A multiple methods approach to determine adherence with prescribed mycophenolate in children with kidney transplant.

AIMS: The aim of this study was, to use a multiple methods approach, including, for the first time, dried blood spot (DBS) sampling with population pharmacokinetic interpretation, to assess adherence to mycophenolate in children with kidney transplant. A second aim was to identify patient/parental factors that influenced adherence and to link adherence behaviour to clinical outcomes. METHODS: A convenience sample of 33 children with kidney transplant (age ≤ 18 years) who had been prescribed mycophenolate for at least 3 months were recruited from participating outpatient clinics in the UK and Jordan. Medication adherence was determined via self-report questionnaires, medication refill data from dispensing records, and via mycophenolic acid concentrations in plasma and DBS samples obtained from children during a clinic visit. RESULTS: Through triangulation of results from the different methodological approaches a total of 12 children (36.4%) were deemed to be nonadherent with their prescribed mycophenolate treatment. Logistic regression analysis indicated that nonadherence was significantly associated with the presence of mycophenolate side effects. Poor adherence was positively linked to measures of poor clinical outcomes (hospitalisation and the need for kidney biopsy). CONCLUSIONS: Despite the imperative regarding medication adherence to help prevent organ rejection, a significant proportion of children are not fully adherent with their therapy. Side-effects appear to be an important factor leading to nonadherence. Measurement of mycophenolate in DBS samples, coupled with the use of population pharmacokinetics modelling, was a convenient direct approach to assessing adherence in children with kidney transplant and has the potential to be introduced into routine practice.

Hospital Admission Profile Related to Inner Ear Diseases in England and Wales.

BACKGROUND: Due to an expansion in the usage of medications (such as anticancer therapies), increased exposure to noise, and an increase in life expectancy, the prevalence of inner ear disease-related hearing loss is rising. Diseases of the inner ear are frequently accompanied by other conditions, such as chronic heart failure, systemic inflammation, arterial hypertension, and cerebrovascular disease. The aim of this study was to investigate the profile of hospital admissions linked to inner ear diseases in England and Wales. METHOD: This was an ecological descriptive study using public medical databases in England and Wales. Diagnostic codes for diseases of the inner ear (H80-H83) were used to identify all hospital admissions. Between 1999 and 2020, the chi-squared test was used to assess the difference between the admission rates. RESULTS: From 5704 in 1999 to 19,097 in 2020, the total annual number of hospital admissions increased by 234.8%, which corresponds to a 192.3% increase in the admission rate [from 10.94 (95% CI 10.66-11.22) in 1999 to 31.98 (95% CI 31.52-32.43) in 2020 per 100,000 people, p < 0.01]. "Disorders of vestibular function" and "other inner ear diseases" were the most frequent causes of hospital admissions due to inner ear diseases, accounting for 47.6% and 43.6%, respectively. The age range of 15 to 59 years accounted for 42.3% of all diseases of the inner ear hospital admissions. Around 59.6% of all admissions were made by females. The female admission rate increased by 210.1% (from 12.43 (95% CI 12.01-12.85) in 1999 to 38.54 (95% CI 37.84-39.24) in 2020 per 100,000 people). The male admission rate for diseases of the inner ear increased by 169.6% [from 9.37 (95% CI 9.00-9.75) in 1999 to 25.26 (95% CI 24.69-25.84) per 100,000 people] in 2020. CONCLUSION: Inner ear disease admissions increased markedly in England and Wales during the past two decades. Females and the middle-aged population were at higher risk of being admitted for inner ear diseases. Further cohort studies are warranted to identify other risk factors and develop effective prevention strategies.

Hospital Admission Due to Hypotension in Australia and in England and Wales.

OBJECTIVES: Hypotension is overlooked because it is often harmless, easily reversed, and can have few or even no symptoms. However, complications of untreated hypotension are dangerous and can result in death. The aim of this study was to examine the trend of hospital admission due to hypotension in Australia and in England and Wales between 1999 and 2020. METHOD: This was a secular trend analysis study that examined the hospitalisation pattern for hypotension in Australia, England, and Wales between 1999 and 2020. Hospitalisation data were obtained from the National Hospital Morbidity Database in Australia, Hospital Episode Statistics database in England, and Patient Episode Database for Wales. We analysed the variation in hospitalisation rates using the Pearson chi-square test for independence. RESULTS: Our study showed that hypotension hospital admission rates increased significantly between 1999 and 2020 by 168%, 398%, and 149% in Australia, England, and Wales, respectively. The most common hypotension hospital admissions reason was orthostatic hypotension. All types of hypotension-related hospital admissions in Australia, England, and Wales were directly related to age, more common among the age group 75 years and above. Bed-days hypotension hospital admission patients accounted for 84.6%, 99.5%, and 99.7% of the total number of hypotension hospital admissions in Australia, England, and Wales. CONCLUSION: In the past two decades, orthostatic hypotension was the most prevalent type of hypotension that required hospitalization in Australia, England, and Wales. Age was identified as the primary risk factor for hypotension across all causes. Future research should focus on identifying modifiable risk factors for hypotension and developing strategies to reduce the burden of orthostatic hypotension.

