Medication adherence among vulnerable populations with chronic diseases

[ES]Introducción.- A pesar de la amplia oferta y la contrastada efectividad de los tratamientos farmacológicos a largo plazo que existen en la actualidad para controlar la clínica y la progresión de las enfermedades crónicas, la efectividad de estos puede quedar comprometida debido al elevado incumplimiento existente en la población. Relativamente, poco es conocido sobre la adherencia al tratamiento en sujetos que padecen enfermedades crónicas pertenecientes a grupos de población vulnerable. Un mayor conocimiento de los factores y de las barreras que condicionan y/o determinan el tratamiento terapéutico de estos grupos poblacionales permitirá a los profesionales sanitarios identificar y controlar a los pacientes con problemas de incumplimiento. Objetivos.- Analizar el fenómeno de incumplimiento, sus causas, y los factores relacionados de acuerdo al marco conceptual propuesto por la OMS: i) factores socioeconómicos; ii) factores relacionados con el sistema o el equipo de asistencia médica; iii) factores relacionados con la enfermedad; iv) factores relacionados con el tratamiento y v) factores relacionados con el paciente. Material y Métodos.- Estudio observacional, descriptivo, y transversal, con dos momentos de recogida de información en el tiempo, en los primeros seis meses tras el inicio de un nuevo tratamiento y al noveno mes de tratamiento, realizado en dos centros médicos comunitarios del condado de Chatham, GA, USA. Sujetos ≥19 años, con al menos una enfermedad crónica y régimen farmacológico prescrito en los primeros seis meses de tratamiento fueron invitados a participar en el estudio. Se utilizó como instrumento de medida el cuestionario de adherencia a mediación Morisky-Green-Levine para analizar dicho cumplimiento. Resultados.- Un total de 150 pacientes (49.8 ± 10.9 años, 36.7% hombres) fueron entrevistados. El porcentaje de incumplimiento evaluado al noveno meses de tratamiento alcanza el 81%, siendo el olvido de la medicación la principal causa. El análisis bivariado ha identificado la raza/etnia, el lugar de nacimiento, las dificultades en el transporte, la comunicación y el apoyo social recibido, el grupo de riesgo clínico del paciente, las prácticas de monitorización fuera del entorno clínico, y los métodos o estrategias para recordar la toma de medicación como factores estadísticamente significativos asociados con el incumplimiento del tratamiento farmacológico (p<0.005). Por otro lado, el análisis multivariado ha establecido la raza afroamericana (odds ratio ajustado [ORA]= 1.07, intervalo de confianza 95% [IC]= 1.03-8.31, vs blancos), la etnia hispana/latina (ORA= 2.11, 95% [IC]= 1.91-35.56 vs blancos), las dificultades de transporte para recoger las medicinas (ORA= 1.98, 95% [IC]= 2.06-25.41), el grupo de riesgo clínico G2 (ORA= 5.49, 95% [IC]= 1.54-19.57, vs G3), y la ausencia de un método o estrategia para recordar la toma de medicación (ORA=6.32, 95% [IC]= 1.61-24.83) como variables independientes predictoras de incumplimiento. Conclusiones.- El incumplimiento del tratamiento farmacológico de las enfermedades crónicas de los grupos de población vulnerables es más elevado que el incumplimiento de la población general de referencia de los países desarrollados. La mejor comprensión de los factores del marco multidimensional de la OMS ha permitido la construcción de un perfil predictivo de paciente en riesgo de incumplimiento para ayudar a los profesionales sanitarios a identificar a dichos pacientes y proporcionarles recomendaciones y apoyo para evitar el incumplimiento y mejorar su calidad de vida. Implicaciones Prácticas.