Reasons for non-adherence with antidepressants using the Medication Adherence Reasons Scale in five European countries and United States

BACKGROUND

Depression affects approximately 280 million people worldwide. 50 % of individuals with depression discontinue antidepressant therapy within six months of initiation. The study objective was to determine the extent and reasons for non-adherence with antidepressants in the United States (US) and five European Countries (EU).

METHODS

Data from the National Health and Wellness Study (NHWS), a self-administered, internet-based cross-sectional survey of US adults in 2019 and 5 EU countries in 2020 was included. NHWS participants who self-reported taking daily prescription medication(s) to treat depression responded to the 19 reasons for non-adherence and one global item in the Medication Adherence Reasons Scale (MAR-Scale). Frequencies were used to identify the reasons for non-adherence.

RESULTS

Based on data from 7506 US patients and 4230 EU patients, 46.19 % of patients reported non-adherence to at least one reason in the EU, and 42.9 % in the US. The most common reason for non-adherence in the EU was concern about long-term effects and possible side effects from the medication; and in the US, it was simple forgetfulness. Non-adherence lasted longer due to lack of beliefs in needing medication anymore in both US and EU.

LIMITATIONS

The self-reported MAR-Scale can have recall bias and an underestimation of non-adherence. The cross-sectional study design captures the adherence behavior only at one point of time.

CONCLUSION

Individuals on antidepressants have to be educated about the need for the medication and their concerns about long term effects and possible side effects from the medication have to be addressed.

[Current recommendations for congenital melanocytic nevi]

Congenital melanocytic nevi are pigmented birthmarks, some of which have a considerable size. In some cases, not only the skin but also the brain or spinal cord are affected. Many aspects about how to manage this disease have been reconsidered and partly changed over the last 20 years. This article summarizes the current state of knowledge and treatment recommendations.

Spatio-temporal evolution of heat waves severity and expansion across the Iberian Peninsula and Balearic islands

In the current climate change scenario, heat waves have become one of the most concerning extreme climatic events, both because of their implications for human health and the economy, and because of their increase in intensity and frequency in recent decades. This work presents for the first time a climatological analysis of heat waves in the Iberian Peninsula and Balearic Archipelago (IPB) using the Excess Heat Factor index (EHF). This index considers the factor of intensity and the acclimatization process of human body in the study of heat waves. We focused on the intensity (also called severity), duration, frequency and spatial extension of heat waves in the IPB in the 1950-2020 period. The exceptional heat wave of August 2018 was approached in a similar way to further explore the usefulness of the EHF index. We found that the EHF index identified heat wave conditions 2 days earlier than indices that used only maximum temperatures. Results showed a significant increase in intensity, duration, frequency and spatial extension of heat waves for the whole IPB for 1950-2020 period. The average extent of heat waves increased by 4.0% per decade and the maximum extent by 4.1% per decade. This trend suggested a significant increase in human exposure, droughts, fire risk and energy demand in this region in the last decades.

Psychotic symptoms in bipolar disorder and their impact on the illness: A systematic review

BACKGROUND

Lifetime psychotic symptoms are present in over half of the patients with bipolar disorder (BD) and can have an adverse effect on its course, outcome, and treatment. However, despite a considerable amount of research, the impact of psychotic symptoms on BD remains unclear, and there are very few systematic reviews on the subject.

AIM

To examine the extent of psychotic symptoms in BD and their impact on several aspects of the illness.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. An electronic literature search of six English-language databases and a manual search was undertaken to identify published articles on psychotic symptoms in BD from January 1940 to December 2021. Combinations of the relevant Medical Subject Headings terms were used to search for these studies. Articles were selected after a screening phase, followed by a review of the full texts of the articles. Assessment of the methodological quality of the studies and the risk of bias was conducted using standard tools.

RESULTS

This systematic review included 339 studies of patients with BD. Lifetime psychosis was found in more than a half to two-thirds of the patients, while current psychosis was found in a little less than half of them. Delusions were more common than hallucinations in all phases of BD. About a third of the patients reported first-rank symptoms or mood-incongruent psychotic symptoms, particularly during manic episodes. Psychotic symptoms were more frequent in bipolar type I compared to bipolar type II disorder and in mania or mixed episodes compared to bipolar depression. Although psychotic symptoms were not more severe in BD, the severity of the illness in psychotic BD was consistently greater. Psychosis was usually associated with poor insight and a higher frequency of agitation, anxiety, and hostility but not with psychiatric comorbidity. Psychosis was consistently linked with increased rates and the duration of hospitalizations, switching among patients with depression, and poorer outcomes with mood-incongruent symptoms. In contrast, psychosis was less likely to be accompanied by a rapid-cycling course, longer illness duration, and heightened suicidal risk. There was no significant impact of psychosis on the other parameters of course and outcome.

