Search Results (623)

Background: Non-adherence to anti-tuberculosis treatment remains a major obstacle to increasing tuberculosis treatment success rates and enhancing healthcare expenditure. The aim of this study was to identify determinants contributing to non-adherence to anti-tuberculosis treatment in a public primary healthcare clinic in South Africa. Method: A cross-sectional study was carried out to collect data from 65 participants using face-to-face interviews with a structured questionnaire. Data were analyzed using SPSS. Results: Of the 65 participants interviewed, 41 (63.08%) were males and 24 (36.92%) were females. A total of 45 (69.23%) were adherents and 20 (30.77%) were non-adherents. Gender was the major predictor of non-adherence with more males committed to treatment than females with a significant association (X² = 65.00 and p of <0.001). Conclusions: The major contributing factors to non-adherence were long dis-tances to the clinics, a lack of family support, and unemployment. Comprehensive programs addressing these multifactorial factors are needed for successful treatment and eradication of tuberculosis. Full article

Background/Objectives: Understanding the impact of dietary habits in terms of obesity, health outcomes, and functional decline is critical in Europe’s growing elderly population. This study analyzed trends in Mediterranean diet (MD) adherence, obesity prevalence, and grip strength among middle-aged and elderly Europeans using data from the Survey of Health, Ageing and Retirement in Europe (SHARE). Methods: Data from four SHARE waves (2015–2022) across 28 countries were analyzed. Dietary patterns were assessed through food frequency questionnaires classifying participants as MD-adherent or non-adherent where adherent implies daily consumption of fruits and vegetables and occasional (3–6 times/week) intake of eggs, beans, legumes, meat, fish, or poultry (an unvalidated definition of the MD pattern). Handgrip strength, a biomarker of functional capacity, was categorized into low, medium, and high groups. Body mass index (BMI), self-perceived health (SPHUS), chronic disease prevalence, and CASP-12 scores (control, autonomy, self-realization, and pleasure evaluated on the 12-item version) were also evaluated. Statistical analyses included descriptive methods, logistic regressions, and multiple imputations to address missing data. Results: A significant majority (74–77%) consumed fruits and vegetables daily, which is consistent with MD principles; however, the high daily intake of dairy products (>50%) indicates limited adherence to the MD, which advocates for moderate consumption of dairy products. Logistic regression indicated that individuals with two or more chronic diseases were more likely to follow the MD (odds ratio [OR] = 1.21, confidence interval [CI] = 1.11–1.32), as were those individuals who rated their SPHUS as very good/excellent ([OR] = 1.42, [CI] = 1.20–1.69). Medium and high maximal handgrip were also strongly and consistently associated with higher odds of MD adherence (Medium: [OR] = 1.44, [CI] = 1.18–1.74; High: [OR] = 1.27, [CI] = 1.10–1.48). Conclusions: The findings suggest that middle-aged and older adults are more likely to adhere to the MD dietary pattern if they have more than two chronic diseases, are physically active, and have a medium or high handgrip. Although an unvalidated definition of the MD dietary pattern was used, the results highlight the importance of implementing targeted dietary strategies for middle-aged and elderly adults. Full article

Bioactive glass materials have been used for decades in orthopedic surgery, traumatology, and oral and maxillofacial surgery to repair bone defects. This study aimed to evaluate in vitro the survival and proliferation of MG63 human osteosarcoma-derived cells on S53P4 bioactive glass (BonAlive^® granules). Microscopic visualization was performed to directly observe the interactions between the cells and the material. Osteoblast-like cells were examined on non-adherent test plates, on tissue culture (TC)-treated plates and on the surface of the bioglass to assess the differences. Cell survival and proliferation were monitored using a CCK-8 optical density assay. Comparing the mean OD of MG63 cells in MEM on TC-treated plates with cells on BG, we detected a significant difference (p < 0.05), over each time of observation. The sustained cell proliferation confirmed the non-cytotoxic property of the bioglass, as the cell number increased continuously at 48, 72, 96, and 168 h and even did not plateau after 168 h. Since the properties of bioglasses can vary significantly depending on their composition and environment, a thorough characterization of their biocompatibility is crucial to ensure their effective and appropriate application—for example, during hip and knee prosthesis insertion. Full article

