Assessment of motivating factors associated with the initiation and completion of treatment for chronic hepatitis C virus (HCV) infection.

BACKGROUND: Infection with hepatitis C virus (HCV) is associated with high morbidity and increased mortality but many patients avoid initiation of treatment or report challenges with treatment completion. The study objective was to identify motivators and barriers for treatment initiation and completion in a community sample of HCV-infected patients in the United States. METHODS: Survey methods were employed to identify factors reported by patients as important in their decision to start or complete HCV treatment. Study participants included 120 HCV-infected individuals: 30 had previously completed treatment with pegylated interferon/ribavirin (PR), 30 had discontinued PR, 30 were treated with PR at the time of the survey, and 30 were treatment‒naïve. Telephone interviews occurred between May and August of 2011 and employed a standardized guide. Participants assigned factors a rating from 1 (not at all important) to 5 (extremely important). Trained researchers coded and analyzed interview transcripts. RESULTS: Of 33 factors, expected health problems from not treating HCV infection was reported as most encouraging for treatment initiation and completion, while treatment side effects was most discouraging. Sixty-nine percent of participants reported that the ability to obtain information during treatment on the likelihood of treatment success (i.e., results of viral load testing) would motivate them to initiate therapy. Median preferred timing for learning about test results was 5 weeks (range: 1-23 weeks). CONCLUSION: Understanding challenges and expectations from patients is important in identifying opportunities for education to optimize patient adherence to their HCV treatment regimen.

Influence of HbA1c and BMI on Lipid Trajectories in Youths and Young Adults With Type 1 Diabetes.

OBJECTIVE: To assess the influence of HbA1c and BMI (measured as BMI z score [zBMI]) on LDL, HDL, and non-HDL trajectories as youths with type 1 diabetes age into early adulthood. RESEARCH DESIGN AND METHODS: Dynamic, retrospective cohort study examining changes in lipid values in 572 youths with type 1 diabetes followed longitudinally for a median of 9.3 years. Through longitudinal modeling, we describe the relationship of HbA1c and zBMI on lipid values as subjects age after adjusting for other relevant factors, including lipid-lowering medication use. RESULTS: The median number of lipid assessments was 7 (range 2-39). Every 1% increase in HbA1c was associated with an ∼2-6 mg/dL increase in LDL levels, with a greater increase in LDL levels as subjects progressed from prepubertal to postpubertal age ranges. A 1-SD increase in BMI was associated with a mean LDL increase of 2.1 mg/dL when subjects were 10 years old and increased to a mean of 8.2 mg/dL when subjects were 19 years old. The association between changes in HbA1c level and zBMI and changes in non-HDL levels as youths aged were similar to the associations found with LDL. The influence of HbA1c and zBMI on HDL levels was small and not dependent on age. CONCLUSIONS: Changes in HbA1c level and zBMI modestly impact LDL and non-HDL cholesterol and have greater impacts as children age. Addressing elevations in HbA1c and zBMI as children enter into adolescence and beyond may lead to improvements in lipid levels.

Spot urine sodium measurements do not accurately estimate dietary sodium intake in chronic kidney disease.

BACKGROUND: Sodium intake influences blood pressure and proteinuria, yet the impact on long-term outcomes is uncertain in chronic kidney disease (CKD). Accurate assessment is essential for clinical and public policy recommendations, but few large-scale studies use 24-h urine collections. Recent studies that used spot urine sodium and associated estimating equations suggest that they may provide a suitable alternative, but their accuracy in patients with CKD is unknown. OBJECTIVE: We compared the accuracy of 4 equations [the Nerbass, INTERSALT (International Cooperative Study on Salt, Other Factors, and Blood Pressure), Tanaka, and Kawasaki equations] that use spot urine sodium to estimate 24-h sodium excretion in patients with moderate to advanced CKD. DESIGN: We evaluated the accuracy of spot urine sodium to predict mean 24-h urine sodium excretion over 9 mo in 129 participants with stage 3-4 CKD. Spot morning urine sodium was used in 4 estimating equations. Bias, precision, and accuracy were assessed and compared across each equation. RESULTS: The mean age of the participants was 67 y, 52% were female, and the mean estimated glomerular filtration rate was 31 ± 9 mL · min(-1) · 1.73 m(-2) The mean ± SD number of 24-h urine collections was 3.5 ± 0.8/participant, and the mean 24-h sodium excretion was 168.2 ± 67.5 mmol/d. Although the Tanaka equation demonstrated the least bias (mean: -8.2 mmol/d), all 4 equations had poor precision and accuracy. The INTERSALT equation demonstrated the highest accuracy but derived an estimate only within 30% of mean measured sodium excretion in only 57% of observations. Bland-Altman plots revealed systematic bias with the Nerbass, INTERSALT, and Tanaka equations, underestimating sodium excretion when intake was high. CONCLUSION: These findings do not support the use of spot urine specimens to estimate dietary sodium intake in patients with CKD and research studies enriched with patients with CKD. The parent data for this study come from a clinical trial that was registered at clinicaltrials.gov as NCT00785629.