Phenol is an important commodity for the chemical industry, used for many processes and deemed to be a major pollutant due its xenobiotic nature and high toxicity. For the purpose of phenol bioremediation a biotechnol...Phenol is an important commodity for the chemical industry, used for many processes and deemed to be a major pollutant due its xenobiotic nature and high toxicity. For the purpose of phenol bioremediation a biotechnological set up consisting of a continuous packed column bioreactor with Candida tropicalis adhered onto activated carbon beads has been previously described. In this work, we show how the integration of available experimental data of such a biotechnological set up into a mathematical model, can lead both to a better comprehension of the underlying physiological mechanisms operating in the cell culture, and to the identification of the system parameters optimum performance. The model so constructed describes the dynamics of phenol uptake and growth rates by the adhered and suspended biomass;the lethality rates;the adhered biomass removal into suspension or adherence onto carbon beads rates and the phenol and biomass (adhered and suspended) concentrations. It also serves to identify different physiological states for the adhered and the suspended biomass;its predictions being verified by comparing with experimental observations. Based on the model description, different optimization strategies are proposed, some of which have been experimentally tested, encompassing changes in bioreactor operation conditions, process development and strain development.展开更多
BACKGROUND Anxiety and depression are prevalent among patients with chronic heart failure(CHF)and can adversely contribute to treatment adherence and clinical outcomes.Poor fluid restriction adherence is a widespread ...BACKGROUND Anxiety and depression are prevalent among patients with chronic heart failure(CHF)and can adversely contribute to treatment adherence and clinical outcomes.Poor fluid restriction adherence is a widespread challenge in the management of CHF.To effectively manage disease progression and alleviate symptoms,it is crucial to identify key influencing factors to facilitate the implementation of targeted interventions.AIM To investigate the status of anxiety and depression among patients with CHF and determine the factors contributing to poor fluid restriction adherence.METHODS Three hundred CHF patients seeking medical treatment at The First Hospital of Hunan University of Traditional Chinese Medicine between June 2021 and June 2023 were included in the study.Questionnaires,including the Psychosomatic Symptom Scale,Self-Rating Anxiety Scale,Self-Rating Depression Scale,and Fluid Restriction Adherence Questionnaire were administered to patients.Based on their anxiety and depression scores,patients were categorized into anxiety/depression and non-anxiety/depression groups,as well as fluid restriction adherence and fluid restriction non-adherence groups.General patient data were collected,and univariate and logistic regression analyses were conducted to determine the occurrence of depression and anxiety.Logistic regression analysis was used to identify independent factors influencing fluid restriction adherence.RESULTS Statistically significant differences in age,New York Heart Association(NYHA)grading,marital status,educational attainment,and family support were observed between depressed and non-depressed CHF patients(P<0.05).Age,NYHA grading,marital status,educational attainment,and family support were identified as factors influencing the development of depression.The anxiety and non-anxiety groups differed statistically in terms of gender,age,NYHA grading,smoking history,alcohol consumption history,monthly income,educational attainment,and family support(P<0.05).Gender,smoking,alcohol consumption,monthly income,and educational attainment affected anxiety in these patients.The fluid restriction adherence rate was 28.0%,and thirst sensation,anxiety,and depression were identified as independent influencing factors.CONCLUSION CHF patients are susceptible to anxiety and depression,with multiple associated influencing factors.Moreover,anxiety and depression are independent factors that can influence fluid restriction adherence in these patients.展开更多
This editorial highlights a recently published study examining the effectiveness of music therapy combined with motivational interviewing(MI)in addressing an-xiety and depression among young and middle-aged patients f...This editorial highlights a recently published study examining the effectiveness of music therapy combined with motivational interviewing(MI)in addressing an-xiety and depression among young and middle-aged patients following percuta-neous coronary intervention.It further explores existing evidence and potential future research directions for MI in postoperative rehabilitation and chronic disease management.MI aims to facilitate behavioral change and promote healthier lifestyles by fostering a trusting relationship with patients and enhan-cing intrinsic motivation.Research has demonstrated its effectiveness in posto-perative recovery for oncological surgery,stroke,organ transplants,and gastroin-testinal procedures,as well as in managing chronic conditions such as diabetes,obesity,and periodontal disease.The approach is patient-centered,adaptable,cost-effective,and easily replicable,though its limitations include reliance on the therapist’s expertise,variability in individual responses,and insufficient long-term follow-up studies.Future research could focus on developing individualized and precise intervention models,exploring applications in digital health management,and confirming long-term outcomes to provide more compre-hensive support for patient rehabilitation.展开更多
BACKGROUND Mesalamine is the recommended first-line treatment for inducing and maintaining remission in mild-to-moderate ulcerative colitis(UC).However,adherence in real-world settings is frequently suboptimal.Encoura...BACKGROUND Mesalamine is the recommended first-line treatment for inducing and maintaining remission in mild-to-moderate ulcerative colitis(UC).However,adherence in real-world settings is frequently suboptimal.Encouraging collaborative patient-provider relationships may foster better adherence and patient outcomes.AIM To quantify the association between patient participation in treatment decisionmaking and adherence to oral mesalamine in UC.METHODS We conducted a 12-month,prospective,non-interventional cohort study at 113 gastroenterology practices in Germany.Eligible patients were aged≥18 years,had a confirmed UC diagnosis,had no prior mesalamine treatment,and provided informed consent.At the first visit,we collected data on demographics,clinical characteristics,patient preference for mesalamine formulation(tablets or granules),and disease knowledge.Self-reported adherence and disease activity were assessed at all visits.Correlation analyses and logistic regression were used to examine associations between adherence and various factors.RESULTS Of the 605 consecutively screened patients,520 were included in the study.The median age was 41 years(range:18-91),with a male-to-female ratio of 1.1:1.0.Approximately 75%of patients reported good adherence at each study visit.In correlation analyses,patient participation in treatment decision-making was significantly associated with better adherence across all visits(P=0.04).In the regression analysis at 12 months,this association was evident among patients who both preferred and received prolonged-release mesalamine granules(odds ratio=2.73,P=0.001).Patients reporting good adherence also experienced significant improvements in disease activity over 12 months(P<0.001).CONCLUSION Facilitating patient participation in treatment decisions and accommodating medication preferences may improve adherence to mesalamine.This may require additional effort but has the potential to improve long-term management of UC.展开更多
HIV-related stigma,discrimination,and other forms of oppression can severely undermine adherence to antiretroviral therapy(ART)among people living with HIV[1].For example,Kerr et al.reveal that perceived discriminatio...HIV-related stigma,discrimination,and other forms of oppression can severely undermine adherence to antiretroviral therapy(ART)among people living with HIV[1].For example,Kerr et al.reveal that perceived discrimination based on sexual orientation in healthcare settings significantly reduces ART adherence[1].This highlights the urgent need for targeted strategies to address stigma,discrimination,and social marginalization,especially within healthcare facilities,to improve HIV care outcomes.展开更多