A focus on postpartum depression among Jordanian mothers.

BACKGROUND: The magnitude of postpartum depression in Jordan is under documented, and little is known about its potential sociodemographic and clinical correlates. PURPOSE: The aim of this study was to explore the prevalence and risk factors associated with postpartum depression among Jordanian mothers in the first 18 months after delivery. METHOD: This descriptive cross-sectional study was carried out from April to June 2020 in Jordan. A web-based survey was used for recruiting eligible participants. An Arabic version of the validated self-administered Edinburgh Postnatal Depression Scale questionnaire was used to measure postpartum depression with a cut-off score of ⩾12 which indicates probable depression. RESULTS: A total of 1,071 Jordanian women participated in the study. Of those, 567 women had postpartum depression (52.9%). Multivariate logistic regression analysis revealed that postpartum depression was significantly associated with marital conflict (OR: 4.91; 95% CI: 2.36-10.20), negative attitude from the pregnancy (OR: 0.67; 95% CI: 0.45-0.99), unplanned pregnancies (OR: 1.73; 95% CI: 1.16-2.60), lack of social support (OR: 1.93; 95% CI: 1.12-3.32), time from last delivery (OR: 0.99; 95% CI: 0.98-1.00), insomnia (OR: 0.53; 95% CI: 0.35-0.82), and depression during the pregnancy (OR: 0.51; 95% CI: 0.33-0.78). Most of the participants (65.7%) sought social support to avoid, reduce, or treat postpartum depression. CONCLUSIONS: Postpartum depression among Jordanian women was the highest in comparison to that of women in other countries in the region. Therefore, screening for the presence of depressive symptoms should be implemented during regular pregnancy care visits. Social support should be encouraged in order to avoid, reduce, or treat postpartum depression.

Mothers' Impressions and Beliefs About Taking a Booster Dose for COVID-19 Vaccine During Pregnancy and Lactation.

OBJECTIVES: This study aimed to explore perceptions and willingness to get coronavirus disease 2019 (COVID-19) booster vaccination among pregnant and lactating women in Jordan. METHODS: A cross-sectional study using a 29-item web-based questionnaire was conducted. Sociodemographic characteristics, vaccine acceptance, confidence in the booster dose of COVID-19 vaccine, perception of risk for COVID-19, and acceptance to participate in COVID-19 booster vaccine clinical trials were prospectively evaluated. Logistic regression was used to identify factors that might affect the participants' acceptance of a COVID-19 vaccine and their willingness to enroll in clinical trials of a booster dose of COVID-19 vaccine. RESULTS: Among all participants (pregnant and lactating women, n = 584), 328 (56.2%) intended to receive the booster dose of the COVID-19 vaccine. Predictors of booster dose acceptance were a medical-related degree (OR 1.62, CI 1.06-2.5, p = 0.028), income (OR 0.677, CI 0.52-0.88, p = 0.004), living residency (OR 0.44, CI 0.32-0.60, p < 0.001), knowing pregnant/lactating women previously infected with infectious microbe (OR 1.539, CI 1.07-2.23, p = 0.022), commitment to immunization for children (OR 3.01, CI 1.03-8.82, p = 0.044), receiving an influenza vaccine (OR 1.46, CI 1.04-2.05, p = 0.031), and worried about infectious microbes (OR 1.32, CI 1.15-1.52, p < 0.001). Among participants, only 22.9% were willing to participate in clinical trials of the booster dose of COVID-19 vaccine. The biggest motivator for participation was the participants' desire to help find the best vaccine during pregnancy/lactation (57.5%) while the main barrier towards participation was not wanting to expose themselves and their babies to more side effects (88.0%). CONCLUSION: This study reported reasonable acceptance of vaccination in a sample of pregnant/lactating women. Vaccination hesitancy for the booster dose was in-line with similar studies on the primary series around the globe, but the willingness to participate in clinical trials was lower than non-pregnant/non-lactating women.