on a second-by-second basis.In our investigations, adherence has been defined as the percent time spent within a specified target heart rate range. As such, using a combination of hardware and software, heart rate is measured, tracked, and recorded during cycling second-by-second for each participant, for each exercise session. Using statistical software, the data is subsequently extracted and analyzed. The same protocol can be applied to determine adherence to other measures of exercise intensity, such as time spent at a specified wattage, level, or speed on the cycle ergometer. Furthermore, the hardware and software is also available to measure adherence to other modes of training, such as the treadmill, elliptical, stepper, and arm ergometer. The present protocol, therefore, has a vast applicability to directly measure adherence to aerobic exercise.     

Population Dynamics of Aphids on Cereals: Digging in the Time-Series Data to Reveal Population Regulation Caused by Temperature

Aphid populations show periodic fluctuations and many causes are attributed to their dynamic. We investigated the regulation by temperature of the aphid populations composed of Metopolophium dirhodum, Sitobion avenae, and Rhopalosiphum padi on winter wheat using a 24 years long time series data. We computed the sum of daily temperatures above 5°C, the threshold temperature for aphid development, and the sum of daily temperatures within the [0(threshold for wheat development),5] °C interval. Applying Generalised Additive Model framework we tested influences of temperature history expressed via degree days before the start of the aphid immigration on the length of their occurrence. We aimed to estimate the magnitude and direction of this influence, and how far to the past before the start of the aphid season the temperature effect goes and then identify processes responsible for the effect. We fitted four models that differed in the way of correcting for abundance in the previous year and in specification of temperature effects. Abundance in the previous year did not affect the length of period of aphid population growth on wheat. The temperature effect on the period length increased up to 123 days before the start of the current season, i.e. when wheat completed vernalization. Increased sum of daily temperatures above 5°C and the sum of daily temperatures within the [0,5] °C interval both shortened the length of period of aphid population growth. Stronger effect of the latter suggests that wheat can escape from aphid attacks if during winter temperatures range from 0 to 5°C. The temperature influence was not homogeneous in time. The strongest effect of past temperature was about 50 to 80 and 90 to 110 days before the beginning of the current aphid season indicating important role of termination of aphid egg dormancy and egg hatching.     

A Data Base for Scaling up from the Leaf to the Canopy

A data base was generated for quantifying effects of thermal time (degree-days) on the appearance of new leaves, the expansion of such leaves to maximum area, their death, the appearance of new internodes below the node associated with such leaves, and the extension of these internodes to maximum length. The data base for a list of crop (agronomic and horticultural), weed, and native Tallgrass Prairie plants has been summarized, with equations for the above events as a function of degree days, with appropriate base temperatures and maximum cut-off temperatures, in a Java applet which is available at a website with the URL . Associated graphical plots such as shown in this paper are also given. Branching behavior was accounted for. These events predict the effect of thermal time on leaf age and its height in the plant canopy, both important factors needed for upscaling functions for leaf behavior to those for behavior of the plant canopy. The data base is evolving to include coefficients for other species. Coefficients are used to predict the leaf area index of the canopy, which is important for predicting evapotranspiration from the crop and the protection of the soil from erosion.     

Quantifying the Contribution of Statins to the Decline in Population Mean Cholesterol by Socioeconomic Group in England 1991 - 2012: A Modelling Study

Background

Serum total cholesterol is one of the major targets for cardiovascular disease prevention. Statins are effective for cholesterol control in individual patients. At the population level, however, their contribution to total cholesterol decline remains unclear. The aim of this study was to quantify the contribution of statins to the observed fall in population mean cholesterol levels in England over the past two decades, and explore any differences between socioeconomic groups.

Methods and Findings

This is a modelling study based on data from the Health Survey for England. We analysed changes in observed mean total cholesterol levels in the adult England population between 1991-92 (baseline) and 2011-12. We then compared the observed changes with a counterfactual ‘no statins’ scenario, where the impact of statins on population total cholesterol was estimated and removed. We estimated uncertainty intervals (UI) using Monte Carlo simulation, where confidence intervals (CI) were impractical. In 2011-12, 13.2% (95% CI: 12.5-14.0%) of the English adult population used statins at least once per week, compared with 1991-92 when the proportion was just 0.5% (95% CI: 0.3-1.0%). Between 1991-92 and 2011-12, mean total cholesterol declined from 5.86 mmol/L (95% CI: 5.82-5.90) to 5.17 mmol/L (95% CI: 5.14-5.20). For 2011-12, mean total cholesterol was lower in more deprived groups. In our ‘no statins’ scenario we predicted a mean total cholesterol of 5.36 mmol/L (95% CI: 5.33-5.40) for 2011-12. Statins were responsible for approximately 33.7% (95% UI: 28.9-38.8%) of the total cholesterol reduction since 1991-92. The statin contribution to cholesterol reduction was greater among the more deprived groups of women, while showing little socio-economic gradient among men.