Objective: Regular cancer screening must be monitored to improve gastric cancer(GC) survival rates and maximize participation. This study examined adherence to regular GC screening over a 10-year period and identified...Objective: Regular cancer screening must be monitored to improve gastric cancer(GC) survival rates and maximize participation. This study examined adherence to regular GC screening over a 10-year period and identified the factors influencing adherence.Methods: This retrospective cohort study was conducted using data from the Korean National Cancer Screening Program(KNCSP) between 2011 and 2020. The total cohort comprised 400,113 adults aged 40 years who were newly eligible for and participated in GC screening in 2011. The participants were followed up for 10 years to assess their adherence to biennial screening recommendations. They were categorized into two groups: the nonregular screening(non-RS) group, which included individuals who did not participate in subsequent screenings, and the regular screening(RS) group, which included those who participated in at least one follow-up screening.Multiple logistic regression analyses were performed to identify the factors associated with adherence to regular GC screening.Results: Over 10 years, 59% of the participants completed at least four of the five recommended screenings,while 10% did not participate after their initial screening. Male participants had higher odds of non-adherence than females [adjusted odds ratio(aOR)=1.429, 95% confidence interval(95% CI): 1.394-1.464;P<0.001]. Nonadherence was more prevalent among self-employed individuals(aOR=1.208, P<0.001). Among males, those in the lowest income group were 1.267 times more likely to not undergo regular screening than those in the highest income group.Conclusions: Long-term adherence to regular GC screening in South Korea remains suboptimal.Socioeconomic disparities persist, highlighting the need for tailored interventions to improve adherence and enhance public health.展开更多
Objective: To assess antiretroviral therapy (ART) adherence rates and associated factors among people living with HIV in Vietnam. Methods: A cross-sectional study was conducted at the Hospital for Tropical Diseases, H...Objective: To assess antiretroviral therapy (ART) adherence rates and associated factors among people living with HIV in Vietnam. Methods: A cross-sectional study was conducted at the Hospital for Tropical Diseases, Ho Chi Minh City from June to August 2022. Data were collected from 347 people living with HIV using structured questionnaires assessing sociodemographics, substance use, drug side effects, treatment beliefs, treatment satisfaction, and depression. ART adherence was evaluated using a multi-method tool, including self-report, pill count, the Provider Interview Tool, and the Visual Analog Scale. Participants were classified as having high adherence only if they met all four criteria across these methods. Multivariable logistic regression was used to identify factors influencing adherence, with significance set at P<0.05. Results: High ART adherence was observed in 69.5% of the participants. Adherence was significantly lower among tobacco users (OR 0.49, 95% CI 0.30-0.83, P=0.007), those with higher depression scores (per 1-point increase) (OR 0.89, 95% CI 0.84-0.95, P<0.001), frequent substance users (OR 0.50, 95% CI 0.30-0.83, P=0.007), and those experiencing more severe drug side effects (per level increase) (OR 0.64, 95% CI 0.45-0.92, P=0.016). Participants able to afford treatment had nearly three times higher odds of adherence than those unable to pay (OR 2.85, 95% CI 1.48-5.47, P=0.002). Conclusions: ART adherence among people living with HIV in Vietnam remains suboptimal. Interventions should target substance use, drug side effects, financial barriers, and depression screening to improve adherence.展开更多
Introduction:Heart rate variability(HRV),defined as fluctuations in the time intervals between successive heartbeats,was generated by the sinoatrial node and modulated by the autonomic nervous system(ANS).HRV emerged ...Introduction:Heart rate variability(HRV),defined as fluctuations in the time intervals between successive heartbeats,was generated by the sinoatrial node and modulated by the autonomic nervous system(ANS).HRV emerged as a prognostic marker in chronic heart failure(CHF),particularly for mortality risk assessment in Western countries.This study aimed to evaluate the utility of HRV measurement in the follow-up of CHF patients in a sub-Saharan African context.Methods:We conducted a cross-sectional,descriptive,and analytical study during six months,in the cardiology departments of the YaoundéGeneral Hospital(HGY)and the YaoundéCentral Hospital(HCY).Eligible participants were adults with a confirmed diagnosis of CHF based on clinical,echocardiographic and electrocardiographic criteria,who had been on treatment for at least three months and provided informed consent.Exclusion criteria included atrial disease,non-sinus rhythm(atrial fibrillation,atrial flutter),loss to follow-up,and death.Consecutive sampling was applied.HRV recordings were obtained twice at a two-month interval using a Polar H10^(®)heart rate monitor connected via Bluetooth to the Elite HRV application installed on an iPhone 12 Pro Max.SDNN was the standard deviation of all normal-to-normal(NN)intervals,and RMSSD was Root Mean Square of Successive Differences.HF(High Frequency,0.15-0.40 Hz)corresponds to respiratory sinus arrhythmia;R-R intervals were recorded at rest for 5 minutes.Treat ment adherence was assessed and its relationship to HRV was explored.Data were entered using CS Pro^(®)7.0 and analyzed with SPSS^(®)23.Results:Thirtyone patients were included,with a median age of 64 years;women accounted for 54.8%of the sample.The most prevalent cardiovascular risk factors were dyslipidemia(38.7%)and alcohol consumption(34.6%).The leading etiologies of CHF were hypertensive cardiomyopathy and dilated cardiomyopathy,each representing 54.8%of cases.Left ventricular failure was present in 74.2%,and 61.3%had a left ventricular ejection fraction(LVEF)<40%.The most commonly prescribed medications were ACE inhibitors(80.6%),beta-blockers(77.4%),and loop diuretics(77.4%).Non-adherence to treatment was reported in 45.2%(14/31)of participants.Patients with good adherence demonstrated significantly higher HRV indices at both time points,including SDNN[46.7(37.3-54.4)ms;p<0.050],RMSSD[58.6(49.5-78.9)ms;p<0.010],and HF power[708.2(417.2-1020.0)ms^(2);p=0.040].Factors associated with HRV impairment found a borderline association with BMI:overweight/obese patients tended to have higher odds of HRV impairment(OR=1.7,95%CI:0.4-7.4,p=0.052);age≤60 years(OR=0.8,95%CI:0.4-8.1,p<0.044)and Beta-blocker(OR=0.5,95%CI:0.1-2.5,p=0.030)use was associated with a lower risk of HRV alteration.Treatment with good adherence showed a significant association linked to a lower risk of HRV impairment(OR=0.2,95%CI:0.0-1.3).Conclusion:This study confirms the potential of HRV as a complementary tool for the follow-up of CHF patients.HRV indices,particularly regarding young age,good weight and combined with treatment adherence assessment,may provide a cost-effective,non-invasive method to improve CHF management in resource-limited settings.展开更多
A recent study by Sala-Miquel et al investigated the diagnostic effectiveness of follow-up strategies in patients with non-metastatic colorectal cancer(CRC)after surgical resection.This research highlighted the signif...A recent study by Sala-Miquel et al investigated the diagnostic effectiveness of follow-up strategies in patients with non-metastatic colorectal cancer(CRC)after surgical resection.This research highlighted the significance of using computed tomography(CT),colonoscopy,and tumor markers for the early detection of recurrence or metastasis.The findings indicated that strict adherence to follow-up protocols can contribute to decreased mortality rates among these patients.However,the study has several limitations that must be considered.It was retrospective and conducted at a single center,which may affect the generalizability of the results.Further,the absence of a control group and the exclusion of stage IV patients limit the study's applicability.Methodological issues,including insufficient adjustment for confounding variables,a lack of sensitivity analyses,and limitations in time-dependent covariate analysis,further constrain the conclusions'robustness.Moreover,while the study emphasizes the role of CT scans,it does not adequately address their potential risks and underrepresents the importance of colonoscopy.Future research should focus on multicenter,prospective studies that integrate personalized follow-up approaches and explore innovative technologies to enhance the efficacy of follow-up strategies in CRC management.By addressing these limitations,researchers can improve the applicability and impact of follow-up strategies in the care of CRC patients.展开更多