Background: The longitudinal RisCoin study investigated risk factors for COVID-19 vaccination failure among healthcare workers (HCWs) and patients with inflammatory bowel disease (IBD) at a University Hospital in Germany. Since the hospital served as the study sponsor and employer of the HCW, we implemented a custom mobile application. We aimed to evaluate the implementation, adherence, benefits, and limitations of this study’s app. Methods: The app allowed secure data collection through questionnaires, disseminated serological results, and managed bidirectional communication. Access was double-pseudonymized and irreversibly anonymized six months after enrollment. Download frequency, login events, and questionnaire submissions between October 2021 and December 2022 were analyzed. Multivariable logistic regression identified factors associated with app adherence. Results: Of the 3979 participants with app access, 3622 (91%) used the app; out of these, 1016 (28%) were “adherent users” (≥12 submitted questionnaires). App adherence significantly increased with age. Among HCW, adherent users were more likely to be non-smokers (p < 0.001), working as administrators or nursing staff vs. physicians (p < 0.001), vaccinated against influenza (p < 0.001), and had not travelled abroad in the past year (p < 0.001). IBD patients exposed to SARS-CoV-2 (p = 0.0133) and those with adverse events following the second COVID-19 vaccination (p = 0.0171) were more likely adherent app users. Despite technical issues causing dropout or non-adherence, the app served as a secure solution for cohort management and longitudinal data collection. Discussion: App-based cohort management enabled continuous data acquisition and individualized care while providing flexibility and anonymity for the study team and participants. App usability, technical issues, and cohort characteristics need to be thoroughly considered prior to implementation to optimize usage and adherence in clinical research. Full article

Background/Objectives: Adherence to oral endocrine therapy (OET) is essential to reduce recurrence but is predominantly lower among underserved patients, leading to worse health outcomes. We aimed to depict longitudinal patterns of OET adherence using group-based trajectory modeling (GBTM) and identify predictors associated with each adherence trajectory. Methods: A single-center, retrospective study was conducted to analyze data from women 18 years or older with metastatic breast cancer who initiated with an OET and were treated from January to December 2022. Adherence was measured using a proportion of days covered (PDC > 80%) for 12 months. Binary monthly indicator of PDC was incorporated into GBTM. Four models were generated by changing the number of groups from 2 to 5, using a 2nd-order polynomial function of time. A multinomial logistic regression model was run to evaluate the predictors of non-adherence trajectories, and “adherence” was considered the reference group. Results: A total of 346 women had a (mean age of 60) years; 93% were Hispanic or of Mexican origin; 90% were taking aromatase inhibitors (AIs), with an endocrine therapy of 1.05 years. Three trajectories of adherence to GBTM were identified: a gradual decline in adherence (n = 88, 25.5%), improving suboptimal adherence (n = 106, 30.6%), and adherent (n = 152, 43.9%). Multinomial logistic regression analysis showed that significant predictors are diabetes (odds ratio (OR), 2.96; 95% confidence interval (CI), 1.57–5.57) and fewer years of therapy (OR, 2.96; 95% CI, 1.57–5.57). Suboptimal adherence among RGV patients receiving OET, with approximately 56% following a non-adherent trajectory. Conclusions: Suboptimal adherence among RGV patients receiving OET, with approximately 56% following a non-adherent trajectory. Significant predictors should be considered when designing targeted interventions. Full article