- Una apreciación de las barreras relacionadas con la adherencia al tratamiento farmacológico permite diseñar futuras intervenciones desde un punto de vista multidimensional para mejorar la calidad asistencial y reducir las desigualdades en los grupos de población vulnerables. Futuras investigaciones centradas en estudios de comparación trans-poblacionales, particularmente en aquellos sistemas donde estas poblaciones reciben más asistencia, como por ejemplo los sistemas de atención sanitaria universal, revelarán nuevas observaciones aplicables a estas poblaciones para mejorar el acceso y la calidad a la atención sanitaria y, por tanto, mejorar su Bienestar y Calidad de Vida.[EN]Introduction. - Although the current availability of a wide range of effective long-term pharmacological therapies to control the symptoms and the progression of chronic diseases, the effectiveness of these therapies may be reduced due to the alarmingly high rates of non-adherence. Relatively little is known about treatment adherence among vulnerable populations with chronic diseases. A greater appreciation of factors and barriers that condition and/or determine treatment adherence among vulnerable populations will allow health professionals to identify and manage patients with those issues. Objectives.- To analyze the extent, the causes, and the related factors of medication adherence according to the conceptual framework proposed by the WHO: i) social and economic factors, ii) healthcare team and system- related factors, iii) condition-related factors, iv) therapy-related factors, and v) patient-related factors. Materials and Methods.- An observational, cross sectional study across two time points, including data collection within first six months of treatment and data collection at the ninth month of treatment, was carried out in two community health centers from Chatham County, Georgia, in the United States. Subjects ≥ 19 years with at least one chronic condition and a prescribed medication within the first 6 months of treatment, were invited to participate in the study. The Morisky-Green-Levine adherence questionnaire was used to assess medication adherence. Results.- A total of 150 patients (49.8 ± 10.9 years, 36.7% men) were interviewed. Non-adherence rate was 81% at the 9th month of treatment, being forgetfulness in taking medication the main reason for non-adherence. Factors-related identified in the bivariate analyses were: race/ethnicity, place of birth, transportation issues, communication received, social support received, clinical risk group, monitoring techniques in non-clinical settings, and medication reminders (p<0.005). In the multivariate analyses, Afro-Americans (adjusted odds ratio [AOR]= 1.07, 95% confidence interval [CI]= 1.03-8.31, vs whites), Hispanic/Latinos (AOR= 2.11, 95% CI=1.91-35.56, vs whites), transportation issues to pick up medicines (AOR= 1.98, 95% CI = 2.06-25.41), clinical risk group G2 (AOR= 5.49, 95% CI= 1.54-19.57, vs G3), and lack of reminders to remember the medication intake (AOR= 6.32, 95% CI= 1.61-24.83), were independently associated with non-adherence. Conclusions.- Medication non-adherence rates among vulnerable population groups is higher than among reference population in developed countries. A larger comprehension of the multidimensional framework proposed by the WHO has allowed to create a non-adherence predictive risk profile. This profile will help health professionals to identify such patients and provide them with recommendations and social support to avoid the non-adherence problem and improve their quality of life. Practical Implications.- An understanding of the related barriers to medication adherence allows to design further interventions from a multidimensional perspective to improve quality of healthcare and reduce inequalities among vulnerable populations. Future research focused on cross-population comparisons, particularly on those healthcare systems in which vulnerable populations receive more assistance, e.g., universal healthcare systems, will yield new findings that can improve access to healthcare and, consequently, improve their well-being and quality of life

