Mobile phone text messaging to improve medication adherence in secondary prevention of cardiovascular disease.

BACKGROUND: Worldwide at least 100 million people are thought to have prevalent cardiovascular disease (CVD). This population has a five times greater chance of suffering a recurrent cardiovascular event than people without known CVD. Secondary CVD prevention is defined as action aimed to reduce the probability of recurrence of such events. Drug interventions have been shown to be cost-effective in reducing this risk and are recommended in international guidelines. However, adherence to recommended treatments remains sub-optimal. In order to influence non-adherence, there is a need to develop scalable and cost-effective behaviour-change interventions. OBJECTIVES: To assess the effects of mobile phone text messaging in patients with established arterial occlusive events on adherence to treatment, fatal and non-fatal cardiovascular events, and adverse effects. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, the Conference Proceedings Citation Index - Science on Web of Science on 7 November 2016, and two clinical trial registers on 12 November 2016. We contacted authors of included studies for missing information and searched reference lists of relevant papers. We applied no language or date restrictions. SELECTION CRITERIA: We included randomised trials with at least 50% of the participants with established arterial occlusive events. We included trials investigating interventions using short message service (SMS) or multimedia messaging service (MMS) with the aim to improve adherence to medication for the secondary prevention of cardiovascular events. Eligible comparators were no intervention or other modes of communication. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. In addition, we attempted to contact all authors on how the SMS were developed. MAIN RESULTS: We included seven trials (reported in 13 reports) with 1310 participants randomised. Follow-up ranged from one month to 12 months. Due to heterogeneity in the methods, population and outcome measures, we were unable to conduct meta-analysis on these studies. All seven studies reported on adherence, but using different methods and scales. Six out of seven trials showed a beneficial effect of mobile phone text messaging for medication adherence. Dale 2015a, reported significantly greater medication adherence score in the intervention group (Mean Difference (MD) 0.58, 95% confidence interval (CI) 0.19 to 0.97; 123 participants randomised) at six months. Khonsari 2015 reported less adherence in the control group (Relative Risk (RR) 4.09, 95% CI 1.82 to 9.18; 62 participants randomised) at eight weeks. Pandey 2014 (34 participants randomised) assessed medication adherence through self-reported logs with 90% adherence in the intervention group compared to 70% in the control group at 12 months. Park 2014a (90 participants randomised) reported a greater increase of the medication adherence score in the control group, but also measured adherence with an event monitoring system for a number of medications with adherence levels ranging from 84.1% adherence to 86.2% in the intervention group and 79.7% to 85.7% in the control group at 30 days. Quilici 2013, reported reduced odds of non-adherence in the intervention group (Odds Ratio (OR) 0.43, 95% CI 0.22 to 0.86, 521 participants randomised) at 30 days. Fang 2016, reported that participants given SMS alone had reduced odds of being non-adherent compared to telephone reminders (OR 0.40 95% CI 0.18 to 0.63; 280 patients randomised). Kamal 2015 reported higher levels of adherence in the intervention arm (adjusted MD 0.54, 95% CI 0.22 to 0.85; 200 participants randomised). Khonsari 2015 was the only study to report fatal cardiovascular events and only reported two events, both in the control arm. No study reported on the other primary outcomes. No study reported repetitive thumb injury or road traffic crashes or other adverse events that were related to the intervention.Four authors replied to our questionnaire on SMS development. No study reported examining causes of non-adherence or provided SMS tailored to individual patient characteristics.The included studies were small, heterogeneous and included participants recruited directly after acute events. All studies were assessed as having high risk of bias across at least one domain. Most of the studies came from high-income countries, with two studies conducted in an upper middle-income country (China, Malaysia), and one study from a lower middle-income country (Pakistan). The quality of the evidence was found to be very low. There was no obvious conflicts of interest from authors, although only two declared their funding. AUTHORS' CONCLUSIONS: While the results of this systematic review are promising, there is insufficient evidence to draw conclusions on the effectiveness of text message-based interventions for adherence to medications for secondary prevention of CVD. Sufficiently powered, high-quality randomised trials are needed, particularly in low- and middle-income countries

