Katie Kiser

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José Rogelio L S Lozano Sánchez

UNAM Universidad Nacional Autónoma de México

Armando Marques-Guedes

UNL - New University of Lisbon

Diego Villar

National Scientific and Technical Research Council

José Ercolino

Universidad Central de Venezuela

Carlos Quiles

Universidad de Extremadura

Werner Bonefeld

University of York

Tatiana Sorókina

Universidad Autónoma Metropolitana

Edwin-Francisco Herrera-Paz

Universidad Catolica de Honduras

Rodrigo G de Azevedo

Pontifícia Universidade Católica do Rio Grande do Sul

Rodrigo Toniol

Universidade Federal do Rio de Janeiro (UFRJ)

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Risk Factors for Venous Thromboembolism in Patients with Human Immunodeficiency Virus Infection

Pharmacotherapy, Dec 1, 2010

Prevention and treatment of venous thromboembolism are gaining attention in the lay and medical c... more Prevention and treatment of venous thromboembolism are gaining attention in the lay and medical communities because of an increase in frequency, cost, and risk factors. Evidence shows that patients with human immunodeficiency virus (HIV) have multiple risk factors and a 2-10-fold increased risk for venous thromboembolism compared with the general population. A higher rate of venous thromboembolism also occurs in patients with HIV who are younger than 50 years (3.31% vs 0.53% in age-matched healthy controls, p&amp;amp;amp;amp;lt;0.0001), have a CD4(+) cell count less than 200 cells/mm³, or have a diagnosis of acquired immunodeficiency syndrome. Both protein S and C deficiencies--disorders that may predispose individuals to thrombotic disease--are considered risk factors; in addition, the use of protease inhibitors and the presence of active opportunistic infections or antiphospholipid antibodies may be associated with venous thromboembolism. It is imperative that all risk factors for venous thromboembolism be identified and incorporated into medical decision making for high-risk patients, including those with HIV. The classification and mechanism of these risk factors are not well understood. Long-term, prospective studies assessing the factors associated with venous thromboembolism in patients with HIV are needed. Risk stratification systems or screening tools, as well as effective preventive measures, must be developed.

A Randomized Controlled Trial of a Literacy-Sensitive Self-Management Intervention for Chronic Obstructive Pulmonary Disease Patients

Carolina Digital Repository (University of North Carolina at Chapel Hill), 2012

BACKGROUND: Low literacy skills are common and associated with a variety of poor health outcomes.... more BACKGROUND: Low literacy skills are common and associated with a variety of poor health outcomes. This may be particularly important in patients with chronic illnesses such as chronic obstructive pulmonary disease (COPD) that require appropriate inhaler technique to maintain quality of life and avoid exacerbations. OBJECTIVE: To explore the impact of a literacy-sensitive self-management intervention on inhaler technique scores in COPD patients and to determine if effects differ by literacy. DESIGN: Randomized controlled trial. PARTICIPANTS: Ninety-nine patients with COPD. INTERVENTION: Patients were randomly assigned to a one-on-one self-management educational intervention or usual care. The intervention focused on inhaler technique, smoking cessation, and using a COPD action plan. MAIN MEASURES: At baseline, an inhaler technique assessment, literacy assessment, health-related quality of life questionnaires, and pulmonary function tests were completed. Inhaler technique was re-evaluated after two to eight weeks. KEY RESULTS: Mean age 63, 65% female, 69% Caucasian, moderate COPD severity on average, 36% with low literacy, moderately impaired health-related quality of life, and similar baseline metered dose inhaler technique scores. Patients in the intervention group had greater mean improvement from baseline in metered dose inhaler technique score compared to those in the usual care group (difference in mean change 2.1, 95% CI 1.1, 3.0). The patients in the intervention group also had greater mean improvements in metered dose inhaler technique score than those in the usual care group whether they had low health literacy (difference in mean change 2.8, 95% CI 0.6, 4.9) or higher health literacy (1.8, 95% CI 0.7, 2.9). CONCLUSIONS: A literacy-sensitive self-management intervention can lead to improvements in inhaler technique, with benefits for patients with both low and higher health literacy.

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