Background and Objectives: Investigating the adherence to antihypertensive medication and identifying patients with low adherence allows targeted interventions to improve therapeutic outcomes. Artificial intelligence (AI) offers advanced tools for analyzing medication adherence data. This study aimed to develop and validate several predictive models for non-adherence, using patient-reported data collected via a structured questionnaire. Materials and Methods: A cross-sectional, multi-center study was conducted on 3095 hypertensive patients from community pharmacies. A structured questionnaire was administered, collecting data on sociodemographic factors, medical history, self-monitoring behaviors, and informational exposure, alongside medication adherence measured using the Romanian-translated and validated ARMS (Adherence to Refills and Medications Scale). Five machine learning models were developed to predict non-adherence, defined by ARMS quartile-based thresholds. The models included Logistic Regression, Random Forest, and boosting algorithms (CatBoost, LightGBM, and XGBoost). Models were evaluated based on their ability to stratify patients according to adherence risk. Results: A total of 79.13% of respondents had an ARMS Score ≥ 15, indicating a high prevalence of suboptimal adherence. Better adherence was statistically associated (adjusted for age and sex) with more frequent blood pressure self-monitoring, a reduced salt intake, fewer daily supplements, more frequent reading of medication leaflets, and the receipt of specific information from pharmacists. Among the ML models, CatBoost achieved the highest ROC AUC Scores across the non-adherence classifications, although none exceeded 0.75. Conclusions: Several machine learning models were developed and validated to estimate levels of medication non-adherence. While the performance was moderate, the results demonstrate the potential of AI in identifying and stratifying patients by adherence profiles. Notably, to our knowledge, this study represents the first application of permutation and SHapley Additive exPlanations feature importance in combination with probability-based adherence stratification, offering a novel framework for predictive adherence modelling. Full article

Background: Medication adherence is essential for managing chronic conditions, while non-adherence remains a widespread issue, leading to poorer health outcomes and higher healthcare costs. This study aimed to identify key adherence barriers, explore their relationship with patient satisfaction, and assess their impact on overall well-being among ambulatory patients in Albania. Methods: A cross-sectional study was conducted in three public urban health centers in Vlora, Albania, between November 2024 and January 2025. A total of 80 ambulatory patients were recruited using convenience sampling. Data were collected through face-to-face interviews using validated questionnaires, including the Adherence Barriers Questionnaire (ABQ), the Patient Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ), and the Patient Health Questionnaire (PHQ-9) for depression screening. Results: The study included 80 ambulatory patients (mean age 66.7 years; 48.7% female), predominantly diagnosed with diabetes (42.5%) and rheumatic diseases (36.3%). All participants reported at least one adherence barrier, with 92.5% experiencing multiple barriers. The most common were financial burden (91.3%) and fear of side effects (77.5%). A significant positive correlation was found between adherence barriers and depression severity (ρ = 0.518, p < 0.0001), while patient satisfaction did not significantly influence adherence barriers (ρ = −0.217, p = 0.053) or depression severity (ρ = −0.004, p = 0.969). Multiple regression analysis showed that higher depression severity (p = 0.0049) was significantly associated with greater adherence barriers, while postgraduate education was associated with fewer barriers (p = 0.0175). Conclusions: Financial burden, fear of side effects, and psychological distress are key barriers to adherence among Albanian ambulatory patients. Although there are limitations inherent to the cross-sectional design and modest sample size, our findings highlight the potential benefit of routine mental health screening, targeted financial support, and improved patient education on medication management within primary care. These insights may help inform future research and interventions aimed at enhancing adherence and overall well-being. Patient satisfaction did not significantly impact adherence or depression. Targeted interventions focusing on financial support, mental health care, and patient education are needed to improve adherence and patient well-being. These findings underscore the need for integrated mental health and adherence support strategies within routine primary care services. Full article

