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Sample records for general adherence scale

  1. Adherence to COPD guidelines in general practice

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli; Sørensen, Tina Brandt; Højmark, Torben Brunse

    2013-01-01

    BACKGROUND: The general practitioner (GP) is often the first healthcare contact for patients with chronic obstructive pulmonary disease (COPD). AIMS: To determine whether participating in a standardised educational programme delivered in the GP's own practice is associated with adherence to COPD...... guidelines. METHODS: A nationwide register-based observational before and after study was undertaken with a control group of propensity-matched practices (follow-up period 6 months). COPD was defined as age 40+ years and at least two prescriptions for inhaled medication. The educational programme consisted...... were used to compare the rate of spirometry testing, preventive consultations, and influenza vaccinations provided to COPD patients and the rate of spirometry testing in non-COPD individuals, assumed to reflect diagnostic activity. RESULTS: Data for 102 participating GP practices were analysed...

  2. Limits to the adherence of oxide scales

    International Nuclear Information System (INIS)

    Robertson, J.; Manning, M.I.

    1989-10-01

    Fracture mechanics is used to identify criteria under which uniform oxide scales may be expected to fail due to rapidly applied strains. The most common failure mode occurs when the strain, ε, builds up in the scale until the strain energy density per unit area exceeds the fracture surface energy, γ, of the oxide. This produces spalling when ε > (2γ/hE) 1/2 , where h is the scale thickness and E is the oxide Youngs modulus. In thin scales, as the external strain is applied to the oxide via the metal substrate, it is clear that no further strain can be applied to the oxide if the substrate has itself been strained beyond yield. This gives rise to extended oxide adherence in which the oxide cracks and forms a series of islands but remains attached to the deformed metal. When the oxide thickness is less than its comminution limit, the flaw size necessary for brittle fracture exceeds the oxide thickness and the oxide yields in a ductile manner without cracking. The results are presented as maps of failure strain versus oxide thickness for various oxide systems such as Fe 3 O 4 , Cr 2 O 3 , Al 2 O 3 , SiO 2 and NiO. The observed cases of spalling are found to lie within the predicted regions. (author)

  3. Development and validation of a tuberculosis medication adherence scale.

    Directory of Open Access Journals (Sweden)

    Xiaoxv Yin

    Full Text Available BACKGROUND: Medication adherence is critical in Tuberculosis (TB treatment success, but existing tools are inadequate in identifying non-adherents, reasons for non-adherence or interventions to improve adherence. This study intended to fill the gap by developing and validating a TB medication adherence scale (TBMAS. METHODS: An initial 41-item TBMAS was designed through review of literature, consultation from an 8-member clinical expert panel and a 15-patient focus group, and pilot-testing in 25 TB patients. The questionnaire was validated in 438 patients who visited 23 community health centers for TB treatment in Wuhan from September 1, 2010, to August 31, 2011, using pharmacy refill records in a 15-week period as external criteria for medication adherence. After removing redundant and cross-loading items, the internal consistency, reliability and validity of TBMAS in identifying non-adherents were examined. RESULTS: The final TBMAS included 30 items scored on a 5-point Likert scale, and these items were loaded in nine distinct factors that explained 65% of cumulative variance among respondents. Cronbach's alpha, test-retest reliability and split-half reliability were 0.87, 0.83, and 0.85, respectively. Convergent validity was supported by statistically significant associations between TBMAS scores and adherence measured by pharmacy refill records. Receiver Operating Characteristics curve analysis suggested a cut-off point at 113, with which TBMAS showed a positive predictive value of 65.5% and sensitivity of 82.9% in identifying non-adherents. CONCLUSION: TBMAS demonstrated satisfactory internal consistency, reliability and validity in identifying TB patients with poor adherence and potential causes for non-adherence.

  4. Development and validation of a tuberculosis medication adherence scale.

    Science.gov (United States)

    Yin, Xiaoxv; Tu, Xiaochen; Tong, Yeqing; Yang, Rui; Wang, Yunxia; Cao, Shiyi; Fan, Hong; Wang, Feng; Gong, Yanhong; Yin, Ping; Lu, Zuxun

    2012-01-01

    Medication adherence is critical in Tuberculosis (TB) treatment success, but existing tools are inadequate in identifying non-adherents, reasons for non-adherence or interventions to improve adherence. This study intended to fill the gap by developing and validating a TB medication adherence scale (TBMAS). An initial 41-item TBMAS was designed through review of literature, consultation from an 8-member clinical expert panel and a 15-patient focus group, and pilot-testing in 25 TB patients. The questionnaire was validated in 438 patients who visited 23 community health centers for TB treatment in Wuhan from September 1, 2010, to August 31, 2011, using pharmacy refill records in a 15-week period as external criteria for medication adherence. After removing redundant and cross-loading items, the internal consistency, reliability and validity of TBMAS in identifying non-adherents were examined. The final TBMAS included 30 items scored on a 5-point Likert scale, and these items were loaded in nine distinct factors that explained 65% of cumulative variance among respondents. Cronbach's alpha, test-retest reliability and split-half reliability were 0.87, 0.83, and 0.85, respectively. Convergent validity was supported by statistically significant associations between TBMAS scores and adherence measured by pharmacy refill records. Receiver Operating Characteristics curve analysis suggested a cut-off point at 113, with which TBMAS showed a positive predictive value of 65.5% and sensitivity of 82.9% in identifying non-adherents. TBMAS demonstrated satisfactory internal consistency, reliability and validity in identifying TB patients with poor adherence and potential causes for non-adherence.

  5. Factors influencing adherence to guidelines in general practice

    NARCIS (Netherlands)

    Stewart, RE; Vroegop, S; van der Werf, GT; Meyboom-de Jong, B; Kamps, G.

    2003-01-01

    Objectives: To identify and assess the effects of general practitioner and patient characteristics on global adherence to pharmacotherapeutic guidelines. Methods: In a cross-sectional study in the northern Netherlands, a two-level multilevel model was applied to patients (n = 269,067) in 190

  6. Revision and validation of Medication Adherence Reasons Scale (MAR-Scale).

    Science.gov (United States)

    Unni, Elizabeth J; Olson, Jeffery L; Farris, Karen B

    2014-02-01

    Medication non-adherence is a complex phenomenon that requires tailored interventions to improve it. A new self-reported measure of medication non-adherence was previously reported based on the commonly reported reasons underlying non-adherence with the intention to match the items in the scale with tailored interventions. The objectives were to revise the original Medication Adherence Reasons Scale (MAR-Scale) based on expert opinion and cognitive interviewing, and establish the psychometric properties of the revised scale. A cross-sectional design was used in cholesterol lowering and asthma maintenance medications in collaboration with an integrated medical center in the Mountain West. In the first phase, the original MAR-Scale was revised based on expert opinion and cognitive interviewing. In the second phase, the revised MAR-Scale was tested for psychometric properties in a random sample of 350 subjects on each medication. Revisions based on expert opinion included asking a global question about adherence in the past 7 days, simplifying the items and converting them into first person sentences, objective anchoring of the scale, and expanding the 'forgetfulness' item. Cognitive interviewing added one additional item to the survey. The revised MAR- Scale identified 50% of the cholesterol lowering respondents and 68% of the asthma maintenance respondents as non-adherents. An exploratory factor analysis identified four domains in the scale, with Cronbach's alpha ranging from 0.848-0.953 in cholesterol lowering and 0.827-0.891 in asthma maintenance medications. The scale also exhibited significant correlations with few other self-reported measures, consistent with hypotheses. A key limitation of the study was the moderate response rate to the survey for both medications. The revised MAR-Scale demonstrates better psychometric properties than the original.

  7. Adherence to cancer treatment guidelines: influence of general and cancer-specific guideline characteristics.

    NARCIS (Netherlands)

    Heins, M.J.; Jong, J.D. de; Spronk, I.; Ho, V.K.; Brink, M.; Korevaar, J.C.

    2017-01-01

    Background: Guideline adherence remains a challenge in clinical practice, despite guidelines’ ascribed potential to improve patient outcomes. We studied the level of adherence to recommendations from Dutch national cancer treatment guidelines, and the influence of general and

  8. Adaptation and evaluation of the measurement properties of the Brazilian version of the Self-efficacy for Appropriate Medication Adherence Scale.

    Science.gov (United States)

    Pedrosa, Rafaela Batista dos Santos; Rodrigues, Roberta Cunha Matheus

    2016-01-01

    to undertake the cultural adaptation of, and to evaluate the measurement properties of, the Brazilian version of the Self-efficacy for Appropriate Medication Adherence Scale in coronary heart disease (CHD) patients, with outpatient monitoring at a teaching hospital. the process of cultural adaptation was undertaken in accordance with the international literature. The data were obtained from 147 CHD patients, through the application of the sociodemographic/clinical characterization instrument, and of the Brazilian versions of the Morisky Self-Reported Measure of Medication Adherence Scale, the General Perceived Self-Efficacy Scale, and the Self-efficacy for Appropriate Medication Adherence Scale. the Brazilian version of the Self-efficacy for Appropriate Medication Adherence Scale presented evidence of semantic-idiomatic, conceptual and cultural equivalencies, with high acceptability and practicality. The floor effect was evidenced for the total score and for the domains of the scale studied. The findings evidenced the measure's reliability. The domains of the Brazilian version of the Self-efficacy for Appropriate Medication Adherence Scale presented significant inverse correlations of moderate to strong magnitude between the scores of the Morisky scale, indicating convergent validity, although correlations with the measure of general self-efficacy were not evidenced. The validity of known groups was supported, as the scale discriminated between "adherents" and "non-adherents" to the medications, as well as to "sufficient dose" and "insufficient dose". the Brazilian version of the Self-efficacy for Appropriate Medication Adherence Scale presented evidence of reliability and validity in coronary heart disease outpatients.

  9. Primary non-adherence to prescribed medication in general practice

    DEFF Research Database (Denmark)

    Linnet, Kristján; Halldórsson, Matthías; Thengilsdóttir, Gudrún

    2013-01-01

    prescriptions issued electronically by 140 physicians at 16 primary health care centres in the Reykjavik capital area during two periods before and after increases in copayment were matched with those dispensed in pharmacies, the difference constituting primary non-adherence (population: 200&emsp14...

  10. Comparing Adherence in Cardiac Clinic Versus General Outpatient ...

    African Journals Online (AJOL)

    pharmacy registers with individual patient electronic records will help in measuring the adherence in an objective manner. Financial support and sponsorship. Nil. Conflicts of interest. There are no conflicts of interest. Kalaiselvi Selvaraj, Pruthu Thekkur,. Palanivel Chinnakali. Department of Preventive and Social Medicine, ...

  11. The Danish version of the Medication Adherence Report Scale: preliminary validation in cancer pain patients

    DEFF Research Database (Denmark)

    Jacobsen, Ramune; Møldrup, Claus; Christrup, Lona Louring

    2009-01-01

    into Danish following the repeated back-translation procedure. Cancer patients for the study were recruited from specialized pain management facilities. Thirty-three patients responded to the DMARS-4, the Danish Barriers Questionnaire II, The Danish version of Patient Perceived Involvement in Care Scale......OBJECTIVE: To examine the psychometric properties of the Danish version of the Medication Adherence Report Scale (DMARS-4) adapted to measure adherence to analgesic regimen among cancer patients. METHODS: The validated English version of the Medication Adherence Report Scale was translated...

  12. Adaptation and evaluation of the measurement properties of the Brazilian version of the Self-efficacy for Appropriate Medication Adherence Scale

    Directory of Open Access Journals (Sweden)

    Rafaela Batista dos Santos Pedrosa

    2016-01-01

    Full Text Available Objectives: to undertake the cultural adaptation of, and to evaluate the measurement properties of, the Brazilian version of the Self-efficacy for Appropriate Medication Adherence Scale in coronary heart disease (CHD patients, with outpatient monitoring at a teaching hospital. Method: the process of cultural adaptation was undertaken in accordance with the international literature. The data were obtained from 147 CHD patients, through the application of the sociodemographic/clinical characterization instrument, and of the Brazilian versions of the Morisky Self-Reported Measure of Medication Adherence Scale, the General Perceived Self-Efficacy Scale, and the Self-efficacy for Appropriate Medication Adherence Scale. Results: the Brazilian version of the Self-efficacy for Appropriate Medication Adherence Scale presented evidence of semantic-idiomatic, conceptual and cultural equivalencies, with high acceptability and practicality. The floor effect was evidenced for the total score and for the domains of the scale studied. The findings evidenced the measure's reliability. The domains of the Brazilian version of the Self-efficacy for Appropriate Medication Adherence Scale presented significant inverse correlations of moderate to strong magnitude between the scores of the Morisky scale, indicating convergent validity, although correlations with the measure of general self-efficacy were not evidenced. The validity of known groups was supported, as the scale discriminated between "adherents" and "non-adherents" to the medications, as well as to "sufficient dose" and "insufficient dose". Conclusion: the Brazilian version of the Self-efficacy for Appropriate Medication Adherence Scale presented evidence of reliability and validity in coronary heart disease outpatients.

