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PloS One 2024Antidepressants are a first-line treatment for depression, yet many patients do not respond. There is a need to understand which patients have greater treatment response... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
Antidepressants are a first-line treatment for depression, yet many patients do not respond. There is a need to understand which patients have greater treatment response but there is little research on patient characteristics that moderate the effectiveness of antidepressants. This study examined potential moderators of response to antidepressant treatment.
METHODS
The PANDA trial investigated the clinical effectiveness of sertraline (n = 326) compared with placebo (n = 329) in primary care patients with depressive symptoms. We investigated 11 potential moderators of treatment effect (age, employment, suicidal ideation, marital status, financial difficulty, education, social support, family history of depression, life events, health and past antidepressant use). Using multiple linear regression, we investigated the appropriate interaction term for each of these potential moderators with treatment as allocated.
RESULTS
Family history of depression was the only variable with weak evidence of effect modification (p-value for interaction = 0.048), such that those with no family history of depression may have greater benefit from antidepressant treatment. We found no evidence of effect modification (p-value for interactions≥0.29) by any of the other ten variables.
CONCLUSION
Evidence for treatment moderators was extremely limited, supporting an approach of continuing discuss antidepressant treatment with all patients presenting with moderate to severe depressive symptoms.
Topics: Humans; Sertraline; Male; Antidepressive Agents; Female; Primary Health Care; Depression; Middle Aged; Adult; Treatment Outcome; Aged; Data Analysis; Secondary Data Analysis
PubMed: 38722970
DOI: 10.1371/journal.pone.0300366 -
Frontiers in Public Health 2024The COVID-19 pandemic has presented new challenges to adhering to ART, and its influence on adherence and related factors has not been thoroughly studied. This study...
Adherence to antiretroviral therapy and determining factors in adults living with HIV receiving services at public health facilities amidst the COVID-19 crisis in Bahir Dar city, Northwest Ethiopia.
BACKGROUND
The COVID-19 pandemic has presented new challenges to adhering to ART, and its influence on adherence and related factors has not been thoroughly studied. This study examines ART adherence and its associated factors during the COVID-19 pandemic.
METHODS
A cross-sectional study was conducted on HIV-positive individuals receiving care and treatment in public health facilities. A total of 612 participants were selected using a multi-stage sampling procedure. Data were collected through interviewer-administered questionnaires and chart reviews. We used Epi-data for data entry and Stata for data analysis.
RESULTS
Good adherence to antiretroviral therapy in this study was 76.5% (95% CI, 72.9, 79.7). Divorced marital status (AOR = 0.45,95%CI:0.22,0.90), regular follow-up (AOR = 3.01,95%CI:1.81,5.01), adherence counseling and information in the context of COVID-19 pandemic (AOR = 2.57,95%CI:1.63,4.08), and knowledge about ART (AOR = 1.81,95%CI:1.11,2.94) were significantly associated with adherence to antiretroviral therapy.
CONCLUSION
The observed adherence rate in this study was lower than the World Health Organization recommendation and previous studies. The study highlighted the importance of addressing adherence to ART among HIV-positive adults during the COVID-19 pandemic and other upcoming emerging and reemerging outbreaks. Strategies to improve adherence should consider factors such as marital status, regular follow-up, provision of counseling and information, and enhancing knowledge about ART.
Topics: Humans; Ethiopia; Cross-Sectional Studies; Male; Female; Adult; HIV Infections; COVID-19; Medication Adherence; Middle Aged; Surveys and Questionnaires; Young Adult; Anti-Retroviral Agents; SARS-CoV-2; Anti-HIV Agents; Adolescent
PubMed: 38721541
DOI: 10.3389/fpubh.2024.1380055 -
Discover Oncology May 2024Supraglottic squamous cell carcinoma (SGSCC) is characterized by low differentiation, rapid growth, and inconspicuous initial manifestations. Early detection and prompt...
