No abstract

BackgroundPoor adherence to disease-modifying drugs is associated with an increased risk of relapse in patients with multiple sclerosis. However, adherence is difficult to assess objectively. RebiSmart® (Merck Serono SA, Geneva, Switzerland), a device for subcutaneous (sc) injection of interferon (IFN) β-1a, features an electronic injection log that can assist in objective monitoring of adherence.ObjectiveTo assess adherence to sc IFN β-1a injections using data from RebiSmart®.MethodsThis was a single-group, observational, retrospective audit. Adherence data were collected from patients with relapsing multiple sclerosis in the United Kingdom and Ireland who had been prescribed sc IFN β-1a and had been using RebiSmart® for a minimum of 24 months.ResultsIn total, 225 patients were included in the full analysis set; 72% were in the United Kingdom, and 28% were in Ireland. Overall, the mean age was 44.1 years, and 73% were women. Patients received sc IFN β-1a 44 µg (68%) or 22 µg (32%) three times per week. Mean adherence over the course of 24 months was 95.0% (median, 99.4%), and similar values were observed across all periods. The proportion of patients with 80% or higher adherence was 92.0% at 12 months and 91.1% at 24 months.ConclusionHigh adherence to sc IFN β-1a was observed across all patient groups using RebiSmart®, according to 2-year treatment adherence data. This may be partly attributed to the expert support patients received, supplemented by routine and regular contact from the MySupport patient-support program, as well as the self-motivation of patients who persisted with treatment for 2 or more years.

Decades of campaigns have cautioned households in Bangladesh about waterborne contaminants such as arsenic. In addition to switching water sources, mothers can protect young children from contaminated water by breastfeeding longer. We exploit time series variation in whether children were born before or after a nationwide information campaign and geographic variation in exposure to arsenic. We find that mothers breast-feed children longer in response to the campaign, especially when they have less access to uncontaminated wells, and that infants are more likely to be exclusively breast-fed. We find consistent evidence of lower mortality rates and diarrheal incidence for infants.

Malnutrition is a growing problem in the UK with as many as 14% of people aged over 65 at risk. It is of particular concern in care homes where more than one third of residents are undernourished. Weight loss is not the only symptom of malnourishment and nurses should examine any changes to a person's health and well-being to identify causes. Regular monitoring of patients' risk of malnutrition through use of screening assessments, such as the Malnutrition Universal Screening Tool, ensures undernourishment is identified early. As the population ages, it is more important than ever that the implications of malnutrition are recognised and addressed.

Helen Willis discusses the often concealed issue of inadequate diets among the over-65s