  13. Validation of the VERITAS-Pro treatment adherence scale in a Spanish sample population with hemophilia

    Directory of Open Access Journals (Sweden)

    Cuesta-Barriuso R

    2017-03-01

    Full Text Available Rubén Cuesta-Barriuso,1–3 Ana Torres-Ortuño,4 Pilar Galindo-Piñana,4 Joaquín Nieto-Munuera,4 Natalie Duncan,5 José Antonio López-Pina6 1Department of Physiotherapy, School of Biomedical and Health Sciences, European University of Madrid, 2Fishemo, Centro Especial de Empleo, Spanish Federation of Hemophilia, 3Royal Foundation Victoria Eugenia, Madrid, 4Department of Psychiatry and Social Psychology, Faculty of Medicine, University of Murcia, Murcia, Spain; 5Indiana Hemophilia & Thrombosis Center, Indianapolis, IN, USA; 6Department of Basic Psychology and Methodology, Faculty of Psychology, University of Murcia, Murcia, Spain Purpose: We aimed to conduct a validation in Spanish of the Validated Hemophilia Regimen Treatment Adherence Scale – Prophylaxis (VERITAS-Pro questionnaire for use in patients with hemophilia under prophylactic treatment.Patients and methods: The VERITAS-Pro scale was adapted through a process of back translation from English to Spanish. A bilingual native Spanish translator translated the scale from English to Spanish. Subsequently, a bilingual native English translator translated the scale from Spanish to English. The disagreements were resolved by agreement between the research team and translators. Seventy-three patients with hemophilia, aged 13–62 years, were enrolled in the study. The scale was applied twice (2 months apart to evaluate the test–retest reliability.Results: Internal consistency reliability was lower on the Spanish VERITAS-Pro than on the English version. Test–retest reliability was high, ranging from 0.83 to 0.92. No significant differences (P>0.05 were found between test and retest scores in subscales of VERITAS-Pro. In general, Spanish patients showed higher rates of nonadherence than American patients in all subscales.Conclusion: The Spanish version of the VERITAS-Pro has high levels of consistency and empirical validity. This scale can be administered to assess the degree of

  14. Therapeutic adherence and competence scales for Developmentally Adapted Cognitive Processing Therapy for adolescents with PTSD

    Directory of Open Access Journals (Sweden)

    Jana Gutermann

    2015-03-01

    Full Text Available Background: The assessment of therapeutic adherence and competence is often neglected in psychotherapy research, particularly in children and adolescents; however, both variables are crucial for the interpretation of treatment effects. Objective: Our aim was to develop, adapt, and pilot two scales to assess therapeutic adherence and competence in a recent innovative program, Developmentally Adapted Cognitive Processing Therapy (D-CPT, for adolescents suffering from posttraumatic stress disorder (PTSD after childhood abuse. Method: Two independent raters assessed 30 randomly selected sessions involving 12 D-CPT patients (age 13–20 years, M age=16.75, 91.67% female treated by 11 therapists within the pilot phase of a multicenter study. Results: Three experts confirmed the relevance and appropriateness of each item. All items and total scores for adherence (intraclass correlation coefficients [ICC]=0.76–1.00 and competence (ICC=0.78–0.98 yielded good to excellent inter-rater reliability. Cronbach's alpha was 0.59 for the adherence scale and 0.96 for the competence scale. Conclusions: The scales reliably assess adherence and competence in D-CPT for adolescent PTSD patients. The ratings can be helpful in the interpretation of treatment effects, the assessment of mediator variables, and the identification and training of therapeutic skills that are central to achieving good treatment outcomes. Both adherence and competence will be assessed as possible predictor variables for treatment success in future D-CPT trials.

  15. Evaluation of the single-item self-rating adherence scale for use in routine clinical care of people living with HIV.

    Science.gov (United States)

    Feldman, B J; Fredericksen, R J; Crane, P K; Safren, S A; Mugavero, M J; Willig, James H; Simoni, J M; Wilson, I B; Saag, M S; Kitahata, M M; Crane, H M

    2013-01-01

    The self-rating scale item (SRSI) is a single-item self-report adherence measure that uses adjectives in a 5-point Likert scale, from "very poor" to "excellent," to describe medication adherence over the past 4 weeks. This study investigated the SRSI in 2,399 HIV-infected patients in routine care at two outpatient primary HIV clinics. Correlations between the SRSI and four commonly used adherence items ranged from 0.37 to 0.64. Correlations of adherence barriers, such as depression and substance use, were comparable across all adherence items. General estimating equations suggested the SRSI is as good as or better than other adherence items (p's <0.001 vs. <0.001-0.99) at predicting adherence-related clinical outcomes, such as HIV viral load and CD4(+) cell count. These results and the SRSI's low patient burden suggest its routine use could be helpful for assessing adherence in clinical care and should be more widespread, particularly where more complex instruments may be impractical.

  16. Large scale road network generalization for vario-scale map

    NARCIS (Netherlands)

    Suba, R.; Meijers, B.M.; Van Oosterom, P.J.M.

    2015-01-01

    The classical approach for road network generalization consists of producing multiple maps, for a different scale or purpose, from a single detailed data source and quite often roads are represented by line objects. Our target is the generalization of a road network for the whole scale range from

  17. Criterion validity of 8-item Morisky Medication Adherence Scale in patients with asthma.

    Directory of Open Access Journals (Sweden)

    Ana Janežič

    Full Text Available The 8-item Morisky Medication Adherence Scale (MMAS-8 is reliable and valid in patients with hypertension, but to our knowledge validity has not been established for patients with asthma. The aim of the study was to determine the criterion validity of the MMAS-8 in patients with asthma. In the cross-sectional study patients older than 12 year were recruited when dispensed asthma medications in community pharmacies. Criterion validity of the scale was assessed through associations with asthma control and quality of life. Asthma control was assessed by the Asthma Control Test (ACT and quality of life was evaluated by the Saint George Respiratory Questionnaire (SGRQ. A total of 208 patients (mean age 56 years, 59% female were included in the study. Almost all patients were prescribed inhaled corticosteroids (96%. Asthma was not controlled in 37% of the patients and 22% experienced at least one exacerbation requiring emergency room visit, hospitalization or treatment with oral corticosteroid therapy in the previous year. The 8-item MMAS was significantly associated with asthma control and quality of life. Patients who scored 8 points, 6 points and ≤6 points on the scale were considered to have high, medium and low adherence, respectively. High, medium and low adherence was found in 53%, 23% and 24% of the patients, respectively. As adherence improved from low to medium or from medium to high, the odds of asthma control increased by 1.7 times (OR 1.65, p = 0.027. Patients with high and medium adherence had SGRQ scores that were 6.1 and 5.3 points lower, respectively, compared with patients with low adherence. The MMAS-8 was found to be valid for assessing medication adherence and predicting health outcomes in patients with asthma.

  18. Criterion validity of 8-item Morisky Medication Adherence Scale in patients with asthma.

    Science.gov (United States)

    Janežič, Ana; Locatelli, Igor; Kos, Mitja

    2017-01-01

    The 8-item Morisky Medication Adherence Scale (MMAS-8) is reliable and valid in patients with hypertension, but to our knowledge validity has not been established for patients with asthma. The aim of the study was to determine the criterion validity of the MMAS-8 in patients with asthma. In the cross-sectional study patients older than 12 year were recruited when dispensed asthma medications in community pharmacies. Criterion validity of the scale was assessed through associations with asthma control and quality of life. Asthma control was assessed by the Asthma Control Test (ACT) and quality of life was evaluated by the Saint George Respiratory Questionnaire (SGRQ). A total of 208 patients (mean age 56 years, 59% female) were included in the study. Almost all patients were prescribed inhaled corticosteroids (96%). Asthma was not controlled in 37% of the patients and 22% experienced at least one exacerbation requiring emergency room visit, hospitalization or treatment with oral corticosteroid therapy in the previous year. The 8-item MMAS was significantly associated with asthma control and quality of life. Patients who scored 8 points, 6 points and ≤6 points on the scale were considered to have high, medium and low adherence, respectively. High, medium and low adherence was found in 53%, 23% and 24% of the patients, respectively. As adherence improved from low to medium or from medium to high, the odds of asthma control increased by 1.7 times (OR 1.65, p = 0.027). Patients with high and medium adherence had SGRQ scores that were 6.1 and 5.3 points lower, respectively, compared with patients with low adherence. The MMAS-8 was found to be valid for assessing medication adherence and predicting health outcomes in patients with asthma.

  19. Relationship between self-efficacy and patient knowledge on adherence to oral contraceptives using the Morisky Medication Adherence Scale (MMAS-8).

    Science.gov (United States)

    Tomaszewski, Daniel; Aronson, Benjamin D; Kading, Margarette; Morisky, Donald

    2017-09-06

    Preconception care, including family planning, is a vital component of healthcare for women of reproductive age. An average female spends the majority of her reproductive life trying to prevent a pregnancy. In order to prevent unintended pregnancy, women often rely on the use of hormonal contraceptives. In the United States, the majority of hormonal contraceptive users are prescribed oral contraceptive pills (OCPs). Reduced adherence to OCPs decreases their ability to prevent pregnancy. The study aimed to measure OCP adherence among female college students, and explore the relationship between OCP adherence, knowledge, and self-efficacy. This cross-sectional study recruited a random sample of female college students to participate in an online survey. OCP adherence was based on the 8-item Morisky Medication Adherence Scale (MMAS-8). Secondary reporting of medication adherence included participant reports of the number of missed OCP doses in the previous month and typical month of use. Of the 5000 invited, 1559 (31.3%) completed the survey. Of those responding, 670 (41.3%) reported use of OCPs. A total of 293 (44.3%) OCP users met criteria for low adherence, 241 (36.4%) met criteria for medium adherence, and 128 (19.3%) met criteria for high adherence. Those with high adherence had higher self-efficacy (P media to increase the knowledge and self-efficacy of patients using OCPs may improve adherence rates. Additional research is needed to evaluate the impact of innovative interventions focused on social and behavioral patient factors, like knowledge and self-efficacy, on adherence to OCPs.

  20. Validation of the Adherence Determinants Questionnaire scale among women with breast and cervical cancer

    Directory of Open Access Journals (Sweden)

    Paula Renata Amorim Lessa

    2015-10-01

    Full Text Available Objectives: the aim was to translate and culturally adapt the Adherence Determinants Questionnaire scale for the Portuguese language in the Brazilian context, and to check its reliability and validity to analyze the elements of the adherence of patients to the clinical treatment for breast and cervical cancer.Method: this was a methodological study, carried out in two oncology reference centers. The sample consisted of 198 participants, with 152 being treated for breast cancer and 46 being treated for cervical cancer. The content validation was performed by a committee of experts. The construct validation was demonstrated through factor analysis and the reliability was analyzed using Cronbach's alpha.Results: the committee of experts made the necessary adjustments so that the scale was adapted to the Brazilian context. The factor analysis suggested a reduction from seven to five factors and the maintenance of 38 items similar to those of the original scale. The reliability, investigated through Cronbach's alpha, was .829, showing high internal consistency.Conclusion: it was concluded that the Brazilian version of the Adherence Determinants Questionnaire scale is a valid and reliable instrument that is able to measure the elements of adherence to the treatment for breast and cervical cancer.

  1. Continuous Road Network Generalization throughout All Scales

    Directory of Open Access Journals (Sweden)

    Radan Šuba

    2016-08-01

    Full Text Available Until now, road network generalization has mainly been applied to the task of generalizing from one fixed source scale to another fixed target scale. These actions result in large differences in content and representation, e.g., a sudden change of the representation of road segments from areas to lines, which may confuse users. Therefore, we aim at the continuous generalization of a road network for the whole range, from the large scale, where roads are represented as areas, to mid- and small scales, where roads are represented progressively more frequently as lines. As a consequence of this process, there is an intermediate scale range where at the same time some roads will be represented as areas, while others will be represented as lines. We propose a new data model together with a specific data structure where for all map objects, a range of valid map scales is stored. This model is based on the integrated and explicit representation of: (1 a planar area partition; and (2 a linear road network. This enables the generalization process to include the knowledge and understanding of a linear network. This paper further discusses the actual generalization options and algorithms for populating this data structure with high quality vario-scale cartographic content.

  2. Defining the minimal detectable change in scores on the eight-item Morisky Medication Adherence Scale.

    Science.gov (United States)

    Muntner, Paul; Joyce, Cara; Holt, Elizabeth; He, Jiang; Morisky, Donald; Webber, Larry S; Krousel-Wood, Marie

    2011-05-01

    Self-report scales are used to assess medication adherence. Data on how to discriminate change in self-reported adherence over time from random variability are limited. To determine the minimal detectable change for scores on the 8-item Morisky Medication Adherence Scale (MMAS-8). The MMAS-8 was administered twice, using a standard telephone script, with administration separated by 14-22 days, to 210 participants taking antihypertensive medication in the CoSMO (Cohort Study of Medication Adherence among Older Adults). MMAS-8 scores were calculated and participants were grouped into previously defined categories (<6, 6 to <8, and 8 for low, medium, and high adherence). The mean (SD) age of participants was 78.1 (5.8) years, 43.8% were black, and 68.1% were women. Overall, 8.1% (17/210), 16.2% (34/210), and 51.0% (107/210) of participants had low, medium, and high MMAS-8 scores, respectively, at both survey administrations (overall agreement 75.2%; 158/210). The weighted κ statistic was 0.63 (95% CI 0.53 to 0.72). The intraclass correlation coefficient was 0.78. The within-person standard error of the mean for change in MMAS-8 scores was 0.81, which equated to a minimal detectable change of 1.98 points. Only 4.3% (9/210) of the participants had a change in MMAS-8 of 2 or more points between survey administrations. Within-person changes in MMAS-8 scores of 2 or more points over time may represent a real change in antihypertensive medication adherence.