BACKGROUND
Supraglottic squamous cell carcinoma (SGSCC) is characterized by low differentiation, rapid growth, and inconspicuous initial manifestations. Early detection and prompt treatment can significantly improve survival rates. The main focus of treatment is to maintain optimal laryngeal function.
METHODS
Using the Surveillance, Epidemiology, and End Results (SEER) database, we conducted univariate and multivariate Cox regression analyses to identify independent prognostic factors for T1-T2 SGSCC. We also enrolled 109 patients with T1-T2 SGSCC from the First Affiliated Hospital of Xinjiang Medical University as an external validation set. In addition, we developed a nomogram to predict the prognosis of T1-T2 SGSCC, assessed the predictive accuracy and discriminatory ability of the nomogram using the area under the curve (AUC), C-index, receiver operating characteristic (ROC) curve and calibration curve, and confirmed the clinical validity of the nomogram using decision curve analysis (DCA).
RESULTS
Our investigation identified nine prognostic indicators for T1-T2 SGSCC: age (≥ 65 years), marital status, American Joint Committee on Cancer (AJCC) stage (II-IV), grade (III-IV), M stage (M1), radiotherapy, chemotherapy, sex (female), and surgery. These variables were used to create accurate nomograms that predict overall and specific survival rates at 1, 3, and 5 years. The nomograms demonstrated superior prognostic value and accuracy compared to AJCC staging. Laryngectomy with partial laryngectomy is the preferred treatment option for T1-T2 SGSCC cases, providing superior overall survival (OS) and cancer-specific survival (CSS). Radiotherapy also improves OS and CSS. Our results were based on a comprehensive analysis of various indicators, including the C-index, ROC curve, calibration curve, and DCA curve.
CONCLUSION
Nomograms provide significant advantages in treatment decision making and diagnosis. Laryngectomy with partial laryngectomy is the most appropriate method for T1-T2 SGSCC cases. However, radiotherapy can also be used. Thus, patients with T1-T2 SGSCC should be evaluated to determine if combination therapy is the optimal treatment approach. Nevertheless, further research is needed to understand the role of chemotherapy. Overall, this study identified nine key predictors of future outcomes, aiding healthcare professionals in assessing risks and making treatment decisions for T1-T2 SGSCC patients.
PubMed: 38717631
DOI: 10.1007/s12672-024-01015-y -
Journal of Clinical Nursing May 2024Patients with stroke require long-term rehabilitation for functional recovery and daily activities. The health-related quality of life (HRQOL) of patients with stroke...
BACKGROUND
Patients with stroke require long-term rehabilitation for functional recovery and daily activities. The health-related quality of life (HRQOL) of patients with stroke may deteriorate because of family caregivers' nonpreparedness and increased role burden.
AIM(S)
To investigate how caregivers' preparedness and sense of competence predict the HRQOL of patients with stroke.
DESIGN
A prospective longitudinal study.
METHODS
The study population comprised patients with stroke who were hospitalized for rehabilitation and their family caregivers. A total of 158 patient-family caregiver dyads were recruited from June to September 2021. Data were collected at the initiation of rehabilitation therapy and upon discharge. Information about the characteristics of the family caregivers and patients with stroke and about the former's preparedness and sense of competence were collected at baseline. Furthermore, the HRQOL of patients with stroke was measured at baseline and upon discharge to evaluate the change.
RESULTS
This study of matched pairs of patients and family caregivers demonstrated that the latter's caregiving preparedness and sense of competence predicted positive changes in patients' HRQOL. Family caregivers who were satisfied with their care recipients (patients) and had better recognition of the consequences of care involvement better predicted changes in patients' HRQOL.
CONCLUSION
The findings of this study indicate the importance of family caregivers' caregiving preparedness and sense of competence in predicting changes in patients' HRQOL.