Objective:To investigate the impact of progressive effect nutritional care on uremia patients undergoing dialysis.Methods:A total of 101 uremia patients undergoing dialysis admitted from January 2024 to March 2025 wer...Objective:To investigate the impact of progressive effect nutritional care on uremia patients undergoing dialysis.Methods:A total of 101 uremia patients undergoing dialysis admitted from January 2024 to March 2025 were selected as the study subjects and divided into two groups by lottery method.The control group(55 cases)received routine care,while the observation group(56 cases)received a combination of routine care and progressive effect nutritional care.Results:After 4 weeks of care,the observation group demonstrated higher treatment adherence(P<0.05),better quality of life(P<0.05),and improved nutritional status(P<0.05)compared to the control group.Conclusion:Progressive effect nutritional care can significantly enhance treatment adherence,quality of life,and nutritional status in uremia patients undergoing dialysis.展开更多
Resilience-the dynamic capacity to maintain or restore mental and physical health in the face of adversity-has been linked to improved treatment adherence,reduced psychological distress,and enhanced long-term recovery...Resilience-the dynamic capacity to maintain or restore mental and physical health in the face of adversity-has been linked to improved treatment adherence,reduced psychological distress,and enhanced long-term recovery in patients confronting serious illnesses such as cancer.Psychosocial resources(e.g.,social support,peer-led groups)and neurobiological mechanisms(e.g.,Hypothalamic-Pituitary-Adrenal axis modulation,neural plasticity)interact to buffer the physiological and emotional impact of diagnosis and therapy.Interventions including cognitive-behavioural therapy,mindfulness-based stress reduction,and digitally delivered programs demonstrate moderate-to-large effect sizes(Hedges'g 0.33-1.45)in strengthening resilience and improving quality of life.However,inconsistent terminology,the absence of standardized,multidimensional assessment tools,and logistical challenges in implementation limit widespread adoption.We advocate for a unified resilience framework that integrates psychometric scales,biomarker assays,and real-time digital monitoring;the embedding of resilience-promoting strategies within multidisciplinary care pathways;and the alignment of policy support and reimbursement models to sustain these efforts.Longitudinal,multicenter trials and culturally sensitive adaptation will be essential to validate scalable models,ensuring that resilience becomes a fundamental pillar of compassionate,patient-centered care.展开更多
BACKGROUND Diabetic ketoacidosis(DKA)remains a serious and potentially preventable complication among children with type 1 diabetes mellitus(T1DM),particularly in Saudi Arabia.Psychological constructs such as perceive...BACKGROUND Diabetic ketoacidosis(DKA)remains a serious and potentially preventable complication among children with type 1 diabetes mellitus(T1DM),particularly in Saudi Arabia.Psychological constructs such as perceived severity and susceptibility influence health behaviour,yet their role in pediatric diabetes management remains underexplored.AIM To examine psychological predictors of DKA in children with T1DM using the health belief model,and to assess the role of caregiver-perceived understanding in influencing adherence and DKA occurrence.METHODS A case-control study was conducted at Prince Sultan Military Medical City in Riyadh,Saudi Arabia,involving 191 caregivers of children with T1DM(96 cases with a history of DKA and 95 controls without).Validated questionnaires measured perceived severity,susceptibility,understanding,and adherence.Statistical analyses included independent t-tests,Pearson and Spearman correlations,and multiple regression.RESULTS Perceived understanding was the strongest predictor of adherence(β=1.03,P<0.001)and was inversely associated with DKA occurrence(P<0.001).Children without a DKA history had significantly higher levels of perceived understanding and adherence.Perceived severity had a moderate positive association with adherence,while perceived susceptibility showed a weak negative correlation.CONCLUSION Caregiver-perceived understanding plays a critical role in adherence and DKA prevention.These findings support expanding the health belief model to include perceived understanding as a distinct construct and highlight the importance of integrating comprehension-focused strategies into pediatric diabetes education.展开更多
Patients with cardiovascular disease rely on medication to achieve favorable longterm clinical results.Poor adherence has been linked to a relative increase in mortality of 50%-80%as well as higher health care costs.T...Patients with cardiovascular disease rely on medication to achieve favorable longterm clinical results.Poor adherence has been linked to a relative increase in mortality of 50%-80%as well as higher health care costs.This scoping review thus aimed to explore the evidence of the effects of mobile health care apps on medication adherence in patients with cardiovascular diseases.A comprehensive data search and extraction was done in line with the updated Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist.A total of 10 studies were included for the review.The mean pooled improvement in adherence was found to be 18%and the most effective tool was the digital therapeutics app discussed in Li et al’s study.Smartphones and apps enhance coronary artery disease management by promoting medication compliance.Challenges include data security and smartphone usage among the elderly.Tailored apps or voice assistants offer potential solutions.展开更多
BACKGROUND Despite therapeutic benefits,discontinuation of tirzepatide is common in randomized controlled trials(RCTs)due to adverse events(AEs)and other causes.No previous systematic reviews have explored the reasons...BACKGROUND Despite therapeutic benefits,discontinuation of tirzepatide is common in randomized controlled trials(RCTs)due to adverse events(AEs)and other causes.No previous systematic reviews have explored the reasons for discontinuing tirzepatide in the RCTs.AIM To explore the reasons for permanent discontinuation of tirzepatide vs controls[placebo,insulin,and glucagon-like peptide-1 receptor agonists(GLP-1Ras)]in RCTs.METHODS Relevant RCTs were systematically searched using related terms through multiple databases such as MEDLINE(via PubMed),Scopus,Cochrane Central Register,and ClinicalTrials.gov from their inception until June 20,2024.RevMan web was used to conduct meta-analysis using random-effects models.Outcomes were presented as risk ratios(RR)with 95%confidence intervals(CI).RESULTS Seventeen RCTs(n=14645),mostly having low risks of bias,were analyzed.Compared to placebo,the risk of permanent discontinuation of the study drug was substantially lower with tirzepatide 10 mg(RR:0.69,95%CI:0.51-0.93,P=0.02)and similar with tirzepatide 5 mg(RR:0.74,95%CI:0.47-1.17,P=0.20)and 15 mg(RR:0.94,95%CI:0.68-1.31,P=0.71).Tirzepatide had identical discontinuation risks when compared to insulin at 5 mg(RR:0.96,95%CI:0.75-1.24,P=0.77)and 10 mg(RR:1.19,95%CI:0.77-1.82,P=0.44)doses,whereas such risk was higher with tirzepatide 15 mg than insulin(RR:1.31,95%CI:1.03-1.67,P=0.03).Compared to GLP-1RA,the permanent discontinuation risk was similar with tirzepatide 5 mg(RR:0.98,95%CI:0.70-1.37,P=0.90)but was higher with tirzepatide 10 mg(RR:1.40,95%CI:1.03-1.90,P=0.03)and 15 mg(RR:1.70,95%CI:1.27-2.27,P=0.0004).Tirzepatide,at all doses,had higher risks of AE-related discontinuation than insulin;such risks were only greater with higher doses of tirzepatide than with placebo or GLP-1RA.Discontinuation risk due to withdrawal by the study subjects was lower with tirzepatide than with placebo or insulin.Compared to the placebo,tirzepatide(all doses)conferred a lower risk of study drug discontinuation due to other causes not specifically mentioned.CONCLUSION The discontinuation risk is not higher in tirzepatide group than in the placebo arm.Many factors other than AEs led to drug discontinuation in the included RCTs.展开更多
