Factors associated with non-participation in and dropout from cardiac rehabilitation programmes: a systematic review of prospective cohort studies

Background: Although evidence exists for the efficacy of cardiac rehabilitation programmes to reduce morbidity and mortality among patients with cardiovascular disease, cardiac rehabilitation programmes are underused. We aimed systematically to review the evidence from prospective cohort studies on factors associated with non-participation in and/or dropping out from cardiac rehabilitation programmes. Methods: MedLine, Embase, Scopus, Open Grey and Cochrane Database were searched for relevant publications from inception to February 2018. Search terms included (a) coronary heart disease and other cardiac conditions; (b) cardiac rehabilitation and secondary prevention; and (c) non-participation in and/or dropout. Databases were searched following the PRISMA statement. Study selection, data extraction and the assessment of study quality were performed in duplicate. Results: We selected 43 studies with a total of 63,425 patients from 10 different countries that met the inclusion criteria. Factors associated with non-participation in and dropout from cardiac rehabilitation were grouped into six broad categories: intrapersonal factors, clinical factors, interpersonal factors, logistical factors, cardiac rehabilitation programme factors and health system factors. We found that clinical factors, logistical factors and health system factors were the main factors assessed for non-participation in cardiac rehabilitation. We also found differences between the factors associated with non-participation and dropout. Conclusions: Several factors were determinant for non-participation in and dropout from cardiac rehabilitation. These findings could be useful to clinicians and policymakers for developing interventions aimed at improving participation and completion of cardiac rehabilitation, such as E-health or home-based delivery programmes. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) identifier: CRD42016032973

Guia de medicaments d’Atenció Primària que requereixen una vigilància especial per la seva dispensació en pacients amb funció renal disminuïda.

Projecte: AVCRI 279 Requeriments tècnics: L’entorn és l’EXCEL de Microsoft. L'accés al codi no estarà disponible fins la fi de la data d'embargament. Si esteu interessats a accedir-hi, contacteu amb idea(at)fbg.ub.eduAquesta Base de Dades (Guia de Medicaments) recull informació per tal d’indicar quins medicaments són susceptibles d'ajustos de dosi per evitar la iatrogènia medicamentosa en pacients amb deteriorament de la funció renal. Aquesta informació s'ha consensuat entre farmacèutics i metges nefròlegs a partir de la informació disponible en diferents bases de dades nacionals i internacionals. Per agilitzar l'ús de la Guia s'ha consensuat categoritzar en nivell baix, moderat o alt el risc que suposa pel pacient l’ús d'aquests medicaments segons el seu filtrat glomerular. A més la Guia recull els ajustos de dosi a realitzar, les interaccions medicamentoses i la simptomatologia per sobre dosificació en pacients amb funció renal disminuïda. A partir d'aquesta Base de Dades, s'ha dissenyat una aplicació web que facilita al professional sanitari la presa de decisions per a l'ajust de dosis de medicaments en funció del filtrat glomerular del pacient

Coordination of mitochondrial and lysosomal homeostasis mitigates inflammation and muscle atrophy during aging

Sarcopenia is one of the main factors contributing to disability of aged people. Among the possible molecular determinants of sarcopenia, increasing evidences suggest that chronic inflammation contributes to its development. However, a key unresolved question is the nature of the factors that drive inflammation during aging and that participate in the development of sarcopenia. In this regard, mitochondrial dysfunction and alterations in mitophagy induce inflammatory responses in a wide range of cells and tissues. However, whether accumulation of damaged mitochondria in muscle could trigger inflammation in the context of aging is still unknown. Here, we demonstrate that BNIP3 plays a key role in the control of mitochondrial and lysosomal homeostasis, and mitigates muscle inflammation and atrophy during aging. We show that muscle BNIP3 expression increases during aging in mice and in some humans. BNIP3 deficiency alters mitochondrial function, decreases mitophagic flux and, surprisingly, induces lysosomal dysfunction, leading to an upregulation of TLR9-dependent inflammation and activation of the NLRP3 inflammasome in muscle cells and mouse muscle. Importantly, downregulation of muscle BNIP3 in aged mice exacerbates inflammation and muscle atrophy, and high BNIP3 expression in aged human subjects associates with a low inflammatory profile, suggesting a protective role for BNIP3 against age-induced muscle inflammation in mouse and humans. Taken together, our data allows us to propose a new adaptive mechanism involving the mitophagy protein BNIP3, which links mitochondrial and lysosomal homeostasis with inflammation and is key in maintaining muscle health during aging

Association of Candidate Gene Polymorphisms With Chronic Kidney Disease: Results of a Case-Control Analysis in the Nefrona Cohort