IMPLICATIONS FOR PATIENT CARE
Clinically, the findings of this study highlight the importance of assessing and supporting family caregivers in developing a strong caregiving preparedness and sense of competence and in understanding the implications of their role as caregivers as it may help improve patients' HRQOL. The integration of interventions that enhance caregiver satisfaction and awareness into clinical practice may result in a more comprehensive and effective patient care. WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?: Previous studies have demonstrated that the health-related quality of life (HRQOL) of patients with stroke is influenced by sociodemographic factors, such as sex, age, marital status, pain, cognitive ability and activities of daily living. A substantial association was observed between caregivers' preparedness and the HRQOL of patients with stroke. However, few studies have examined the association between caregivers' sense of competence and the HRQOL of patients with stroke.
IMPLICATIONS FOR PRACTICE
The present study indicated that clinical nursing activity must include assessment and intervention of family caregivers to improve the HRQOL of patients with stroke. The family caregivers of patients with stroke hospitalized in the post-stroke period may experience a sense of sacrifice and limitation in their personal lives. Clinical nursing practice should assess family caregivers' caregiving preparedness and sense of competence to improve the HRQOL of patients with stroke.
REPORTING METHOD
This study adhered to the relevant EQUATOR guidelines and named the reporting method.
PubMed: 38716815
DOI: 10.1111/jocn.17173 -
PloS One 2024Diabetes Mellitus is a serious and expanding health problem, together with the issues of health- related quality of life (HRQoL). This further puts pressure on the...
BACKGROUND
Diabetes Mellitus is a serious and expanding health problem, together with the issues of health- related quality of life (HRQoL). This further puts pressure on the government to allocate more funds for public healthcare.
OBJECTIVES
This study was devised to evaluate the health-related quality of life of people living with diabetes in Hail region of Saudi Arabia.
METHODS
This cross-sectional research was carried out at eight locations in the Hail region of Saudi Arabia between 21st March-20th May 2022 using the adapted version of the Euro QoL-5 dimension (EQ-5D-3L) questionnaire. A multistage random sample approach was used to choose the diabetes clinics, and data collectors approached the participants in the waiting areas to collect the information. The data were analyzed using logistic regression analysis, Mann-Whitney test, and Kruskal-Wallis tests in IBM SPSS statistics 21.0.
RESULTS
The mean HRQoL score was 0.71±0.21 with a visual analog score of 68.4±16.2. Despite having much higher levels of quality of life in terms of self-care (85.8%), regular activity (73.8%) and anxiety (71.8%), nearly one half of the people reported moderate pain or discomfort, and more than one third reported having moderate mobility issues. In general, the quality of life for women was poorer than for men. Individuals with diabetes who were unmarried, young, educated, financially secure, and taking only oral medication had much improved HRQoL. The Euro QoL of people with diabetes patients were significantly influenced by gender, marital status, age, education, employment and treatment modality (p-values < 0.05), whereas only treatment modality had a significant impact on the patients' visual analogue measures (p-values < 0.05).
CONCLUSIONS
The HRQoL of people with diabetes in Hail region was moderate in general, with pain and mobility issues being particularly prevalent. Gender, marital status, age, education, employment and type of medication therapy are significant predictors of HRQoL of patients with diabetes. Hence, planning and programs to enhance the HRQoL of people with diabetes, especially women is recommended.
Topics: Humans; Quality of Life; Saudi Arabia; Male; Female; Cross-Sectional Studies; Middle Aged; Adult; Diabetes Mellitus; Surveys and Questionnaires; Aged; Young Adult
PubMed: 38713663
DOI: 10.1371/journal.pone.0299995 -
Reviews in Medical Virology May 2024Despite advances in HIV treatment, the burden of viral non-suppression (VNS) remains a treatment success concern, particularly in Sub-Saharan African (SSA) countries. We... (Meta-Analysis)
Meta-Analysis Review
Prevalence and factors associated with viral non-suppression in people living with HIV receiving antiretroviral therapy in sub-Saharan Africa: A systematic review and meta-analysis.