Effects of Tribulus terrestris L. on Sport and Health Biomarkers in Physically Active Adult Males: A Systematic Review

[EN] Tribulus terrestris L. (TT) is a plant used in traditional Chinese medicine, Ayurvedic medicine, and sports nutrition to improve health and performance. However, no conclusive evidence exists about the potential beneficial effects of TT on sport and health biomarkers in physically active adults. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the modified McMaster Critical Review Form for methodological quality assessment, we systematically reviewed studies indexed in Web of Science, Scopus, and PubMed, to assess the effects of TT on immunological, hematological, biochemical, renal, lipidic, hormonal behavior, and anti-inflammatory response in physically active adult males. Among 340 records identified in the search, a total of 7 studies met the inclusion and exclusion criteria. Overall, participants supplemented with TT displayed significant improvements in lipid profile. Inflammatory and hematological biomarkers showed moderate beneficial effects with no significant changes on renal biomarkers. No positive effects were observed on the immune system response. Additionally, no TT-induced toxicity was reported. In conclusion, there was no clear evidence of the beneficial effects of TT supplementation on muscle damage markers and hormonal behavior. More studies are needed to confirm the benefits of TT due to the limited number of studies available in the current literature.S

Modulation of Exercise-Induced Muscle Damage, Inflammation, and Oxidative Markers by Curcumin Supplementation in a Physically Active Population: A Systematic Review

[EN] hysical activity, particularly high-intensity eccentric muscle contractions, produces exercise-induced muscle damage (EIMD). The breakdown of muscle fibers and the consequent inflammatory responses derived from EIMD affect exercise performance. Curcumin, a natural polyphenol extracted from turmeric, has been shown to have mainly antioxidant and also anti-inflammatory properties. This effect of curcumin could improve EIMD and exercise performance. The main objective of this systematic review was to critically evaluate the effectiveness of curcumin supplementation on EIMD and inflammatory and oxidative markers in a physically active population. A structured search was carried out following Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines in the databases SCOPUS, Web of Science (WOS), and Medline (PubMed) from inception to October 2019. The search included original articles with randomized controlled crossover or parallel design in which the intake of curcumin administered before and/or after exercise was compared with an identical placebo situation. No filters were applied to the type of physical exercise performed, the sex or the age of the participants. Of the 301 articles identified in the search, 11 met the established criteria and were included in this systematic review. The methodological quality of the studies was assessed using the McMaster Critical Review Form. The use of curcumin reduces the subjective perception of the intensity of muscle pain; reduces muscle damage through the decrease of creatine kinase (CK); increases muscle performance; has an anti-inflammatory effect by modulating the pro-inflammatory cytokines, such as TNF-α, IL-6, and IL-8; and may have a slight antioxidant effect. In summary, the administration of curcumin at a dose between 150–1500 mg/day before and during exercise, and up until 72 h’ post-exercise, improved performance by reducing EIMD and modulating the inflammation caused by physical activity. In addition, humans appear to be able to tolerate high doses of curcumin without significant side-effects.S

The Role of Selenium Mineral Trace Element in Exercise: Antioxidant Defense System, Muscle Performance, Hormone Response, and Athletic Performance. A Systematic Review

[EN] Exercise overproduces oxygen reactive species (ROS) and eventually exceeds the body’s antioxidant capacity to neutralize them. The ROS produce damaging effects on the cell membrane and contribute to skeletal muscle damage. Selenium (Se), a natural mineral trace element, is an essential component of selenoproteins that plays an important role in antioxidant defense. The activity of the enzyme glutathione peroxidase (GPx), a highly-efficient antioxidant enzyme, is closely dependent on the presence of Se. These properties of Se may be potentially applicable to improve athletic performance and training recovery. We systematically searched for published studies to evaluate the effectiveness of Se supplementation on antioxidant defense system, muscle performance, hormone response, and athletic performance among physically active individuals. We used the Preferred Reporting Elements for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and searched in SCOPUS, Web of Science (WOS), and PubMed databases to identify published studies until March 2020. The systematic review incorporated original studies with randomized controlled crossover or parallel design in which intake of Se administered once a day was compared with the same placebo conditions. No exclusions were applied for the type of physical exercise performed, the sex, nor the age of the participants. Among 150 articles identified in the search, 6 met the criteria and were included in the systematic review. The methodological quality of the studies was evaluated using the McMaster Critical Review Form. Oral Se supplementation with 180 µg/day or 240 µg/day (selenomethionine) and 200 µg/day (Sodium Selenite), significantly decreased lipid hydroperoxide levels and increased GPx in plasma, erythrocyte, and muscle. No significant effects were observed on athletic performance, testosterone hormone levels, creatine kinase activity, and exercise training-induced adaptations on oxidative enzyme activities or on muscle fiber type myosin heavy chain expression. In addition, Se supplementation showed to have a dampening effect on the mitochondria changes in chronic and acute exercise. In summary, the use of Se supplementation has no benefits on aerobic or anaerobic athletic performance but it may prevent Se deficiencies among athletes with high-intensity and high-volume training. Optimal Se plasma levels may be important to minimize chronic exercise-induced oxidative effects and modulate the exercise effect on mitochondrial changes.S