The Brera Multi-scale Wavelet Chandra Survey. I. Serendipitous source catalogue

We present the BMW-Chandra source catalogue drawn from essentially all Chandra ACIS-I pointed observations with an exposure time in excess of 10ks public as of March 2003 (136 observations). Using the wavelet detection algorithm developed by Lazzati et al. (1999) and Campana et al. (1999), which can characterise both point-like and extended sources, we identified 21325 sources. Among them, 16758 are serendipitous, i.e. not associated with the targets of the pointings, and do not require a non-automated analysis. This makes our catalogue the largest compilation of Chandra sources to date. The 0.5--10 keV absorption corrected fluxes of these sources range from ~3E-16 to 9E-12 erg cm^-2 s^-1 with a median of 7E-15 erg cm^-2 s^-1. The catalogue consists of count rates and relative errors in three energy bands (total, 0.5-7keV; soft, 0.5-2keV; and hard, 2-7keV), and source positions relative to the highest signal-to-noise detection among the three bands. The wavelet algorithm also provides an estimate of the extension of the source. We include information drawn from the headers of the original files, as well, and extracted source counts in four additional energy bands, SB1 (0.5-1keV), SB2 (1-2keV), HB1 (2-4keV), and HB2 (4-7keV). We computed the sky coverage for the full catalogue and for a subset at high Galactic latitude (|b|> 20deg). The complete catalogue provides a sky coverage in the soft band (0.5-2keV, S/N =3) of ~8 deg^2 at a limiting flux of 1E-13 erg cm^-2 s^-1, and ~2 deg^2 at a limiting flux of ~1E-15 erg cm^-2 s^-1.Comment: Accepted by A&A, Higher res. Figs 4 and 5 at http://www.ifc.inaf.it/~romano/BMC/Docs/aapaper/9601f4.eps http://www.ifc.inaf.it/~romano/BMC/Docs/aapaper/9601f5.eps, Catalog Web pages: http://www.brera.inaf.it/BMC/bmc_home.html http://www.ifc.inaf.it/~romano/BMC/bmc_home.html (Mirror

The XMM large scale structure survey: optical vs. X-ray classifications of active galactic nuclei and the unified scheme

Our goal is to characterize AGN populations by comparing their X-ray and optical classifications. We present a sample of 99 spectroscopically identified X-ray point sources in the XMM-LSS survey which are significantly detected in the [2-10] keV band, and with more than 80 counts. We performed an X-ray spectral analysis for all of these 99 X-ray sources. Introducing the fourfold point correlation coefficient, we find only a mild correlation between the X-ray and the optical classifications, as up to 30% of the sources have differing X-ray and optical classifications: on one hand, 10% of the type 1 sources present broad emission lines in their optical spectra and strong absorption in the X-rays. These objects are highly luminous AGN lying at high redshift and thus dilution effects are totally ruled out, their discrepant nature being an intrinsic property. Their X-ray luminosities and redshifts distributions are consistent with those of the unabsorbed X-ray sources with broad emission lines. On the other hand, 25/32 are moderate luminosity AGN, which are both unabsorbed in the X-rays and only present narrow emission lines in their optical spectra. The majority of them have an optical spectrum which is representative of the host galaxy. We finally infer that dilution of the AGN by the host galaxy seems to account for their nature. 5/25 have been defined as Seyfert 2. In conclusion, most of these 32 discrepant cases can be accounted for by the standard AGN unified scheme, as its predictions are not met for only 12% of the 99 X-ray sources. ABRIDGEDComment: 25 pages, 19 figures, Accepted for publication in A&

A multi-wavelength survey of AGN in the XMM-LSS field: I. Quasar selection via the KX technique

AIMS: We present a sample of candidate quasars selected using the KX-technique. The data cover 0.68 deg^2 of the X-ray Multi-Mirror (XMM) Large-Scale Structure (LSS) survey area where overlapping multi-wavelength imaging data permits an investigation of the physical nature of selected sources. METHODS: The KX method identifies quasars on the basis of their optical (R and z') to near-infrared (Ks) photometry and point-like morphology. We combine these data with optical (u*,g'r',i',z') and mid-infrared (3.6-24 micron) wavebands to reconstruct the spectral energy distributions (SEDs) of candidate quasars. RESULTS: Of 93 sources selected as candidate quasars by the KX method, 25 are classified as quasars by the subsequent SED analysis. Spectroscopic observations are available for 12/25 of these sources and confirm the quasar hypothesis in each case. Even more, 90% of the SED-classified quasars show X-ray emission, a property not shared by any of the false candidates in the KX-selected sample. Applying a photometric redshift analysis to the sources without spectroscopy indicates that the 25 sources classified as quasars occupy the interval 0.7 < z < 2.5. The remaining 68/93 sources are classified as stars and unresolved galaxies.Comment: 13 pages, 9 figures, A&A 494, p. 579-589. Replaced with published version. Fig. 9 in first astro-ph submission has been update

