***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: Background and objectives Recent findings from r and omized clinical trials indicate an improved patient adherence and blood pressure ( BP ) control by using fixed-dose combinations ( FDCs ) in the treatment of hypertension . The aim of the present study was to verify those data in a large real-world sample of hypertensive patients and to cross-check adherence evaluation performed by physicians and patients self- assessment . Methods A European multi-center , prospect i ve , 24-week , non-interventional study was conducted including 14,979 patients with essential hypertension and new treatment with olmesartan , amlodipine and hydrochlorothiazide as an FDC .  Patients ’ adherence was measured using the  Morisky Medication Adherence Scale ( MMAS-8 ) and a non-st and ardized question naire was used by physicians and patients for self- assessment . Results The mean age of the patients was 63.9 ± 11.78 years and 46.5 % were women . One or more cardiovascular risk factors were present in 71.9 % of patients and 94.7 % had been treated for hypertension before study entry . Mean adherence to medication by MMAS-8 improved from 6.0 to 6.9 at study end . Corresponding improvements of adherence were seen on physicians ’ and patients ’ self- assessment s throughout the study . Mean decrease of systolic/diastolic BP was 26.4/12.8 mmHg without a relevant difference between the MMAS-8 adherence levels . BP target achievement improved from 55.3 to 67.7 % in patients with low versus high adherence . The overall rate of patients with adverse drug reactions was very low ( 1.76 % ) but more frequent in patients with low adherence . Conclusions Our data confirm previous clinical trial data on the improvement of medication adherence by switching antihypertensive combination therapy to an FDC and a subsequent improvement in BP target achievement . An observed trend toward a reduction in adverse drug reactions needs to be further investigated in clinical trials Adherence to antiretroviral therapy ( ART ) represents one of the strongest predictors of progression to AIDS , yet it is difficult for most patients to sustain high levels of adherence . This study compares the efficacy of a personalized cell phone reminder system ( ARemind ) in enhancing adherence to ART versus a beeper .  Twenty-three HIV-infected subjects on ART with self-reported adherence less than 85 % were r and omized to a cellular phone ( CP ) or beeper ( BP ) . CP subjects received personalized text messages daily ; in contrast , BP subjects received a reminder beep at the time of dosing . Interviews were scheduled at weeks 3 and 6 . Adherence to ART was measured by self-report ( SR , 7-day recall ) , pill count ( PC , past 30 days at baseline , then past 3 weeks ) , Medication Event Monitoring System ( MEMS ; cumulatively at 3 and 6 weeks ) , and via a composite adherence score constructed by combining MEMS , pill count , and self report . A mixed effects model adjusting for baseline adherence was used to compare adherence rates between the intervention groups at 3 and 6 weeks . Nineteen subjects completed all visits , 10 men and 9 females . The mean age was 42.7 ± 6.5 years , 37 % of subjects were Caucasian and 89 % acquired HIV heterosexually .  The average adherence to ART was 79 % by SR and 65 % by PC at baseline in both arms ; over 6 weeks adherence increased and remained significantly higher in the ARemind group using multiple measures of adherence . A larger and longer prospect i ve study is needed to confirm these findings and to better underst and optimal reminder messages and user fatigue Purpose The purpose of this study is to assess factors related to diabetes medication nonadherence in a sample of predominantly Spanish-speaking Mexican-origin adults residing along the US-Mexico border . Methods As part of a r and omized controlled trial , 302 patients r and omly sample d from a clinic roster completed a baseline interview .  Medication nonadherence was assessed with the  Morisky Medication Adherence Scale .  