CONCLUSION

Though psychotic symptoms are very common in BD, they are not always associated with an adverse impact on BD and its course and outcome.

Current status of periodontal disease in adults in Takahagi, Japan: a cross-sectional study

BACKGROUND

To date, a few studies have documented the detailed periodontal conditions of a Japanese population. It is important to know if the awareness of Japanese nationals and dentists regarding oral hygiene and prevention of periodontal disease have improved when compared with the past in Japan for the development of future scenarios regarding prevention. The aim of this study was to investigate the severity, prevalence, and extent of periodontal disease in the adult population of the city of Takahagi, Japan. Results were also compared with those of an epidemiological study performed in Japan in the 1980s.

METHODS

A total of 582 (aged 20 to 89 years) randomly sampled Takahagi residents answered a comprehensive questionnaire and participated in clinical examinations.

RESULTS

The mean percentages of tooth surfaces harboring plaque and exhibiting BOP were 59.5 ± 20.9% and 31.1 ± 21.1%, respectively. The mean PPD and CAL were 2.5 ± 0.5 mm and 2.9 ± 1.0 mm, respectively. Compared with results of the 1980s survey, the mean percentages of plaque and bleeding on probing were lower in the current population. The mean CAL and prevalence of attachment loss of ≥5 mm in some age groups were higher in the present study than in the 1980s study. There were no statistically significant differences with respect to mean probing depth between the 1980s and current age groups.

CONCLUSIONS

Periodontal disease was still prevalent in the current Japanese population, even though some improvement occurred. Proper public health programs therefore need to be established.

The Influence of the Extent of Color-Vision Deficiency on Shade-Matching Ability

Objective

To evaluate the influence of the extent of color-vision deficiency on visual shade-matching ability.

Materials and methods

Six groups were investigated: the control group (N = 68), the protan medium deficiency (PMED) group (N = 5), the protan strong deficiency (PSTD) group (N = 5), the deutan mild deficiency (DMID) group (N = 5), the deutan medium deficiency (DMED) group (N = 5) and the deutan strong deficiency (DSTD) group (N = 8). The color vision of the participants was evaluated monocularly using the Hardy-Rand-Rittler (HRR) test and on an HMC Anomaloskop MR (Rayleigh test). The final exam on a Toothguide Training Box consisted of 15 lightness–chroma–hue tasks. The color difference (∆E*_ab) and the shade-matching score (Σ∆E*_ab) were computed. The means and the standard deviations for the Σ∆E*_ab were calculated. An independent t-test was used for statistical analyses of the data and a comparison of means (α = .05) for protan groups and a one-way analysis of variance (ANOVA) and a post-hoc Bonferroni test (α = .05) for deutan groups.

Results

The PSTD group had a mean Σ∆E*_ab of 63.38 ± 9.52, which means their selections were significantly worse in comparison to the PMED group (Σ∆E*_ab = 47.62 ± 9.88, p = 0.033). The selections of the control group were significantly better in comparison to all groups with color-vision deficiency (control – PMED, p = 0.031; control – PSTD, p < 0.0001; control – DMED, p < 0.0001; control – DSTD, p < 0.0001), except in comparison with DMID group (p = 0.082). The comparisons between deutan groups were not significantly different (DMID – DMED, p = 0.352; DMID – DSTD, p = 0.323; DMED – DSTD, p = 1.000).

Conclusion

Participants with strong protan color-vision deficiency are worse at shade matching than participants with medium protan color-vision deficiency.

Extent of positive surgical margins following radical prostatectomy: impact on biochemical recurrence with long-term follow-up

Background

To assess the prognostic value of the extent of positive surgical margins (PSM) following radical prostatectomy (RP) on biochemical recurrence (BR) with long-term follow-up.

Methods

This retrospective study analyzed 1275 RPs performed between January 1992 and December 2013 in two university centers in Marseille (France). The inclusion criteria were: follow-up > 24 months, undetectable postoperative prostate-specific antigen (PSA), no seminal vesicle (SV) invasion, no lymph node invasion confirmed by surgery (pN0) or imaging (pNx), and no neoadjuvant or adjuvant treatment. BR was defined by PSA level ≥ 0.2 ng/mL on two successive samples. We included 189 patients, divided into two groups:

- Focal PSM (fPSM): single PSM (sPSM) ≤3 mm;

- Extensive PSM (ePSM): sPSM with linear length > 3 mm or several margins regardless of the length.