Despite advances in HIV treatment, the burden of viral non-suppression (VNS) remains a treatment success concern, particularly in Sub-Saharan African (SSA) countries. We determined the prevalence and factors associated with VNS for people living with HIV (PLHIV) receiving antiretroviral therapy (ART). This review, registered with PROSPERO (CRD42023470234), conducted an extensive search for evidence, focusing on PLHIV living in SSA on ART from the year 2000 to 19 October 2023, across databases including PubMed/MEDLINE, Embase, Web of Science, and Scopus. A total of 2357 articles were screened, from which 32 studies met the criteria for the final analysis, involving 756,620 PLHIV of all ages. The pooled prevalance for VNS was found to be 20.0% (95% CI: 15.43%-25.52%, I = 100%, p-value <0.01) Children and adolescents demonstrated the highest prevalence of VNS (viral load ≥1000 copies/mL) at 27.98% (95% CI: 21.91%-34.97%, I = 94%, p-value <0.01). The study revealed various factors associated with increased odds (risk) of VNS, p-value <0.05. These factors encompassed socio-demographics such as sex, age, education level, and marital status. Additionally, aspects related to HIV care, such as the facility attended, HIV status disclosure and adherence exhibited higher odds of VNS. Suboptimal ART adherence, longer duration on ART, socio-economic factors, lack of family and social support, presence of co-morbidities, advanced WHO HIV clinical stage, ART regimens, lower CD4+ count, abnormal body mass index, history of treatment interruptions, and progression of HIV illness were associated with VNS. Furthermore, behavioural/psychological factors including depression, substance use, negative perceptions towards ART, experiences of abuse, alcohol use, stigma, and certain patterns of sexual behaviour were also identified as factors for VNS. The occurrence of two VNS to every ten PLHIV on ART poses a threat to the progress made towards reaching the third 95% UNAIDS target in SSA. Additionally, these findings highlight the intricate interplay of various factors, encompassing patient characteristics, behavioural patterns, sociocultural influences, and pharmacological factors, all impacting VNS among PLHIV. Recognising its multifaceted nature, we recommend designing and implementing high impact interventions to effectively address VNS in SSA.
Topics: Humans; HIV Infections; Africa South of the Sahara; Prevalence; Viral Load; Anti-HIV Agents; Risk Factors; Adolescent; Female; Male; Adult; Anti-Retroviral Agents; Antiretroviral Therapy, Highly Active; Child
PubMed: 38708846
DOI: 10.1002/rmv.2540 -
Journal of Sleep Research May 2024Psychological flexibility has recently attracted the attention of researchers in the field of sleep disorders; therefore, in the study, psychological flexibility was...
Psychological flexibility has recently attracted the attention of researchers in the field of sleep disorders; therefore, in the study, psychological flexibility was evaluated as a predictor or factor related to the presence/severity of insomnia. We included 2218 individuals selected from the randomized-control trial for behavioural therapy for insomnia and cross-sectional studies, including 1797 individuals with insomnia and 421 controls without insomnia. All participants completed the DSM-5-based insomnia diagnosis interview, Insomnia Severity Index, Hospital Anxiety and Depression Scale, and Acceptance Action Questionnaire-II. Linear regression and multinomial logistic regression models were used. Sex, education, occupation, marital status, anxiety, depression and psychological inflexibility were possible predictors or factors associated with the severity of insomnia. Multivariate linear regression analysis demonstrated that sex (𝛽 = 0.88; t = 2.80; p = 0.005), depression (𝛽 = 0.41; t = 10.7; p < 0.001), anxiety (𝛽 = 0.58; t = 14.1; p < 0.001) and psychological inflexibility (𝛽 = 0.09; t = 5.07; p < 0.001) were predictors of insomnia. The results of the multinomial logistic regression demonstrate that, in comparison to the absence of insomnia, insomnia at all levels (mild, moderate and severe) was associated with sex, anxiety and depression. Psychological inflexibility was only associated with severe insomnia (odds ratio = 1.04). These findings are important from a public health perspective because behavioural strategies designed to treat insomnia with a focus on psychological flexibility are low-cost and may help improve sleep quality in adults with insomnia, which also influences mental health.
