How patients' use of social media impacts their interactions with healthcare professionals.

INTRODUCTION: Patients are increasingly accessing online health information and have become more participatory in their engagement with the advent of social media (SM). This study explored how patients' use of SM impacted their interactions with healthcare professionals (HCPs). METHODS: Focus groups (n=5) were conducted with 36 patients with chronic conditions and on medication who used SM for health-related purposes. The discussions lasted 60-90min, were audio-recorded, transcribed verbatim, and thematically analysed. RESULTS: Participants did not interact with HCPs on SM and were not expecting to do so as they used SM exclusively for peer interactions. Most reported improvement in the patient-HCP relationship due to increased knowledge, better communication, and empowerment. Participants supplemented HCP-provided information with peer interactions on SM, and prepared themselves for consultations. They shared online health information with HCPs, during consultations, to validate it and to actively participate in the decision-making. Although some participants reported HCP support for their online activities, most perceived overt or tacit opposition. CONCLUSION: Participants perceived that their SM use positively impacted relationships with HCPs. They felt empowered and were more assertive in participating in decision-making. PRACTICE IMPLICATIONS: HCPs should be aware of patients' activities and expectations, and support them in their online activities.

New insight to IL-23/IL-17 axis in Iranian infected adult patients with gastritis: effects of genes polymorphisms on expression of cytokines.

BACKGROUND AND OBJECTIVE: Chronic inflammation is the hallmark of the pathogenesis of H. pylori-induced gastric cancer. IL-17A and IL-17F are inflammatory cytokines expressed by a novel subset of CD4+Th cells and play critical function in inflammation. We evaluated the relationship between IL-17A G197A, IL-17F A7488G and IL23R+2199 A/C polymorphisms with IL-6, IL-17, IL-21, IL-23 and TGF-ß1 mRNAs expression in regard to H. pylori infection with chronic gastritis. MATERIAL AND METHODS: Total RNA and genomic DNA were extracted from gastric biopsies of 58 H. pylori-infected patient with gastritis. Afterward, mucosal IL-6, IL-17, IL-21, IL-23 and TGF-ß1 mRNAs expression and polymorphisms in IL-17A G197A, IL-17F A7488G and IL-23R +2199A/Cin gastric biopsies were determined by real-time PCR and PCR-RFLP. RESULTS: Our results show that IL-17A G197A, IL-17F A7488G andIL23R +2199A/C polymorphisms have no effect on mucosal expression of IL-6, IL-17, IL-21 and TGF-ß1 mRNAs expression in H. pylori-infected patients with chronic gastritis. CONCLUSIONS: These results suggest that IL-17A G197A, IL-17F A7488G and IL23R +2199A/C polymorphisms no alter mucosal cytokine pattern in Iranian patients with H. pylori-associated gastritis diseases.

Effectiveness of interventions to improve antidepressant medication adherence: a systematic review.

Non-adherence to antidepressant medications is a significant barrier to the successful treatment of depression in clinical practice. This review aims to systematically assess the effectiveness of interventions for improving antidepressant medication adherence among patients with unipolar depression, and to evaluate the effect of these interventions on depression clinical outcomes. MEDLINE, PsycINFO and EMBASE databases were searched for English-language randomised controlled trials published between January 1990 and December 2010 on interventions to improve antidepressant adherence. The impact of interventions on antidepressant medication adherence (compliance and persistence) and depression clinical outcomes was evaluated. Data concerning the quality of the included studies were also extracted. Twenty-six studies met the inclusion criteria. Interventions were classified as educational, behavioural and multifaceted interventions. A total of 28 interventions were tested, as two studies investigated two interventions each. Sixteen (57%) of the 28 interventions showed significant effects on antidepressant adherence outcomes, whereas 12 (43%) interventions demonstrated significant effects on both antidepressant adherence and depression outcomes. The interventions which showed significant improvement in outcomes were primarily multifaceted and complex, with proactive care management and involvement of mental health specialists. The most commonly used elements of multifaceted interventions included patient educational strategies, telephone follow-up to monitor patients' progress, as well as providing medication support and feedback to primary care providers. Overall, educational interventions alone were ineffective in improving antidepressant medication adherence. In conclusion, improving adherence to antidepressants requires a complex behavioural change and there is some evidence to support behavioural and multifaceted interventions as the most effective in improving antidepressant medication adherence and depression outcomes. More carefully designed and well-conducted studies are needed to clarify the effect of interventions in different patient populations and treatment settings.

Effect of gelation conditions and dissolution media on the release of paracetamol from alginate gel beads.

Paracetamol was entrapped in alginate beads gelled with calcium or zinc at 0.1, 0.34 or 0.7M. The payloads were of the order of 60-70% w/w which represented an entrapment yield of > 75%. The release of drug from the beads was observed in three media; water, Simulated Gastric Fluid USP without pepsin (SGF) and 0.1% trisodium citrate solution. Release was slowest in water and was complete within 4-5 h. The zinc beads released more slowly than calcium beads prepared at the same molar concentration of cation. Complete release of drug from the alginate gel beads in SGF occurred within 2 h and was unaffected by the cation type and concentration. Except for beads prepared from 0.1M zinc, paracetamol was released rapidly in the citrate solution. All release profiles could be described by first-order kinetics with half-lives which ranged from 25-73 min. Due to the rapid release in acidic conditions, it is unlikely that alginate beads loaded with a relatively water soluble drug will provide satisfactory prolonged release orally.