Conclusions

Our model suggests that statins explained around a third of the substantial falls in total cholesterol observed in England since 1991. Approximately two thirds of the cholesterol decrease can reasonably be attributed non-pharmacological determinants.     

Association between Adherence to Nutritional Guidelines,the Metabolic Syndrome and Adiposity Markers in a French Adult General Population

Introduction

Few studies have focused on the association between diet quality scores and the Metabolic Syndrome (MetS), a multi-component condition predictive of cardiovascular diseases (CVD) and death. The present study aims at investigating, in a cross-sectional design, the association between adherence to the French dietary guidelines through an a priori score – the French Nutrition and Health Program-Guideline Score (PNNS-GS) – and cardiovascular risk factors (CVRF) including the MetS and adiposity markers.

Methods

7902 French adults participating in the NutriNet-Santé study (an on-going web-based cohort study) attended a clinical and biological examination between January 2011 and November 2012: a fasting blood sample was drawn, blood pressure and body composition (bio-impedance) were measured. Multivariate linear and logistic regression models were used to assess the association between PNNS-GS and CVRF or the MetS.

Results

An increase of PNNS-GS was significantly negatively associated with waist circumference (WC), systolic and diastolic blood pressure (SBP and DBP) and serum triglycerides concentrations. From bottom to top quartile of PNNS-GS, SBP decreased from 129.9 to 128.8 mm Hg, DBP from 76.7 to 75.9 mm Hg, serum triglycerides concentrations from 110.8 to 104.6 mg/dL and WC from 94.8 to 90.1 cm for men and 81.3 to 78.9 cm for women. All adiposity markers (waist and hip circumference, % body fat, % trunk fat, % leg fat) were markedly reduced across quartiles of PNNS-GS and linearly. Individuals with a better PNNS-GS (quartile 4 vs quartile 1) were less likely to have the MetS (OR=0.71, 95% CI: 0.56-0.89).

Conclusion

The negative association between a higher adherence to the French dietary guidelines and a number of CVRF, the MetS prevalence and regional adiposity supports the importance of promoting the PNNS dietary guidelines in the population for the prevention of cardiometabolic abnormalities and hence, cardiovascular diseases.     

Ancestral Alleles in the Human Genome Based on Population Sequencing Data

Ancestral allele information is useful for genetics studies. Previously, the identification of ancestral alleles was primarily based on sequence alignments between species. Alternative ways to identify ancestral alleles were proposed in this study based on population sequencing data. The methods described here utilized the diversity between haplotypes harboring ancestral and newly emerged alleles. Simulations showed that these methods were reliable for identifying ancestral alleles when the variants had not aged too greatly. Application to the human genome sequencing data suggested the role of indels in maintaining the GC content in the human genome. The deletion-to-insertion ratios and GC proportions were correlated depending on the sizes of insertions and deletions in the direction of increasing GC content. There were GC-biased fixations in single base-pair insertions and AT-biased fixations in single base-pair deletions in the results based on the proposed methods. In the current study, GC-biased gene conversions in nucleotide substitutions were very slight or insignificant. In the variants of several quantitative trait loci (QTLs), slight GC-biased gene conversion was observed in nucleotide substitutions. For the QTL indels, insertions were observed more often than deletions, and deletion-biased fixation was observed, providing new insights into the evolution of functional genes.     

Influence of the Interaction for Fitness on the Population Structure

The incidence of non-allelic interaction for fitness in a diallelic digenic model is analyzed. Three types of interaction between the fitnesses are considered, namely: i) additive, ii) exponential and, iii) logarithmic. The model of MATHER and JINKS (1970) is applied in the computation of the interaction parameters. The theory of finite absorbing Markov chains (FELLER, 1968) is utilized in the representation of the genotypic structure of the selfing population over time. Expressions depending on the parameters of interaction are obtained for the mean number of generations that the process of genetic information flow delays in transitions among transient states. Also, a numerical example is studied in which the mean absorption times and the variances are calculated. Finally, the impact of fitness interaction on the genetic diversity of some populations is analyzed through the calculation of the genetic information neg-entropy (BRILLOUIN, 1959).     