Chronic kidney disease (CKD) is a major risk factor for end-stage renal disease, cardiovascular disease and premature death. Despite classical clinical risk factors for CKD and some genetic risk factors have been identified, the residual risk observed in prediction models is still high. Therefore, new risk factors need to be identified in order to better predict the risk of CKD in the population. Here, we analyzed the genetic association of 79 SNPs of proteins associated with mineral metabolism disturbances with CKD in a cohort that includes 2, 445 CKD cases and 559 controls. Genotyping was performed with matrix assisted laser desorption ionizationtime of flight mass spectrometry. We used logistic regression models considering different genetic inheritance models to assess the association of the SNPs with the prevalence of CKD, adjusting for known risk factors. Eight SNPs (rs1126616, rs35068180, rs2238135, rs1800247, rs385564, rs4236, rs2248359, and rs1564858) were associated with CKD even after adjusting by sex, age and race. A model containing five of these SNPs (rs1126616, rs35068180, rs1800247, rs4236, and rs2248359), diabetes and hypertension showed better performance than models considering only clinical risk factors, significantly increasing the area under the curve of the model without polymorphisms. Furthermore, one of the SNPs (the rs2248359) showed an interaction with hypertension, being the risk genotype affecting only hypertensive patients. We conclude that 5 SNPs related to proteins implicated in mineral metabolism disturbances (Osteopontin, osteocalcin, matrix gla protein, matrix metalloprotease 3 and 24 hydroxylase) are associated to an increased risk of suffering CKD

Factors associated with non-participation in and dropout from cardiac rehabilitation programmes: a systematic review of prospective cohort studies.

Although evidence exists for the efficacy of cardiac rehabilitation programmes to reduce morbidity and mortality among patients with cardiovascular disease, cardiac rehabilitation programmes are underused. We aimed systematically to review the evidence from prospective cohort studies on factors associated with non-participation in and/or dropping out from cardiac rehabilitation programmes. MedLine, Embase, Scopus, Open Grey and Cochrane Database were searched for relevant publications from inception to February 2018. Search terms included (a) coronary heart disease and other cardiac conditions; (b) cardiac rehabilitation and secondary prevention; and (c) non-participation in and/or dropout. Databases were searched following the PRISMA statement. Study selection, data extraction and the assessment of study quality were performed in duplicate. We selected 43 studies with a total of 63,425 patients from 10 different countries that met the inclusion criteria. Factors associated with non-participation in and dropout from cardiac rehabilitation were grouped into six broad categories: intrapersonal factors, clinical factors, interpersonal factors, logistical factors, cardiac rehabilitation programme factors and health system factors. We found that clinical factors, logistical factors and health system factors were the main factors assessed for non-participation in cardiac rehabilitation. We also found differences between the factors associated with non-participation and dropout. Several factors were determinant for non-participation in and dropout from cardiac rehabilitation. These findings could be useful to clinicians and policymakers for developing interventions aimed at improving participation and completion of cardiac rehabilitation, such as E-health or home-based delivery programmes. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) identifier: CRD42016032973

Factors affecting collaboration between general practitioners and community pharmacists:a qualitative study

<p>Abstract</p> <p>Background</p> <p>Although general practitioners (GPs) and community pharmacists (CPs) are encouraged to collaborate, a true collaborative relationship does not exist between them. Our objective was to identify and analyze factors affecting GP-CP collaboration.</p> <p>Methods</p> <p>This was a descriptive-exploratory qualitative study carried out in two Spanish regions: Catalonia (Barcelona) and Balearic Islands (Mallorca). Face-to-face semi-structured interviews were conducted with GPs and CPs from Barcelona and Mallorca (January 2010-February 2011). Analysis was conducted using Colaizzi’s method.</p> <p>Results</p> <p>Thirty-seven interviews were conducted. The factors affecting the relationship were different depending on timing: 1) Before collaboration had started (prior to collaboration) and 2) Once the collaboration had been initiated (during collaboration). Prior to collaboration, four key factors were found to affect it: the perception of usefulness; the Primary Care Health Center (PCHC) manager’s interest; the professionals’ attitude; and geography and legislation. These factors were affected by economic and organizational aspects (i.e. resources or PCHC management styles) and by professionals’ opinions and beliefs (i.e. perception of the existence of a public-private conflict). During collaboration, the achievement of objectives and the changes in the PCHC management were the key factors influencing continued collaboration. The most relevant differences between regions were due to the existence of privately-managed PCHCs in Barcelona that facilitated the implementation of collaboration. In comparison with the group with experience in collaboration, some professionals without experience reported a skeptical attitude towards it, reporting that it might not be necessary.</p> <p>Conclusions</p> <p>Factors related to economic issues, management and practitioners’ attitudes and perceptions might be crucial for triggering collaboration. Interventions and strategies derived from these identified factors could be applied to achieve multidisciplinary collaboration.</p

Effect of copayment policies on initial medication non-adherence according to income: a population-based study.