BACKGROUND Post-procedural psychological disorders are frequently overlooked in elderly patients undergoing percutaneous coronary intervention(PCI),despite their potential impact on long-term cardiovascular outcomes.A...BACKGROUND Post-procedural psychological disorders are frequently overlooked in elderly patients undergoing percutaneous coronary intervention(PCI),despite their potential impact on long-term cardiovascular outcomes.AIM To evaluate the incidence and prognostic significance of post-PCI psychological disorders in elderly patients with heart failure,and to examine their association with medication adherence and major adverse cardiovascular events(MACE).METHODS This retrospective cohort study included 330 consecutive patients aged≥60 years with heart failure who underwent PCI between 2018 and 2021 at a single center,excluding those with prior psychiatric diagnoses.Psychological status within six months post-discharge was assessed using validated Chinese versions of the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder Scale,and medication adherence was measured by the 8-item Morisky Medication Adherence Scale(MMAS-8)scale.A subset of 145 patients with≥24 months of follow-up were analyzed for MACEs.Multivariate logistic regression and Kaplan-Meier survival analyses were performed.RESULTS Post-PCI psychological disorders were identified in 40%of patients,with anxiety(36%),depression(32%),and comorbid symptoms(22%)being most prevalent.Affected patients had lower MMAS-8 scores[median 5(IQR 4-6)vs 6(IQR 5-7),P=0.002]and a higher rate of low adherence(51.5%vs 30.3%,P<0.001).Among the 145 patients followed longitudinally,MACEs occurred in 17.9%,with 65.4%of events in those with psychological disorders.Psychological disorders(OR=2.66,95% CI:1.11-6.41,P=0.028)and low adherence(OR=2.77,95% CI:1.17-6.56,P=0.021)were independently associated with increased MACE risk.Kaplan-Meier analysis showed reduced MACE-free survival in patients with psychological disorders(HR=2.68,95%CI:1.25-5.73;log-rank P=0.008).CONCLUSION Post-PCI psychological disorders are common in elderly patients with heart failure and independently predict poorer adherence and worse cardiovascular outcomes.Routine psychological assessment and adherence interventions may improve prognosis in this vulnerable population.展开更多
This minireview focuses on psychological distress and treatment adherence-issues in patients with chronic hepatitis B(CHB).It begins by discussing the epidemiology and disease burden of CHB,and addresses the relations...This minireview focuses on psychological distress and treatment adherence-issues in patients with chronic hepatitis B(CHB).It begins by discussing the epidemiology and disease burden of CHB,and addresses the relationship between psychological distress and treatment adherence.Next,it delves into the current status and risk factors for psychological distress among patients with CHB,and explores the challenges and risk factors related to treatment adherence.Subsequently,it explores the development and implementation of integrated nursing strategies,including psychological interventions and support,self-efficacy enhancement strategies,social support-system optimization,personalized medical care,and technological innovation.Finally,it highlights the limitations of current interventions and clarifies future research priorities.This minireview aims to provide a comprehensive theoretical basis and practical guidance for improving treatment outcomes and quality of life of patients with CHB.In summary,we reveal that psychological distress significantly impacts treatment adherence in patients with CHB and that it is essential to adopt integrated nursing strategies to address these challenges.These findings highlight the need to consider the psychological states of individuals and develop targeted interventions to improve treatment outcomes.展开更多
Introduction Percutaneous coronary intervention(PCI),as a primary treatment for coronary artery disease,has made significant strides in both technology and clinical practice since its inception.However,long-term manag...Introduction Percutaneous coronary intervention(PCI),as a primary treatment for coronary artery disease,has made significant strides in both technology and clinical practice since its inception.However,long-term management of post-PCI patients,particularly restenosis prevention and disease progression control,continues to face numerous challenges[1].Insufficient patient adherence to lifestyle interventions and secondary prevention,coupled with low utilization of cardiac rehabilitation,leads to a sustained increase in the risk of postoperative adverse cardiac events[2,3].The rapid development of digital health technologies(DHTs)offers opportunities to overcome these persistent difficulties.This editorial reviewed the latest applications and multiple challenges,and suggested future directions of DHTs in post-PCI patients(Figure 1).展开更多
BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is the most common liver disease worldwide,affecting about 1/4th of the global population and causing a huge global economic burden.To date,no drugs have been approve...BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is the most common liver disease worldwide,affecting about 1/4th of the global population and causing a huge global economic burden.To date,no drugs have been approved for the treatment of NAFLD,making the correction of unhealthy lifestyles the principle method of treatment.Identifying patients with poor adherence to lifestyle correction and attempting to improve their adherence are therefore very important.AIM To develop and validate a scale that can rapidly assess the adherence of patients with NAFLD to lifestyle interventions.METHODS The Exercise and Diet Adherence Scale(EDAS)was designed based on com-pilation using the Delphi method,and its reliability was subsequently evaluated.Demographic and laboratory indicators were measured,and patients completed the EDAS questionnaire at baseline and after 6 months.The efficacy of the EDAS was evaluated in the initial cohort.Subsequently,the efficacy of the EDAS was internally verified in a validation cohort.RESULTS The EDAS consisted of 33 items in six dimensions,with a total of 165 points.Total EDAS score correlated significantly with daily number of exercise and daily reduction in calorie intake(P<0.05 each),but not with overall weight loss.A total score of 116 was excellent in predicting adherence to daily reduction in calorie intake(>500 kacl/d),(sensitivity/specificity was 100.0%/75.8%),while patients score below 97 could nearly rule out the possibility of daily exercise(sensitivity/specificity was 89.5%/44.4%).Total EDAS scores≥116,97-115,and<97 points were indicative of good,average,and poor adherence,respectively,to diet and exercise recommendations.CONCLUSION The EDAS can reliably assess the adherence of patients with NAFLD to lifestyle interventions and have clinical application in this population.展开更多
Non-alcoholic fatty liver disease(NAFLD)is characterized by symptoms of excessive fat accumulation and steatosis in the liver without alcohol intake in patients.The associated pathogenic mechanism is not completely un...Non-alcoholic fatty liver disease(NAFLD)is characterized by symptoms of excessive fat accumulation and steatosis in the liver without alcohol intake in patients.The associated pathogenic mechanism is not completely understood and there are no specific drugs for patients with NAFLD.Exercise and diet adherence are the best options for the management of NAFLD patients.Questionnaire associated analysis models of adherence to these interventions are used to assess their effectiveness in the management of NAFLD patients using specificity,sensitivity,and so on.Studies have indicated that the relative ratio of NAFLD can be reduced by physical activity with diet control.In the future,the pathogenesis of NAFLD should be clarified with stratified efforts to develop appropriate drugs,and both exercise and diet adherence should be optimized using better questionnaire design and evaluation models for patients with NAFLD.展开更多
文摘Phenol is an important commodity for the chemical industry, used for many processes and deemed to be a major pollutant due its xenobiotic nature and high toxicity. For the purpose of phenol bioremediation a biotechnological set up consisting of a continuous packed column bioreactor with Candida tropicalis adhered onto activated carbon beads has been previously described. In this work, we show how the integration of available experimental data of such a biotechnological set up into a mathematical model, can lead both to a better comprehension of the underlying physiological mechanisms operating in the cell culture, and to the identification of the system parameters optimum performance. The model so constructed describes the dynamics of phenol uptake and growth rates by the adhered and suspended biomass;the lethality rates;the adhered biomass removal into suspension or adherence onto carbon beads rates and the phenol and biomass (adhered and suspended) concentrations. It also serves to identify different physiological states for the adhered and the suspended biomass;its predictions being verified by comparing with experimental observations. Based on the model description, different optimization strategies are proposed, some of which have been experimentally tested, encompassing changes in bioreactor operation conditions, process development and strain development.
