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rowidtitleDOIURLcreatedsubjectreferences-countis-referenced-by-countISSNcontainer-titleabstractauthor_numberorcidsnamesaward_numbersfunder_namesfunder_dois
33 ["Adherence and persistence to direct oral anticoagulants in atrial fibrillation: a population-based study"] 10.1136/heartjnl-2019-315307 http://dx.doi.org/10.1136/heartjnl-2019-315307 2019-10-10T21:25:20Z ["Cardiology and Cardiovascular Medicine"] 30 2 ["1355-6037", "1468-201X"] Heart <jats:sec><jats:title>Background</jats:title><jats:p>Despite simpler regimens than vitamin K antagonists (VKAs) for stroke prevention in atrial fibrillation (AF), adherence (taking drugs as prescribed) and persistence (continuation of drugs) to direct oral anticoagulants are suboptimal, yet understudied in electronic health records (EHRs).</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>We investigated (1) time trends at individual and system levels, and (2) the risk factors for and associations between adherence and persistence.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>In UK primary care EHR (The Health Information Network 2011–2016), we investigated adherence and persistence at 1 year for oral anticoagulants (OACs) in adults with incident AF. Baseline characteristics were analysed by OAC and adherence/persistence status. Risk factors for non-adherence and non-persistence were assessed using Cox and logistic regression. Patterns of adherence and persistence were analysed.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Among 36 652 individuals with incident AF, cardiovascular comorbidities (median CHA<jats:sub>2</jats:sub>DS<jats:sub>2</jats:sub>VASc[Congestive heart failure, Hypertension, Age≥75 years, Diabetes mellitus, Stroke, Vascular disease, Age 65-74 years, Sex category] 3) and polypharmacy (median number of drugs 6) were common. Adherence was 55.2% (95% CI 54.6 to 55.7), 51.2% (95% CI 50.6 to 51.8), 66.5% (95% CI 63.7 to 69.2), 63.1% (95% CI 61.8 to 64.4) and 64.7% (95% CI 63.2 to 66.1) for all OACs, VKA, dabigatran, rivaroxaban and apixaban. One-year persistence was 65.9% (95% CI 65.4 to 66.5), 63.4% (95% CI 62.8 to 64.0), 61.4% (95% CI 58.3 to 64.2), 72.3% (95% CI 70.9 to 73.7) and 78.7% (95% CI 77.1 to 80.1) for all OACs, VKA, dabigatran, rivaroxaban and apixaban. Risk of non-adherence and non-persistence increased over time at individual and system levels. Increasing comorbidity was associated with reduced risk of non-adherence and non-persistence across all OACs. Overall rates of ‘primary non-adherence’ (stopping after first prescription), ‘non-adherent non-persistence’ and ‘persistent adherence’ were 3.5%, 26.5% and 40.2%, differing across OACs.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Adherence and persistence to OACs are low at 1 year with heterogeneity across drugs and over time at individual and system levels. Better understanding of contributory factors will inform interventions to improve adherence and persistence across OACs in individuals and populations.</jats:p></jats:sec> 11 ["http://orcid.org/0000-0001-8741-3411"] ["Amitava Banerjee", "Valerio Benedetto", "Philip Gichuru", "Jane Burnell", "Sotiris Antoniou", "Richard J Schilling", "William David Strain", "Ronan Ryan", "Caroline Watkins", "Tom Marshall", "Chris J Sutton"] ["(FP/2007-2013)/ERC Grant Agreement no. 339239."] ["FP7 Ideas: European Research Council"] ["10.13039/100011199"]
67 ["Risk and protective factors associated with BV chronicity among women in Rakai, Uganda"] 10.1136/sextrans-2019-054145 http://dx.doi.org/10.1136/sextrans-2019-054145 2019-10-10T21:16:02Z ["Infectious Diseases", "Dermatology"] 0 0 ["1368-4973", "1472-3263"] Sexually Transmitted Infections <jats:sec><jats:title>Objectives</jats:title><jats:p>To assess risk and protective factors associated with bacterial vaginosis (BV) chronicity ascertained by Nugent score criteria.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A longitudinal cohort study included 255 sexually experienced, postmenarcheal women who provided weekly self-collected vaginal swabs for up to 2 years. Vaginal swabs were scored using Nugent criteria and classified as normal (≤3), intermediate (4–6) and Nugent-BV (≥7). Detailed behavioural/health information were assessed every 6 months. A per-woman longitudinal summary measure of BV chronicity was defined as the percentage of each woman’s weekly vaginal assessments scored as Nugent-BV over a 6-month interval. Risk and protective factors associated with BV chronicity were assessed using multiple linear regression with generalised estimating equations.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Average BV chronicity was 39% across all follow-up periods. After adjustment, factors associated with BV chronicity included baseline Nugent-BV (β=35.3, 95% CI 28.6 to 42.0) compared with normal baseline Nugent scores and use of unprotected water for bathing (ie, rainwater, pond, lake/stream) (β=12.0, 95% CI 3.4 to 20.5) compared with protected water sources (ie, well, tap, borehole). Women had fewer BV occurrences if they were currently pregnant (β=−6.6, 95% CI −12.1 to 1.1), reported consistent condom use (β=−7.7, 95% CI −14.2 to 1.3) or their partner was circumcised (β=−5.8, 95% CI −11.3 to 0.3).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Factors associated with higher and lower values of BV chronicity were multifactorial. Notably, higher values of BV chronicity were associated with potentially contaminated bathing water. Future studies should examine the role of waterborne microbial agents in the pathogenesis of BV.</jats:p></jats:sec> 5 ["http://orcid.org/0000-0001-9267-4384", "http://orcid.org/0000-0001-8762-6214"] ["Marie E Thoma", "Rebecca M Brotman", "Ronald H Gray", "Nelson K Sewankambo", "Maria J Wawer"] ["R01AI47608"] ["Eunice Kennedy Shriver National Institute of Child Health and Human Development", "Centers for Disease Control and Prevention", "National Institute of Allergy and Infectious Diseases"] ["10.13039/100009633", "10.13039/100000030", "10.13039/100000060"]