  3. Generalized probabilistic scale space for image restoration.

    Science.gov (United States)

    Wong, Alexander; Mishra, Akshaya K

    2010-10-01

    A novel generalized sampling-based probabilistic scale space theory is proposed for image restoration. We explore extending the definition of scale space to better account for both noise and observation models, which is important for producing accurately restored images. A new class of scale-space realizations based on sampling and probability theory is introduced to realize this extended definition in the context of image restoration. Experimental results using 2-D images show that generalized sampling-based probabilistic scale-space theory can be used to produce more accurate restored images when compared with state-of-the-art scale-space formulations, particularly under situations characterized by low signal-to-noise ratios and image degradation.

  4. The Self-Efficacy Scale for Adherence to the Mediterranean Diet (SESAMeD): A scale construction and validation.

    Science.gov (United States)

    Cuadrado, Esther; Gutiérrez-Domingo, Tamara; Castillo-Mayen, Rosario; Luque, Bárbara; Arenas, Alicia; Taberneroa, Carmen

    2018-01-01

    The Mediterranean diet has several beneficial impacts on health. Self-efficacy may be crucial for adhering to the diet. This study set out to develop a reliable and valid instrument that would enable measurement of the extent to which people are confident about their ability to adhere to the Mediterranean diet: the Self-Efficacy Scale for Adherence to the Mediterranean Diet (SESAMeD). The study was carried out in two stages. In Stage 1, a pilot questionnaire was administrated to 170 students to reduce and refine items. In Stage 2, the validity and reliability of the scale were evaluated among a sample of 348 patients who have suffered from cardiovascular disease. After items reduction, the scale consisted of 22 items. The factor structure of SESAMeD was tested across exploratory factorial analysis and confirmatory factorial analysis, with both analyses confirming a robust adjustment for the bi-factorial structure. The two factors identified were (a) self-efficacy for the avoidance of determined unhealthy foods not recommended in the Mediterranean diet and (b) self-efficacy for the consumption of determined healthy foods recommended in this diet. The pattern of relations between the SESAMeD and the SESAMeD subscales and other different psychological variables (outcome expectancies, motivation, affective balance, and life satisfaction) supported the validity of the bi-factorial structure and provided strong evidence of construct validity. The instrument can help health professionals and researchers to assess patients' confidence of their ability to adhere to the Mediterranean diet, a psychological variable that may affect adherence to this healthy food consumption pattern. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Doctors as patients: postal survey examining consultants and general practitioners adherence to guidelines.

    Science.gov (United States)

    Forsythe, M; Calnan, M; Wall, B

    1999-09-04

    To examine the adherence by senior NHS medical staff to the BMA guidelines on the ethical responsibilities of doctors towards themselves and their families. Postal semistructured questionnaire. Four randomly selected NHS trusts and three local medical committees in South Thames region. Consultants and principals in general practice. Personal use of health services. The response rate was 64% (724) for general practitioners and 72% (427) for consultants after three mailings. Most (1106, 96%) respondents were registered with a general practitioner, although little use was made of their services. 159 (26%) general practitioners were registered with a general practitioner in their own practice and 80 (11%) admitted to looking after members of their family. 73 (24%) consultants would never see their general practitioner before obtaining consultant advice. Most consultants and general practitioners admitted to prescribing for themselves and their family. Responses to vignettes for different health problems indicated a general reluctance to take time off, but there were differences between consultants and general practitioners and by sex. Views on improvements needed included the possibility of a "doctor's doctor," access to out of area secondary care, an occupational health service for general practitioners, and regular health check ups. The guidelines are largely not being followed, perhaps because of the difficulties of obtaining access to general practitioners outside working hours. The occupational health service should be expanded and a general practitioner service for NHS staff piloted.

  6. Verifying quantitative stigma and medication adherence scales using qualitative methods among Thai youth living with HIV/AIDS.

    Science.gov (United States)

    Fongkaew, Warunee; Viseskul, Nongkran; Suksatit, Benjamas; Settheekul, Saowaluck; Chontawan, Ratanawadee; Grimes, Richard M; Grimes, Deanna E

    2014-01-01

    HIV/AIDS-related stigma has been linked to poor adherence resulting in drug resistance and the failure to control HIV. This study used both quantitative and qualitative methods to examine stigma and its relationship to adherence in 30 HIV-infected Thai youth aged 14 to 21 years. Stigma was measured using the HIV stigma scale and its 4 subscales, and adherence was measured using a visual analog scale. Stigma and adherence were also examined by in-depth interviews. The interviews were to determine whether verbal responses would match the scale's results. The mean score of stigma perception from the overall scale and its 4 subscales ranged from 2.14 to 2.45 on a scale of 1 to 4, indicating moderate levels of stigma. The mean adherence score was .74. The stigma scale and its subscales did not correlate with the adherence. Totally, 17 of the respondents were interviewed. Contrary to the quantitative results, the interviewees reported that the stigma led to poor adherence because the fear of disclosure often caused them to miss medication doses. The differences between the quantitative and the qualitative results highlight the importance of validating psychometric scales when they are translated and used in other cultures.

  7. The design of the MBT-G adherence and quality scale.

    Science.gov (United States)

    Folmo, Espen J; Karterud, Sigmund W; Bremer, Kjetil; Walther, Kristoffer L; Kvarstein, Elfrida H; Pedersen, Geir A F

    2017-08-01

    Few group psychotherapy studies focus on therapists' interventions, and instruments that can measure group psychotherapy treatment fidelity are scarce. The aim of the present study was to evaluate the reliability of the Mentalization-based Group Therapy Adherence and Quality Scale (MBT-G-AQS), which is a 19-item scale developed to measure adherence and quality in mentalization-based group therapy (MBT-G). Eight MBT groups and eight psychodynamic groups (a total of 16 videotaped therapy sessions) were rated independently by five raters. All groups were long-term, outpatient psychotherapy groups with 1.5 hours weekly sessions. Data were analysed by a Generalizability Study (G-study and D-study). The generalizability models included analyses of reliability for different numbers of raters. The global (overall) ratings for adherence and quality showed high to excellent reliability for all numbers of raters (the reliability by use of five raters was 0.97 for adherence and 0.96 for quality). The mean reliability for all 19 items for a single rater was 0.57 (item range 0.26-0.86) for adherence, and 0.62 (item range 0.26-0.83) for quality. The reliability for two raters obtained mean absolute G-coefficients on 0.71 (item range 0.41-0.92 for the different items) for adherence and 0.76 (item range 0.42-0.91) for quality. With all five raters the mean absolute G-coefficient for adherence was 0.86 (item range 0.63-0.97) and 0.88 for quality (item range 0.64-0.96). The study demonstrates high reliability of ratings of MBT-G-AQS. In models differentiating between different numbers of raters, reliability was particularly high when including several raters, but was also acceptable for two raters. For practical purposes, the MBT-G-AQS can be used for training, supervision and psychotherapy research. © 2017 Scandinavian Psychological Associations and John Wiley & Sons Ltd.

  8. Multi-scale surface topography to minimize adherence and viability of nosocomial drug-resistant bacteria.

    Science.gov (United States)

    Hasan, Jafar; Jain, Shubham; Padmarajan, Rinsha; Purighalla, Swathi; Sambandamurthy, Vasan K; Chatterjee, Kaushik

    2018-02-15

    Toward minimizing bacterial colonization of surfaces, we present a one-step etching technique that renders aluminum alloys with micro- and nano-scale roughness. Such a multi-scale surface topography exhibited enhanced antibacterial effect against a wide range of pathogens. Multi-scale topography of commercially grade pure aluminum killed 97% of Escherichia coli and 28% of Staphylococcus aureus cells in comparison to 7% and 3%, respectively, on the smooth surfaces. Multi-scale topography on Al 5052 surface was shown to kill 94% of adhered E . coli cells. The microscale features on the etched Al 1200 alloy were not found to be significantly bactericidal, but shown to decrease the adherence of S . aureus cells by one-third. The fabrication method is easily scalable for industrial applications. Analysis of roughness parameters determined by atomic force microscopy revealed a set of significant parameters that can yield a highly bactericidal surface; thereby providing the design to make any surface bactericidal irrespective of the method of fabrication. The multi-scale roughness of Al 5052 alloy was also highly bactericidal to nosocomial isolates of E . coli , K . pneumoniae and P . aeruginosa . We envisage the potential application of engineered surfaces with multi-scale topography to minimize the spread of nosocomial infections.

  9. The ARGA study with Italian general practitioners: prescriptions for allergic rhinitis and adherence to ARIA guidelines.

    Science.gov (United States)

    Maio, S; Simoni, M; Baldacci, S; Angino, A; Martini, F; Cerrai, S; Sarno, G; Silvi, P; Borbotti, M; Pala, A P; Bresciani, M; Paggiaro, P L; Viegi, G

    2012-10-01

    General practitioners (GPs) are the healthcare professionals to whom patients with rhinitis firstly refer for their symptoms. In the present study, we assessed drug prescriptions for allergic rhinitis (AR) and evaluated prescriptive adherence to ARIA treatment guidelines. Data on 1379 AR patients were collected by 107 Italian GPs. Adherence to ARIA guidelines was evaluated according to AR severity classification. AR was diagnosed by GPs as mild intermittent for 46.2% of patients, mild persistent for 26.6%, moderate-severe intermittent for 20.2%, and moderate-severe persistent for 7%; 43.7% of AR patients had concomitant asthma. The most frequently prescribed therapeutic groups were antihistamines (anti-H, 76%) and nasal corticosteroids (NCS, 46%). Anti-H were significantly used more often to treat AR alone than AR + asthma (85 vs. 68%, p < 0.001), whereas NCS were used more often to treat AR + asthma than AR alone (50 vs. 42%, p = 0.01). Among patients with only mild intermittent AR, 39% were prescribed combined therapy. Among patients with moderate-severe persistent AR, 30% of those with AR alone and 18% of those with AR + asthma were prescribed monotherapy based on anti-H. GPs were more compliant with ARIA guidelines while treating AR alone (57%) than AR + asthma (46%) patients. The adherence increased according to the severity grade and was satisfactory for moderate-severe persistent AR (89% for AR alone and 95% for AR + asthma). Adherence to ARIA guidelines is satisfactory only for treatment of more severe patients, thus GPs often tend to treat patients independently from ARIA guidelines. Since prescription data only provide limited information to judge prescribing quality, some deviation from the gold standard are to be expected.

  10. How General Practitioners and Their Patients Adhere to Osteoporosis Management: A Follow-Up Survey among Czech General Practitioners

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    Magda Vytrisalova

    2017-05-01

    Full Text Available Introduction: General practitioners (GPs are key participants in osteoporosis (OP management. The aim was to evaluate their adherence to lege artis management of the disease, potential barriers, and to discuss differences observed in comparison with the baseline survey carried out in 2007; the focus was on secondary prevention.Methods: On behalf of two professional associations, 2-round postal survey among randomly selected GPs (>1/4 of all Czech GPs was performed in 2014. The questionnaire covered areas concerning GP's role in the fight against OP, knowledge about OP, management of OP-related fractures, barriers to the management of OP, system- and patient-related in particular, and availability and use of information sources.Results: The overall questionnaire return rate was 37% (551 respondents; mean age of the respondents was 53 year (37% men. The GP's role in the treatment of OP was rated as essential in 28 and 37% of men and women, respectively (P = 0.012. The guideline for diagnosis and treatment of OP for GPs was considered accessible by 92% of respondents. As much as 60% of the respondents were adherent to the guideline, i.e., used it repeatedly. The knowledge of several risk factors was very good, however, recommended daily intake of calcium was stated correctly by only 41% of respondents, and daily intake of vitamin D by only 40%. Three quarters reported active steps after a fracture: referral to a specialist, life-style recommendations, prescription of calcium/vitamin D supplements. Half of the respondents focus on fall prevention. System-related barriers, such as lack of possibility to prescribe selected drugs (61% and financial limits set by health insurance company (44% were most frequently reported. Patient-related barriers were also common, patient's non-adherence (reported by 29% and patient's reluctance to go to a specialist (18%.Conclusion: GPs adhered to OP management more than in 2007. Knowledge of risk factors and

  11. Development of a new diabetes medication self-efficacy scale and its association with both reported problems in using diabetes medications and self-reported adherence

    Science.gov (United States)

    Sleath, Betsy; Carpenter, Delesha M; Blalock, Susan J; Davis, Scott A; Hickson, Ryan P; Lee, Charles; Ferreri, Stefanie P; Scott, Jennifer E; Rodebaugh, Lisa B; Cummings, Doyle M

    2016-01-01

    Background Although there are several different general diabetes self-efficacy scales, there is a need to develop a self-efficacy scale that providers can use to assess patient’s self-efficacy regarding medication use. The purpose of this study was to: 1) develop a new diabetes medication self-efficacy scale and 2) examine how diabetes medication self-efficacy is associated with patient-reported problems in using diabetes medications and self-reported adherence. Patients and methods Adult English-speaking patients with type 2 diabetes were recruited from a family medicine clinic and a pharmacy in Eastern North Carolina, USA. The patients were eligible if they reported being nonadherent to their diabetes medicines on a visual analog scale. Multivariable regression was used to examine the relationship between self-efficacy and the number of reported diabetes medication problems and adherence. Results The diabetes medication self-efficacy scale had strong reliability (Cronbach’s alpha =0.86). Among a sample (N=51) of mostly African-American female patients, diabetes medication problems were common (6.1±3.1) and a greater number of diabetes medications were associated with lower medication adherence (odds ratio: 0.35; 95% confidence interval: 0.13, 0.89). Higher medication self-efficacy was significantly related to medication adherence (odds ratio: 1.17; 95% confidence interval: 1.05, 1.30) and inversely related to the number of self-reported medication problems (β=−0.13; P=0.006). Conclusion Higher diabetes medication self-efficacy was associated with fewer patient-reported medication problems and better medication adherence. Assessing medication-specific self-efficacy may help to identify medication-related problems that providers can help the patients address, potentially improving adherence and patient outcomes. PMID:27354769