基金Huxiang TCM Physique Intervention Clinical Research Center,No.2023SK4061Traditional Chinese Medicine Research Project of Hunan Province,No.B2023065+4 种基金Hunan Province"14th Five-Year Plan"key specialty of TCM,No.[2023]4Hunan University of Chinese Medicine and Hospital Joint Foundation,No.2023XYLH019 and 2024XYLH365R&D Plan for Key Areas of Hunan Provincial Department of Science and Technology,No.2019SK2321Excellent Youth Program of Hunan Education Department,No.24B0346Hunan Provincial Natural Science Foundation for Young Scientists,No.2025JJ60626.
文摘BACKGROUND Anxiety and depression are prevalent among patients with chronic heart failure(CHF)and can adversely contribute to treatment adherence and clinical outcomes.Poor fluid restriction adherence is a widespread challenge in the management of CHF.To effectively manage disease progression and alleviate symptoms,it is crucial to identify key influencing factors to facilitate the implementation of targeted interventions.AIM To investigate the status of anxiety and depression among patients with CHF and determine the factors contributing to poor fluid restriction adherence.METHODS Three hundred CHF patients seeking medical treatment at The First Hospital of Hunan University of Traditional Chinese Medicine between June 2021 and June 2023 were included in the study.Questionnaires,including the Psychosomatic Symptom Scale,Self-Rating Anxiety Scale,Self-Rating Depression Scale,and Fluid Restriction Adherence Questionnaire were administered to patients.Based on their anxiety and depression scores,patients were categorized into anxiety/depression and non-anxiety/depression groups,as well as fluid restriction adherence and fluid restriction non-adherence groups.General patient data were collected,and univariate and logistic regression analyses were conducted to determine the occurrence of depression and anxiety.Logistic regression analysis was used to identify independent factors influencing fluid restriction adherence.RESULTS Statistically significant differences in age,New York Heart Association(NYHA)grading,marital status,educational attainment,and family support were observed between depressed and non-depressed CHF patients(P<0.05).Age,NYHA grading,marital status,educational attainment,and family support were identified as factors influencing the development of depression.The anxiety and non-anxiety groups differed statistically in terms of gender,age,NYHA grading,smoking history,alcohol consumption history,monthly income,educational attainment,and family support(P<0.05).Gender,smoking,alcohol consumption,monthly income,and educational attainment affected anxiety in these patients.The fluid restriction adherence rate was 28.0%,and thirst sensation,anxiety,and depression were identified as independent influencing factors.CONCLUSION CHF patients are susceptible to anxiety and depression,with multiple associated influencing factors.Moreover,anxiety and depression are independent factors that can influence fluid restriction adherence in these patients.
文摘This editorial highlights a recently published study examining the effectiveness of music therapy combined with motivational interviewing(MI)in addressing an-xiety and depression among young and middle-aged patients following percuta-neous coronary intervention.It further explores existing evidence and potential future research directions for MI in postoperative rehabilitation and chronic disease management.MI aims to facilitate behavioral change and promote healthier lifestyles by fostering a trusting relationship with patients and enhan-cing intrinsic motivation.Research has demonstrated its effectiveness in posto-perative recovery for oncological surgery,stroke,organ transplants,and gastroin-testinal procedures,as well as in managing chronic conditions such as diabetes,obesity,and periodontal disease.The approach is patient-centered,adaptable,cost-effective,and easily replicable,though its limitations include reliance on the therapist’s expertise,variability in individual responses,and insufficient long-term follow-up studies.Future research could focus on developing individualized and precise intervention models,exploring applications in digital health management,and confirming long-term outcomes to provide more compre-hensive support for patient rehabilitation.
文摘BACKGROUND Mesalamine is the recommended first-line treatment for inducing and maintaining remission in mild-to-moderate ulcerative colitis(UC).However,adherence in real-world settings is frequently suboptimal.Encouraging collaborative patient-provider relationships may foster better adherence and patient outcomes.AIM To quantify the association between patient participation in treatment decisionmaking and adherence to oral mesalamine in UC.METHODS We conducted a 12-month,prospective,non-interventional cohort study at 113 gastroenterology practices in Germany.Eligible patients were aged≥18 years,had a confirmed UC diagnosis,had no prior mesalamine treatment,and provided informed consent.At the first visit,we collected data on demographics,clinical characteristics,patient preference for mesalamine formulation(tablets or granules),and disease knowledge.Self-reported adherence and disease activity were assessed at all visits.Correlation analyses and logistic regression were used to examine associations between adherence and various factors.RESULTS Of the 605 consecutively screened patients,520 were included in the study.The median age was 41 years(range:18-91),with a male-to-female ratio of 1.1:1.0.Approximately 75%of patients reported good adherence at each study visit.In correlation analyses,patient participation in treatment decision-making was significantly associated with better adherence across all visits(P=0.04).In the regression analysis at 12 months,this association was evident among patients who both preferred and received prolonged-release mesalamine granules(odds ratio=2.73,P=0.001).Patients reporting good adherence also experienced significant improvements in disease activity over 12 months(P<0.001).CONCLUSION Facilitating patient participation in treatment decisions and accommodating medication preferences may improve adherence to mesalamine.This may require additional effort but has the potential to improve long-term management of UC.