Results

The median follow-up was 101 months (18–283) and the median age was 63 years (46–76). BR occurred in only 12.1% (14/115) of cases involving fPSM and in 54.1% (40/74) of cases involving ePSM. In the multivariate model, ePSM patients were significantly associated with increased BR compared to fPSM (hazard ratio [HR] = 6.11; 95% confidence interval [CI] = 3.25–11.49). The ePSM significantly decreased BR-free survival (p < 0.001) for every patient and every subgroup (pT2, pT3a, pG ≤6, and pG ≥7). The median BR time following RP was significantly shorter for ePSM patients than fPSM (57.2 vs. 89.2 months p < 0.001).

Conclusion

With a median 8-year follow-up, ePSM was strongly associated with BR compared to fPSM. Therefore, it seems legitimate to monitor patients with fPSM. In cases of ePSM, adjuvant treatment appears effective.

Patients with Acute Ischemic Cerebrovascular Disease with Coronary Artery Stenosis Have More Diffused Cervicocephalic Atherosclerosis

Aims: Coronary artery stenosis (CAS) ≥ 50% frequently coexists in patients with acute ischemic cerebrovascular disease (AICVD), which portends unfavorable outcomes. We sought to examine whether patients with AICVD with CAS had more severe and more diffused cervicocephalic atherosclerosis (CA).

Methods: Patients with AICVD were consecutively enrolled and underwent simultaneous computed tomography angiography (CTA) of the coronary and cervicocephalic arteries. A total of 140 patients were divided into “AICVD + CAS” and “AICVD only” groups according to whether CTA showed stenosis of ≥ 50% in at least one coronary arterial segment. The relationship of the presence of CAS with the severity and extent of CA were examined.

Results: The CA severity characteristics, including the presence of stenosis ≥ 50% and the grade of the most severe stenotic segment, were not significantly different between the two groups. Regarding the extent of CA, the presence of stenosis ≥ 50% in both sides (adjusted odds ratio [OR]: 4.29, 95% confidence interval [CI]: 1.67–10.98), both extracranial and intracranial (adjusted OR: 5.26, 95% CI: 2.24–12.35), both anterior and posterior circulation (adjusted OR: 5.29, 95% CI: 2.22–12.64), and the number of stenotic segments ≥ 50% in cervicocephalic arteries (adjusted OR: 1.58, 95% CI: 1.28–1.96) were associated with CAS in patients with AICVD, independently of clinical demographics and CA severity characteristics.

Conclusion: CA was similarly severe in patients with AICVD with and without CAS, but those with CAS had significantly more diffused CA. The extent of CA and CAS were mutual indicators in patients with AICVD, irrespective of CA severity.

Underestimation of pelvic organ prolapse in the supine straining position, based on magnetic resonance imaging findings

Objective

Pelvic organ prolapse (POP) is clinically diagnosed in the supine position, where the effect of gravity is simulated by having the patients put strain on their pelvic floor. The objective of this study was to determine the degree of POP underestimation in the supine position based on magnetic resonance imaging (MRI) findings.

Methods

This prospective study was conducted with symptomatic POP grade ≥ 2 patients. Fifteen female patients were examined with an MRI system that allows supine and upright imaging. The differences between supine and upright in distances of the bladder neck, cervix, and pouch of Douglas from the pubococcygeal line (PCL) were estimated, together with changes in the genital hiatal area. Patients were scanned at rest and during straining. All distances were compared using the Wilcoxon ranking test.

Results

All mean distances from the PCL increased from the supine–strain to the upright–rest and from the supine–strain to the upright–strain position. These distances were found in the supine and upright positions: the bladder descended 1.3 cm to 1.4 cm, the cervix 1.1 cm to 2.2 cm, and the pouch of Douglas 0.8 cm to 1.5 cm respectively (all p values <0.05). The hiatal area was larger in the upright–strain position (mean 42.0 cm²; SD ±14.8) than during the supine–strain position (mean 33.5 cm²; SD ±14.5), with a p value of 0.02.

Conclusion

Upright MRI scanning of patients with POP grade ≥ 2 both at rest and during straining shows a significantly larger extent of the prolapse than that observed during supine straining.

Finding some seagrass optimism in Wales, the case of Zostera noltii

There exists limited understanding of the long-term dynamics of the seagrass Zostera noltii and how this is influenced by anthropogenic pressures. Milford Haven is a heavily industrialised estuary and also one of the important sites for Zostera sp. in the UK. In this study we examine all available long-term spatial variability and abundance data of Zostera noltii within Milford Haven using historic datasets. Results show that Z. noltii in all sites have shown meadow expansion when compared to the first obtainable records. Little change in abundance over the past 10-15years for the two sites confirms certain seagrass populations to be robust and thriving. We hypothesise that these populations are showing a level of resilience to the high nutrient levels, disturbance and high turbidity present within the water column of the Haven.