  12. Utility of the Morisky Medication Adherence Scale in gout: a prospective study

    Directory of Open Access Journals (Sweden)

    Tan CSL

    2016-12-01

    Full Text Available CSL Tan,1 GG Teng,1,2 KJ Chong,2 PP Cheung,1,2 AYN Lim,1,2 HL Wee,3,4 A Santosa1,2 1University Medicine Cluster, Division of Rheumatology, National University Health System, 2Department of Medicine, Yong Loo Lin School of Medicine, 3Department of Pharmacy, Faculty of Science, 4Saw Swee Hock School of Public Health, National University of Singapore, Singapore Background: The outcomes of any chronic illness often depend on patients’ adherence with their treatment. A tool is lacking to assess adherence in gout that is standardized, allows real-time feedback, and is easy to understand.Objective: We set out to evaluate the utility of the 8-item Morisky Medication Adherence Scale (MMAS-8 in monitoring medication adherence in a multiethnic Asian gout cohort on urate-lowering therapy (ULT.Methods: This cohort study recruited patients with gout where baseline and 6-monthly clinical data, self-report of adherence, and health status by Gout Impact Scale (GIS and EuroQoL-5 dimension 3 levels were collected. Those who received at least 9 months of ULT were analyzed. Convergent and construct validities of MMAS-8 were evaluated against medication possession ratio (MPR and known groups, clinical outcomes, and patient-reported outcomes. Internal consistency and test–retest reliability were assessed using Cronbach’s alpha and intraclass correlation coefficient (ICC, respectively.Results: Of 91 patients, 92.3% were male, 72.5% Chinese with mean age 53.5 years. MMAS-8 (mean 6.17 and MPR (mean 96.3% were poorly correlated (r=0.069, P=0.521. MMAS-8 did not differ between those who did or did not achieve target serum urate (SU <360 µmol/L (P=0.852; or among those whose SU improved, stagnated, or worsened during follow-up (P=0.777. Adherence was associated with age (β=0.256, P=0.015 and education level (P=0.011 but not comorbidities, polypharmacy, or flare frequency. Concerns for medication side effects and anxiety or depression were associated with lower MMAS

  13. Validated adherence scales used in a measurement-guided medication management approach to target and tailor a medication adherence intervention: a randomised controlled trial.

    Science.gov (United States)

    Nguyen, Thi-My-Uyen; La Caze, Adam; Cottrell, Neil

    2016-11-30

    To determine if a targeted and tailored intervention based on a discussion informed by validated adherence scales will improve medication adherence. Prospective randomised trial. 2 community pharmacies in Brisbane, Australia. Patients recently initiated on a cardiovascular or oral hypoglycaemic medication within the past 4-12 weeks were recruited from two community pharmacies. Participants identified as non-adherent using the Medication Adherence Questionnaire (MAQ) were randomised into the intervention or control group. The intervention group received a tailored intervention based on a discussion informed by responses to the MAQ, Beliefs about Medicines Questionnaire-Specific and Brief Illness Perception Questionnaire. Adherence was measured using the MAQ at 3 and 6 months following the intervention. A total of 408 patients were assessed for eligibility, from which 152 participants were enrolled into the study. 120 participants were identified as non-adherent using the MAQ and randomised to the 'intervention' or 'control' group. The mean MAQ score at baseline in the intervention and control were similar (1.58: 95% CI (1.38 to 1.78) and 1.60: 95% CI (1.43 to 1.77), respectively). There was a statistically significant improvement in adherence in the intervention group compared to control at 3 months (mean MAQ score 0.42: 95% CI (0.27 to 0.57) vs 1.58: 95% CI (1.42 to 1.75); p<0.001). The significant improvement in MAQ score in the intervention group compared to control was sustained at 6 months (0.48: 95% CI (0.31 to 0.65) vs 1.48: 95% CI (1.27 to 1.69); p<0.001). An intervention that targeted non-adherent participants and tailored to participant-specific reasons for non-adherence was successful at improving medication adherence. ACTRN12613000162718; Results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  14. The A14-scale: development and evaluation of a questionnaire for assessment of adherence and individual barriers.

    Science.gov (United States)

    Jank, Susanne; Bertsche, Thilo; Schellberg, Dieter; Herzog, Wolfgang; Haefeli, Walter E

    2009-08-01

    To develop a questionnaire ("A14") for the description of adherence and individual barriers as basis for adherence-enhancing interventions in the clinical and pharmaceutical setting, and to compare it to the validated German MMAS (Morisky Medication Adherence Scale). Fourteen questions with a 5-item likert-scale from "never" (4) to "very often" (0) were given to 150 medical inpatients. According to their score, patients were classified into non-adherent (score scales were compared with the remaining patients regarding socio-demographic factors. Descriptive statistics, Cronbach's Alpha, Spearman correlation, and kappa were computed. Eighty-three participants completed both scales. Patients with missing values differed significantly regarding age, education, and adherence according to MMAS. Cronbach's Alpha for A14 was 0.861. MMAS and A14 median total scores were 4 and 52, respectively. About 39.5% of patients were non-adherent as per MMAS compared to 40% as per A14; kappa was 0.262 (P = 0.016). The total scores correlated with a Rho-value of 0.43 (P scale showed good internal consistency and a significant correlation with the MMAS suggesting that it merits further investigation.

  15. General gauge mediation at the weak scale

    Energy Technology Data Exchange (ETDEWEB)

    Knapen, Simon [Berkeley Center for Theoretical Physics,University of California, Berkeley, CA 94720 (United States); Theoretical Physics Group, Lawrence Berkeley National Laboratory,Berkeley, CA 94720 (United States); Redigolo, Diego [Sorbonne Universités, UPMC Univ Paris 06,UMR 7589, LPTHE, F-75005, Paris (France); CNRS, UMR 7589,LPTHE, F-75005, Paris (France); Shih, David [New High Energy Theory Center, Rutgers University,Piscataway, NJ 08854 (United States)

    2016-03-09

    We completely characterize General Gauge Mediation (GGM) at the weak scale by solving all IR constraints over the full parameter space. This is made possible through a combination of numerical and analytical methods, based on a set of algebraic relations among the IR soft masses derived from the GGM boundary conditions in the UV. We show how tensions between just a few constraints determine the boundaries of the parameter space: electroweak symmetry breaking (EWSB), the Higgs mass, slepton tachyons, and left-handed stop/sbottom tachyons. While these constraints allow the left-handed squarks to be arbitrarily light, they place strong lower bounds on all of the right-handed squarks. Meanwhile, light EW superpartners are generic throughout much of the parameter space. This is especially the case at lower messenger scales, where a positive threshold correction to m{sub h} coming from light Higgsinos and winos is essential in order to satisfy the Higgs mass constraint.

  16. Scaling Irrational Beliefs in the General Attitude and Belief Scale

    Directory of Open Access Journals (Sweden)

    Lindsay R. Owings

    2013-04-01

    Full Text Available Accurate measurement of key constructs is essential to the continued development of Rational-Emotive Behavior Therapy (REBT. The General Attitude and Belief Scale (GABS, a contemporary inventory of rational and irrational beliefs based on current REBT theory, is one of the most valid and widely used instruments available, and recent research has continued to improve its psychometric standing. In this study of 544 students, item response theory (IRT methods were used (a to identify the most informative item in each irrational subscale of the GABS, (b to determine the level of irrationality represented by each of those items, and (c to suggest a condensed form of the GABS for further study with clinical populations. Administering only the most psychometrically informative items to clients could result in economies of time and effort. Further research based on the scaling of items could clarify the specific patterns of irrational beliefs associated with particular clinical syndromes.

  17. Cross-cultural adaptation to Brazil of Medication Adherence Rating Scale for psychiatric patients

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    Icaro Carvalho Moreira

    2014-12-01

    Full Text Available Objective The purpose of this research was to make a cross-cultural adaptation of the Medication Adherence Rating Scale (MARS for psychiatric patients to the Brazilian context. Methods The procedure consisted of four phases: translation of the original scale, back-translation, review by an Expert Committee and Pre-test study with a patients’ sample. Results The Expert Committee corrected the items’ translation when necessary and modified the scale administration format and its instructions from self-report to face-to-face interview form in order to ensure easy understanding by the target population. During Pre-test, the instructions and most of the items were properly understood by patients, with the exception of three of them which had to be changed in order to ensure better understanding. The Pre-test sample was composed by 30 psychiatric patients, with severe and persistent disorders mainly single (46.7%, female (60.0%, with a mean age of 43.8 years old and an average of five years of education. Conclusion The Brazilian version of MARS scale is now adapted to the Brazilian Portuguese language and culture and is easily understood by the psychiatric target population. It is necessary to do further research to evaluate the scale psychometric qualities of validity and reliability in order to use it in Brazil.

  18. Stigma, medication adherence and coping mechanism among people living with HIV attending General Hospital, Lagos Island, Nigeria

    Directory of Open Access Journals (Sweden)

    Adekemi O. Sekoni

    2012-11-01

    Full Text Available Background: People living with HIV and AIDS (PLWHA experience some form of stigma which could lead to poor medication adherence.Objectives: This study assessed the various domains of stigma experienced by PLWHAs attending an HIV clinic at General Hospital, Lagos Island, their medication adherence patterns and their coping mechanisms for ensuring adherence to antiretroviral therapy.Method: A cross-sectional study design with a sample size of 200 was used. Respondents were selected using systematic random sampling. Interviewers administered structured questionnaires were used to collect information on the domains of stigma. Data was analysedusing EPI info©. This was followed by a focus group discussion (FGD with seven participants at the clinic using an interview guide with open-ended questions.Results: Overall, stigma was experienced by 35% of the respondents. Within this group, 6.6%, 37.1%, 43.1% and 98.0% of the respondents reported experiencing negative self image stigma, personalised stigma, disclosure stigma and public attitude stigma respectively. Almost 90% of the respondents were adherent. The FGD revealed that disclosure was usually confined to family members and the coping mechanism for achieving adherence was to put antiretroviral (ARVs in unlabelled pill boxes.Conclusion: This study found that stigma was low and that the most common domain of stigma experienced was public attitude stigma. Medication adherence of respondents was good as a result of the coping mechanism, which involves putting ARVs in unlabelled pill boxes.

  19. Stigma, medication adherence and coping mechanism among people living with HIV attending General Hospital, Lagos Island, Nigeria

    Directory of Open Access Journals (Sweden)

    Adekemi O. Sekoni

    2012-02-01

    Full Text Available Background: People living with HIV and AIDS (PLWHA experience some form of stigma which could lead to poor medication adherence.Objectives: This study assessed the various domains of stigma experienced by PLWHAs attending an HIV clinic at General Hospital, Lagos Island, their medication adherence patterns and their coping mechanisms for ensuring adherence to antiretroviral therapy.Method: A cross-sectional study design with a sample size of 200 was used. Respondents were selected using systematic random sampling. Interviewers administered structured questionnaires were used to collect information on the domains of stigma. Data was analysed using EPI info©. This was followed by a focus group discussion (FGD with seven participants at the clinic using an interview guide with open-ended questions.Results: Overall, stigma was experienced by 35% of the respondents. Within this group, 6.6%, 37.1%, 43.1% and 98.0% of the respondents reported experiencing negative self image stigma, personalised stigma, disclosure stigma and public attitude stigma respectively. Almost 90% of the respondents were adherent. The FGD revealed that disclosure was usually confined to family members and the coping mechanism for achieving adherence was to put antiretroviral (ARVs in unlabelled pill boxes.Conclusion: This study found that stigma was low and that the most common domain of stigma experienced was public attitude stigma. Medication adherence of respondents was good as a result of the coping mechanism, which involves putting ARVs in unlabelled pill boxes.

  20. Development and initial evaluation of the psychometric properties of self-efficacy and adherence scales for patients with a left ventricular assist device.