文摘HIV-related stigma,discrimination,and other forms of oppression can severely undermine adherence to antiretroviral therapy(ART)among people living with HIV[1].For example,Kerr et al.reveal that perceived discrimination based on sexual orientation in healthcare settings significantly reduces ART adherence[1].This highlights the urgent need for targeted strategies to address stigma,discrimination,and social marginalization,especially within healthcare facilities,to improve HIV care outcomes.
基金supported by the National R&D Program for Cancer Control through the National Cancer Center funded by the Ministry of Health & Welfare, Republic of Korea (No. HA21C0225)。
文摘Objective: Regular cancer screening must be monitored to improve gastric cancer(GC) survival rates and maximize participation. This study examined adherence to regular GC screening over a 10-year period and identified the factors influencing adherence.Methods: This retrospective cohort study was conducted using data from the Korean National Cancer Screening Program(KNCSP) between 2011 and 2020. The total cohort comprised 400,113 adults aged 40 years who were newly eligible for and participated in GC screening in 2011. The participants were followed up for 10 years to assess their adherence to biennial screening recommendations. They were categorized into two groups: the nonregular screening(non-RS) group, which included individuals who did not participate in subsequent screenings, and the regular screening(RS) group, which included those who participated in at least one follow-up screening.Multiple logistic regression analyses were performed to identify the factors associated with adherence to regular GC screening.Results: Over 10 years, 59% of the participants completed at least four of the five recommended screenings,while 10% did not participate after their initial screening. Male participants had higher odds of non-adherence than females [adjusted odds ratio(aOR)=1.429, 95% confidence interval(95% CI): 1.394-1.464;P<0.001]. Nonadherence was more prevalent among self-employed individuals(aOR=1.208, P<0.001). Among males, those in the lowest income group were 1.267 times more likely to not undergo regular screening than those in the highest income group.Conclusions: Long-term adherence to regular GC screening in South Korea remains suboptimal.Socioeconomic disparities persist, highlighting the need for tailored interventions to improve adherence and enhance public health.
文摘Objective: To assess antiretroviral therapy (ART) adherence rates and associated factors among people living with HIV in Vietnam. Methods: A cross-sectional study was conducted at the Hospital for Tropical Diseases, Ho Chi Minh City from June to August 2022. Data were collected from 347 people living with HIV using structured questionnaires assessing sociodemographics, substance use, drug side effects, treatment beliefs, treatment satisfaction, and depression. ART adherence was evaluated using a multi-method tool, including self-report, pill count, the Provider Interview Tool, and the Visual Analog Scale. Participants were classified as having high adherence only if they met all four criteria across these methods. Multivariable logistic regression was used to identify factors influencing adherence, with significance set at P<0.05. Results: High ART adherence was observed in 69.5% of the participants. Adherence was significantly lower among tobacco users (OR 0.49, 95% CI 0.30-0.83, P=0.007), those with higher depression scores (per 1-point increase) (OR 0.89, 95% CI 0.84-0.95, P<0.001), frequent substance users (OR 0.50, 95% CI 0.30-0.83, P=0.007), and those experiencing more severe drug side effects (per level increase) (OR 0.64, 95% CI 0.45-0.92, P=0.016). Participants able to afford treatment had nearly three times higher odds of adherence than those unable to pay (OR 2.85, 95% CI 1.48-5.47, P=0.002). Conclusions: ART adherence among people living with HIV in Vietnam remains suboptimal. Interventions should target substance use, drug side effects, financial barriers, and depression screening to improve adherence.
文摘Introduction:Heart rate variability(HRV),defined as fluctuations in the time intervals between successive heartbeats,was generated by the sinoatrial node and modulated by the autonomic nervous system(ANS).HRV emerged as a prognostic marker in chronic heart failure(CHF),particularly for mortality risk assessment in Western countries.This study aimed to evaluate the utility of HRV measurement in the follow-up of CHF patients in a sub-Saharan African context.Methods:We conducted a cross-sectional,descriptive,and analytical study during six months,in the cardiology departments of the YaoundéGeneral Hospital(HGY)and the YaoundéCentral Hospital(HCY).Eligible participants were adults with a confirmed diagnosis of CHF based on clinical,echocardiographic and electrocardiographic criteria,who had been on treatment for at least three months and provided informed consent.Exclusion criteria included atrial disease,non-sinus rhythm(atrial fibrillation,atrial flutter),loss to follow-up,and death.Consecutive sampling was applied.HRV recordings were obtained twice at a two-month interval using a Polar H10^(®)heart rate monitor connected via Bluetooth to the Elite HRV application installed on an iPhone 12 Pro Max.SDNN was the standard deviation of all normal-to-normal(NN)intervals,and RMSSD was Root Mean Square of Successive Differences.HF(High Frequency,0.15-0.40 Hz)corresponds to respiratory sinus arrhythmia;R-R intervals were recorded at rest for 5 minutes.Treat ment adherence was assessed and its relationship to HRV was explored.Data were entered using CS Pro^(®)7.0 and analyzed with SPSS^(®)23.Results:Thirtyone patients were included,with a median age of 64 years;women accounted for 54.8%of the sample.The most prevalent cardiovascular risk factors were dyslipidemia(38.7%)and alcohol consumption(34.6%).The leading etiologies of CHF were hypertensive cardiomyopathy and dilated cardiomyopathy,each representing 54.8%of cases.Left ventricular failure was present in 74.2%,and 61.3%had a left ventricular ejection fraction(LVEF)<40%.The most commonly prescribed medications were ACE inhibitors(80.6%),beta-blockers(77.4%),and loop diuretics(77.4%).Non-adherence to treatment was reported in 45.2%(14/31)of participants.Patients with good adherence demonstrated significantly higher HRV indices at both time points,including SDNN[46.7(37.3-54.4)ms;p<0.050],RMSSD[58.6(49.5-78.9)ms;p<0.010],and HF power[708.2(417.2-1020.0)ms^(2);p=0.040].Factors associated with HRV impairment found a borderline association with BMI:overweight/obese patients tended to have higher odds of HRV impairment(OR=1.7,95%CI:0.4-7.4,p=0.052);age≤60 years(OR=0.8,95%CI:0.4-8.1,p<0.044)and Beta-blocker(OR=0.5,95%CI:0.1-2.5,p=0.030)use was associated with a lower risk of HRV alteration.Treatment with good adherence showed a significant association linked to a lower risk of HRV impairment(OR=0.2,95%CI:0.0-1.3).Conclusion:This study confirms the potential of HRV as a complementary tool for the follow-up of CHF patients.HRV indices,particularly regarding young age,good weight and combined with treatment adherence assessment,may provide a cost-effective,non-invasive method to improve CHF management in resource-limited settings.