Copayment policies aim to reduce the burden of medication expenditure but may affect adherence and generate inequities in access to healthcare. The objective was to evaluate the impact of two copayment measures on initial medication non-adherence (IMNA) in several medication groups and by income level. A population-based study was conducted using real-world evidence. Primary care in Catalonia (Spain) where two separate copayment measures (fixed copayment and coinsurance) were introduced between 2011 and 2013. Every patient with a new prescription issued between 2011 and 2014 (3 million patients and 10 million prescriptions). IMNA was estimated throughout dispensing and invoicing information. Changes in IMNA prevalence after the introduction of copayment policies (immediate level change and trend changes) were estimated through segmented logistic regression. The regression models were stratified by economic status and medication groups. Before changes to copayment policies, IMNA prevalence remained stable. The introduction of a fixed copayment was followed by a statistically significant increase in IMNA in poor population, low/middle-income pensioners and low-income non-pensioners (OR from 1.047 to 1.370). In high-income populations, there was a large statistically non-significant increase. IMNA decreased in the low-income population after suspension of the fixed copayment and the introduction of a coinsurance policy that granted this population free access to medications (OR=0.676). Penicillins were least affected while analgesics were affected to the greatest extent. IMNA to medications for chronic conditions increased in low/middle-income pensioners. Even nominal charge fixed copayment may generate inequities in access to health services. An anticipation effect and expenses associated with IMNA may have generated short-term costs. A reduction in copayment can protect from non-adherence and have positive, long-term effects. Copayment scenarios could have considerable long-term consequences for health and costs due to increased IMNA in medication for chronic physical conditions

Guía de consenso para el uso de medicamentos en insuficiencia renal

La seguridad del paciente es uno de los pilares de la calidad asistencial. En este sentido, el Grupo de Farmacia Práctica promueve un Convenio de Colaboración entre la Universidad de Barcelona (UB) y la Sociedad Española de Nefrología (S.E.N) para promocionar la formación, la investigación y la colaboración entre médicos y farmacéuticos en el uso seguro de los medicamentos en pacientes (28 de diciembre de 2013). Fruto de este Convenio de Colaboración se crea un grupo de trabajo integrado por miembros de la S.E.N. y del Grupo de Farmacia Práctica para revisar y consensuar la Guía de medicamentos que requieren ajuste posológico en pacientes con función renal disminuida. Esta Guía se ha elaborado a partir del análisis de los medicamentos más dispensados en la farmacia comunitaria. Se han ordenado por grupos terapéuticos según la clasificación ATC, se ha incluido información sobre los síntomas por sobredosificación y se ha consensuado categorizar por niveles el riesgo, bajo, moderado o alto, que supone para el paciente la toma de estos medicamentos en función de su filtrado glomerular. Para facilitar la utilización de esta Guía por parte de los profesionales sanitarios, se ha llevado a cabo un proyecto de transferencia de conocimiento con la Facultad de Matemáticas de la Universidad de Barcelona para desarrollar esta web. Esta herramienta, de fácil manejo, es útil para valorar el uso seguro de los medicamentos, proponer ajustes posológicos o cambios en la medicación e impulsar la práctica colaborativa entre profesionales sanitarios

Guía de consenso para el uso de medicamentos en insuficiencia renal

La seguridad del paciente es uno de los pilares de la calidad asistencial. En este sentido, el Grupo de Farmacia Práctica promueve un Convenio de Colaboración entre la Universidad de Barcelona (UB) y la Sociedad Española de Nefrología (S.E.N) para promocionar la formación, la investigación y la colaboración entre médicos y farmacéuticos en el uso seguro de los medicamentos en pacientes (28 de diciembre de 2013). Fruto de este Convenio de Colaboración se crea un grupo de trabajo integrado por miembros de la S.E.N. y del Grupo de Farmacia Práctica para revisar y consensuar la Guía de medicamentos que requieren ajuste posológico en pacientes con función renal disminuida. Esta Guía se ha elaborado a partir del análisis de los medicamentos más dispensados en la farmacia comunitaria. Se han ordenado por grupos terapéuticos según la clasificación ATC, se ha incluido información sobre los síntomas por sobredosificación y se ha consensuado categorizar por niveles el riesgo, bajo, moderado o alto, que supone para el paciente la toma de estos medicamentos en función de su filtrado glomerular. Para facilitar la utilización de esta Guía por parte de los profesionales sanitarios, se ha llevado a cabo un proyecto de transferencia de conocimiento con la Facultad de Matemáticas de la Universidad de Barcelona para desarrollar esta web. Esta herramienta, de fácil manejo, es útil para valorar el uso seguro de los medicamentos, proponer ajustes posológicos o cambios en la medicación e impulsar la práctica colaborativa entre profesionales sanitarios