Comparisons of Adherence to Antiretroviral Therapy in a High- Risk Population in China: A Systematic Review and Meta-Analysis

Background

Reports on antiretroviral therapy (ART) adherence are scare in China; we performed this meta-analysis to estimate ART adherence rates in different populations at high risk for HIV transmission in China.

Methods

We searched PubMed, Chinese Biomedical Literature Database (Chinese), China National Knowledge Infrastructure (Chinese), and Wanfang (Chinese) to identify studies published from January 1985 to May 2015. We used random-effects meta-analysis to calculate weighted mean estimates across studies and 95% CIs. Data were pooled with proportions transformed prior to pooling using the Freeman–Tukey double arcsine transformation and then back transformed to the original scale. We calculated the I² (and its 95% confidence intervals) and tau² to assess between-study heterogeneity.

Results

We identified 36 eligible articles, including 6885 HIV-positive individuals, reporting ART adherence. Pooled analysis produced an estimate of 77.61% (95% CI = 71.63–83.08) of patients with HIV with adequate adherence; however, high heterogeneity was observed between studies (I² = 96.60%, 95%CI = 96.00%-97.20%; tau² = 0.16). Three studies, which included 149 old HIV-infected patients, reported the highest ART adequate adherence rate (89.39%, 95% CI = 72.01–99.26) with high heterogeneity between the studies (I² = 86.20%, 95%CI = 60.00–95.20%; tau² = 0.13). While, only two studies, which included 143 heterosexual transmission group (HTG) patients, reported the lowest ART adequate adherence rate (51.55%, 95% CI = 41.33–61.71) with low heterogeneity between the studies (I² = 31.3%, tau² = 0.007). In the multivariable meta-regression model, high-risk populations was the main factor explaining heterogeneity (variance explained 28.14%).

Conclusions

ART adherence in some high-risk populations (e.g., heterosexual transmission group) is below the recommended levels for maintaining virologic suppression. It is crucial to develop comprehensive intervention strategies to promote ART adherence in high-risk populations and effectively prevent the spread of HIV/AIDS in China.     

瑞舒伐他汀和阿托伐他汀在急性冠脉综合症中对氯吡格雷抗血小板活性的对比研究

目的：在急性冠脉综合征（acute coronary syndromes,ACS）的治疗中,抗血小板治疗及调脂治疗是最基础的治疗方案。近来有学者提出,氯吡格雷和他汀类药物都经过细胞色素CYP3A4途径代谢,二者因存在竞争性抑制,有可能降低氯吡格雷抗血小板的活性。本试验将针对阿托伐他汀及瑞舒伐他汀进行研究。方法：选择急性冠脉综合症的患者42例,所有患者均接受氯吡格雷治疗（负荷剂量300mg,维持剂量75mg／d）。随机分配为A、B两组,A组（n=20）服用阿托伐他汀治疗（20mg／d）,B组（n=22服用瑞舒伐他汀治疗（10mg／d）。分别于氯吡格雷服用前、服药治疗后3天、服药治疗后7天后采静脉血送检,测定ADP（10μmol／L）诱导的血小板聚集率。结果：阿托伐他汀组（A组）及瑞舒伐他汀组（B组）相比,服用氯吡格雷前ADP诱导的血小板聚集率基线值无统计学差异。服用氯吡格雷3日及7日后,ADP诱导的血小板聚集率明显降低,（3．85±2．58）vs（3．09±2．27）,（0．65±0．88）vs（1．05±0．95）,P〉0．05,无明显统计学差异。结论：氯吡格雷的确可以降低血小板的活性。同时,短期之内氯吡格雷的抗血小板活性未受到他汀类的影响。包括经过CPY3A4途径的他汀,如阿托伐他汀。     