文摘A recent study by Sala-Miquel et al investigated the diagnostic effectiveness of follow-up strategies in patients with non-metastatic colorectal cancer(CRC)after surgical resection.This research highlighted the significance of using computed tomography(CT),colonoscopy,and tumor markers for the early detection of recurrence or metastasis.The findings indicated that strict adherence to follow-up protocols can contribute to decreased mortality rates among these patients.However,the study has several limitations that must be considered.It was retrospective and conducted at a single center,which may affect the generalizability of the results.Further,the absence of a control group and the exclusion of stage IV patients limit the study's applicability.Methodological issues,including insufficient adjustment for confounding variables,a lack of sensitivity analyses,and limitations in time-dependent covariate analysis,further constrain the conclusions'robustness.Moreover,while the study emphasizes the role of CT scans,it does not adequately address their potential risks and underrepresents the importance of colonoscopy.Future research should focus on multicenter,prospective studies that integrate personalized follow-up approaches and explore innovative technologies to enhance the efficacy of follow-up strategies in CRC management.By addressing these limitations,researchers can improve the applicability and impact of follow-up strategies in the care of CRC patients.
文摘Objective:To investigate the impact of progressive effect nutritional care on uremia patients undergoing dialysis.Methods:A total of 101 uremia patients undergoing dialysis admitted from January 2024 to March 2025 were selected as the study subjects and divided into two groups by lottery method.The control group(55 cases)received routine care,while the observation group(56 cases)received a combination of routine care and progressive effect nutritional care.Results:After 4 weeks of care,the observation group demonstrated higher treatment adherence(P<0.05),better quality of life(P<0.05),and improved nutritional status(P<0.05)compared to the control group.Conclusion:Progressive effect nutritional care can significantly enhance treatment adherence,quality of life,and nutritional status in uremia patients undergoing dialysis.
文摘Resilience-the dynamic capacity to maintain or restore mental and physical health in the face of adversity-has been linked to improved treatment adherence,reduced psychological distress,and enhanced long-term recovery in patients confronting serious illnesses such as cancer.Psychosocial resources(e.g.,social support,peer-led groups)and neurobiological mechanisms(e.g.,Hypothalamic-Pituitary-Adrenal axis modulation,neural plasticity)interact to buffer the physiological and emotional impact of diagnosis and therapy.Interventions including cognitive-behavioural therapy,mindfulness-based stress reduction,and digitally delivered programs demonstrate moderate-to-large effect sizes(Hedges'g 0.33-1.45)in strengthening resilience and improving quality of life.However,inconsistent terminology,the absence of standardized,multidimensional assessment tools,and logistical challenges in implementation limit widespread adoption.We advocate for a unified resilience framework that integrates psychometric scales,biomarker assays,and real-time digital monitoring;the embedding of resilience-promoting strategies within multidisciplinary care pathways;and the alignment of policy support and reimbursement models to sustain these efforts.Longitudinal,multicenter trials and culturally sensitive adaptation will be essential to validate scalable models,ensuring that resilience becomes a fundamental pillar of compassionate,patient-centered care.
基金Supported by the Ongoing Research Funding Program at King Saud University,Riyadh,Saudi Arabia,No.ORF-2025-1315.
文摘BACKGROUND Diabetic ketoacidosis(DKA)remains a serious and potentially preventable complication among children with type 1 diabetes mellitus(T1DM),particularly in Saudi Arabia.Psychological constructs such as perceived severity and susceptibility influence health behaviour,yet their role in pediatric diabetes management remains underexplored.AIM To examine psychological predictors of DKA in children with T1DM using the health belief model,and to assess the role of caregiver-perceived understanding in influencing adherence and DKA occurrence.METHODS A case-control study was conducted at Prince Sultan Military Medical City in Riyadh,Saudi Arabia,involving 191 caregivers of children with T1DM(96 cases with a history of DKA and 95 controls without).Validated questionnaires measured perceived severity,susceptibility,understanding,and adherence.Statistical analyses included independent t-tests,Pearson and Spearman correlations,and multiple regression.RESULTS Perceived understanding was the strongest predictor of adherence(β=1.03,P<0.001)and was inversely associated with DKA occurrence(P<0.001).Children without a DKA history had significantly higher levels of perceived understanding and adherence.Perceived severity had a moderate positive association with adherence,while perceived susceptibility showed a weak negative correlation.CONCLUSION Caregiver-perceived understanding plays a critical role in adherence and DKA prevention.These findings support expanding the health belief model to include perceived understanding as a distinct construct and highlight the importance of integrating comprehension-focused strategies into pediatric diabetes education.
文摘Patients with cardiovascular disease rely on medication to achieve favorable longterm clinical results.Poor adherence has been linked to a relative increase in mortality of 50%-80%as well as higher health care costs.This scoping review thus aimed to explore the evidence of the effects of mobile health care apps on medication adherence in patients with cardiovascular diseases.A comprehensive data search and extraction was done in line with the updated Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist.A total of 10 studies were included for the review.The mean pooled improvement in adherence was found to be 18%and the most effective tool was the digital therapeutics app discussed in Li et al’s study.Smartphones and apps enhance coronary artery disease management by promoting medication compliance.Challenges include data security and smartphone usage among the elderly.Tailored apps or voice assistants offer potential solutions.
文摘BACKGROUND Despite therapeutic benefits,discontinuation of tirzepatide is common in randomized controlled trials(RCTs)due to adverse events(AEs)and other causes.No previous systematic reviews have explored the reasons for discontinuing tirzepatide in the RCTs.AIM To explore the reasons for permanent discontinuation of tirzepatide vs controls[placebo,insulin,and glucagon-like peptide-1 receptor agonists(GLP-1Ras)]in RCTs.METHODS Relevant RCTs were systematically searched using related terms through multiple databases such as MEDLINE(via PubMed),Scopus,Cochrane Central Register,and ClinicalTrials.gov from their inception until June 20,2024.RevMan web was used to conduct meta-analysis using random-effects models.Outcomes were presented as risk ratios(RR)with 95%confidence intervals(CI).RESULTS Seventeen RCTs(n=14645),mostly having low risks of bias,were analyzed.Compared to placebo,the risk of permanent discontinuation of the study drug was substantially lower with tirzepatide 10 mg(RR:0.69,95%CI:0.51-0.93,P=0.02)and similar with tirzepatide 5 mg(RR:0.74,95%CI:0.47-1.17,P=0.20)and 15 mg(RR:0.94,95%CI:0.68-1.31,P=0.71).Tirzepatide had identical discontinuation risks when compared to insulin at 5 mg(RR:0.96,95%CI:0.75-1.24,P=0.77)and 10 mg(RR:1.19,95%CI:0.77-1.82,P=0.44)doses,whereas such risk was higher with tirzepatide 15 mg than insulin(RR:1.31,95%CI:1.03-1.67,P=0.03).Compared to GLP-1RA,the permanent discontinuation risk was similar with tirzepatide 5 mg(RR:0.98,95%CI:0.70-1.37,P=0.90)but was higher with tirzepatide 10 mg(RR:1.40,95%CI:1.03-1.90,P=0.03)and 15 mg(RR:1.70,95%CI:1.27-2.27,P=0.0004).Tirzepatide,at all doses,had higher risks of AE-related discontinuation than insulin;such risks were only greater with higher doses of tirzepatide than with placebo or GLP-1RA.Discontinuation risk due to withdrawal by the study subjects was lower with tirzepatide than with placebo or insulin.Compared to the placebo,tirzepatide(all doses)conferred a lower risk of study drug discontinuation due to other causes not specifically mentioned.CONCLUSION The discontinuation risk is not higher in tirzepatide group than in the placebo arm.Many factors other than AEs led to drug discontinuation in the included RCTs.
