A Cross-Sectional Survey on Medication Management Practices for Noncommunicable Diseases in Europe During the Second Wave of the COVID-19 Pandemic

Maintaining healthcare for noncommunicable diseases (NCDs) is particularly important during the COVID-19 pandemic; however, diversion of resources to acute care, and physical distancing restrictions markedly affected management of NCDs. We aimed to assess the medication management practices in place for NCDs during the second wave of the COVID-19 pandemic across European countries. In December 2020, the European Network to Advance Best practices & technoLogy on medication adherencE (ENABLE) conducted a cross-sectional, web-based survey in 38 European and one non-European countries. Besides descriptive statistics of responses, nonparametric tests and generalized linear models were used to evaluate the impact on available NCD services of the number of COVID-19 cases and deaths per 100,000 inhabitants, and gross domestic product (GDP) per capita. Fifty-three collaborators from 39 countries completed the survey. In 35 (90%) countries face-to-face primary-care, and out-patient consultations were reduced during the COVID-19 pandemic. The mean ± SD number of available forms of teleconsultation services in the public healthcare system was 3 ± 1.3. Electronic prescriptions were available in 36 (92%) countries. Online ordering and home delivery of prescription medication (avoiding pharmacy visits) were available in 18 (46%) and 26 (67%) countries, respectively. In 20 (51%) countries our respondents were unaware of any national guidelines regarding maintaining medication availability for NCDs, nor advice for patients on how to ensure access to medication and adherence during the pandemic. Our results point to an urgent need for a paradigm shift in NCD-related healthcare services to assure the maintenance of chronic pharmacological treatments during COVID-19 outbreaks, as well as possible future disasters

Crave-Out: A Distraction/Motivation Mobile Game to Assist in Smoking Cessation

BACKGROUND: Smoking is still the number one preventable cause of death. Cravings-an intense desire or longing for a cigarette-are a major contributor to quit attempt failure. New tools to help smokers\u27 manage their cravings are needed. OBJECTIVE: To present a case study of the development process and testing of a distraction/motivation game (Crave-Out) to help manage cravings. METHODS: We used a phased approach: in Phase 1 (alpha testing), we tested and refined the game concept, using a Web-based prototype. In Phase 2 (beta testing), we evaluated the distraction/motivation potential of the mobile game prototype, using a prepost design. After varying duration of abstinence, smokers completed the Questionnaire of Smoking Urge-Brief (QSU-Brief) measurement before and after playing Crave-Out. Paired t tests were used to compare pregame and postgame QSU-Brief levels. To test dissemination potential, we released the game on the Apple iTunes App Store and tracked downloads between December 22, 2011, and May 5, 2014. RESULTS: Our concept refinement resulted in a multilevel, pattern memory challenge game, with each level increasing in difficulty. Smokers could play the game as long as they wanted. At the end of each level, smokers were provided clear goals for the next level and rewards (positive reinforcement using motivational tokens that represented a benefit of quitting smoking). Negative reinforcement was removed in alpha testing as smokers felt it reminded them of smoking. Measurement of QSU-Brief (N=30) resulted in a pregame mean of 3.24 (SD 1.65) and postgame mean of 2.99 (SD 1.40) with an overall decrease of 0.25 in cravings (not statistically significant). In a subset analysis, the QSU-Brief decrease was significant for smokers abstinent for more than 48 hours (N=5) with a pregame mean of 2.84 (SD 1.16) and a postgame mean of 2.0 (SD 0.94; change=0.84; P =.03). Between December 22, 2011, and May 29, 2014, the game was downloaded 3372 times from the App-Store, with 1526 smokers visiting the online resource www.decide2quit.org linked to the game. CONCLUSIONS: Overall, playing the game resulted in small, but nonsignificant decreases in cravings, with changes greater for those had already quit for more than 48 hours. Lessons learned can inform further development. Future research could incorporate mHealth games in multicomponent cessation interventions. TRIAL REGISTRATION: Clinicaltrials.gov NCT00797628; https://clinicaltrials.gov/ct2/show/NCT00797628 (Archived by WebCite at http://www.webcitation.org/6hbJr6LWG)

IL-1α Signaling Is Critical for Leukocyte Recruitment after Pulmonary Aspergillus fumigatus Challenge

Aspergillus fumigatus is a mold that causes severe pulmonary infections. Our knowledge of how A. fumigatus growth is controlled in the respiratory tract is developing, but still limited. Alveolar macrophages, lung resident macrophages, and airway epithelial cells constitute the first lines of defense against inhaled A. fumigatus conidia. Subsequently, neutrophils and inflammatory CCR2+ monocytes are recruited to the respiratory tract to prevent fungal growth. However, the mechanism of neutrophil and macrophage recruitment to the respiratory tract after A. fumigatus exposure remains an area of ongoing investigation. Here we show that A. fumigatus pulmonary challenge induces expression of the inflammasome-dependent cytokines IL-1β and IL-18 within the first 12 hours, while IL-1α expression continually increases over at least the first 48 hours. Strikingly, Il1r1-deficient mice are highly susceptible to pulmonary A. fumigatus challenge exemplified by robust fungal proliferation in the lung parenchyma. Enhanced susceptibility of Il1r1-deficient mice correlated with defects in leukocyte recruitment and anti-fungal activity. Importantly, IL-1α rather than IL-1β was crucial for optimal leukocyte recruitment. IL-1α signaling enhanced the production of CXCL1. Moreover, CCR2+ monocytes are required for optimal early IL-1α and CXCL1 expression in the lungs, as selective depletion of these cells resulted in their diminished expression, which in turn regulated the early accumulation of neutrophils in the lung after A. fumigatus challenge. Enhancement of pulmonary neutrophil recruitment and anti-fungal activity by CXCL1 treatment could limit fungal growth in the absence of IL-1α signaling. In contrast to the role of IL-1α in neutrophil recruitment, the inflammasome and IL-1β were only essential for optimal activation of anti-fungal activity of macrophages. As such, Pycard-deficient mice are mildly susceptible to A. fumigatus infection. Taken together, our data reveal central, non-redundant roles for IL-1α and IL-1β in controlling A. fumigatus infection in the murine lung