Background: Community-acquired pneumonia (CAP) is the leading cause of death in infants aged 1–59 months. Concurrent with this, there is a need to prescribe antibiotics wisely in Vietnam due to concerns with rising antimicrobial resistance (AMR). Consequently, an urgent need has arisen to treat patients according to agreed guidelines. The aim of this study was to investigate the current management of infants under five years old with CAP in Vietnam as well as identify possible obstacles to adhering to national guidelines. Methods: A mixed-method approach was used incorporating both quantitative and qualitative data analysis in a leading hospital in Vietnam, which influences others. Data from 108 pediatric patient records were collected and analyzed. Subsequently, in-depth interviews were conducted with pediatric doctors treating these patients to ascertain possible reasons for non-adherence to guidelines. Results: The mean age of children diagnosed with CAP was 27.94 ± 12.99 months, with 82.4% having non-severe CAP, and 41.7% of children had previously used antibiotics before hospitalization. The median length of hospital stay was 7 days. All children were prescribed antibiotics, 91.4% of children received these initially intravenously, with third-generation cephalosporins being the most (91.7%) commonly prescribed. Cefoperazone/sulbactam was the most frequently prescribed (48.2%) antibiotic. However, on 96.1% of occasions cefoperazone/sulbactam was given at higher doses than the label instructions. Overall, 73.3% of antibiotics prescribed were “Watch” antibiotics. In addition, the proportion of initial antibiotic regimens that were consistent with current national guidelines was only 4.63%. Conclusions: There were considerable concerns with low adherence rates to current guidelines alongside high rates of prescribing of injectable third-generation cephalosporins due to various internal and external barriers. Antimicrobial stewardship programs with updated national guidelines are urgently needed in Vietnamese hospitals to treat CAP in children as part of ongoing measures to reduce increasing AMR rates. Such activities should also help improve antibiotic use in the community following improved education of trainee ambulatory care physicians regarding appropriate management of children with CAP. Full article

Background/Objectives: Men choosing active surveillance (AS) for low- and intermediate risk prostate cancer (PCa) must weigh its harms and benefits against those of active treatment (AT). To understand factors influencing treatment decision-making (TDM) for and adherence to AS, we performed a systematic review. Methods: This systematic review followed the PRISMA guidelines and was registered with PROSPERO (ID CRD42024490427). A comprehensive search strategy from 1990 to 2024 was executed across multiple databases, including Medline and Embase. Studies were included if they examined factors influencing TDM for AS or active monitoring (AM) and adherence to AS/AM. Results: Of the 8316 articles identified, 223 articles were eligible for inclusion. The decision for AS was influenced by different factors, including comprehensive information about treatment options, social support, and wanting to avoid side-effects. Key reasons to choose AT over AS included a lack of information from healthcare professionals about AS and fear of disease progression. Reasons for adhering to the AS protocol included better quality of life and social support. While non-adherence to the AS protocol is prompted by, e.g., biopsy burden and uncertainty, AS discontinuation is generally a results of medical reasons (namely disease upgrading) or from anxiety and family pressure. Conclusions: Numerous factors influence men’s treatment pathway choices. Involving family members in shared decision-making and ensuring that patients have detailed information about AS as a treatment option could help to improve AS uptake. Addressing psychosocial challenges through education and family involvement could improve AS adherence. These insights can help healthcare providers by addressing men’s needs during TDM and AS. Full article

Background: Glioblastoma (GBM IDH-wildtype WHO 2021) is an aggressive central nervous system malignancy with a poor prognosis despite standard therapy. Integrative oncology approaches involving natural compounds have shown potential in preclinical studies to enhance the efficacy of chemoradiotherapy. Methods: This prospective, longitudinal observational pilot study, lacking a randomized control group, followed 72 newly diagnosed glioblastoma patients (diagnosed by histological examination and MGMT promoter molecular study alone, grade 4 glioma patients) treated with the STUPP protocol. This group could voluntarily opt to receive integrative therapy (IT), which included polydatin, curcumin, and Boswellia serrata, in addition to standard care. Survival outcomes were compared between IT-adherent and non-adherent patients. Multivariate Cox regression was employed to adjust for potential confounders, including age, extent of surgical resection, and corticosteroid use. Results: The median overall survival (OS) for the entire cohort was 13.3 months. Patients who adhered to IT (n = 60) had a median OS of 25.4 months, which increased to 34.4 months for those who underwent gross total resection. The non-IT group (n = 12) exhibited a median OS of 10.6 months. Multivariate analysis confirmed that IT adherence and the extent of resection were independent predictors of prolonged survival (p < 0.05). No severe adverse events were reported with IT. Conclusions: Integrative therapy combining polydatin, curcumin, and Boswellia serrata with standard treatment would appear to be associated with prolonged survival in glioblastoma patients, particularly among those who underwent gross total resection. However, the small size of the control group, the absence of randomization, and the inclusion solely of primary glioblastoma limit the generalizability of these findings. These results underscore the need for further investigation through randomized controlled trials. Full article

