Low levels of adherence with proton pump inhibitor therapy contribute to therapeutic failure in gastroesophageal reflux disease

To assess adherence to proton pump inhibitor (PPI) treatment and associated variables in patients with gastroesophageal reflux disease (GERD). Cross-sectional and prospective comprising 240 consecutive adult patients, diagnosed with GERD for whom continuous use of standard or double dose of omeprazole had been prescribed. Patients were ranked as ne-GERD (162: 67.5%) or e-GERD classified according to the Los Angeles classification as A (48:20.0%), B (21:8.6%), C (1:0.5%), D (1:0.5%), and Barrett's esophagus (7:2.9%). The Morisky questionnaire was applied to assess adherence to therapy and a GERD questionnaire to assess symptoms and their impact. Adherence was correlated with demographics, cotherapies, comorbidities, treatment duration, symptoms scores, endoscopic findings, and patient awareness of their disease. 126 patients (52.5%) exhibited high level of adherence and 114 (47.5%) low level. Youngers (P= 0.002) or married (O.R. 2.41, P= 0.03 vs. widowers) patients had lower levels of adherence; symptomatic patients exhibited lower adherence (P= 0.02). All other variables studied had no influence on adherence. Patients with GERD attending a tertiary referral hospital in Sao Paulo exhibited a high rate of low adherence to the prescribed PPI therapy that may play a role in the therapy failure. Age <60 years, marital status and being symptomatic were risk factors for low adherence.

Too Big to Ignore: Global Partnership on Small-Scale Fisheries Research - the Latin America and Caribbean network

Too Big to Ignore (TBTI; www.toobigtoignore.net) is a research network and knowledge mobilization partnership established to elevate the profile of small-scale fisheries (SSF), to argue against their marginalization in national and international policies, and to develop research and governance capacity to address global fisheries challenges. Network participants and partners are conducting global and comparative analyses, as well as in-depth studies of SSF in the context of local complexity and dynamics, along with a thorough examination of governance challenges, to encourage careful consideration of this sector in local, regional and global policy arenas. Comprising 15 partners and 62 researchers from 27 countries, TBTI conducts activities in five regions of the world. In Latin America and the Caribbean (LAC) region, we are taking a participative approach to investigate and promote stewardship and self-governance in SSF, seeking best practices and success stories that could be replicated elsewhere. As well, the region will focus to promote sustainable livelihoods of coastal communities. Key activities include workshops and stakeholder meetings, facilitation of policy dialogue and networking, as well as assessing local capacity needs and training. Currently, LAC members are putting together publications that examine key issues concerning SSF in the region and best practices, with a first focus on ecosystem stewardship. Other planned deliverables include comparative analysis, a regional profile on the top research issues on SSF, and a synthesis of SSF knowledge in LAC