Determining the size of a complete disturbance landscape: multi-scale, continental analysis of forest change

The scale of investigation for disturbance-influenced processes plays a critical role in theoretical assumptions about stability, variance, and equilibrium, as well as conservation reserve and long-term monitoring program design. Critical consideration of scale is required for robust planning designs, especially when anticipating future disturbances whose exact locations are unknown. This research quantified disturbance proportion and pattern (as contagion) at multiple scales across North America. This pattern of scale-associated variability can guide selection of study and management extents, for example, to minimize variance (measured as standard deviation) between any landscapes within an ecoregion. We identified the proportion and pattern of forest disturbance (30 m grain size) across multiple landscape extents up to 180 km². We explored the variance in proportion of disturbed area and the pattern of that disturbance between landscapes (within an ecoregion) as a function of the landscape extent. In many ecoregions, variance between landscapes within an ecoregion was minimal at broad landscape extents (low standard deviation). Gap-dominated regions showed the least variance, while fire-dominated showed the largest. Intensively managed ecoregions displayed unique patterns. A majority of the ecoregions showed low variance between landscapes at some scale, indicating an appropriate extent for incorporating natural regimes and unknown future disturbances was identified. The quantification of the scales of disturbance at the ecoregion level provides guidance for individuals interested in anticipating future disturbances which will occur in unknown spatial locations. Information on the extents required to incorporate disturbance patterns into planning is crucial for that process.

Dominant factors affecting reproductive outcomes of fertility-desiring young women with intrauterine adhesions

PURPOSE

To identify the dominant factors affecting reproductive outcomes of fertility-desiring young women with intrauterine adhesions (IUA) after hysteroscopic adhesiolysis.

METHODS

This prospective observational study included 104 cases of women with IUA. Logistic regression analysis was applied to analyze the value of the location and extent of adhesions, the number of previous uterine cavity surgery, menstrual patterns, and second look hysteroscopy time.

RESULTS

In the total 104 patients with IUA, 91 patients (87.5%) had a history of at least one previous uterine cavity surgery. Hypomenorrhoea and amenorrhoea were two most common presenting menstrual abnormalities occurring in 59 (56.7%) and 28 (26.9%) cases, respectively. The clinical pregnancy rate was 60.6% (63/104) and the live birth rate was 39.4% (41/104). Pregnancy rate was higher in patients having mild IUA (81.5%) as compared to moderate (61.3%) or severe type (20.0%) (p < 0.001). The bivariate and binary logistic regression analysis revealed that the location and extent of adhesions were the independent parameters related to the reproductive outcome after hysteroscopic adhesiolysis for fertility-desiring women with IUA (p = 0.011 and p = 0.003, respectively), but not the number of previous uterine cavity surgery, menstrual patterns, and second look hysteroscopy time (p = 0.232, p = 0.239 and p = 0.120, respectively).

CONCLUSION

The extent and location of IUA are the dominant factors affecting reproductive outcomes, which are possibly regarded as a potential predictor evaluating prognosis of IUA after hysteroscopic adhesiolysis.

Imaging brain source extent from EEG/MEG by means of an iteratively reweighted edge sparsity minimization (IRES) strategy

Estimating extended brain sources using EEG/MEG source imaging techniques is challenging. EEG and MEG have excellent temporal resolution at millisecond scale but their spatial resolution is limited due to the volume conduction effect. We have exploited sparse signal processing techniques in this study to impose sparsity on the underlying source and its transformation in other domains (mathematical domains, like spatial gradient). Using an iterative reweighting strategy to penalize locations that are less likely to contain any source, it is shown that the proposed iteratively reweighted edge sparsity minimization (IRES) strategy can provide reasonable information regarding the location and extent of the underlying sources. This approach is unique in the sense that it estimates extended sources without the need of subjectively thresholding the solution. The performance of IRES was evaluated in a series of computer simulations. Different parameters such as source location and signal-to-noise ratio were varied and the estimated results were compared to the targets using metrics such as localization error (LE), area under curve (AUC) and overlap between the estimated and simulated sources. It is shown that IRES provides extended solutions which not only localize the source but also provide estimation for the source extent. The performance of IRES was further tested in epileptic patients undergoing intracranial EEG (iEEG) recording for pre-surgical evaluation. IRES was applied to scalp EEGs during interictal spikes, and results were compared with iEEG and surgical resection outcome in the patients. The pilot clinical study results are promising and demonstrate a good concordance between noninvasive IRES source estimation with iEEG and surgical resection outcomes in the same patients. The proposed algorithm, i.e. IRES, estimates extended source solutions from scalp electromagnetic signals which provide relatively accurate information about the location and extent of the underlying source.