瑞舒伐他汀和阿托伐他汀在急性冠脉综合症中对氯吡格雷抗血 小板活性的对比研究

目的：在急性冠脉综合征( acute coronary syndromes, ACS )的治疗中,抗血小板治疗及调脂治疗是最基础的治疗方案。近来 有学者提出,氯吡格雷和他汀类药物都经过细胞色素CYP 3A4 途径代谢,二者因存在竞争性抑制,有可能降低氯吡格雷抗血小板 的活性。本试验将针对阿托伐他汀及瑞舒伐他汀进行研究。方法：选择急性冠脉综合症的患者42 例,所有患者均接受氯吡格雷治 疗（负荷剂量300 mg,维持剂量75 mg/d）。随机分配为A、B 两组,A 组（n=20）服用阿托伐他汀治疗（20 mg/d）,B 组（n=22 服用瑞 舒伐他汀治疗（10 mg/d）。分别于氯吡格雷服用前、服药治疗后3 天、服药治疗后7 天后采静脉血送检,测定ADP（10 滋mol/L）诱导 的血小板聚集率。结果：阿托伐他汀组（A 组）及瑞舒伐他汀组（B 组）相比,服用氯吡格雷前ADP 诱导的血小板聚集率基线值无 统计学差异。服用氯吡格雷3 日及7 日后,ADP诱导的血小板聚集率明显降低,(3.85± 2.58)vs(3.09± 2.27),(0.65± 0.88)vs(1.05± 0.95),P>0.05,无明显统计学差异。结论：氯吡格雷的确可以降低血小板的活性。同时,短期之内氯吡格雷的抗血小板活性未受到 他汀类的影响,包括经过CPY3A4途径的他汀,如阿托伐他汀。     

Evaluation of the Airborne Bacterial Population in the Periodically Confined Antarctic Base Concordia

The environmental airborne bacterial population in relation to human confinement was investigated over a period of 1 year in the Concordia Research Station, which is located on the Eastern Antarctic plateau. The unique location of the station makes it suitable for different research domains such as glaciology, atmospheric sciences, astronomy, etc. Furthermore, it is used as a test bed for long-duration spaceflights to study the physiologic and psychological adaptation to isolated environments. A total of 96 samples were collected at eight different locations in the station at regular intervals. The airborne bacterial contamination was for 90% of the samples lower than 10.0 × 10² colony-forming units per cubic meter of air (CFU/m³) and the total bacterial contamination increased over time during confinement but diminished after re-opening of the base. Viable airborne bacteria with different morphology were identified by biochemical analyses. The predominant microflora was identified as Staphylococcus sp. (24.9% of total) and Bacillus sp. (11.6% of total) and was associated with human activity, but also environmental species such as Sphingomonas paucimobilis (belonging to the α-Proteobacteria) could establish themselves in the airborne population. A few opportunistic pathogens (6%) were also identified. Rob Van Houdt and Patrick De Boever contributed equally.     

An analysis of the Gene-Tox Carcinogen Data Base

The Gene-Tox Carcinogen Data Base is an evaluated source of cancer data on 506 chemicals selected in part for their previous assessment in genetic toxicology bioassays. This data base has been analyzed for the distribution of these chemicals into chemical classes. The major chemical classes (6% or greater of the total data base) are: acyl-, alkyl-, and aryl-halides; alcohols and phenols; aliphatic and aromatic amines, amides, and sulfonamides; benzene-ring-containing chemicals; organo-lead, -mercury, -phosphorous compounds, metals and derivatives, phosphoric acid esters, and phosphoramides; and polycyclic aromatic hydrocarbons. Cancer studies representing a subset of the Gene-Tox Carcinogen Data Base, 199 chemicals which were rated as Sufficient Positive/Negative or Limited Positive/Negative, were examined for distribution of those studies by animal species, gender, route of chemical administration, duration of study, major tumor sites, and major tumor types. These analyses revealed that the Gene-Tox Carcinogen Data Base contains a large number of lifetime studies involving the rat and mouse treated by oral routes of administration. The major organs that were targets were: liver, lung, skin, forestomach, bladder, and mammary gland, while the major tumor types were: carcinoma, sarcoma, papilloma, and adenoma. Chemicals in the data base have been assessed for species-specific carcinogenic effects, and these results indicate that for mice and rats there is a high correspondence (85%). This number is higher than that (71%) reported by Tennant et al. (1986) based on the recent results of 72 chronic cancer bioassays performed by the National Toxicology Program. This difference is probably based on the nature of the chemicals selected for inclusion in both data bases. Although the absolute value of this correspondence is unknown, it would seem to be within this range. When chemicals in the Gene-Tox Carcinogen Data Base were examined for their previous evaluation in 73 genetic toxicology bioassays, only 26 of these bioassays had 30 or more chemicals. In these 26 bioassays, the prevalence of positive chemicals was generally greater than 80-90%. This suggests that a thorough evaluation of genetic toxicology bioassays in regard to their ability to predict carcinogenic effects in animals is premature at this time.