    Science.gov (United States)

    Casida, Jesus; Wu, Horng-Shiuann; Harden, Janet; Chern, Joy; Carie, Austen

    2015-06-01

    No tools exist to measure patients' self-efficacy for and adherence to the complex home-care regimen after having a left ventricular device (LVAD) implanted. To develop 2 new instruments, the LVAD Patient Self-Efficacy Scale (LPSES) and the LVAD Patient Home Management Adherence Scale (LPHMAS), and evaluate their psychometric properties. This multistage instrumentation study recruited 102 patients (77.5% men and 22.5% women) aged 20 to 82 years, predominantly from the Midwest (34.3%) and the Northeast (26.5%) regions of the United States. Main indications for LVAD were bridge-to-transplant (69.6%) and destination therapy (21.6%), with mean implant duration of 19.9 (SD, 15.5) months. Study participants completed the following instruments: LPSES, LPHMAS, General Self-Efficacy Scale (GSES), Medical Outcomes Study General Adherence (MOSGA), and Self-Care Heart Failure Index (SCHFI) confidence and maintenance subscales. Item analyses, psychometric properties including factorial and convergent validities, and internal consistency reliability were tested. Factor analyses showed that the variances for the 20-item LPSES and 9-item LPHMAS were 60.2% and 53.6%, respectively. Convergent validity of the newly developed instruments was supported by the following correlations: LPSES and GSES (r = 0.34); LPSES and SCHFI-confidence (r = 0.60); LPHMAS and MOSGA (r = 0.33); LPHMAS and SCHFI-maintenance (r = 0.40). Internal consistency reliability coefficients were 0.94 (LPSES) and 0.84 (LPHMAS). Based on these data, the LPSES and LPHMAS are valid and reliable measures of self-efficacy and adherence specific for LVAD patients. Confirmatory testing is needed to further support the validity of these instruments for use in research and clinical practice.

  1. 30 CFR 77.1005 - Scaling highwalls; general.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Scaling highwalls; general. 77.1005 Section 77... Ground Control § 77.1005 Scaling highwalls; general. (a) Hazardous areas shall be scaled before any other work is performed in the hazardous area. When scaling of highwalls is necessary to correct conditions...

  2. Stigma, medication adherence and coping mechanism among people living with HIV attending General Hospital, Lagos Island, Nigeria

    Directory of Open Access Journals (Sweden)

    Adekemi O. Sekoni

    2012-11-01

    Objectives: This study assessed the various domains of stigma experienced by PLWHAs attending an HIV clinic at General Hospital, Lagos Island, their medication adherence patterns and their coping mechanisms for ensuring adherence to antiretroviral therapy. Method: A cross-sectional study design with a sample size of 200 was used. Respondents were selected using systematic random sampling. Interviewers administered structured questionnaires were used to collect information on the domains of stigma. Data was analysed using EPI info©. This was followed by a focus group discussion (FGD with seven participants at the clinic using an interview guide with open-ended questions. Results: Overall, stigma was experienced by 35% of the respondents. Within this group, 6.6%, 37.1%, 43.1% and 98.0% of the respondents reported experiencing negative self image stigma, personalised stigma, disclosure stigma and public attitude stigma respectively. Almost 90% of the respondents were adherent. The FGD revealed that disclosure was usually confined to family members and the coping mechanism for achieving adherence was to put antiretroviral (ARVs in unlabelled pill boxes. Conclusion: This study found that stigma was low and that the most common domain of stigma experienced was public attitude stigma. Medication adherence of respondents was good as a result of the coping mechanism, which involves putting ARVs in unlabelled pill boxes.

  3. A Persian Adaptation of Medication Adherence Self-Efficacy Scale (MASES) in Hypertensive Patients: Psychometric Properties and Factor Structure.

    Science.gov (United States)

    Saffari, Mohsen; Zeidi, Isa Mohammadi; Fridlund, Bengt; Chen, Hui; Pakpour, Amir H

    2015-09-01

    Poor adherence to anti-hypertensive treatment significantly contributes to the failure to achieve well-controlled blood pressure in patients with hypertension. To convert the original English version of Medication Adherence Self-efficacy Scale (MASES) into a Persian version for clinical application in hypertensive patients. The backward-forward translation method was used to produce the Persian version of the questionnaire. Then the internal consistency was assessed using Cronbach's alpha. Exploratory Factor Analysis was applied to extract the components of the questionnaire. Correlation between blood pressures and drug adherence was then determined using the Persian MASES in hypertensive patients. Cronbach's alpha coefficient of the Persian version of MASES was >0.92, suggesting that it can yield consistent results. Exploratory Factor Analysis suggested an uni-dimensionality of the scale. Patients with uncontrolled hypertension showed poor adherence to hypertensive medications, therefore had significant lower self-efficacy scores than those with well-controlled blood pressure by medications. The Persian version of MASES is valid and reliable to assess self-efficacy of antihypertensive medication adherence in hypertensive patient, which is helpful to improve medication compliance in such patients in order to achieve better blood pressure controls.

  4. Let's talk about medication: concordance in rating medication adherence among multimorbid patients and their general practitioners

    NARCIS (Netherlands)

    Ose, D.; Mahler, C.; Vogel, I.; Ludt, S.; Szecsenyi, J.; Freund, T.

    2012-01-01

    BACKGROUND: Medication adherence can be essential for improving health outcomes. Patients with multiple chronic conditions, often receiving multiple medications, are at higher risk for medication nonadherence. Previous research has focused on concordance between patients and providers about which

  5. Nonadherence and factors affecting adherence of diabetic patients to anti-diabetic medication in Assela General Hospital, Oromia Region, Ethiopia

    Directory of Open Access Journals (Sweden)

    Ashebir Kassahun

    2016-01-01

    Full Text Available Background: Diabetes mellitus is a major global health problem covering approximately 347 million persons worldwide. Glycemic control has a main role in its management which mainly depends upon patient adherence to the treatment plan. Accurate assessment of medication adherence is necessary for effective management of diabetes. Objective: To assess nonadherence and factors affecting adherence of diabetic patients to anti-diabetic medication in Assela General Hospital (AGH, Oromia Region, Ethiopia. Materials and Methods: A descriptive cross-sectional study was conducted on patients seeking anti-diabetic drug treatment and follow-up at AGH using structured questionnaire and reviewing the patient record card using check list from January 24, 2014 to February 7, 2014. Descriptive analysis was used to describe the percentages and number of distributions of the variables in the study; and association was identified for categorical data. P ≤ 0.05 was considered as statistically significant. Result: Of all respondents, 149 (52.3% and 136 (47.7% were female and male, respectively. The majority of the study participants 189 (66.3% were in the age group of 30–60 years. Two-hundred nineteen (76.8% of respondents were married currently. The majority, 237 (83.2% of respondents did not have blood glucose self-monitoring equipment (glucometer. A total of 196 (68.8% respondents were adhered to anti-diabetic medication. There was a significant association between adherence to the medication and side effect, level of education, monthly income and presence of glucometer at home (P < 0.05. Conclusion: The participants in the area of study were moderately adherent to their anti-diabetic medications with nonadherence rate of 31.2%. Different factors of medication nonadherence were identified such as side effect and complexity of regimen, failure to remember, and sociodemographic factors such as educational level and monthly income.

  6. [Spanish translation and cross-cultural adaptation of the ARMS-scale for measuring medication adherence in polypathological patients].

    Science.gov (United States)

    González-Bueno, Javier; Calvo-Cidoncha, Elena; Sevilla-Sánchez, Daniel; Espaulella-Panicot, Joan; Codina-Jané, Carles; Santos-Ramos, Bernardo

    2017-10-01

    Translate the ARMS scale into Spanish ensuring cross-cultural equivalence for measuring medication adherence in polypathological patients. Translation, cross-cultural adaptation and pilot testing. Secondary hospital. (i)Forward and blind-back translations followed by cross-cultural adaptation through qualitative methodology to ensure conceptual, semantic and content equivalence between the original scale and the Spanish version. (ii)Pilot testing in non-institutionalized polypathological patients to assess the instrument for clarity. The Spanish version of the ARMS scale has been obtained. Overall scores from translators involved in forward and blind-back translations were consistent with a low difficulty for assuring conceptual equivalence between both languages. Pilot testing (cognitive debriefing) in a sample of 40 non-institutionalized polypathological patients admitted to an internal medicine department of a secondary hospital showed an excellent clarity. The ARMS-e scale is a Spanish-adapted version of the ARMS scale, suitable for measuring adherence in polypathological patients. Its structure enables a multidimensional approach of the lack of adherence allowing the implementation of individualized interventions guided by the barriers detected in every patient. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  7. Nonadherence and factors affecting adherence of diabetic patients to anti-diabetic medication in Assela General Hospital, Oromia Region, Ethiopia.

    Science.gov (United States)

    Kassahun, Ashebir; Gashe, Fanta; Mulisa, Eshetu; Rike, Wote Amelo

    2016-01-01

    Diabetes mellitus is a major global health problem covering approximately 347 million persons worldwide. Glycemic control has a main role in its management which mainly depends upon patient adherence to the treatment plan. Accurate assessment of medication adherence is necessary for effective management of diabetes. To assess nonadherence and factors affecting adherence of diabetic patients to anti-diabetic medication in Assela General Hospital (AGH), Oromia Region, Ethiopia. A descriptive cross-sectional study was conducted on patients seeking anti-diabetic drug treatment and follow-up at AGH using structured questionnaire and reviewing the patient record card using check list from January 24, 2014 to February 7, 2014. Descriptive analysis was used to describe the percentages and number of distributions of the variables in the study; and association was identified for categorical data. P ≤ 0.05 was considered as statistically significant. Of all respondents, 149 (52.3%) and 136 (47.7%) were female and male, respectively. The majority of the study participants 189 (66.3%) were in the age group of 30-60 years. Two-hundred nineteen (76.8%) of respondents were married currently. The majority, 237 (83.2%) of respondents did not have blood glucose self-monitoring equipment (glucometer). A total of 196 (68.8%) respondents were adhered to anti-diabetic medication. There was a significant association between adherence to the medication and side effect, level of education, monthly income and presence of glucometer at home (P diabetic medications with nonadherence rate of 31.2%. Different factors of medication nonadherence were identified such as side effect and complexity of regimen, failure to remember, and sociodemographic factors such as educational level and monthly income.

  8. Evaluation of the psychometric properties of self-efficacy and adherence scales for caregivers of patients with a left ventricular assist device.

    Science.gov (United States)

    Casida, Jesus; Wu, Horng-Shiuann; Harden, Janet; Carie, Austen; Chern, Joy

    2015-06-01

    No published instrument has been designed to measure caregivers' self-efficacy for and adherence to the complex home-care regimen of patients with a left ventricular assist device (LVAD). To evaluate the psychometric properties of 2 newly developed instruments: the LVAD Caregiver Self-Efficacy Scale (LCSS) and the LVAD Caregiver Home Management Adherence Scale (LCAS). A multistage design was employed for this instrumentation study. Of the 125 LVAD caregivers recruited from online support groups, 98 (78.4%) provided complete data. Participants were predominantly female (80%), aged 18 to 79 years, from 4 regions of the United States. They completed the following instruments: LCSS, LCAS, General Self-Efficacy Scale (GSE), and the confidence and maintenance subscales of the Caregiver Contribution to Self-Care of Heart Failure Index (CC-SCHFI). Item analyses, factorial construct validity, convergent validity, and internal consistency reliability of the scales were evaluated. The analysis of the LCSS (21 items) revealed a 2-factor solution, which consisted of a 17-item routine factor and a 4-item anticipatory factor. Convergent validity of the LCSS was supported by moderate correlations among LCSS, GSE, and CC-SCHFI-confidence. The analysis of LCAS (17 items) revealed a 1-factor solution. Its convergent validity was supported by moderate correlation between LCAS and CC-SCHFI-maintenance. Internal consistency reliability coefficients of the LCSS and LCAS were α = 0.93 and α = 0.96, respectively. These data suggest that the 2 instruments are adequately valid and reliable measures of self-efficacy and adherence in the context of LVAD patient care managed by home caregivers. Further research is needed to support the applicability of these instruments in other research and practice settings.

  9. Digital terrain model generalization incorporating scale, semantic and cognitive constraints

    Science.gov (United States)

    Partsinevelos, Panagiotis; Papadogiorgaki, Maria

    2014-05-01

    Cartographic generalization is a well-known process accommodating spatial data compression, visualization and comprehension under various scales. In the last few years, there are several international attempts to construct tangible GIS systems, forming real 3D surfaces using a vast number of mechanical parts along a matrix formation (i.e., bars, pistons, vacuums). Usually, moving bars upon a structured grid push a stretching membrane resulting in a smooth visualization for a given surface. Most of these attempts suffer either in their cost, accuracy, resolution and/or speed. Under this perspective, the present study proposes a surface generalization process that incorporates intrinsic constrains of tangible GIS systems including robotic-motor movement and surface stretching limitations. The main objective is to provide optimized visualizations of 3D digital terrain models with minimum loss of information. That is, to minimize the number of pixels in a raster dataset used to define a DTM, while reserving the surface information. This neighborhood type of pixel relations adheres to the basics of Self Organizing Map (SOM) artificial neural networks, which are often used for information abstraction since they are indicative of intrinsic statistical features contained in the input patterns and provide concise and characteristic representations. Nevertheless, SOM remains more like a black box procedure not capable to cope with possible particularities and semantics of the application at hand. E.g. for coastal monitoring applications, the near - coast areas, surrounding mountains and lakes are more important than other features and generalization should be "biased"-stratified to fulfill this requirement. Moreover, according to the application objectives, we extend the SOM algorithm to incorporate special types of information generalization by differentiating the underlying strategy based on topologic information of the objects included in the application. The final

  10. Developing an instrument for assessing fidelity of motivational care planning: The Aboriginal and Islander Mental health initiative adherence scale.

