***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The importance of adherence to antihypertensive treatments for the prevention of cardiovascular disease has not been well eluci date d. This study evaluated the effect of antihypertensive medication adherence on specific cardiovascular disease mortality ( ischemic heart disease [ IHD ] , cerebral hemorrhage , and cerebral infa rct ion ) . Our study used data from a 3 % sample cohort that was r and omly extracted from enrollees of Korean National Health Insurance . Study subjects were aged ≥20 years , were diagnosed with hypertension , and started newly prescribed antihypertensive medication in 2003 to 2004 . Adherence to antihypertensive medication was estimated as the cumulative medication adherence . Subjects were divided into good ( cumulative medication adherence , ≥80 % ) , intermediate ( cumulative medication adherence , 50%–80 % ) , and poor ( cumulative medication adherence , < 50 % ) adherence groups . We used time-dependent Cox proportional hazards models to evaluate the association between medication adherence and health outcomes . Among 33 728 eligible subjects , 670 ( 1.99 % )  died of coronary heart disease or stroke during follow-up . Patients with poor medication adherence had worse mortality from IHD ( hazard ratio , 1.64 ; 95 % confidence interval , 1.16–2.31 ; P for trend=0.005 ) , cerebral hemorrhage ( hazard ratio , 2.19 ; 95 % confidence interval , 1.28–3.77 ; P for trend=0.004 ) , and cerebral infa rct ion ( hazard ratio , 1.92 ; 95 % confidence interval , 1.25–2.96 ; P for trend=0.003 ) than those with good adherence . The estimated hazard ratios of hospitalization for cardiovascular disease were consistent with the mortality end point . Poor medication adherence was associated with higher mortality and a greater risk of hospitalization for specific cardiovascular diseases , emphasizing the importance of a monitoring system and strategies to improve medication adherence in clinical practice ABSTRACT Introduction : This study was aim ed at evaluating whether once-daily regimens ( od-r ) show benefits in adherence when compared to twice-daily ( td-r ) . Methods : Prospect i ve , multicenter , 6-month follow-up study with two visits . The main objective was to compare adherence assessed by the  electronic prescription refill rate ( EPRR ) and by the  10-item Test of Adherence to Inhalers ( TAI ) in patients with od-r and td-r . Suboptimal adherence was defined as TAI < 50 or EPRR ≤ 80 % . The effect of suboptimal adherence on meaningful clinical outcomes and the concordance between EPRR and TAI were also examined . Results : One hundred and ninety-seven patients ( 47.3 ± 15.9 years , 65 % women ) were included and 180 completed the study . TAI score was < 50 in 29.8 % od-r patients and 46.9 % in td-r ( p = 0.01 ) and EPRR was ≤80 % in 22.6 % and 37.5 % respectively ( p = 0.02 ) . The correlation between the two methods was moderate ( rho = 0.548 ; p < 0.001 ) . There were no significant differences in FEV1 ( % ) , symptoms or exacerbations between patients with optimal and suboptimal adherence . During follow-up , five patients ( 6 % ) with o-dr and 17 patients ( 17.7 % ) with t-dr suffered an exacerbation ( p = 0.013 ) . At visit two , 13.1 % of the patients with o-dr and 31.3 % with t-dr had uncontrolled asthma ( p = 0.003 ) , although more patients with o-dr were receiving inhaled corticosteroids in the high-dose stratum ( 25.8 % vs. 11.5 % ; p = 0.001 ) . Conclusion : Mean adherence rates were greater with od-r than with td-r , but we did not observe an effect on clinical outcomes OBJECTIVES The primary aims of the study were to : ( a ) describe the trajectories of adherence to daily inhaled corticosteroid ( ICS ) medication for a year in economically disadvantaged , African-American youth with asthma based on growth curve modeling ; and ( b ) test the relationship of treatment adherence to symptom control , quick-relief medication , and healthcare utilization . METHODS This prospect i ve study measured adherence to daily ICS treatment using electronic monitoring in 92 children and adolescents with moderate to severe asthma for 9 - 12 months and assessed clinical outcomes , including asthma-related symptoms , quick-relief medication , and healthcare utilization . RESULTS Youth showed a decrement in treatment adherence to less than