Obscured and powerful AGN and starburst activities at z~3.5

We report the discovery of two sources at z=3.867 and z=3.427 that exhibit powerful starburst and AGN activities. They benefit from data from radio to X rays from the CFHTLS-D1/SWIRE/XMDS surveys. Follow-up optical and near-infrared spectroscopy, and millimeter IRAM/MAMBO observations are also available. We performed an analysis of their spectral energy distributions to understand the origin of their emission and constrain their luminosities. A comparison with other composite systems at similar redshifts from the literature is also presented. The AGN and starburst bolometric luminosities are ~10^13 Lsun. The AGN emission dominates at X ray, optical, mid-infrared wavelengths, and probably in the radio. The starburst emission dominates in the far-infrared. The estimated star formation rates range from 500 to 3000Msun/yr. The AGN near-infrared and X ray emissions are heavily obscured in both sources with an estimated dust extinction Av>4, and Compton-thick gas column densities. The two sources are the most obscured and most luminous AGNs detected at millimeter wavelengths currently known. The sources presented in this work are heavily obscured QSOs, but their properties are not fully explained by the standard AGN unification model. In one source, the ultraviolet and optical spectra suggest the presence of outflowing gas and shocks, and both sources show emission from hot dust, most likely in the vicinity of the nucleus. Evidence of moderate AGN-driven radio activity is found in both sources. The two sources lie on the local M_BH-M_bulge relation. To remain on this relation, their star formation rate has to decrease. Our results support evolutionary models that invoke radio feedback as star formation quenching mechanism, and suggest that such a mechanism might play a major role also in powerful AGNs.Comment: Accepted for publication in Astronomy & Astrophysics (12 pages; 6 figures); replaced version includes minor language editing and revised reference

Epidemiology in Latin America and the Caribbean: current situation and challenges

Background This article analyses the epidemiological research developments in Latin America and the Caribbean (LAC). It integrates the series commissioned by the International Epidemiological Association to all WHO Regions to identify global opportunities to promote the development of epidemiology

The X-ray luminosity function and number counts of spiral galaxies

(abridged) A detailed comparison is performed of the LFs compiled at infrared, radio and optical wavelengths and converted into XLFs using available relations with the XLF directly estimated in the 0.5--2 keV energy band from X-ray surveys (Norman et al). We find that the XLF from the local sample of IRAS galaxies (Takeuchi et al) provides a good representation of all available data samples; pure luminosity evolution of the form (1+z)^\eta, with \eta< ~3, is favoured over pure density. The local X-ray luminosity density is also well defined. We discuss different estimates of the galaxies LogN-LogS, selected from the Chandra Deep Fields with different selection criteria: these have similar slopes, but normalisations scattered within a factor ~2, of the same order of the Poissonian error on the counts. We compare the observed LogN-LogS with the counts predicted by integrating our reference z=0 XLF. By using number counts alone, it is not possible to discriminate between density and luminosity evolution; however, the evolution of galaxies must be stopped in both cases at z~1-2. The contribution of galaxies to the X-ray background is found to be in the range 6%--12%. Making use of cosmic star formation models, we find that the X-ray LogN-LogS might be not compatible with very large star formation rates at z ~ 3 as suggested by sub-mm observations in Blain et al. 1999. As to the content of current and, possibly, future X-ray surveys, we determine the fraction of galaxies around the current flux limit: (30+-12 %). At fainter fluxes the fraction of galaxies will probably rise, and overcome the counts from AGN at fluxes < ~10^{-17} erg/s/cm^2.Comment: LaTeX, 16 pages, 10 figures. Accepted by Astronomy and Astrophysic

The Comparison of Hierarchical Structure of Subject Directories Yahoo, the Open Directory & Looksmart With Dewey Decimal Classification in 10 Selective Subjects

This survey is aimed to compare the hierarchical structure of subject directories, including Yahoo, The Open Directory and Looksmart with Dewey Decimal Classification (DDC) in 10 selective subjects. Five questions are raised to compare the broadness and the depth of the hierarchical structures in the subject directories and DDC and to study the effectiveness of the usage of DDC in the organization of the Internet resources. The data were collected by counting links and indentions. The results show that the hierarchical structure of Looksmart is broader and deeper than Yahoo, The Open Directory and DDC. This characteristic decreases its effectiveness as a classification scheme. This study also shows that subdivisions are rather evenly distributed in different hierarchical levels of DDC in comparison to subject directories. These features in addition to their general nature make DDC a suitable instrument for organizing Internet resources

Les observateurs - 02/2018

Les Géminides; Un nouvel observateur à la SA