    Science.gov (United States)

    Prowse, Phuong-Tu; Nagel, Tricia

    2014-01-01

    The aim of this study was to design and trial an Adherence Scale to measure fidelity of Motivational Care Planning (MCP) within a clinical trial. This culturally adapted therapy MCP uses a client centered holistic approach that emphasises family and culture to motivate healthy life style changes. The Motivational Care Planning-Adherence Scale (MCP-AS) was developed through consultation with Aboriginal and Islander Mental Health Initiative (AIMhi) Indigenous and non-Indigenous trainers, and review of MCP training resources. The resultant ten-item scale incorporates a 9-Point Likert Scale with a supporting protocol manual and uses objective, behaviourally anchored criteria for each scale point. A fidelity assessor piloted the tool through analysis of four audio-recordings of MCP (conducted by Indigenous researchers within a study in remote communities in Northern Australia). File audits of the remote therapy sessions were utilised as an additional source of information. A Gold Standard Motivational Care Planning training video was also assessed using the MCP-AS. The Motivational Care Planning-Adherence Scale contains items measuring both process and content of therapy sessions. This scale was used successfully to assess therapy through observation of audio or video-recorded sessions and review of clinical notes. Treatment fidelity measured by the MCP-AS within the pilot study indicated high fidelity ratings. Ratings were high across the three domains of rapport, motivation, and self-management with especially high ratings for positive feedback and engagement, review of stressors and goal setting. The Motivational Care Planning-Adherence Scale has the potential to provide a measure of quality of delivery of Motivation Care Planning. The pilot findings suggest that despite challenges within the remote Indigenous community setting, Indigenous therapists delivered therapy that was of high fidelity. While developed as a research tool, the scale has the potential to

  11. Large-scale tides in general relativity

    Energy Technology Data Exchange (ETDEWEB)

    Ip, Hiu Yan; Schmidt, Fabian, E-mail: iphys@mpa-garching.mpg.de, E-mail: fabians@mpa-garching.mpg.de [Max-Planck-Institut für Astrophysik, Karl-Schwarzschild-Str. 1, 85741 Garching (Germany)

    2017-02-01

    Density perturbations in cosmology, i.e. spherically symmetric adiabatic perturbations of a Friedmann-Lemaȋtre-Robertson-Walker (FLRW) spacetime, are locally exactly equivalent to a different FLRW solution, as long as their wavelength is much larger than the sound horizon of all fluid components. This fact is known as the 'separate universe' paradigm. However, no such relation is known for anisotropic adiabatic perturbations, which correspond to an FLRW spacetime with large-scale tidal fields. Here, we provide a closed, fully relativistic set of evolutionary equations for the nonlinear evolution of such modes, based on the conformal Fermi (CFC) frame. We show explicitly that the tidal effects are encoded by the Weyl tensor, and are hence entirely different from an anisotropic Bianchi I spacetime, where the anisotropy is sourced by the Ricci tensor. In order to close the system, certain higher derivative terms have to be dropped. We show that this approximation is equivalent to the local tidal approximation of Hui and Bertschinger [1]. We also show that this very simple set of equations matches the exact evolution of the density field at second order, but fails at third and higher order. This provides a useful, easy-to-use framework for computing the fully relativistic growth of structure at second order.

  12. [Psychometric properties of the diabetes mellitus 2 treatment adherence scale version III (EATDM-III) adapted for Chilean patients].

    Science.gov (United States)

    Urzúa, Alfonso; Cabrera, Carlos; González, Christofer; Arenas, Pablo; Guzmán, Mónica; Caqueo-Urízar, Alejandra; Villalobos, Alfonso; Irarrázaval, Matías

    2015-06-01

    The Diabetes Mellitus 2 treatment adherence scale version III (EATDM-III) was devised in Costa Rica. Its seven factors are family support, community organization and support, physical exercise, medical control, hygiene and self-care and assessment of physical condition. To assess the psychometric properties of the scale in Chilean patients. The results of the EATDM-III scale, applied to 274 patients with Diabetes Mellitus 2 aged 59 ± 11 years (59% women), were analyzed. Reliability, item, exploratory and confirmatory factorial analyses were carried out both in the initial and the proposed model. We propose a version of 30 items grouped in six dimensions, improving the fit indices obtained with the original scale. The review of item factor loadings shows that all are appropriate both in magnitude and statistical significance, with values between 0.46 and 0.93. Internal consistency measured by Cronbach's alpha, was 0.85 for the total scale. The adapted EATDM-III scale is reliable and can be used to assess treatment adherence in Chilean patients.

  13. Management of COPD in general practice in Denmark--participating in an educational program substantially improves adherence to guidelines

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli; Hansen, Ejvind Frausing; Jensen, Michael Skov

    2010-01-01

    . DESIGN AND SETTING: Two cross-sectional surveys were performed precisely one year apart before and after an educational program for the participating GPs. A total of 124 GPs completed the study; 1716 and 1342 patients with GP-diagnosed COPD and no concomitant asthma, respectively, were included......BACKGROUND AND AIM: The general practitioner (GP) is the first contact with the health care system for most patients with COPD in Denmark. We studied, if participating in an educational program could improve adherence to guidelines, not least for diagnosis, staging, and treatment of the disease...... by focused education of GPs and their staff....

  14. Management of COPD in general practice in Denmark--participating in an educational program substantially improves adherence to guidelines

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli; Hansen, Ejvind Frausing; Jensen, Michael Skov

    2010-01-01

    BACKGROUND AND AIM: The general practitioner (GP) is the first contact with the health care system for most patients with COPD in Denmark. We studied, if participating in an educational program could improve adherence to guidelines, not least for diagnosis, staging, and treatment of the disease....... DESIGN AND SETTING: Two cross-sectional surveys were performed precisely one year apart before and after an educational program for the participating GPs. A total of 124 GPs completed the study; 1716 and 1342 patients with GP-diagnosed COPD and no concomitant asthma, respectively, were included...... activity, and referral for rehabilitation; use of inhaled corticosteroids in patients with mild COPD (FEV(1) > 80%pred) declined from 76% to 45%. CONCLUSION: Diagnosis and management of COPD in general practice in Denmark is not according to guidelines, but substantial improvements can be achieved...

  15. Management of Ménière's disease in general practice: adherence to the UK National Health Service 'Prodigy' guidelines.

    Science.gov (United States)

    Smale, E; McDonald, S; Maha, N; Short, S

    2008-08-01

    Dizziness is a common presenting complaint in primary healthcare. One differential diagnosis is Ménière's disease. The UK National Health Service 'Prodigy' guidelines have been produced to help healthcare professionals to diagnose and manage Ménière's disease. The aim of this audit was to consider how Ménière's disease is managed in general practice, and to assess how well general practitioners adhere to the Prodigy guidelines. We identified general practices near the Torbay region of south Devon which had a 'TQ' postcode. There were 41 practices, staffed by a total of 203 general practitioners. We wrote to each general practitioner, asking them to fill in a questionnaire regarding Ménière's disease. Our practice response rate was 68 per cent and our individual rate 43 per cent. The mean correct answer rate was >50 per cent. The respondents achieved this despite few being aware of any formal guidelines, and none being aware of the Prodigy guidelines. Detailed knowledge of Ménière's disease was uncommon, and formal guidelines were not frequently consulted.

  16. UJI VALIDITAS DAN RELIABILITAS KUESIONER MEDICATION ADHERENCE REPORT SCALE (MARS TERHADAP PASIEN DIABETES MELLITUS

    Directory of Open Access Journals (Sweden)

    Riza Alfian

    2017-10-01

    Full Text Available Diabetes mellitus is one of the degenerative diseases that can lead to decreased quality of life. Uncomprehension of medicinal purposes may lead to noncompliance to take medication. Patient non-compliance with therapy or given drug use may lead to treatment failure. Levels of adherence to taking drugs for diabetes mellitus patients should be known. Levels of adherence to the treatment of patients with diabetes mellitus can be measured using a MARS questionnaire and serve as a benchmark for the type of therapy and interventions given. The purpose of this study was to test the validity and reliability of MARS questionnaires with the intention that the questionnaire can be applied to patients with diabetes mellitus in Indonesia This type of research is descriptive observasional. The research instrument used is MARS questionnaire. The number of samples involved in this study were 25 patients with diabetes mellitus at Ulin Hospital Banjarmasin. Sampling using consecutive sampling method. The sampling inclusion criteria were patients with diabetes mellitus aged 18-65 years, at least once having undergone drug therapy, received oral medication, and were willing to follow the study. Sample exclusion criteria were diabetes mellitus patients with deaf and illiterate conditions. Test the validity of the questionnaire in this study using Pearson Product Moment correlation test. Test the reliability of the questionnaire in this study using Cronbach alpha coefficient test. The results showed that the value of the correlation score of each question with a total score shows a correlation value of more than 0.396. Questions 1.4, and 5 are classified as having a strong correlation with the total score of MARS questionnaire questions. Questions 2 and 3 are classified as having a moderate correlation to the total score of MARS questionnaire questions. The results of the reliability test show that the value of Cronbach Alpha Coefficient 0.803. Based on the results

  17. GENERALIZATION TECHNIQUE FOR 2D+SCALE DHE DATA MODEL

    Directory of Open Access Journals (Sweden)

    H. Karim

    2016-10-01

    Full Text Available Different users or applications need different scale model especially in computer application such as game visualization and GIS modelling. Some issues has been raised on fulfilling GIS requirement of retaining the details while minimizing the redundancy of the scale datasets. Previous researchers suggested and attempted to add another dimension such as scale or/and time into a 3D model, but the implementation of scale dimension faces some problems due to the limitations and availability of data structures and data models. Nowadays, various data structures and data models have been proposed to support variety of applications and dimensionality but lack research works has been conducted in terms of supporting scale dimension. Generally, the Dual Half Edge (DHE data structure was designed to work with any perfect 3D spatial object such as buildings. In this paper, we attempt to expand the capability of the DHE data structure toward integration with scale dimension. The description of the concept and implementation of generating 3D-scale (2D spatial + scale dimension for the DHE data structure forms the major discussion of this paper. We strongly believed some advantages such as local modification and topological element (navigation, query and semantic information in scale dimension could be used for the future 3D-scale applications.

  18. Penalized Estimation in Large-Scale Generalized Linear Array Models

    DEFF Research Database (Denmark)

    Lund, Adam; Vincent, Martin; Hansen, Niels Richard

    2017-01-01

    Large-scale generalized linear array models (GLAMs) can be challenging to fit. Computation and storage of its tensor product design matrix can be impossible due to time and memory constraints, and previously considered design matrix free algorithms do not scale well with the dimension of the para......Large-scale generalized linear array models (GLAMs) can be challenging to fit. Computation and storage of its tensor product design matrix can be impossible due to time and memory constraints, and previously considered design matrix free algorithms do not scale well with the dimension...... of the parameter vector. A new design matrix free algorithm is proposed for computing the penalized maximum likelihood estimate for GLAMs, which, in particular, handles nondifferentiable penalty functions. The proposed algorithm is implemented and available via the R package glamlasso. It combines several ideas...

  19. Homogeneity and scale testing of generalized gamma distribution

    International Nuclear Information System (INIS)

    Stehlik, Milan

    2008-01-01

    The aim of this paper is to derive the exact distributions of the likelihood ratio tests of homogeneity and scale hypothesis when the observations are generalized gamma distributed. The special cases of exponential, Rayleigh, Weibull or gamma distributed observations are discussed exclusively. The photoemulsion experiment analysis and scale test with missing time-to-failure observations are present to illustrate the applications of methods discussed

  20. Do general practices adhere to organizational guidelines for effective cervical cancer screening?

    NARCIS (Netherlands)

    Hermens, R P; Hak, E; Hulscher, M E; Mulder, J; Braspenning, J C; Grol, R P

    BACKGROUND: Well-organized cervical screening has been shown to be effective in the reduction of both morbidity and mortality from cancer of the uterine cervix. In The Netherlands, the GP plays an important role in the cervical screening. The question is whether the general practices are able to

  1. Scaling of Precipitation Extremes Modelled by Generalized Pareto Distribution

    Science.gov (United States)

    Rajulapati, C. R.; Mujumdar, P. P.

    2017-12-01

    Precipitation extremes are often modelled with data from annual maximum series or peaks over threshold series. The Generalized Pareto Distribution (GPD) is commonly used to fit the peaks over threshold series. Scaling of precipitation extremes from larger time scales to smaller time scales when the extremes are modelled with the GPD is burdened with difficulties arising from varying thresholds for different durations. In this study, the scale invariance theory is used to develop a disaggregation model for precipitation extremes exceeding specified thresholds. A scaling relationship is developed for a range of thresholds obtained from a set of quantiles of non-zero precipitation of different durations. The GPD parameters and exceedance rate parameters are modelled by the Bayesian approach and the uncertainty in scaling exponent is quantified. A quantile based modification in the scaling relationship is proposed for obtaining the varying thresholds and exceedance rate parameters for shorter durations. The disaggregation model is applied to precipitation datasets of Berlin City, Germany and Bangalore City, India. From both the applications, it is observed that the uncertainty in the scaling exponent has a considerable effect on uncertainty in scaled parameters and return levels of shorter durations.

  2. A Reliability Generalization Study of the Geriatric Depression Scale.

    Science.gov (United States)

    Kieffer, Kevin M.; Reese, Robert J.