half of prescribed corticosteroid treatment over the course of the study , which related to increased healthcare utilization ( p < .04 ) , but not to asthma symptoms or albuterol use . CONCLUSION Economically disadvantaged youth with asthma demonstrate high rates of chronic nonadherence that warrant identification and intervention to reduce asthma-related healthcare utilization The assessment of compliance is critical in the evaluation of the effectiveness of a new therapeutic agent . Fifteen patients with transfusion-dependent beta-thalassemia , many of whom had previously demonstrated erratic compliance with deferoxamine , were enrolled in a clinical trial of a new oral iron chelator , 1,2-dimethyl-3-hydroxypyrid-4-one ( L1 ) . Their compliance with this medication was estimated by several existing methods and the novel Medication Event Monitoring System ( MEMS ) . Overall compliance as assessed by the MEMS was 78.5 + /- 13.0 % of prescribed doses taken , significantly lower than the corresponding rates calculated by pill counts and diaries ( 91.5 + /- 9.2 % and 94.1 + /- 4.3 % , respectively ) . However , several serious problems were encountered with the MEMS , mostly in the form of incorrect use of the device by the patients . Disclosure of the nature of the MEMS and the compliance monitoring process did not alter the rate of adherence with L1 therapy .  Compliance as determined by pill counts did not differ between the 1st and 2nd 6-month periods . Although not reaching statistical significance , a trend towards better L1 compliance occurred in those patients in whom serum ferritin levels decreased . Patients who filled at least 50 % of their diaries had significantly better compliance by pill counts than those who completed less than 50 % of their diaries ( 95.9 + /- 4.1 % and 86.5 + /- 11.1 % , respectively ) . Steady-state L1 trough concentrations and 24-hour urinary iron excretion did not correlate with L1 compliance . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND Patients who adhere to medications experience better outcomes than their nonadherent counterparts . However , these observations may be confounded by patient behaviors . The level of adherence necessary for patients to derive benefit and whether adherence to all agents is important for diseases that require multiple drugs remain unclear . This study quantifies the relationship between medication adherence and  post-myocardial infa rct ion (  MI ) adverse coronary events . METHODS This is a secondary analysis of the r and omized MI FREEE trial . Patients who received full prescription coverage  were classified as adherent ( proportion of days covered ≥80 % ) or not based upon achieved adherence in the 6 months after r and omization . First major vascular event or revascularization rates were compared using multivariable Cox models adjusting for comorbidity and health-seeking behavior . RESULTS Compared with patients r and omized to usual care , full coverage patients adherent to statin , β-blocker , or angiotensin-converting enzyme inhibitor/angiotensin receptor blocker were significantly less likely to experience the study 's primary outcome ( hazard ratio [ HR ] range 0.64 - 0.81 ) . In contrast , nonadherent patients derived no benefit ( HR range 0.98 - 1.04 , P ≤ .01 for the difference in HRs between adherent and nonadherent patients ) . Partially adherent patients had no reduction in clinical outcomes for any of the drugs evaluated , although their achieved adherence was higher than that among controls . CONCLUSION Achieving high levels of adherence to each and all guideline -recommended post-MI secondary prevention medication is associated with improved event-free survival . Lower levels of adherence appear less protective BACKGROUND Unmeasured confounders and selection bias can significantly influence the results of retrospective observational analyses of asthma therapy . OBJECTIVE To evaluate the efficacy of oral montelukast and inhaled fluticasone propionate in a r and omized , prospect i ve 12-month " real-world " observational analysis of children with mild persistent asthma . METHODS Children ( n = 104 ) between 6 and 15 years of age with mild asthma as determined by forced expiratory volume in 1 second , symptoms , and evaluation by an experienced pediatric allergist or pulmonologist , who were not currently receiving controller