Poor medication adherence (PMA) is associated with higher risks of morbidity, hospitalization, and mortality. Polypharmacy is not only a determinant of PMA but is also associated with many adverse ...health outcomes.
We aimed to determine the prevalence and correlates of PMA in an older population with polypharmacy.
Baseline data from 193 older adults from the Medication Safety Review Clinic Taiwan Study were analyzed. Patients were either prescribed ≥8 long-term medications or visited ≥3 different physicians between August and October 2007. PMA was defined as taking either <80% or >120% of prescribed amounts of a medication. Patients were classified as no (0%), low level (>0 but <25%), and high level (≥25%) PMA depending on what percentage of entire medication regimen taken reached PMA.
Mean (SD) age was 76 (6) years, and mean number of medications was 9 (3), with a mean medication class number of 4 (1). Of the 1713 medications reviewed, 19% had PMA. However, at patient level, 34%, 32%, and 34% of patients were classified as no, low level, and high level PMA, respectively. Correlates varied by levels of PMA. Compared with patients without PMA, higher medication class number and use of alimentary tract, psychotropic, and hematologic agents were associated with both low and high level PMA. History of dizziness was associated with low level PMA, and higher Mini Mental Status Examination score was associated with high level PMA.
To enhance medication adherence in older adults prescribed multiple medications, medication class numbers and certain high-risk medication classes should be taken into account. Physicians should also routinely assess systemic (eg, cognition) or drug-specific characteristics (eg, side effects).
Malnutrition is common in patients with chronic kidney disease (CKD) who are on low-protein diets and is a powerful predictor of morbidity and mortality in CKD. Studies have shown that patients on ...low-protein diets often have difficulty meeting nutritional energy requirements. Our study evaluated the effects of a nonprotein calorie (NPC) supplement on renal function and nutritional status in patients on a low-protein diet.
This was a prospective, randomized, open-label, controlled clinical trial.
A total of 109 patients with CKD (men, 67%; mean age, 54.5 ± 13 years) with stage 3 to 4 disease were randomly assigned to the intervention group (n = 55) or the control group (n = 54).
All participants received individualized dietary counseling aimed at achieving a daily protein intake of 0.6 to 0.8 g and a daily energy intake of 30 to 35 kcal/kg. The intervention group consumed a 200-kcal NPC supplement daily. The control group received dietary counseling only.
The estimated glomerular filtration rate (eGFR) was calculated using the 4-variable Modification of Diet in Renal Disease (MDRD) Study equation. Urine protein excretion, dietary protein and energy intake, and serum levels of creatinine, urea nitrogen, cholesterol, triglycerides, and albumin were assessed at baseline, at 12 weeks, and at 24 weeks.
Dietary protein intake and urine protein excretion levels decreased significantly in the intervention group and were significantly lower than those of the control group. In addition, serum levels of creatinine and urea nitrogen decreased significantly, and eGFR increased significantly in the intervention group compared with baseline assessments. No significant differences were observed in the control group.
The NPC supplement improved patient adherence to the low-protein diet and reduced urine protein excretion in patients with CKD.
To investigate the role of hepatitis B virus (HBV) infection in pediatric fulminant hepatic failure (FHF) after the launch of universal HBV vaccination, the authors analyzed the data from patients ...with FHF collected from a nationwide collaborative study group. Children aged 1 month to 15 years who were diagnosed with FHF (62 males and 33 females) between 1985–1999 were included. HBV infection (hepatitis B surface antigen HBsAg and/or immunoglobulin M hepatitis B core antibody IgM anti‐HBc seropositive) accounted for 46% (43 of 95 cases) of all the cases of FHF. The average annual incidence of FHF in the time period 1985–1999 was 0.053/100,000 in the group of patients ages 1–15 years and 1.29/100,000 in those patients age < 1 year. Approximately 61% (58 of 95 cases) of all FHF cases were infants. The percentage of HBV infection was found to be higher in infants (57%) compared with children ages 1–15 years (27%) (P = 0.004). The incidence rate ratio of those patients age < 1 year to those ages 1–15 years was 54.2 for HBV‐positive FHF and 15.2 for HBV‐negative FHF. Maternal HBsAg was found to be positive in 97% of the infants with HBV‐positive FHF, and hepatitis B e antigen (HBeAg) was found to be negative in 84% of these infants. Approximately 74% of all HBV‐positive FHF patients and 81% of the infantile HBV‐positive patients had been vaccinated. In conclusion, within the first 15 years of universal vaccination, HBV was found to rarely cause FHF in children age > 1 year but remained a significant cause of FHF in infants. HBV‐positive FHF was prone to develop in infants born to HBeAg‐negative, HBsAg‐carrier mothers; these infants had not received hepatitis B immunoglobulin according to the vaccination program in place. (HEPATOLOGY 2004;39:58–63.)
Background: Influenza surveillance in recent decades in Taiwan showed that the major virus isolates were A/Hong Kong/68-like (H3N2), A/England/42/72-like (H3N2), A/Taiwan/1/86 (H1N1), ...A/Texas/36/91-like (H1N1), A/Taiwan/112/96 (H1N1), and A/Taiwan/118/96 (H1N1) based on passive virologic surveillance before 1999.
Materials and methods: To prevent the potential public health threat of a newly emerged influenza A strain like H5N1 in Hong Kong, seven surveillance systems have been established in Taiwan since 1999, including severe case reporting, sentinel physician, contract-laboratory, poultry market, domestic avian, wild bird and pig surveillance. Scientific exchanges and possible public health actions are discussed in regular meetings during the winter season.
Results: The isolation rates of influenza A virus were higher among ducks than chickens in both domestic avian and market surveillance systems. Ten subtypes of influenza A virus can be found in migrating wild birds, which may serve as a reservoir for the genetic and antigenic changes of the virus. The H6 subtype was isolated from both wild birds and market surveillance systems. Pig surveillance found that H3 occurred more in the winter, whereas H1 appeared predominantly in the summer. Human virologic surveillance also demonstrated summer and winter peaks. Market surveillance in Taipei showed H6, H4, and H3 subtypes isolated from ducks only. Sentinel physician surveillance experience has taught us the importance of involving local clinics, particularly in farm areas. The traditional passive physician reporting surveillance provided limited information and it was replaced by severe case reporting. Most elderly physicians in Taiwan did not like to report influenza even after implementation of direct electronic reporting through a worldwide web system. More modern technology will be applied to increase the timeliness and representativeness of influenza surveillance in preparing for future pandemics.
Conclusion: Integration of animal and human influenza surveillance systems in the high population density in Taiwan serves as a model in the efforts of global influenza surveillance to detect newly emerged influenza virus strains via several channels, particularly useful in detecting severity of cases and inter-species transmission.
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