Consistent with the framework proposed by Venturini et al , four factors were examined : patient-related attributes , drug regimen characteristics and complexity , health status , and patient-provider interaction characteristics . Results Sixty percent of the patients were classified as nonadherent . Men , those who engaged in diabetes control behaviors less frequently , and individuals with depression were more likely to be classified as nonadherent . Among those who were Spanish-dominant , education and self-rated health also were significantly and negatively related to medication adherence ; patients with a high school education or greater and those who more positively rated their health were more likely to be classified as nonadherent compared to those with less than a high school education and those who rated their health as poor . Conclusions Results reflect potentially higher medication nonadherence rates for Latinos with type 2 diabetes living in rural communities along the US-Mexico border . Additionally , this study supports the need to address strategies to support medication adherence , including addressing depression , for diabetes control . Strategies to promote adherence among Latino men are sorely needed , as are strategies to address forgetfulness and carelessness regarding diabetes medicine taking Poor adherence to combination  antiretroviral therapy  ( ART ) is a major global challenge . In this study we examined the efficacy of a smartphone application incorporating personalized health-related visual imagery that provided real-time information about the level of medication and the patient 's level of immunoprotection , in order to improve adherence to ART . We r and omized 28 people on ART to either a  st and ard or augmented version of the smartphone application . The augmented version contained components that illustrated participants ' current estimated plasma concentrations of antiretroviral drugs and the immune protection provided by ART . Adherence to ART was assessed at baseline and at 3 months using self-reported adherence , pharmacy dispensing records , and HIV viral load . Information was also collected on illness and medication beliefs and use of the application . Participants who received the augmented application showed a significantly higher level of self-reported adherence to ART at 3 months ( p=0.03 ) and decreased viral load ( p=0.023 ) as compared to individuals using the st and ard version . Greater usage of the extra components of the augmented application was associated with greater perceived underst and ing of HIV infection and increased perceived necessity for ART . Smartphone applications that incorporate personalized health-related visual imagery may have potential to improve adherence to ART OBJECTIVE The purpose of the current study was to test theory-based predictions of mediators and moderators of treatment effects of a pilot r and omized controlled trial , which aim ed to increase adherence to preventive medication in stroke survivors via addressing both automatic ( i.e. , habitual responses ) and reflective ( i.e. , beliefs and value systems ) aspects of medication-taking behavior . METHOD Sixty-two stroke survivors were r and omly allocated to either an intervention or control group . Intervention participants received a brief 2-session intervention aim ed at increasing adherence via ( a ) helping patients establish better medication-taking routines using implementation intentions plans ( automatic ) , and ( b ) eliciting and modifying any mistaken patient beliefs regarding medication and /or stroke ( reflective ) . The control group received similar levels of non-medication-related contact . Primary outcome was adherence to antihypertensive medicine  measured objective ly over 3 months using an electronic pill bottle . Secondary outcome measures included self-reported adherence ( including forgetting ) and beliefs about medication . RESULTS Intervention participants had 10 % greater adherence on doses taken on schedule ( intervention , 97 % ; control , 87 % ; 95 % CI [ 0.2 , 16.2 ] , p = .048 ) , as well as significantly greater increases in self-reported adherence and reductions in concerns about medication . Treatment effects were mediated by reductions in both forgetting and concerns about medication , and moderated by the presence of preexisting medication-taking routines . CONCLUSIONS Addressing both automatic and reflective aspects of behavior via helping stroke survivors develop planned regular routines for medication-taking , and addressing any concerns or misconceptions about their medication , can improve adherence and thus potentially patient outcomes BACKGROUND We aim ed to evaluate treatment responses to atazanavir plus ritonavir ( ATV/r ) or efavirenz ( EFV ) in initial antiretroviral regimens among women and men , and determine if treatment outcomes differ by sex . METHODS We performed a r and omized trial of open-label ATV/r or EFV combined with abacavir/lamivudine ( ABC/3TC ) or tenofovir/emtricitabine ( TDF/FTC ) in 1857 human immunodeficiency