Effect of Iron Supplementation on the Modulation of Iron Metabolism, Muscle Damage Biomarkers and Cortisol in Professional Cyclists

Background: The intense efforts made during 3-week stage races may reduce iron metabolism and hematological parameters. These efforts may increase the levels of circulating muscle damage markers and some hormones. All of these physiological changes may have negative consequences not only for the performance of athletes but also for their health. The main aim of this study was to evaluate the effects of supplementation with 80 mg/day of iron on haematological parameters, serum cortisol and biochemical muscle indicators on elite male cyclists during the 3-week stage race the Vuelta a España. Our secondary aim was to examine whether the hematological profile is associated with muscular damage parameters and cortisol. Methods: Eighteen elite male cyclists from two teams were randomly assigned to one of two groups: (1) control group (CG, n = 9; age: 26.1 ± 4.6 years; maximum oxygen uptake per kg: 78.0 ± 5.4 mL/kg/min) or (2) group treated with 80 mg/day iron (800 mg of iron protein succinylate, ITG, n = 9; age: 25.7 ± 6.4 years; maximum oxygen uptake per kg: 77.6 ± 6.5 mL/kg/min). The cyclists were subjected to blood tests one week before the start of the race (T1) and after 4 weeks of treatment, coinciding with the end of the competition (T2). Iron metabolism parameters, muscle damage indicators and serum cortisol were assessed. Repeated-measures ANOVA with group as a factor (GC and ITG) were used to examine the differences between groups throughout the study (time × group) after iron supplementation treatment. Results: Significant differences were observed between groups throughout the study in the group-by-time interaction and changes in serum iron (GC: -8.93 ± 10.35% vs. ITG: 0.60 ± 8.64%; p = 0.018), ferritin (GC: -13.88 ± 23.53% vs. ITG: 91.08 ± 118.30%; p = 0.004), haemoglobin (GC: 10.00 ± 3.32% vs. ITG: 13.04 ± 5.64%; p < 0.001), haematocrit (GC: -1.17 ± 3.78% vs. ITG: 7.32 ± 3.92%; p < 0.001) and cortisol (GC: 24.74 ± 25.84% vs. ITG: ⁻13.54 ± 13.61%; p = 0.005). However, no significant group-by-time interaction was observed for the circulating muscle biomarkers. Additionally, significant negative correlations of serum iron, haemoglobin and haematocrit with muscle circulating biomarkers and cortisol (p < 0.05) were observed. Conclusions: Oral iron supplementation with 80 mg/day iron (800 mg of iron protein succinylate) effectively prevented a decline in haematological parameters (serum iron, ferritin, haemoglobin and haematocrit) and maintained optimal levels of recovery in elite cyclists during the Vuelta a España. Moreover, the hematological values were shown to have relationship with muscular recovery parameters

The role of selenium mineral trace element in exercise: antioxidant defense system, muscle performance, hormone response, and athletic performance. A systematic review

