BACKGROUND

Efforts to control Hansen's d isease have progressed through multidrug therapy implementation. However, documented cases of relapse present challenges to its effective management and eradication. Understanding the contributing factors to relapse is crucial for optimizing treatment strategies and achieving better outcomes against Hansen's Disease.

OBJECTIVE

To determine the epidemiological profile and clinical patterns of patients diagnosed with Hansen's Disease Relapse in selected Tertiary Government Hospitals in the Philippines from November 2016 to October 2021.

METHODOLOGY

This was a multi-center, retrospective study involving a five-year chart review method. Charts of all Hansen's Disease Relapse patients were obtained from participating institutions with necessary approvals. Data collection followed approved forms, and patient profiles were analyzed using descriptive statistics. Pre- and post- relapse profiles were compared using T-tests, Wilcoxon tests, and Fisher's Exact Test. Relapse time across subgroups were assessed using Kruskal-Wallis and Mann-Whitney U tests.

RESULTS

A total of 60 relapse cases were included in the study. Majority were single, unemployed males aged 26-35, with low household screening. The Bacillary Index significantly decreased post- relapse. Documented comorbidities included G6PD deficiency before treatment and lepra reactions during MDT. Patients on 12-month MDT regimens had higher relapse time than those on 24-month regimens.

CONCLUSION

This study underscores the influence of socioeconomic, gender, and age-related factors on relapse. It emphasizes the imperative for enhanced public health measures in accordance with the WHO Global Leprosy Strategy and the importance of considering clinical factors while advocating for continuous improvements in leprosy management protocols.

Human ; Multiple Chronic Conditions

OBJECTIVES: Older adults in rural areas with multiple chronic conditions (MCC) generally exhibit poorer medication adherence than the general elderly population. Considering individual heterogeneity helps to design precise subgroup-based interventions. This study aims to identify latent profile types of medication adherence mechanisms among rural older adults with MCC based on the capability-opportunity-motivation-behavior (COM-B) model, and to explore factors influencing medication adherence. METHODS: A multistage sampling method was used to recruit 349 rural older adults with MCC from 10 administrative villages in Jianghua County, Yongzhou City, Hunan Province, between July and September, 2024. Participants were surveyed using a general information questionnaire, the Health Literacy Scale for Chronic Patients, the Beliefs about Medicines Questionnaire-Specific, the Multidimensional Scale of Perceived Social Support, and the Morisky Medication Adherence Scale. Latent profile analysis based on the COM-B model was conducted to identify subgroups of medication adherence mechanisms. Univariate and Logistic regression analyses were used to identify influencing factors associated with different latent profiles and adherence levels. RESULTS: Among the participants, 33.5% demonstrated good medication adherence. The 5 most prevalent chronic diseases were hypertension (86.5%), diabetes (36.7%), arthritis or rheumatism (34.4%), stroke (21.8%), and heart disease (17.5%). Overall, rural older adults with MCC exhibited relatively good medication capability, opportunity, and motivation. Their medication adherence mechanisms were classified into 3 latent profiles: "family-support restrained type" (5.2%), "family-support driven type" (52.1%), and "comprehensive advantage type" (42.7%). Significant differences were observed among the three profiles in terms of education level, marital status, living arrangement, and per capita monthly household income (all P<0.05). Multivariate Logistic regression revealed that higher education level was a protective factor for belonging to the "comprehensive advantage type" rather than the "family-support driven type" [OR=0.277, 95% CI (PL) 0.126 to 0.614, P=0.002]. Furthermore, significant differences in education level, self-rated health status, and latent profile type were found between participants with good and poor adherence (P<0.05). Binary Logistic regression indicated that with each one-level increase in self-rated health status, the risk of poor adherence increased by 293.9% [OR=3.939, 95% CI (PL) 1.610 to 9.636, P=0.003]. Compared with the "family-support restrained type", individuals classified as the "comprehensive advantage type" had a 96.8% [OR=0.032, 95% CI (PL) 0.008 to 0.123, P<0.001] lower risk of poor medication adherence. CONCLUSIONS The mechanisms underlying medication adherence among rural older adults with MCC show clear heterogeneity. Primary healthcare providers should focus on the "family-support restrained type" subgroup, strengthen social support networks, and implement targeted interventions to improve medication adherence.
Humans ; Aged ; Rural Population ; Male ; Female ; China ; Medication Adherence/psychology* ; Surveys and Questionnaires ; Chronic Disease/drug therapy* ; Multiple Chronic Conditions/drug therapy* ; Social Support ; Motivation ; Middle Aged ; Health Literacy ; Aged, 80 and over

OBJECTIVETo assess the association of single nucleotide polymorphisms (SNPs) of endotheline receptor gene with the severity of coronary heart disease (CHD).

METHODSA total of 553 CHD patients, including 324 patients with mult-vessel disease based on result of selected coronary angiography, and 553 age- and sex-frequency matched controls were selected. Clinical data were collected. Genotypes of rs501120, rs899997, rs1878406 and rs7173743 were determined with TaqMan-MGB probes.

RESULTSThe distribution of genotypes of the 4 SNPs showed no significant difference between the two groups. However, the frequency of A allele of rs501120 and T allele of rs1878406 were significantly higher in the CHD group compared with the control group (P< 0.05). For rs7173743 and rs899997, no significant difference was detected between the two groups. After adjusting for conventional risk factors by logistic regression analysis, the results suggested that the distribution of rs1878406 TT+TC genotype in severe multi-vessel disease group is significantly higher than that in the control group (OR=1.43, 95% CI: 1.05-2.07, P=0.033).

CONCLUSIONThe above results suggested that the rs1878406 polymorphism of endotheline receptor gene may serve as a genetic marker for severe multi-vessel disease in CHD among ethnic Han Chinese.

Case-Control Studies ; Coronary Disease ; genetics ; Endothelins ; genetics ; Female ; Genetic Predisposition to Disease ; Humans ; Male ; Middle Aged ; Multiple Chronic Conditions ; Polymorphism, Single Nucleotide ; genetics