virus type 1-infected , treatment-naive persons enrolled between September 2005 and November 2007 at 59 sites in the United States and Puerto Rico . Associations of sex with 3 primary study endpoints of time to virologic failure , safety , and tolerability events were analyzed using Cox proportional hazards models . Model-based population pharmacokinetic analysis was performed using nonlinear mixed effects modeling ( NONMEM version VII ) . RESULTS Of 1857 participants , 322 were women . Women assigned to ATV/r had a higher risk of virologic failure with either nucleoside reverse transcriptase inhibitor backbone than women assigned to EFV , or men assigned to ATV/r . The effects of ATV/r and EFV upon safety and tolerability risk did not differ significantly by sex . With ABC/3TC , women had a significantly higher ( 32 % ) safety risk compared to men ; with TDF/FTC , the safety risk was 20 % larger for women compared to men , but not statistically significant . Women had slower ATV clearance and higher predose levels of ATV compared to men . Self-reported adherence did not differ significantly by sex . CONCLUSIONS This is the first r and omized clinical trial to identify a significantly earlier time to virologic failure in women r and omized to ATV/r compared to women r and omized to EFV . This finding has important clinical implication s given that boosted protease inhibitors are often favored over EFV in women of childbearing potential . CLINICAL TRIALS REGISTRATION NCT00118898 OBJECTIVE : To evaluate the accordance between three measures of self-reported medication adherence . METHODS : A survey was administered to HIV patients . The three adherence measures included a four-item Morisky-type scale  ( Measure1 ) and two measures defining adherence as the percentage of doses taken as prescribed during the past two days ( Measure2 ) or past two weeks ( Measure3 ) . RESULTS : For Measure1 , 29.2 % of the patients were categorized as high adherence and 61.5 % as medium adherence . For Measure2 and Measure3 , the mean scores were 93.6 % and 96.5 % , respectively . Using 90 % as cutoff values , 78.5 % and 95.4 % of the patients were classified as adherent by Measure2 and Measure3 , respectively ( k = 0.30 ; p = 0.001 ) . When 80 % was used , 90.8 % of the patients were classified as adherent for Measure2 and 96.9 % for Measure3 ( k = 0.48 ; p < 0.001 ) . When using 90 % and 80 % as cutoff values to categorize Measure2 and Measure3 as three levels , there was no agreement between Measure1 and the other two measures . The accordance of Measure2 and Measure3 was significant albeit not high ( k = 0.31 ; p < 0.001 ) . CONCLUSIONS : The accordance between a Morisky-type adherence scale and measures of missed doses is unsatisfactory . However , “ missed-dose ” measures using two-day or two-week time periods yield fairly similar results . Research ers should be cautious when comparing adherence rates between studies that use different methods for assessing adherence BACKGROUND Adequate exposure to antiretrovirals is important to maintain durable responses , but methods to assess exposure ( eg , querying adherence and single plasma drug level measurements ) are limited . Hair concentrations of antiretrovirals can integrate adherence and pharmacokinetics into a single assay . METHODS Small hair sample s were collected from participants in the Women 's Interagency HIV Study ( WIHS ) , a large cohort of human immunodeficiency virus (HIV)-infected ( and at-risk noninfected ) women . From 2003 through 2008 , we analyzed atazanavir hair concentrations longitudinally for women reporting receipt of atazanavir-based therapy . Multivariate r and om effects logistic regression models for repeated measures were used to estimate the association of hair drug levels with the primary outcome of virologic suppression ( HIV RNA level , < 80 copies/mL ) . RESULTS 424 WIHS participants ( 51 % African-American , 31 % Hispanic ) contributed 1443 person-visits to the analysis . After adjusting for age , race , treatment experience , pretreatment viral load , CD4 count and AIDS status , and self-reported adherence , hair levels were the strongest predictor of suppression . Categorized hair antiretroviral levels revealed a monotonic relationship to suppression ; women with atazanavir levels in the highest quintile had odds ratios ( ORs ) of 59.8 ( 95 % confidence ratio , 29.0 - 123.2 ) for virologic suppression . Hair atazanavir concentrations were even more strongly 
    Output:
    
There appears to be no st and ardized method to measure MMA .