Although transplantation remains the gold-standard treatment for patients with end-organ failure, lifelong adherence to immunosuppressant medication is required to prevent rejection, graft failure, and mortality. Given the increase in thoracic organ transplantation, it is crucial to better understand the associated barriers to treatment. Examining sociodemographic, transplant, healthcare access, post-transplant treatment, and patient-related psychosocial factors may help to elucidate treatment barriers that have not been previously considered in the existing literature. This single-site cross-sectional study surveyed 65 thoracic (heart and lung) transplant recipients (mean age: 62 years; 76.2% male; 72.3% White, and 21.5% Black) via phone interviews. Immunosuppressant nonadherence was found in 49.2% of participants (46.9% heart, 51.5% lung). In a four-week period, 20% of participants missed at least one dose, 40% did not take their medications on time, and 1% stopped completely. Significant correlates of nonadherence included poorer diet quality, fewer comorbidities, and maladaptive coping responses to perceived discrimination. This preliminary study highlights the importance of considering the social determinants of health—particularly post-transplant treatment and psychosocial patient-related factors—to inform post-transplant care. Addressing such variables may improve medication adherence and, subsequently, overall health outcomes. Further research with larger samples is needed to better understand the associated correlates and inform effective interventions for enhanced medication adherence. Full article

Background/Objectives: The impact of dietary adherence and regular formula intake on the vitamin levels in individuals with phenylketonuria (PKU) remains unclear. This study aimed to assess the influence of both adherence to dietary management and regular formula intake on the vitamin B12 and folate levels in individuals with PKU. Methods: This cross-sectional multicentre study included 63 patients with PKU aged 12–41 years. The participants were classified as adherent or non-adherent based on their mean plasma phenylalanine levels or as regular or irregular formula consumers. The participants’ vitamin B12 and folate levels were compared across these groups. In addition, a systematic search of PubMed, Web of Science, Scopus, and Cochrane Library identified 11,631 studies comparing vitamin B12 and folate levels between adherent vs. non-adherent patients and regular vs. irregular formula intake groups, of which eight met the inclusion criteria. Analyses were conducted using random-effects and fixed-effects models and effect sizes were expressed as standardised mean differences (SMDs). Results: This cross-sectional study showed significantly higher vitamin B12 and folate levels in adherent vs. non-adherent individuals (767.6 ± 264.5 vs. 524.7 ± 216.4 pg/mL; 13.44 ± 1.96 vs. 10.62 ± 3.36 ng/mL, both p < 0.001) and in regular vs. irregular formula consumers (746.7 ± 228.4 vs. 527.4 ± 281.9 pg/mL; 13.32 ± 2.25 vs. 10.48 ± 3.23 ng/mL, p < 0.0001 and p < 0.001 respectively). The meta-analysis found no significant differences between the adherent and non-adherent groups, which were defined based on their phenylalanine levels, but showed higher vitamin B12 levels (fixed-effects model, SMD: 1.080, 95% CI: 0.754, 1.405, p < 0.0001) and a near-significant trend toward higher folate levels (random-effects model, SMD: 0.729, 95% CI: −0.032, 1.490, p = 0.061) in regular formula consumers. Conclusions: Regular formula intake is a key determinant of vitamin B12 in patients with PKU. These findings highlight the importance of consistent formula use in dietary management and warrant further research. Full article