文摘BACKGROUND Post-procedural psychological disorders are frequently overlooked in elderly patients undergoing percutaneous coronary intervention(PCI),despite their potential impact on long-term cardiovascular outcomes.AIM To evaluate the incidence and prognostic significance of post-PCI psychological disorders in elderly patients with heart failure,and to examine their association with medication adherence and major adverse cardiovascular events(MACE).METHODS This retrospective cohort study included 330 consecutive patients aged≥60 years with heart failure who underwent PCI between 2018 and 2021 at a single center,excluding those with prior psychiatric diagnoses.Psychological status within six months post-discharge was assessed using validated Chinese versions of the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder Scale,and medication adherence was measured by the 8-item Morisky Medication Adherence Scale(MMAS-8)scale.A subset of 145 patients with≥24 months of follow-up were analyzed for MACEs.Multivariate logistic regression and Kaplan-Meier survival analyses were performed.RESULTS Post-PCI psychological disorders were identified in 40%of patients,with anxiety(36%),depression(32%),and comorbid symptoms(22%)being most prevalent.Affected patients had lower MMAS-8 scores[median 5(IQR 4-6)vs 6(IQR 5-7),P=0.002]and a higher rate of low adherence(51.5%vs 30.3%,P<0.001).Among the 145 patients followed longitudinally,MACEs occurred in 17.9%,with 65.4%of events in those with psychological disorders.Psychological disorders(OR=2.66,95% CI:1.11-6.41,P=0.028)and low adherence(OR=2.77,95% CI:1.17-6.56,P=0.021)were independently associated with increased MACE risk.Kaplan-Meier analysis showed reduced MACE-free survival in patients with psychological disorders(HR=2.68,95%CI:1.25-5.73;log-rank P=0.008).CONCLUSION Post-PCI psychological disorders are common in elderly patients with heart failure and independently predict poorer adherence and worse cardiovascular outcomes.Routine psychological assessment and adherence interventions may improve prognosis in this vulnerable population.
文摘This minireview focuses on psychological distress and treatment adherence-issues in patients with chronic hepatitis B(CHB).It begins by discussing the epidemiology and disease burden of CHB,and addresses the relationship between psychological distress and treatment adherence.Next,it delves into the current status and risk factors for psychological distress among patients with CHB,and explores the challenges and risk factors related to treatment adherence.Subsequently,it explores the development and implementation of integrated nursing strategies,including psychological interventions and support,self-efficacy enhancement strategies,social support-system optimization,personalized medical care,and technological innovation.Finally,it highlights the limitations of current interventions and clarifies future research priorities.This minireview aims to provide a comprehensive theoretical basis and practical guidance for improving treatment outcomes and quality of life of patients with CHB.In summary,we reveal that psychological distress significantly impacts treatment adherence in patients with CHB and that it is essential to adopt integrated nursing strategies to address these challenges.These findings highlight the need to consider the psychological states of individuals and develop targeted interventions to improve treatment outcomes.
文摘Introduction Percutaneous coronary intervention(PCI),as a primary treatment for coronary artery disease,has made significant strides in both technology and clinical practice since its inception.However,long-term management of post-PCI patients,particularly restenosis prevention and disease progression control,continues to face numerous challenges[1].Insufficient patient adherence to lifestyle interventions and secondary prevention,coupled with low utilization of cardiac rehabilitation,leads to a sustained increase in the risk of postoperative adverse cardiac events[2,3].The rapid development of digital health technologies(DHTs)offers opportunities to overcome these persistent difficulties.This editorial reviewed the latest applications and multiple challenges,and suggested future directions of DHTs in post-PCI patients(Figure 1).
基金the Science and Technology Foundation of Tianjin Municipal Health Bureau,No.12KG119Tianjin Key Medical Discipline(Specialty)Construction Project,No.TJYXZDXK-059B+1 种基金Tianjin Health Science and Technology Project key discipline special,No.TJWJ2022XK034Research project of Chinese traditional medicine and Chinese traditional medicine combined with Western medicine of Tianjin municipal health and Family Planning Commission,No.2021022.
文摘BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is the most common liver disease worldwide,affecting about 1/4th of the global population and causing a huge global economic burden.To date,no drugs have been approved for the treatment of NAFLD,making the correction of unhealthy lifestyles the principle method of treatment.Identifying patients with poor adherence to lifestyle correction and attempting to improve their adherence are therefore very important.AIM To develop and validate a scale that can rapidly assess the adherence of patients with NAFLD to lifestyle interventions.METHODS The Exercise and Diet Adherence Scale(EDAS)was designed based on com-pilation using the Delphi method,and its reliability was subsequently evaluated.Demographic and laboratory indicators were measured,and patients completed the EDAS questionnaire at baseline and after 6 months.The efficacy of the EDAS was evaluated in the initial cohort.Subsequently,the efficacy of the EDAS was internally verified in a validation cohort.RESULTS The EDAS consisted of 33 items in six dimensions,with a total of 165 points.Total EDAS score correlated significantly with daily number of exercise and daily reduction in calorie intake(P<0.05 each),but not with overall weight loss.A total score of 116 was excellent in predicting adherence to daily reduction in calorie intake(>500 kacl/d),(sensitivity/specificity was 100.0%/75.8%),while patients score below 97 could nearly rule out the possibility of daily exercise(sensitivity/specificity was 89.5%/44.4%).Total EDAS scores≥116,97-115,and<97 points were indicative of good,average,and poor adherence,respectively,to diet and exercise recommendations.CONCLUSION The EDAS can reliably assess the adherence of patients with NAFLD to lifestyle interventions and have clinical application in this population.
基金Supported by Natural Science Foundation of Shanghai,No.17ZR1431400and National Key R&D Program of China,No.2017YFA0103902.
文摘Non-alcoholic fatty liver disease(NAFLD)is characterized by symptoms of excessive fat accumulation and steatosis in the liver without alcohol intake in patients.The associated pathogenic mechanism is not completely understood and there are no specific drugs for patients with NAFLD.Exercise and diet adherence are the best options for the management of NAFLD patients.Questionnaire associated analysis models of adherence to these interventions are used to assess their effectiveness in the management of NAFLD patients using specificity,sensitivity,and so on.Studies have indicated that the relative ratio of NAFLD can be reduced by physical activity with diet control.In the future,the pathogenesis of NAFLD should be clarified with stratified efforts to develop appropriate drugs,and both exercise and diet adherence should be optimized using better questionnaire design and evaluation models for patients with NAFLD.