therapy , were r and omly assigned to fluticasone or montelukast on an alternating basis . Subjects were asked to complete a question naire at 6 and 12 months ; otherwise , medical care was identical to that of similar managed care patients . Outcome parameters were evaluated after 12 months by cl aims data base analysis . An acute asthma attack requiring emergent care was the primary outcome parameter . Measures of adherence , symptoms , and asthma control , as measured by the pediatric Asthma Therapy Assessment Question naire , were secondary outcome parameters . RESULTS Demographics , spirometry , symptoms at enrollment , emergent care visits , asthma hospitalizations , routine office visits , and symptoms at study completion were not significantly different between study groups . Adherence , as evaluated by the number of controller fills , was significantly ( P = 0.0003 ) better for montelukast ( 7.65 + /- 3.01 ) than fluticasone ( 5.46 + /- 3.01 ) . Similar numbers of subjects in each study group required beta-agonists and oral prednisone . CONCLUSIONS These results suggest that oral montelukast and inhaled fluticasone have similar real-world efficacies in the treatment of children with mild asthma , possibly as a result of the significantly better adherence with oral montelukast therapy compared with inhaled fluticasone BACKGROUND Being able to identify patients at risk of exacerbations is useful as it enables re sources to be targeted at these patients . AIMS To test the theoretically-derived prediction that the frequency of non-asthma related visits to the general practitioner ( GP ) predicts exacerbations . METHODS Clinical and demographic data and both self-report and prescription-based adherence data were obtained from 166 patients diagnosed with asthma attending a GP clinic , all of whom were prescribed inhaled corticosteroids ( ICS ) .  Asthma exacerbations ( treated by the GP or in hospital ) and non-asthma visits and symptoms were assessed from notes for the subsequent 5 years . RESULTS Exacerbations correlated with non-asthma visits ( 0.35 ) , severity as measured by BTS step ( 0.28 ) , and with prescription-based adherence ( 0.28 ) . Asthma severity correlated with non-asthma visits ( 0.35 ) . Receiver operating curves showed that ≥2 non-asthma visits per year provided 79 % sensitivity and 58 % specificity for detecting ≥3 exacerbations over 5 years . Poor adherence predicted outcomes only for patients with high levels of non-asthma visits ( ≥3 ) and only for those reporting regular-but-less ICS use but not symptom-directed ICS use . CONCLUSIONS Non-asthma visits are a good predictor of asthma exacerbations , particular in non-adherent patients . These results are consistent with a mechanism where exacerbations result from a combination of r and om oscillating specific and non-specific inflammatory processes . It is important to consider the total patient rather than just the lung when managing patients with asthma BACKGROUND Information comparing subjective and objective measurements of adherence to study medications and the effects of adherence on treatment-related differences in asthma clinical trials are limited . OBJECTIVE We sought to compare subjective and objective measurements of children 's adherence to inhaled corticosteroids or placebo and to determine whether adherence to study medications modified treatment-related differences in outcomes . METHODS In an ancillary study conducted in 3 of 8 Childhood Asthma Management Program Clinical Centers , adherence was assessed by using self-reported and objective data in 5- to 12-year-old children with mild or moderate asthma who were r and omly assigned to 200 μg of inhaled budesonide twice per day ( n = 84 ) or placebo  ( n = 56 ) for 4 years . The κ statistic was used to evaluate agreement between self-reported adherence ( daily diary cards ) and objective ly measured adherence ( number of doses left in study inhalers ) . Multivariable analyses were used to determine whether adherence to study treatment modified treatment-related differences in out 
    Output:
    
The highest reduction in the odds of exacerbation was associated with patients achieving 80 % or more adherence , and the odds also reduced among those with 50 % or more adherence , whereas a substantial increase in exacerbation was associated with discontinuation of therapy