Exercise overproduces oxygen reactive species (ROS) and eventually exceeds the body’s antioxidant capacity to neutralize them. The ROS produce damaging effects on the cell membrane and contribute to skeletal muscle damage. Selenium (Se), a natural mineral trace element, is an essential component of selenoproteins that plays an important role in antioxidant defense. The activity of the enzyme glutathione peroxidase (GPx), a highly-efficient antioxidant enzyme, is closely dependent on the presence of Se. These properties of Se may be potentially applicable to improve athletic performance and training recovery. We systematically searched for published studies to evaluate the effectiveness of Se supplementation on antioxidant defense system, muscle performance, hormone response, and athletic performance among physically active individuals. We used the Preferred Reporting Elements for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and searched in SCOPUS, Web of Science (WOS), and PubMed databases to identify published studies until March 2020. The systematic review incorporated original studies with randomized controlled crossover or parallel design in which intake of Se administered once a day was compared with the same placebo conditions. No exclusions were applied for the type of physical exercise performed, the sex, nor the age of the participants. Among 150 articles identified in the search, 6 met the criteria and were included in the systematic review. The methodological quality of the studies was evaluated using the McMaster Critical Review Form. Oral Se supplementation with 180 µg/day or 240 µg/day (selenomethionine) and 200 µg/day (Sodium Selenite), significantly decreased lipid hydroperoxide levels and increased GPx in plasma, erythrocyte, and muscle. No significant effects were observed on athletic performance, testosterone hormone levels, creatine kinase activity, and exercise training-induced adaptations on oxidative enzyme activities or on muscle fiber type myosin heavy chain expression. In addition, Se supplementation showed to have a dampening effect on the mitochondria changes in chronic and acute exercise. In summary, the use of Se supplementation has no benefits on aerobic or anaerobic athletic performance but it may prevent Se deficiencies among athletes with high-intensity and high-volume training. Optimal Se plasma levels may be important to minimize chronic exercise-induced oxidative effects and modulate the exercise effect on mitochondrial changes

Electromyography: a simple and accessible tool to assess physical performance and health during hypoxia training. A systematic review

Hypoxia causes reduced partial pressure of oxygen in arterial blood and induces adaptations in skeletal muscle that may affect individuals’ physical performance and muscular health. These muscular changes are detectable and quantifiable by electromyography (EMG), an instrument that assesses electrical activity during active contraction at rest. EMG is a relatively simple and accessible technique for all patients, one that can show the degree of the sensory and motor functions because it provides information about the status of the peripheral nerves and muscles. The main goal of this review is to evaluate the scientific evidence of EMG as an instrument for monitoring different responses of skeletal muscles subjected to external stimuli such as hypoxia and physical activity. A structured search was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines in Medline/PubMed, Scielo, Google Scholar, Web of Science, and Cochrane Library Plus. The search included articles published in the last 25 years until May 2020 and was restricted to English- and Spanish-language publications. As such, investigators identified nine articles that met the search criteria. The results determined that EMG was able to detect muscle fatigue from changes in the frequency spectrum. When a muscle was fatigued, high frequency components decreased and low frequency components increased. In other studies, EMG determined muscle activation increased during exercise by recruiting motor units and by increasing the intensity of muscle contractions. Finally, it was also possible to calculate the mean quadriceps quadratic activity used to obtain an image of muscle activation. In conclusion, EMG offers a suitable tool for monitoring the different skeletal muscle responses and has sufficient sensitivity to detect hypoxia-induced muscle changes produced by hypoxic stimuli. Moreover, EMG enhances an extension of physical examination and tests motor-system integrity

Effects of Withania somnifera (Ashwagandha) on hematological and biochemical markers, hormonal behavior, and oxidant response in healthy adults: A systematic review

