[Diabetic nephropathy: Interprofessional support of medication adherence]. / Néphropathie diabétique : soutenir l'adhésion médicamenteuse de façon interprofessionnelle.

Medication non-adherence in patients with diabetic kidney disease (DKD) is endemic. The PANDIA-IRIS study, implemented at the community pharmacy of Unisanté, illustrates the support of medication adherence in patients with DKD by pharmacists, through an interprofessional program (IMAP) based on a behavioral science theoretical framework. Implementing behavioural support programmes such as PANDIA-IRIS on a large scale in Switzerland is both a necessity and a challenge. These programmes should be an integral part of standard patient care. The transition of care towards interprofessional collaborations and a clarification of roles in supporting adherence, including the patient as a partner, will contribute to fully considering adherence in therapeutic decision making and support to enable better achievement of long-term clinical goals.

La non-adhésion médicamenteuse chez les patient-es avec une néphropathie diabétique (ND) est endémique. L'étude PANDIA-IRIS, implémentée à la pharmacie communautaire d'Unisanté, illustre le soutien de l'adhésion des patient-es avec ND par des pharmacien-nes, au travers d'un programme interprofessionnel (IMAP) fondé sur un cadre théorique des sciences du comportement. Mettre en place des programmes d'accompagnement comportemental comme PANDIA-IRIS à large échelle en Suisse est à la fois une nécessité et un défi. Ces programmes devraient faire partie intégrante des soins standards des patient-es. La transition des soins vers des collaborations interprofessionnelles et une clarification des rôles dans le soutien de l'adhésion, incluant le-la patient-e comme partenaire, contribueront à considérer pleinement l'adhésion dans la prise de décisions thérapeutiques et dans son accompagnement pour permettre une meilleure atteinte des objectifs cliniques à long terme.

Understanding reasons and factors for participation and non-participation to a medication adherence program for patients with diabetic kidney disease in Switzerland: a mixed methods study.

BACKGROUND: An interprofessional medication adherence intervention led by pharmacists, combining motivational interviews and feedback with electronic monitor (EM) drug assessment, was offered to all consecutive patients with diabetic kidney disease (DKD) (estimated glomerular filtration rate < 60 mL/min/1.73 m2) visiting their nephrologist or endocrinologist. Approximately 73% (202/275) of eligible patients declined to participate, and the factors and reasons for refusal were investigated. METHODS: Sociodemographic and clinical data of included patients and those who refused were collected retrospectively for those who had previously signed the general consent form. Multivariate logistic regression analysis was performed to identify independent variables associated with non-participation. Patients who refused or accepted the adherence study were invited to participate in semi-structured interviews. Verbatim transcription, thematic analysis, and inductive coding were performed. RESULTS: Patients who refused to participate were older (n = 123, mean age 67.7 years, SD:10.4) than those who accepted (n = 57, mean age 64.0 years, SD:10.0, p = 0.027) and the proportion of women was higher among them than among patients who accepted it (30.9% vs 12.3%, p = 0.007). The time from diabetes diagnosis was longer in patients who refused than in those who accepted (median 14.2 years IQR 6.9-22.7 vs. 8.6 years, IQR 4.5-15.9, p = 0.003). Factors associated with an increased risk of non-participation were female sex (OR 3.8, 95% CI 1.4-10.0, p = 0.007) and the time from diabetes diagnosis (OR 1.05, 95% CI 1.01-1.09, p = 0.019). The included patients who were interviewed (n = 14) found the interprofessional intervention useful to improve their medication management, support medication literacy, and motivation. Patients who refused to participate and who were interviewed (n = 16) explained no perceived need, did not agree to use EM, and perceived the study as a burden and shared that the study would have been beneficial if introduced earlier in their therapeutic journey. Other barriers emerged as difficult relationships with healthcare providers, lack of awareness of the pharmacist's role, and negative perception of clinical research. CONCLUSIONS: Investigating the factors and reasons for participation and non-participation in a study helps tailor intervention designs to the needs of polypharmacy patients. Patients who refused the adherence intervention may not be aware of the benefits of medication management and medication literacy. There is an urgent need to advocate for interprofessional outpatient collaborations to support medication adherence in patients with DKD. Trial registration Clinicaltrials.gov NCT04190251_PANDIA IRIS.

Avaliação de rótulos para verificar a presença de edulcorantes em produtos tradicionais / Evaluation of labels to verify the presence of sweeteners in traditional products

Produtos com edulcorantes em sua composição já é esperado em produtos diet e light, entretanto, nota-se a presença mais freqüente desses aditivos em produtos tradicionais. Assim, o objetivo do trabalho foi avaliar a presença de edulcorantes em produtos tradicionais através da análise de rótulos. A pesquisa foi realizada em 2018, em supermercados de Fortaleza (CE), nas categorias de bebidas industrializadas, laticínios e sobremesas, totalizando 50 produtos. A partir das análises dos rótulos verificou-se que 28 não continham edulcorantes e 22 apresentaram esse aditivo. Dentre os produtos com edulcorantes os tipo sutilizados variaram de um a quatro no mesmo alimento. Na categoria sobremesa foi encontrado edulcorante em todos os produtos avaliados. E o edulcorante de maior prevalência nos produtos foi o acessulfame de potássio.

Comparative study on the fractionation of cellulases on some hydrophobic interaction chromatography adsorbents.

In this work, a comparative study for the fractionation of Trichoderma reesei cellulases on five different hydrophobic interaction chromatography adsorbents (Butyl-Sepharose 4 FF, Phenyl-Sepharose 6 FF, Octyl-Sepharose 4 FF, Epoxy-Sepharose CL-6B and Polypropylene glycol-Sepharose CL-6B) is shown. The influence of the mobile phase composition on the chromatographic behaviour of T. reesei cellulases complex was evaluated using different concentrations of ammonium sulphate in the eluent buffer. A selective separation of beta-glucosidase with two-fold increase in specific activity and good recoveries of cellobiase activity were obtained with Butyl-Sepharose 4 FF and Phenyl-Sepharose 6 FF using 7% (w/v) ammonium sulphate in the eluent buffer. A beta-glucosidase fractionation was also obtained with Epoxy-Sepharose CL-6B, using 13% (w/v) of the salt in the mobile phase.