Evaluation of technical quality and periapical health of root-filled teeth by using cone-beam CT

Objective This study aimed to assess the quality of root fillings, coronal restorations, complications of all root-filled teeth and their association with apical periodontitis (AP) detected by cone-beam computed tomography (CBCT) images from an adult Turkish subpopulation. Material and Methods The sample for this study consisted of 242 patients (aging from 15 to 72 years) with 522 endodontically treated teeth that were assessed for technical quality of the root canal filling and periapical status of the teeth. Additionally, the apical status of each root-filled tooth was assessed according to the gender, dental arch, tooth type and age classification, undetected canals, instrument fracture, root fracture, apical resorption, apical lesion, furcation lesion and type and quality of the coronal structure. Statistical analysis was performed using percentages and chi-square test. Results The success rate of the root canal treatment was of 54.4%. The success rates of adequate and inadequate root canal treatment were not significantly different (p>0.05). Apical periodontitis was found in 228 (45.6%) teeth treated for root canals. Higher prevalence of AP was found in patients aging from 20 to 29 years [64 (27%) teeth] and in anterior (canines and incisors) teeth [97 (41%) teeth]. Conclusions The technical quality of root canal filling performed by dental practitioners in a Turkish subpopulation was consistent with a high prevalence of AP. The probable reasons for this failure are multifactorial, and there may be a need for improved undergraduate education and postgraduate courses to improve the clinical skills of dental practitioners in endodontics

Acute retinal necrosis in primary herpes simplex virus type I infection.

Here we report the case of an immunocompetent 8-year-old child who developed acute retinal necrosis concomitant with a primary herpes simplex virus type I infection. Ocular inflammation changed along with the development of a specific antibody titer in the serum. This evidence suggests that the immune response of the host can significantly modulate the clinical aspect of the ocular infection

Acute retinal necrosis in primary herpes simple type I infection

PURPOSE: to report the case of an immunocompetent child who developed severe ocular involvement in primary herpes simplex virus type I (HSV-I) infection. METHOD: (case report) an 8 year-old, HIV-negative child, was referred with ocular redness in his right eye preceded by influenza-like symptoms one week before. RESULTS: first examination revealed poor visual acuity, optic neuritis and peripheral exudative/haemorrhagic retinitis. He tested negative for herpes simplex type I and II. Three days later a granulomatous inflammation of the anterior chamber of the eye developed. Three consecutive serologies revealed a rising of IgM antibody titer in the serum to HSV type 1 (IgG antibody was still negative). Ocular herpes type I infection was confirmed by an anterior chamber tap by a positive polymerase chain reaction analysis of the aqueous humor. Visual acuity did not recover in spite of high dose of intravenous acyclovir therapy. CONCLUSION: presentation concerns a case of ARN syndrome in a child not previously immunized to HSV-1. Ocular inflammation appeared and increased along with the presence in the serum of specific antibody. The immune response of the host may significantly modulate the clinical aspect of an acute herpetic ocular infection. Central nervous system involvement in primary herpetic infection is an extremely rare complication. This child presented a primary acute retinal necrosis syndrome within 7 days following a primary herpes simplex type I infection

Concurrent validation of two key health literacy instruments in a South Eastern European population

Background: Public health practice has come to increasing recognition of health promotion and the central role of knowledge, attitude, beliefs and practices in achieving health promotion. Health literacy (HL) is an under-explored topic in South Eastern European countries. There are no HL reports from Albania to date. The aim of this study was to assess the concurrent validity of the European Health Literacy Survey Questionnaire (HLS-EU-Q) and the Test of Functional Health Literacy in Adults (TOFHLA) in a population-based sample of adults in Albania. Methods: A cross-sectional study was conducted in 2013 in Tirana, Albania, including 239 individuals aged >= 18 years (61% women; 87% response). A structured interviewer-administered questionnaire was applied twice (test and retest procedure after 2 weeks) including HLS-EU-Q and TOFHLA instruments. Results: The internal consistency was high for both instruments (Cronbach's alpha for the test procedure was 0.92 for TOFHLA and 0.98 for HLS-EU-Q). Both tools exhibited a high stability over time (Spearman's rho: 0.88 for TOFHLA and 0.87 for HLS-EU). Mean values of both instruments were similar in men and women (mean score for TOFHLA: 76.0 vs. 76.5, P = 0.83; mean score for HLS-EU-Q: 32.2 vs. 32.6, P = 0.63). For both instruments, higher HL scores were significantly associated with younger age, higher educational and economic level and lower body mass index. Conclusions: Our study provides valuable novel evidence on concurrent validation of two major HL instruments in a South Eastern European population-based sample. Future studies should be conducted in order to confirm and expand our findings