Producción CientíficaPurpose of Review Withania somnifera (L.) Dunal (Ws) is a common herb plant that has been used for centuries to treat a wide range of conditions, particularly certain chronic diseases due to its antidiabetic, cardioprotective, antistress, and chondroprotec- tive effects, among many others. No conclusive evidence, however, exists about the potential health effects of Ws in adults with- out chronic conditions. We aimed to evaluate the current evidence on the health benefits of Ws supplementation in healthy adults. Recent Findings Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically reviewed studies indexed in Web of Science, Scopus, and PubMed to assess the effects of Ws on hema- tological and biochemical markers, hormonal behavior, and oxidant response in healthy adults. Original articles published up to March 5, 2022, with a controlled trial design or pre-post intervention design, in which supplementation of Ws was compared to a control group or data prior to intervention were included. Among 2,421 records identified in the search, 10 studies met the inclusion criteria. Overall, most of the studies reported beneficial effects of the Ws supplementation, and no serious adverse events were reported. Participants supplemented with Ws displayed reduced levels of oxidative stress and inflammation, and counterbalanced hormone levels. No evidence of the beneficial effects of Ws supplementation on hematological markers was reported. Summary Ws supplementation appears to be safe, may regulate hormone levels, and has potent anti-inflammatory and anti- oxidant effects. However, further studies are needed to elucidate the relevance of its application.Publicación en abierto financiada por el Consorcio de Bibliotecas Universitarias de Castilla y León (BUCLE), con cargo al Programa Operativo 2014ES16RFOP009 FEDER 2014-2020 DE CASTILLA Y LEÓN, Actuación:20007-CL - Apoyo Consorcio BUCL

Modulation of exercise-induced muscle damage, inflammation, and oxidative markers by curcumin supplementation in a physically active population: A systematic review

Producción CientíficaPhysical activity, particularly high-intensity eccentric muscle contractions, produces exercise-induced muscle damage (EIMD). The breakdown of muscle fibers and the consequent inflammatory responses derived from EIMD affect exercise performance. Curcumin, a natural polyphenol extracted from turmeric, has been shown to have mainly antioxidant and also anti-inflammatory properties. This effect of curcumin could improve EIMD and exercise performance. The main objective of this systematic review was to critically evaluate the effectiveness of curcumin supplementation on EIMD and inflammatory and oxidative markers in a physically active population. A structured search was carried out following Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines in the databases SCOPUS, Web of Science (WOS), and Medline (PubMed) from inception to October 2019. The search included original articles with randomized controlled crossover or parallel design in which the intake of curcumin administered before and/or after exercise was compared with an identical placebo situation. No filters were applied to the type of physical exercise performed, the sex or the age of the participants. Of the 301 articles identified in the search, 11 met the established criteria and were included in this systematic review. The methodological quality of the studies was assessed using the McMaster Critical Review Form. The use of curcumin reduces the subjective perception of the intensity of muscle pain; reduces muscle damage through the decrease of creatine kinase (CK); increases muscle performance; has an anti-inflammatory effect by modulating the pro-inflammatory cytokines, such as TNF-α, IL-6, and IL-8; and may have a slight antioxidant effect. In summary, the administration of curcumin at a dose between 150–1500 mg/day before and during exercise, and up until 72 h’ post-exercise, improved performance by reducing EIMD and modulating the inflammation caused by physical activity. In addition, humans appear to be able to tolerate high doses of curcumin without significant side-effects

Immunomodulator drugs for the treatment of multiple myeloma

Producción CientíficaThalidomide changed the treatment of patients with multiple myeloma, however, its effectiveness has been compromised due to its side effects. New strategies are needed to specifically target the challenges of multiple myeloma through innovative, more effective, and less toxic therapy. The new immunomodulatory (IMiDs) compounds are structural and functional analogs of thalidomide, which were designed to improve the immunomodulatory and anticancer properties and tolerability profiles. We review the development of second generation IMiDs, lenalidomide and pomalidomide, their immunomodulatory and tumoricidal effects, their mechanisms of action, as well as the influence of dexamethasone on their effect and pharmacological resistance. In conclusion, lenalidomide and pomalidomide demonstrate a powerful activity and they are highly effective and well-tolerated treatment options for patients with myeloma, used alone or in combination with dexamethasone