Medication Nonadherence and Associated Factors among Heart Failure Patients at University of Gondar Comprehensive Specialized Hospital, Northwest EthiopiaRead the full article
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Adherence to Self-Care Recommendations and Associated Factors among Adult Heart Failure Patients in West Gojjam Zone Public Hospitals, Northwest Ethiopia
Background. Self-care practices are an important part of heart failure patient management and essential to control symptoms of the disease and its exacerbation. However, poor adherence to these self-care behaviors could be associated with an increase in hospitalization, morbidity, and mortality. Even if it is an important part of management for heart failure patients, yet information is not adequate in the study area about adherence to self-care recommendations and associated factors among heart failure patients. Purpose. To assess self-care recommendation adherence and associated factors among heart failure patients in West Gojjam Zone public hospitals. Methods. Institutional-based cross-sectional study was conducted on 304 selected heart failure patients attending follow-up at public hospitals in West Gojjam Zone from March 16 to April 16, 2021. Consecutive sampling technique based on patient arrival with proportional allocation to each hospital was employed to select the study participants. Data were collected through face-to-face interview and reviewing patients’ medical records. Data were entered into EpiData version 3.1 and analyzed using Statistical Package for Social Sciences (SPSS) version 25. Binary logistic regression model was fitted to assess the association between adherence to self-care recommendations and associated factors. value < 0.05 with 95% confidence interval (CI) was considered to declare a statistically significant association in multivariable logistic regression. Results. In this study, 304 patients participated with a response rate of 97.4%. Only 32.9% of them had good adherence to self-care recommendations. Having good knowledge on heart failure (adjusted odds ratio ; 95% CI: 1.82, 11.86), no depression (; 95% CI: 1.92, 19.37), having strong social support (; 95% CI: 1.56–8.33), age 30-49 years (; 95% CI: 1.14, 9.89), and college and above level of education (; 95% CI: 1.22, 31.25) were factors significantly associated with good adherence to self-care recommendations. Conclusion. This study showed that most of the heart failure patients had poor adherence to self-care recommendations. Policymakers and other stakeholders should develop and implement appropriate strategies to increase patients’ adherence level to self-care recommendations by emphasizing on addressing identified factors.
Improving Diabetes Care: A Fijian Diabetes Service Improvement Study
Background. Achieving good outcomes in type 2 diabetes mellitus patients’ needs a decent integrated care service with access to resources. The Fiji Islands has one of the highest rates of diabetes disease burden and has available resources to alleviate the diabetic disease pandemic in its population, yet patient outcomes are getting worse. We hypothesize that a dysfunction in health-care delivery system may be accentuating the diabetic disease process; therefore, this service evaluation study was conducted to provide insight into the management of T2DM in a secondary care clinic setting. Methods. We conducted a retrospective chart review of patient records for the past three years (2015-2018). Random quota sampling was used to extract patient folders over a one-month period. A total of 113 patient charts were analyzed which met the inclusion criteria. Results. The overall glycemic levels were uncontrolled in every seven out of ten patients. Most of the patients were on combination drug therapy and at maximum dosing ranges. HbA1c tests, as a monitoring tool, were being inadequately used. Nonadherence to management was prominent in poor controlled patients, and physicians failed to provide appropriate interventions in this group. Nearly all the patients had not received eye assessments, foot risk assessment, and individualized dietetic counselling over three years. Macrovascular complications were more common than microvascular end organ damage. Conclusion. There is a high degree of uncontrolled glycemia and comorbidities in patients attending the service of study which is being perpetuated by poor integrated diabetes care. Strengthening educational initiatives, using validated strategic tools to streamline diabetic services and astute evidence-based resource allocation and management, is needed.
Prevalence and Influencing Factors of Overweight and Obesity among Adult Residents of Western China: A Cross-Sectional Study
Background. Overweight and obesity have become a serious health problem. There are a few data on the prevalence of overweight and obesity in Baoji city of western China, this study was conducted to investigate the epidemiologic features of overweight and obesity and explored influencing factors among Baoji adult residents. Methods. A cross-sectional study, including 36,600 participants aged above 15 years, was carried out in Baoji city in 2018. Each participant’s weight and height were measured, and demographic and behavioral characteristics were collected using questionnaires. Data were analyzed by means of logistic regression considering 95% level of significance. Results. Overall, the prevalence of overweight and obesity was 30.73% and 3.11%, respectively. Male had a significantly higher prevalence of overweight (31.45% vs. 29.98%, ) while female had a higher prevalence of obesity (3.50 vs. 2.74, ). In the logistic regression analysis, being married or living with a partner (, ), unemployed or retired (, ), former smokers (, ), drinking alcohol (, ), sleeping more than 10 hours (, ), and increasing age were all significantly associated with a higher prevalence of overweight/obesity, whereas people who lived in rural areas (, ) or had a sufficient leisure time physical activity per week (, ) were associated with a lower prevalence. Conclusion. Our results demonstrate that demographic and behavioral factors play an important role in prevalence of overweight/obesity, which can support the implementation of interventions aimed at weight control and consequently prevention of related diseases in this population.