    2002-01-01

    Conducted a reliability generalization study of the Geriatric Depression Scale (T. Brink and others, 1982). Results from this investigation of 338 studies shows that the average score reliability across studies was 0.8482 and identifies the most important predictors of score reliability. (SLD)

  3. Validation of the Rasch-based Depression Screening in a large scale German general population sample

    Directory of Open Access Journals (Sweden)

    Norra Christine

    2010-09-01

    Full Text Available Abstract Background The study aimed at presenting normative data for both parallel forms of the "Rasch-based Depression Screening (DESC", to examine its Rasch model conformity and convergent and divergent validity based on a representative sample of the German general population. Methods The sample was selected with the assistance of a demographic consulting company applying a face to face interview (N = 2509; mean age = 49.4, SD = 18.2; 55.8% women. Adherence to Rasch model assumptions was determined with analysis of Rasch model fit (infit and outfit, unidimensionality, local independence (principal component factor analysis of the residuals, PCFAR and differential item functioning (DIF with regard to participants' age and gender. Norm values were calculated. Convergent and divergent validity was determined through intercorrelations with the depression and anxiety subscales of the Hospital Anxiety and Depression Scale (HADS-D and HADS-A. Results Fit statistics were below critical values (rDESC-I = .61 and rDESC-II = .60, whereas correlations with HADS-A were rDESC-I = .62 and rDESC-II = .60. Conclusions This study provided further support for the psychometric quality of the DESC. Both forms of the DESC adhered to Rasch model assumptions and showed intercorrelations with HADS subscales that are in line with the literature. The presented normative data offer important advancements for the interpretation of the questionnaire scores and enhance its usefulness for clinical and research applications.

  4. Adherence to the cervical cancer screening program in women living with HIV in Denmark: comparison with the general population.

    Science.gov (United States)

    Thorsteinsson, Kristina; Ladelund, Steen; Jensen-Fangel, Søren; Katzenstein, Terese L; Johansen, Isik Somuncu; Pedersen, Gitte; Junge, Jette; Helleberg, Marie; Storgaard, Merete; Lebech, Anne-Mette

    2014-05-13

    Women living with HIV (WLWH) are at increased risk of invasive cervical cancer (ICC). International HIV guidelines suggest cervical screening twice the first year after HIV diagnosis and thereafter annually. Adherence to the HIV cervical screening program in Denmark is unknown. We studied women from a population-based, nationwide HIV cohort in Denmark and a cohort of age-matched females from the general population. Screening behaviour was assessed from 1999-2010. Adjusted odds ratios (OR's) for screening attendance in the two cohorts and potential predictors of attendance to guidelines were estimated. Pathology specimens were identified from The Danish Pathology Data Bank. We followed 1143 WLWH and 17,145 controls with no prior history of ICC for 9,509 and 157,362 person-years. The first year after HIV diagnosis 2.6% of WLWH obtained the recommended two cervical cytologies. During the different calendar intervals throughout the study period between 29-46% of WLWH followed the HIV cervical screening guidelines. Adjusted OR's of attendance to the general population screening program for WLWH aged 30, 40 and 50 years, compared to controls, were 0.69 (95% CI: 0.56-0.87), 0.67 (0.55-0.80) and 0.84 (0.61-1.15). Predictors of attendance to the HIV cervical screening program were a CD4 count > 350 cells/μL and HIV RNA < 500 copies/mL. Calendar period after 2002 and HIV RNA < 500 copies/mL predicted attendance to the general population cervical screening program. The majority of WLWH do not follow the HIV guidelines for cervical screening. We support the idea of cytology as part of an annual review and integration of HIV care and cervical screening in a single clinic setting.

  5. Suspected cow's milk allergy in everyday general practice: a retrospective cohort study on health care burden and guideline adherence.

    Science.gov (United States)

    van den Hoogen, Sharayke C T A; van de Pol, Alma C; Meijer, Yolanda; Toet, Jaap; van Klei, Céline; de Wit, Niek J

    2014-08-09

    Cow's milk allergy (CMA) is the most common food allergy among infants. No data are available on the health care burden of suspected CMA in general practice. This study was conducted to evaluate the burden of suspected CMA in general practice (GP): (a) prevalence, (b) presenting symptoms, (c) diagnostic process, (d) guideline adherence, and (e) dietary measures. A retrospective cohort study was carried out in four Julius Healthcare Centers (JHCs). These JHCs form the core primary care academic network of the department of general practice of the University Medical Center of Utrecht. Electronic records of the first year of infants born May 2009 - April 2010 registered in the JHCs were screened for possible CMA suspicion. Preventive child healthcare (PCH) records were reviewed for additional information. Clinical presentation, diagnostic strategies and dietary measures were extracted. Of 804 infants evaluated, 55 presented with symptoms fitting the suspicion of CMA (prevalence of 7%). Presenting complaints involved the skin (71%); the gastrointestinal tract (60%); the respiratory tract (13%) or other symptoms (36%) and 23 infants presented with symptoms of two or more organ systems. In 31 children (56%) a food challenge was performed (n = 28 open and n = 3 double-blind). Open challenge test results were difficult to interpret due to inadequate implementation or reporting. None had confirmed CMA after an adequate challenge test. Long term milk substitute formulas were prescribed in 39 (71%) infants. On a yearly basis seven percent of children visit their GP for suspected CMA. A positive CMA diagnosis was rarely established after adequate implementation and reporting of diagnostics, yet long term dietary measures were prescribed in >70% of patients. There is definitely need for improvement of diagnosing CMA in primary care.

  6. Testing general relativity at cosmological scales: Implementation and parameter correlations

    International Nuclear Information System (INIS)

    Dossett, Jason N.; Ishak, Mustapha; Moldenhauer, Jacob

    2011-01-01

    The testing of general relativity at cosmological scales has become a possible and timely endeavor that is not only motivated by the pressing question of cosmic acceleration but also by the proposals of some extensions to general relativity that would manifest themselves at large scales of distance. We analyze here correlations between modified gravity growth parameters and some core cosmological parameters using the latest cosmological data sets including the refined Cosmic Evolution Survey 3D weak lensing. We provide the parametrized modified growth equations and their evolution. We implement known functional and binning approaches, and propose a new hybrid approach to evolve the modified gravity parameters in redshift (time) and scale. The hybrid parametrization combines a binned redshift dependence and a smooth evolution in scale avoiding a jump in the matter power spectrum. The formalism developed to test the consistency of current and future data with general relativity is implemented in a package that we make publicly available and call ISiTGR (Integrated Software in Testing General Relativity), an integrated set of modified modules for the publicly available packages CosmoMC and CAMB, including a modified version of the integrated Sachs-Wolfe-galaxy cross correlation module of Ho et al. and a new weak-lensing likelihood module for the refined Hubble Space Telescope Cosmic Evolution Survey weak gravitational lensing tomography data. We obtain parameter constraints and correlation coefficients finding that modified gravity parameters are significantly correlated with σ 8 and mildly correlated with Ω m , for all evolution methods. The degeneracies between σ 8 and modified gravity parameters are found to be substantial for the functional form and also for some specific bins in the hybrid and binned methods indicating that these degeneracies will need to be taken into consideration when using future high precision data.

  7. Some general scaling rules in high energy heavy ion reactions

    International Nuclear Information System (INIS)

    Andersson, B.; Idh, J.; Otterlund, I.; Stenlund, E.

    1988-09-01

    We show, using the Fritiof model scenario that the wide variation in the number of participating nucleons tend to drown other dynamical variations in the measurables of high energy ion collisions. We propose a set if general scaling laws for inclusive distributions in which it is the mean multiplicity and the mean transverse energy from each source which are the measurables in the interactions. (authors)

  8. Development of a Scale for Domain General Perceived Control Scale Primary School ChildrensAND#8217;

    Directory of Open Access Journals (Sweden)

    Esra Dereli

    2012-06-01

    Full Text Available SUMMARY AIM: This study aimed to develop a scale to measure domain general perceived control scale for elementary age children. METHOD: Participants were a total of 341 primary school children, 4th and f4th grade for 152 students, 6th, 7th and 8th grade for 162 students aged between 10-14.Skinner (1996, perceived control based on the theory is created 12-item scale of perceived control of the general form of the trial for primary education children and this form, within the scope of the research subjects, are given in order to make the validity and reliability studies. In order to test the validity of the scale developed, Satisfaction with Life was used. This scale was developed by Diener et al. (1985 and adapted into Turkish by Yetim (1993. RESULTS:Exploratory and confirmatory factor analysises and certain reliability analyses were used in the study. As a result of the analysis, four Likert-type five items scale were obtained. The findings revealed one -dimensional scale, 46.35% of whose variance was explained. Cronbach’s coefficient alpha provided evidence for the internal consistency of the exploratory the Scale. The reliability of the scale was 0.70 and indicated that the 5 item scale had good internal consistency for the sample. CONCLUSION: The scale that resulted was given the title “Scale for Primary School Children’ Time Orientation during Classroom Disengagement”. This instrument may be used in various studies in the future, thus contributing to the development of the field. [TAF Prev Med Bull 2012; 11(3.000: 331-338

  9. Exact Solutions of a Generalized Weighted Scale Free Network

    Directory of Open Access Journals (Sweden)

    Li Tan

    2013-01-01

    Full Text Available We investigate a class of generalized weighted scale-free networks, where the new vertex connects to m pairs of vertices selected preferentially. The key contribution of this paper is that, from the standpoint of random processes, we provide rigorous analytic solutions for the steady state distributions, including the vertex degree distribution, the vertex strength distribution and the edge weight distribution. Numerical simulations indicate that this network model yields three power law distributions for the vertex degrees, vertex strengths and edge weights, respectively.

  10. Reliability and validity of the Chinese version of the HIV Treatment Adherence Self-Efficacy Scale in mainland China.

    Science.gov (United States)

    Sun, Liang; Yang, Shu-Min; Wu, Hui; Chen, Bing; Wang, Chong-Jian; Li, Xiao-Fang

    2017-07-01

    The aim of this study was to translate the HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES) and evaluate its reliability and validity in people living with HIV (PLWHIV) in mainland China. The original HIV-ASES was translated from English into Chinese and adapted for cultural context according to cross-cultural adaptation guidelines. A cross-sectional survey investigating 1742 PLWHIV receiving antiretroviral treatment was conducted. Exploratory factor analysis with varimax rotation confirmed the presence of two factors with an accumulated contribution rate of 58.357%. Furthermore, confirmatory factor analysis revealed the model's goodness-of-fit index. The comparative fit index was greater than 0.9 and the overall efficacy of the model was satisfactory. The Cronbach α coefficient of the questionnaire was 0.876 (95% CI: 0.868-0.885), and the correlation coefficient of each item and the total was 0.536-0.660 ( P < 0.01). The Chinese version of the HIV-ASES has high reliability and validity; however, the individual item requires some adjustment.

  11. Ambiguous tests of general relativity on cosmological scales

    International Nuclear Information System (INIS)

    Zuntz, Joe; Baker, Tessa; Ferreira, Pedro G.; Skordis, Constantinos

    2012-01-01

    There are a number of approaches to testing General Relativity (GR) on linear scales using parameterized frameworks for modifying cosmological perturbation theory. It is sometimes assumed that the details of any given parameterization are unimportant if one uses it as a diagnostic for deviations from GR. In this brief report we argue that this is not necessarily so. First we show that adopting alternative combinations of modifications to the field equations significantly changes the constraints that one obtains. In addition, we show that using a parameterization with insufficient freedom significantly tightens the apparent theoretical constraints. Fundamentally we argue that it is almost never appropriate to consider modifications to the perturbed Einstein equations as being constraints on the effective gravitational constant, for example, in the same sense that solar system constraints are. The only consistent modifications are either those that grant near-total freedom, as in decomposition methods, or ones which map directly to a particular part of theory space

  12. Interrelation and independence of positive and negative psychological constructs in predicting general treatment adherence in coronary artery patients - Results from the THORESCI study.

    Science.gov (United States)

    van Montfort, Eveline; Denollet, Johan; Widdershoven, Jos; Kupper, Nina

    2016-09-01

    In cardiac patients, positive psychological factors have been associated with improved medical and psychological outcomes. The current study examined the interrelation between and independence of multiple positive and negative psychological constructs. Furthermore, the potential added predictive value of positive psychological functioning regarding the prediction of patients' treatment adherence and participation in cardiac rehabilitation (CR) was investigated. 409 percutaneous coronary intervention (PCI) patients were included (mean age = 65.6 ± 9.5; 78% male). Self-report questionnaires were administered one month post-PCI. Positive psychological constructs included positive affect (GMS) and optimism (LOT-R); negative constructs were depression (PHQ-9, BDI), anxiety (GAD-7) and negative affect (GMS). Six months post-PCI self-reported general adherence (MOS) and CR participation were determined. Factor Analysis (Oblimin rotation) revealed two components (r = − 0.56), reflecting positive and negative psychological constructs. Linear regression analyses showed that in unadjusted analyses both optimism and positive affect were associated with better general treatment adherence at six months (p positive affect was significantly associated with CR participation. After controlling for multiple covariates, this relation was no longer significant. Positive and negative constructs should be considered as two distinct dimensions. Positive psychological constructs (i.e. optimism) may be of incremental value to negative psychological constructs in predicting patients' treatment adherence. A more complete view of a patients' psychological functioning will open new avenues for treatment. Additional research is needed to investigate the relationship between positive psychological factors and other cardiac outcomes, such as cardiac events and mortality.

  13. Assessing medication adherence in inflammatory bowel diseases. A comparison between a self-administered scale and a pharmacy refill index

    DEFF Research Database (Denmark)

    Weimers, Petra; Burisch, Johan; Munkholm, Pia

    2017-01-01

    Inflammatory bowel diseases (IBDs), due to their chronic and progressive nature, require lifelong treatment to relief and/or prevent inflammation and symptoms, obtaining mucosal healing at best. Therefore, adherence to treatment is an essential topic to address when treating patients with IBD. No...