Extent of morbidity associated with schistosomiasis infection in Malawi: a review paper

Data on the extent of the burden due to schistosomiasis is sparse in most Sub-Saharan African countries. However, this data is crucial for triggering medical attention. A review of extent of morbidity and determinants associated with schistosomiasis in Malawi was therefore conducted to quantify the infection in order to concretise the need for medical intervention. A systematic and traditional search strategy was used to find literature for the review, whilst exclusion and inclusion criteria were used to identify appropriate articles. Logistic regression curves of epidemiological model Y = (a + bx (c) )/(1 + bx (c) ) and the recommendation that schistosomiasis prevalence can be used to estimate morbidity were employed to quantify morbidity at various infection stages. Morbidity was quantified as a direct proportion of the population and the respective national schistosomiasis prevalence. Findings showed that both S. mansoni and S. haematobium are present in Malawi with the latter highly prevalent (50%). Furthermore, out of the estimated population of 16,829 million, approximately 8.4 million have schistosomiasis, with about 4.4 million of these aged 18 years and below. The most frequent manifestation is Katayama syndrome, while ascites is the lowest, impacting about 3.0 million and 960 individuals, respectively. Localised studies on association of schistosomiasis infection to risk factors such as occupation, age and gender found odds ratio (OR) ranging from 1.29 to 5.37. Morbidity due to schistosomiasis is high in Malawi. It is therefore recommended that a more detailed study on the determinants of high schistosomiasis and re-evaluation of the current control measures be conducted if the current morbidity statistics are to be remarkably reduced.

Prognostic stratification of ulcerated melanoma: not only the extent matters

OBJECTIVES

For patients with melanoma, ulceration is an important prognostic marker and interestingly also a predictive marker for the response of adjuvant interferon. A consensual definition and accurate assessment of ulceration are therefore crucial for proper staging and clinical management. We evaluated the prognostic impact of the extent and type of ulceration and the epidermal involvement theoretically preceding it (consumption of epidermis and cleft formation) or seen subsequent to the inflammation (reepithelialization and reactive epidermal hyperplasia), aiming for better prognostic stratification of ulcerated lesions.

METHODS

From H&E-stained sections, the status (presence vs absence), extent (percentage of the total tumor length), and type (infiltrative vs attenuative) of ulceration and epidermal involvement were evaluated from 385 patients with cutaneous melanoma.

RESULTS

The presence of ulceration (hazard ratio [HR], 1.83), an attenuative type of ulceration (HR, 3.02), and excessive ulceration (HR, 3.57) were independent predictors of poor melanoma-specific survival. Further subdivision of minimal/moderate ulceration showed independent prognostic value only for lesions with epidermal involvement of the surrounding epidermis (HR, 1.78).

CONCLUSION

The extent and type of ulceration and involvement of the surrounding epidermis provided more accurate prognostic information than the mere absence or presence and may be useful markers allowing better stratification of ulcerated lesions.

Reconstructing spatially extended brain sources via enforcing multiple transform sparseness

Accurate estimation of location and extent of neuronal sources from EEG/MEG remain challenging. In the present study, a new source imaging method, i.e. variation and wavelet based sparse source imaging (VW-SSI), is proposed to better estimate cortical source locations and extents. VW-SSI utilizes the L1-norm regularization method with the enforcement of transform sparseness in both variation and wavelet domains. The performance of the proposed method is assessed by both simulated and experimental MEG data, obtained from a language task and a motor task. Compared to L2-norm regularizations, VW-SSI demonstrates significantly improved capability in reconstructing multiple extended cortical sources with less spatial blurredness and less localization error. With the use of transform sparseness, VW-SSI overcomes the over-focused problem in classic SSI methods. With the use of two transformations, VW-SSI further indicates significantly better performance in estimating MEG source locations and extents than other SSI methods with single transformations. The present experimental results indicate that VW-SSI can successfully estimate neural sources (and their spatial coverage) located in close areas while responsible for different functions, i.e. temporal cortical sources for auditory and language processing, and sources on the pre-bank and post-bank of the central sulcus. Meantime, all other methods investigated in the present study fail to recover these phenomena. Precise estimation of cortical source locations and extents from EEG/MEG is of significance for applications in neuroscience and neurology.