PubMed: 38703025
DOI: 10.1111/jsr.14232 -
Frontiers in Public Health 2024The increasing adoption of sedentary lifestyles and cultural shifts has fostered unhealthy habits and decreased physical activity, consequently exacerbating the...
BACKGROUND
The increasing adoption of sedentary lifestyles and cultural shifts has fostered unhealthy habits and decreased physical activity, consequently exacerbating the prevalence of diabetes. Diabetes is currently one of the top 10 diseases worldwide, contributing significantly to both mortality and morbidity. Since diabetes hinges on self-care, possessing the right knowledge, attitude, and habits related to the disease is paramount. This study, therefore, aims to examine the knowledge, attitude, and practice of diabetes among the population of Saudi Arabia.
METHODS
The study utilized data from a cross-sectional study conducted via an online self-reported questionnaire among the general population of Saudi Arabia. The study primarily used univariate and multivariable regression data analyses. Univariate analysis was employed to compile social and demographic statistics frequencies, while One-way analysis of variance (ANOVA) was used to assess mean differences in knowledge, attitudes, and practices scores. Furthermore, a multivariable linear regression analysis was executed to identify factors associated with knowledge, attitudes, and practices.
RESULTS
The mean score for diabetes knowledge was 17.79 (SD = 5.39, range: 0-29), with an overall accuracy rate of 61.34%. The mean attitude score for diabetes was 2.33 (SD = 1.91, range: 0-7), while the mean score for diabetes practices was 2.58 (SD = 1.28, range: 0-4). The multivariate analyses reveal distinct variations in knowledge, attitudes, and practices of diabetes among participants based on their gender, education, marital status, income, diabetes patient status, and having a medical field-related education.
CONCLUSION
High knowledge scores do not necessarily equate to positive attitudes and practices related to diabetes. There is need for intensified care and the implementation of specialized educational programs that emphasize the importance of having the right attitude and engaging in the good diabetes practices.
Topics: Humans; Saudi Arabia; Cross-Sectional Studies; Male; Female; Health Knowledge, Attitudes, Practice; Adult; Diabetes Mellitus; Middle Aged; Surveys and Questionnaires; Aged; Adolescent; Young Adult
PubMed: 38694982
DOI: 10.3389/fpubh.2024.1326675 -
BMC Infectious Diseases May 2024Existing research in Ethiopia has primarily focused on the individual epidemiology of HIV and HBV, often overlooking the intricate dynamics of co-infection. This study...
BACKGROUND
Existing research in Ethiopia has primarily focused on the individual epidemiology of HIV and HBV, often overlooking the intricate dynamics of co-infection. This study aims to address this gap by comprehensively exploring the prevalence of HBV and HIV co-infection and the associated factors influencing co-infection rates within the specific context of ART clinics. The existing study provides limited insights into the unique challenges posed by this dual infection in the Ethiopian population receiving ART.
METHODS
An institutional-based cross-sectional study was conducted among people living with HIV aged 18 years and above attending ART clinics in northeast Ethiopia from April to May 2022. A sample size of 350(97% response rate) participants was selected by using a systematic random sampling method. Data were collected using a pre-tested interviewer-administered structured questionnaire. Data was entered into Epi Data version software and was exported to SPSS version 25 for further analysis. Descriptive statistics using Frequency, proportion, and summary measures were done. Binary logistic regressions were done to identify independent variables associated with HBV infection among HIV patients. A P-value less than 0.05 and adjusted odds ratio with a 95% confidence interval non-inclusive of one was considered statistically significant.