Global Burden of Anxiety and Depression among Cystic Fibrosis Patient: Systematic Review and Meta-Analysis
Aims. This systemic review and meta-analysis were aimed at determining the level of anxiety and depression among cystic fibrosis patients in the world. Methods. We conducted a systematic search of published studies from PubMed, EMBASE, MEDLINE, Cochrane, Scopus, Web of Science, CINAHL, and manually on Google Scholar. This meta-analysis follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality of studies was assessed by the modified Newcastle-Ottawa Scale (NOS). Meta-analysis was carried out using a random-effects method using the STATA™ Version 14 software. Trim and fill analysis was done to correct the presence of significant publication bias. Result. From 419,820 obtained studies, 26 studies from 2 different parts of the world including 9766. The overall global pooled prevalence of anxiety and depression after correction for publication bias by trim and fill analysis was found to be 24.91(95% CI: 20.8-28.9) for anxiety. The subgroup analyses revealed with the lowest prevalence, 23.59%, (95% CI: 8.08, 39.09)) in North America and the highest, 26.77%, (95% CI: 22.5, 31.04) seen in Europe for anxiety and with the highest prevalence, 18.67%, (95% CI: 9.82, 27.5) in North America and the lowest, 13.27%, (95% CI: -10.05, 16.5) seen in Europe for depression. Conclusion. The global prevalence of anxiety and depression among cystic fibrosis patients is common. Therefore, close monitoring of the patient, regularly screening for anxiety and depression, and appropriate prevention techniques is recommended.
Point-of-Care Ultrasound (POCUS) in the Field of Diabetology
Ultrasound is increasingly used in daily clinical practice to improve the efficiency of the clinical examination. In this article, we reviewed its various possible uses in the field of diabetology. The ultrasonic evaluation of the carotid arteries (plaques and intima media thickness) allows improving the assessment of the cardiovascular risk. Steatosis can be detected relatively easily on liver ultrasound. Ultrasound also allows a more sensitive detection of lipohypertrophy resulting in glycemic fluctuations and thus increasing the risk of hypoglycemia than the clinical examination. Finally, muscle ultrasound appears to be a promising tool to assess the nutritional status and its consequences (e.g., falls).
Assessment of Prevalence, Associations ,Knowledge, and Practices about Diabetic Foot Disease in a Tertiary Care Hospital in Colombo, Sri Lanka
Background. One in five adults in Sri Lanka has either diabetes or prediabetes, and one-third of those with diabetes are undiagnosed. Diabetic foot is a debilitating condition affecting up to 50% of patients with both type 1 and type 2 diabetes. The risk of nontraumatic lower limb amputations is 15 times higher in diabetic patients when compared with nondiabetics. Patient education about correct foot care practices is the cornerstone of prevention of diabetic foot disease. Objective. To assess the prevalence of diabetic foot disease, knowledge, and practices about diabetic foot care among diabetic patients. Methods. 334 patients attending the diabetic clinic in Colombo South Teaching Hospital were recruited according to the inclusion and exclusion criteria. Data were collected using 3 questionnaires, and they were filled using the foot examination findings, patients’ medical records, and direct interviewing of the patients. Results. The mean age of the patients included in the study was years while the median duration of diabetes was years. 34.1% patients had peripheral neuropathy, and 29.5% had peripheral vascular disease. Diabetic foot disease according to the WHO definition was present only in 23 (6.9%) patients. There was a significant association between peripheral neuropathy and current or past foot ulcer which took more than 2 weeks to heal (). Knowledge about foot care was less among the studied population, and it was associated with poor foot care practices. Presence of diabetic foot and current or past foot ulcer which took more than 2 weeks to heal were significantly associated with the foot care knowledge and practices () Conclusion. Improvement of patients’ knowledge about foot care and their practices have a significant impact on the reduction of diabetic foot disease.