Development and description of measurement properties of an instrument to assess treatment burden among patients with multiple chronic conditions

<p>Abstract</p> <p>Background</p> <p>Patients experience an increasing treatment burden related to everything they do to take care of their health: visits to the doctor, medical tests, treatment management and lifestyle changes. This treatment burden could affect treatment adherence, quality of life and outcomes. We aimed to develop and validate an instrument for measuring treatment burden for patients with multiple chronic conditions.</p> <p>Methods</p> <p>Items were derived from a literature review and qualitative semistructured interviews with patients. The instrument was then validated in a sample of patients with chronic conditions recruited in hospitals and general practitioner clinics in France. Factor analysis was used to examine the questionnaire structure. Construct validity was studied by the relationships between the instrument's global score, the Treatment Satisfaction Questionnaire for Medication (TSQM) scores and the complexity of treatment as assessed by patients and physicians. Agreement between patients and physicians was appraised. Reliability was determined by a test-retest method.</p> <p>Results</p> <p>A sample of 502 patients completed the Treatment Burden Questionnaire (TBQ), which consisted of 7 items (2 of which had 4 subitems) defined after 22 interviews with patients. The questionnaire showed a unidimensional structure. The Cronbach's α was 0.89. The instrument's global score was negatively correlated with TSQM scores (r_s= -0.41 to -0.53) and positively correlated with the complexity of treatment (r_s= 0.16 to 0.40). Agreement between patients and physicians (n = 396) was weak (intraclass correlation coefficient 0.38 (95% confidence interval 0.29 to 0.47)). Reliability of the retest (n = 211 patients) was 0.76 (0.67 to 0.83).</p> <p>Conclusions</p> <p>This study provides the first valid and reliable instrument assessing the treatment burden for patients across any disease or treatment context. This instrument could help in the development of treatment strategies that are both efficient and acceptable for patients.</p

Chemical neuroanatomy of the hypothalamo-hypophyseal system in sturgeons

International audienceThe preoptic-hypothalamo-hypophyseal system of sturgeons, located at the base of the brain, has a neurosecretory role exerted by hypophysiotropic neurons most of them located in the preoptic and hypothalamic periventricular region. The majority of those cells are of the cerebrospinal fluid-contacting type and exhibit short processes reaching the ventricular lumen. Moreover, the processes of those hypophysiotropic neurons course along the hypothalamic floor toward the hypophysis forming a preoptic-hypothalamo-hypophyseal tract. This chapter summarizes available data on the distribution of several hypophysiotropic factors, such as galanin, neurophysin, somatostatin, or gonadotropin-releasing hormone, in the preoptic-hypothalamo-hypophyseal system of sturgeons obtained by the use of immunohistochemical techniques. Immunoreactive neurons to those substances were found in the preoptic and hypothalamic nuclei, and immunoreactive fibers were observed along the preoptic-hypothalamo-hypophyseal tract and in the hypophysis, indicating their hypophysiotrophic role in the brain of sturgeons. Thus, most of the neuropeptides and neurohormones found in tetrapods are also present in sturgeons, suggesting that their common ancestors already possessed such regulatory systems. Unfortunately, because of the difficulty in approaching the physiology of sturgeons (size, cost, etc.), the number of experimental studies aiming at deciphering the roles of such neuropeptides and neurohormones is very limited, although we can speculate that part of the functions supported by these neurohormones would be similar. © Springer International Publishing AG, part of Springer Nature 2018. All rights reserved

Triggers of acute cardiovascular events and potential preventive strategies: Prophylactic role of regular exercise

There is now considerable evidence to suggest that acute myocardial infarction, sudden cardiac death, and stroke can be triggered by physical, chemical, and psychological stressors, including heavy physical exertion and situations that create heightened emotional stress. The increased risk appears to be largely limited to a susceptible subset of the population, that is, individuals with known or occult cardiovascular (CV) disease. In this article, we summarize the evidence supporting the impact of selected triggers in the pathogenesis of acute CV events, as well as the potential role of various preventive strategies, especially regular exercise training and improvements in cardiorespiratory fitness to reduce the CV risk imposed by various triggers