Antimicrobial resistance arises from treatment non-adherence and ineffective delivery systems. Optimal wound dressings combine localized drug release, exudate management, and bacterial encapsulation through hydrogel-forming nanofibers for enhanced therapy. In this work, polylactic acid (PLA) and polyvinylpyrrolidone (PVP) fibers loaded with chlorhexidine (CHX) were developed using Solution Blow Spinning (SBS), a scalable electrospinning alternative that enables in situ deposition. Molecular interactions between CHX and polymers in solution (by UV-Vis and fluorescence spectroscopy) and in solid state (by FTIR, XRD and thermal analysis) were studied. The morphology of the polymeric fibers was determined by optical microscopy, showing that PVP fibers are thinner (1625 nm) and more uniform than those of PLA (2237 nm). Finally, drug release from single-polymer fibers discs, overlapping fibers discs (PLA/PVP/PLA and PVP/PLA/PVP), and solid dispersions was determined by UV-Vis spectrometry. PVP-based fibers exhibited faster CHX release due to their hydrophilic nature, while PLA fibers proved sustained release, attributed to their hydrophobic matrix. This study highlights the potential of PLA/PVP-CHX fibers made from SBS as advanced wound dressings, combining biocompatibility and personalized drug delivery, offering a promising platform for localized and controlled antibiotic delivery. Full article

The oral microbiome, a highly diverse and intricate ecosystem of microorganisms, plays a pivotal role in the maintenance of systemic health. With the oral cavity housing over 700 different bacterial species, the body’s second most diverse microbial community, periodontal pathogens often lead to the dysregulation of immune responses and consequently, neuropsychiatric disorders. Emerging evidence suggests a significant link between the dysbiosis of oral taxa and the progression of neurogenic disorders such as depression, schizophrenia, bipolar disorders, and more. In this paper, we show the relationship between mental health conditions and shifts in the oral microbiome by highlighting inflammatory responses and neuroactive pathways. The connection between the central nervous system and the oral cavity highlights its role as a modulator of mental health. Clinically, these findings have significant importance as dysbiosis could compromise quality of life. The weight of mental health is often compounded with treatment resistance, non-adherence, and relapse, causing a further need for treatment development. This review seeks to underscore the crucial role of the proposed oral–brain axis in hopes of increasing its presence in future intervention strategies and mental health therapies. Full article

Background/Objectives: This study aims to investigate the influence of demographic, behavioral, anthropometric, and comorbid factors on brain atrophy in people living with HIV (PLWH). Methods: We conducted a cross-sectional study involving 121 HIV-positive patients, stratified into two groups, those with and without brain atrophy (BA). For each participant, we recorded demographic data, smoking status, physical activity levels, disease and treatment duration, and comorbidities. BA was quantitatively assessed using MRI-derived volumetric measurements of 47 cerebral substructures. Results: Patients with BA exhibited significantly reduced gray matter (GM) and white matter (WM) volumes alongside increased cerebrospinal fluid volumes, both in absolute and percentage measurements. WM atrophy was most pronounced in the frontal, parietal, and temporal lobes, with relative sparing of the occipital lobe. GM atrophy predominantly affected the basal ganglia (notably, the thalamus and putamen) and cortical regions, including the hippocampus, frontal, and parietal lobes. Significant positive correlations were observed between BA and both smoking status (pack–years) and disease duration, while physical activity demonstrated an inverse relationship (higher atrophy risk in those with less than 30 min of daily continuous walking). Non-adherence to antiretroviral therapy (ART) was also associated with BA. Among comorbidities, type 2 diabetes and HIV-associated neurocognitive disorders (HAND) showed the strongest associations with BA. Conclusions: Brain atrophy in PWH is correlated with smoking, physical inactivity, and the duration of HIV infection. Comorbid conditions, such as type II diabetes and HAND, amplify the risk for BA. We consider that early lifestyle interventions and optimized ART may mitigate the neurodegeneration process. Full article