RESULTS
The prevalence of Hepatitis B Surface Antigen (HBsAg) was identified constituting 7.14% of the study population. Females [AOR] 0.14; 95% Confidence Interval [CI] [0.041-0.478]). Participants with an educational status of only reading and writing (AOR 8.7; 95% CI [1.143-66.5]). Single individuals (AOR 2.04; 95% CI [1.346-28.6]) were associated factors. Moreover, participants with a viral load exceeding 1000 copies/ml were 6.5 times more likely to be infected with HBV compared to those with undetectable viral loads (AOR 6.53, 95% CI [1.87-22.72]). Additionally, individuals with a CD4 count ranging from 351 to 500 cells/ml were 1.2 times more likely to be infected with HBV compared to those with a CD4 count of 500 cells/ml or above (AOR 10.4, 95% CI [1.28-85]).
CONCLUSION
The prevalence of HBV infection was found to be intermediate in HIV-infected patients in the study area. Being male, marital status of single and divorced, educational level was only read and written, current viral load of > 1000 copies/ml &<1000 copies/ml, and current CD4 < 250 cells/ml were found statistically associated factors for HBV infection. Thus, we recommend the provision of routine screening for HBsAg and appropriate treatment with accurate information on risk factors for HBV to improve quality of life and reduce morbidity.
Topics: Humans; Ethiopia; Female; HIV Infections; Male; Adult; Cross-Sectional Studies; Hepatitis B; Coinfection; Prevalence; Middle Aged; Young Adult; Adolescent; Risk Factors; Hepatitis B Surface Antigens; Hepatitis B virus
PubMed: 38693473
DOI: 10.1186/s12879-024-09355-4 -
International Journal of Geriatric... May 2024As symptoms emerge and worsen in people living with dementia, their spouses can benefit from behavioral interventions to support their adjustment as a care partner. The...
"WOOP is my safe haven": A qualitative feasibility and acceptability study of the Wish Outcome Obstacle Plan (WOOP) intervention for spouses of people living with early-stage dementia.
OBJECTIVES
As symptoms emerge and worsen in people living with dementia, their spouses can benefit from behavioral interventions to support their adjustment as a care partner. The Wish Outcome Obstacle Plan (WOOP) intervention improves the well-being of spouses of people living with dementia early in the disease course, but intervention mechanisms and opportunities for improvement are unclear. The present study gave voice to spouses who participated in a trial of WOOP, describing how WOOP was incorporated into their lives and how it could be improved for future implementation.
METHOD
For this qualitative study, we conducted longitudinal semi-structured interviews among 21 spouses of people living with dementia (three interviews over three months; 63 interviews total). Codebook thematic analysis was performed.
RESULTS
Three meta-themes were derived: (1) assessing baseline strengths and limitations of WOOP, (2) learning from experience, and (3) fine-tuning and sustaining WOOP. Participants described how WOOP addressed their interpersonal and emotional stressors, their responses to behaviors of the person living with dementia, and their relationship quality. Considerations for future intervention delivery (e.g., solo vs. in group settings) and instructions (e.g., encouraging writing vs. thinking through the four steps of WOOP) were identified as areas of improvement.
CONCLUSIONS
WOOP was described as a practical, feasible, and desirable intervention for spouses at the early stages of their partner's dementia. Participants made WOOP easier to incorporate in their everyday lives by adapting the design into a mental exercise that they used as needed. Suggestions from participants specified how to make the everyday use of WOOP more feasible, sustainable, and applicable in a variety of contexts.
TRIAL REGISTRATION
ClinicalTrials.gov HIC 2000021852.
Topics: Humans; Male; Female; Dementia; Spouses; Aged; Qualitative Research; Feasibility Studies; Middle Aged; Aged, 80 and over; Caregivers; Longitudinal Studies; Adaptation, Psychological; Behavior Therapy
PubMed: 38687142
DOI: 10.1002/gps.6092