  14. Generalized Chirp Scaling Combined with Baseband Azimuth Scaling Algorithm for Large Bandwidth Sliding Spotlight SAR Imaging.

    Science.gov (United States)

    Yi, Tianzhu; He, Zhihua; He, Feng; Dong, Zhen; Wu, Mnaqing

    2017-05-29

    This paper presents an efficient and precise imaging algorithm for the large bandwidth sliding spotlight synthetic aperture radar (SAR). The existing sub-aperture processing method based on the baseband azimuth scaling (BAS) algorithm cannot cope with the high order phase coupling along the range and azimuth dimensions. This coupling problem causes defocusing along the range and azimuth dimensions. This paper proposes a generalized chirp scaling (GCS)-BAS processing algorithm, which is based on the GCS algorithm. It successfully mitigates the deep focus along the range dimension of a sub-aperture of the large bandwidth sliding spotlight SAR, as well as high order phase coupling along the range and azimuth dimensions. Additionally, the azimuth focusing can be achieved by this azimuth scaling method. Simulation results demonstrate the ability of the GCS-BAS algorithm to process the large bandwidth sliding spotlight SAR data. It is proven that great improvements of the focus depth and imaging accuracy are obtained via the GCS-BAS algorithm.

  15. Reference Priors for the General Location-Scale Model

    NARCIS (Netherlands)

    Fernández, C.; Steel, M.F.J.

    1997-01-01

    The reference prior algorithm (Berger and Bernardo 1992) is applied to multivariate location-scale models with any regular sampling density, where we establish the irrelevance of the usual assumption of Normal sampling if our interest is in either the location or the scale. This result immediately

  16. General adherence to guideline recommendations on initial diagnosis of bladder cancer in the United States and influencing factors.

    Science.gov (United States)

    Karl, Alexander; Adejoro, Oluwakayode; Saigal, Christopher; Konety, Badrinath

    2014-08-01

    Because international guidelines recommend best practices regarding staging of incident bladder cancer, we determined the adherence to such recommendations in the United States, performing a large retrospective database analysis. Patients with the diagnosis of urothelial cancer were identified in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database between 1992 and 2007. Staging procedures were identified and analyzed. As reference for published recommendations, we used the American Urological Association (AUA), European Association of Urology (EAU), and National Comprehensive Cancer Network (NCCN) guidelines. Based on these sources, recommended initial staging of bladder cancer was analyzed. Of all 56,130 patients, 6148 (10.9%) had a cytologic examination, 29,677 (52.9%) had a standard urinalysis, 2882 (5.1%) underwent intravenous pyelography (IVP), 6950 (12.4%) underwent retrograde pyelography (RPG), and 8145 (14.5%) had computed tomography/magnetic resonance imaging (CT/MRI). There was a significant trend over the years to a higher use of cytologic analysis, standard urinalysis, and CT/MRI. We observed a significant trend toward a lower rate of IVP and a stable use of RPG. The limitation of our study is that claims data are designed for payment processing, not quality measurement. Despite published recommendations on the initial diagnosis of bladder cancer, our data show that less than half of the included patients received all the elements thought to be required for an initial diagnosis of bladder cancer as recommended by guidelines. Greater adherence to recommendations may ensure optimal treatment strategies. Appropriate treatment is critical to patient outcomes, because evidence-based therapeutic management can be practiced only if an accurate assessment of the disease takes place at the time of initial diagnosis. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Reliability and validity of Arabic translation of Medication Adherence Report Scale (MARS and Beliefs about Medication Questionnaire (BMQ-specific for use in children and their parents.

    Directory of Open Access Journals (Sweden)

    Mervat Alsous

    Full Text Available to evaluate the reliability and discriminant validity of Arabic translation of the Medication Adherence Report Scale (MARS and the Beliefs about Medication Questionnaire-specific (BMQ-specific.Having developed Arabic translations of the study instruments, a cross-sectional study was carried out between March and October 2015 in two multidisciplinary governmental hospitals in Jordan. An expert panel monitored the forward and backward translation of the MARS and BMQ. Standard Arabic was used (with no specific dialect inclusion to allow greater generalisability across Arabic speaking countries. Once the Arabic translations of the questionnaires were developed they were tested for consistency, validity and reliability on a group of children with chronic diseases and their parents.A total of 258 parents and 208 children were included in the study. The median age of participated children and parents was 15 years and 42 years respectively. Principle component analysis of all questionnaires indicated that all had good construct validity as they clearly measured one construct. The questionnaires were deemed reliable based on the results of Cronbach alpha coefficient. Furthermore, reliability of the questionnaires was demonstrated by test-retest intraclass correlation coefficients (ICC which ranged from good to excellent for all scales (ICC>0.706. The Pearson correlation coefficient ranged from 0.546-0.805 for the entire sample which indicated a significant moderate to strong positive correlation between MARS and BMQ items at time 1 and 2. Reported adherence was greater than 59% using MARS-children and MARS-parents scales, and was correlated with beliefs in necessity and independent of the concerns regarding medications.The Arabic translations of both BMQ and MARS for use in children and their parents have good internal consistency and proved to be valid and reliable tools that can be used by researchers in clinical practice to measure adherence and

  18. Reliability and validity of Arabic translation of Medication Adherence Report Scale (MARS) and Beliefs about Medication Questionnaire (BMQ)–specific for use in children and their parents

    Science.gov (United States)

    Alsous, Mervat; Alhalaiqa, Fadwa; Abu Farha, Rana; Abdel Jalil, Mariam; McElnay, James; Horne, Robert

    2017-01-01

    Objectives to evaluate the reliability and discriminant validity of Arabic translation of the Medication Adherence Report Scale (MARS) and the Beliefs about Medication Questionnaire-specific (BMQ-specific). Methods Having developed Arabic translations of the study instruments, a cross-sectional study was carried out between March and October 2015 in two multidisciplinary governmental hospitals in Jordan. An expert panel monitored the forward and backward translation of the MARS and BMQ. Standard Arabic was used (with no specific dialect inclusion) to allow greater generalisability across Arabic speaking countries. Once the Arabic translations of the questionnaires were developed they were tested for consistency, validity and reliability on a group of children with chronic diseases and their parents. Results A total of 258 parents and 208 children were included in the study. The median age of participated children and parents was 15 years and 42 years respectively. Principle component analysis of all questionnaires indicated that all had good construct validity as they clearly measured one construct. The questionnaires were deemed reliable based on the results of Cronbach alpha coefficient. Furthermore, reliability of the questionnaires was demonstrated by test-retest intraclass correlation coefficients (ICC) which ranged from good to excellent for all scales (ICC>0.706). The Pearson correlation coefficient ranged from 0.546–0.805 for the entire sample which indicated a significant moderate to strong positive correlation between MARS and BMQ items at time 1 and 2. Reported adherence was greater than 59% using MARS-children and MARS-parents scales, and was correlated with beliefs in necessity and independent of the concerns regarding medications. Conclusion The Arabic translations of both BMQ and MARS for use in children and their parents have good internal consistency and proved to be valid and reliable tools that can be used by researchers in clinical practice to

  19. Reliability and validity of Arabic translation of Medication Adherence Report Scale (MARS) and Beliefs about Medication Questionnaire (BMQ)-specific for use in children and their parents.

    Science.gov (United States)

    Alsous, Mervat; Alhalaiqa, Fadwa; Abu Farha, Rana; Abdel Jalil, Mariam; McElnay, James; Horne, Robert

    2017-01-01

    to evaluate the reliability and discriminant validity of Arabic translation of the Medication Adherence Report Scale (MARS) and the Beliefs about Medication Questionnaire-specific (BMQ-specific). Having developed Arabic translations of the study instruments, a cross-sectional study was carried out between March and October 2015 in two multidisciplinary governmental hospitals in Jordan. An expert panel monitored the forward and backward translation of the MARS and BMQ. Standard Arabic was used (with no specific dialect inclusion) to allow greater generalisability across Arabic speaking countries. Once the Arabic translations of the questionnaires were developed they were tested for consistency, validity and reliability on a group of children with chronic diseases and their parents. A total of 258 parents and 208 children were included in the study. The median age of participated children and parents was 15 years and 42 years respectively. Principle component analysis of all questionnaires indicated that all had good construct validity as they clearly measured one construct. The questionnaires were deemed reliable based on the results of Cronbach alpha coefficient. Furthermore, reliability of the questionnaires was demonstrated by test-retest intraclass correlation coefficients (ICC) which ranged from good to excellent for all scales (ICC>0.706). The Pearson correlation coefficient ranged from 0.546-0.805 for the entire sample which indicated a significant moderate to strong positive correlation between MARS and BMQ items at time 1 and 2. Reported adherence was greater than 59% using MARS-children and MARS-parents scales, and was correlated with beliefs in necessity and independent of the concerns regarding medications. The Arabic translations of both BMQ and MARS for use in children and their parents have good internal consistency and proved to be valid and reliable tools that can be used by researchers in clinical practice to measure adherence and beliefs about

  20. Transcultural adaptation and initial validation of Brazilian-Portuguese version of the Basel assessment of adherence to immunosuppressive medications scale (BAASIS) in kidney transplants.

    Science.gov (United States)

    Marsicano, Elisa de Oliveira; Fernandes, Neimar da Silva; Colugnati, Fernando; Grincenkov, Fabiane Rossi dos Santos; Fernandes, Natalia Maria da Silva; De Geest, Sabina; Sanders-Pinheiro, Helady

    2013-05-21

    Transplant recipients are expected to adhere to a lifelong immunosuppressant therapeutic regimen. However, nonadherence to treatment is an underestimated problem for which no properly validated measurement tool is available for Portuguese-speaking patients. We aimed to initially validate the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS®) to accurately estimate immunosuppressant nonadherence in Brazilian transplant patients. The BAASIS® (English version) was transculturally adapted and its psychometric properties were assessed. The transcultural adaptation was performed using the Guillemin protocol. Psychometric testing included reliability (intraobserver and interobserver reproducibility, agreement, Kappa coefficient, and the Cronbach's alpha) and validity (content, criterion, and construct validities). The final version of the transculturally adapted BAASIS® was pretested, and no difficulties in understanding its content were found. The intraobserver and interobserver reproducibility variances (0.007 and 0.003, respectively), the Cronbach's alpha (0.7), Kappa coefficient (0.88) and the agreement (95.2%) suggest accuracy, preciseness and reliability. For construct validity, exploratory factorial analysis demonstrated unidimensionality of the first three questions (r = 0.76, r = 0.80, and r = 0.68). For criterion validity, the adapted BAASIS® was correlated with another self-report instrument, the Measure of Adherence to Treatment, and showed good congruence (r = 0.65). The BAASIS® has adequate psychometric properties and may be employed in advance to measure adherence to posttransplant immunosuppressant treatments. This instrument will be the first one validated to use in this specific transplant population and in the Portuguese language.

  1. Tornadoes and downbursts in the context of generalized planetary scales

    Science.gov (United States)

    Fujita, T. T.

    1981-01-01

    In order to cover a wide range of horizontal dimensions of airflow, the paper proposes a series of five scales, maso, meso, miso (to be read as my-so), moso and muso arranged in the order of the vowels, A, E, I, O, U. The dimensions decrease by two orders of magnitude per scale, beginning with the planet's equator length chosen to be the maximum dimension of masoscale for each planet. Mesoscale highs and lows were described on the basis of mesoanalyses, while sub-mesoscale disturbances were depicted by cataloging over 20,000 photographs of wind effects taken from low-flying aircraft during the past 15 years. Various motion thus classified into these scales led to a conclusion that extreme winds induced by thunderstorms are associated with misoscale and mososcale airflow spawned by the parent, mesoscale disturbances.

  2. Adherence of Surgeons to Antimicrobial Prophylaxis Guidelines in a Tertiary General Hospital in a Rapidly Developing Country

    Directory of Open Access Journals (Sweden)

    Ahmed Abdel-Aziz

    2013-01-01

    Full Text Available Objectives. To assess the standard practice of care of surgeons regarding surgical antibiotic prophylaxis, to identify gaps, and to set recommendations. Methods. A retrospective analysis of data obtained from different surgical units in a single center in Qatar over a 3-month period in 2012. A total of 101 patients who underwent surgery and followed regimes for surgical prophylaxis as per hospital guidelines were included in the study. Results. The overall use of antibiotic was 89%, whereas the current practice did not match the recommended hospital protocols in 53.5% of cases. Prolonged antibiotics use (59.3% was the commonest reason for nonadherence followed by the use of an alternative antibiotic to that recommended in the protocol (31.5% and no prophylaxis was used in 9.2% of cases. The rate of compliance was significantly higher among clean surgery than clean contaminated group (P=0.03. Forty-four percent of clean and 65% of clean-contaminated procedures showed noncompliance with the recommended surgical antimicrobial prophylaxis hospital guidelines. Conclusion. Lack of adherence to hospital protocols is not uncommon. This finding remains a challenge to encourage clinicians to follow hospital guidelines appropriately and to consistently apply the surgical antibiotic prophylaxis. The role of clinical pharmacist may facilitate this process across all surgical disciplines.

  3. Optimal Scaling of Interaction Effects in Generalized Linear Models

    Science.gov (United States)

    van Rosmalen, Joost; Koning, Alex J.; Groenen, Patrick J. F.

    2009-01-01

    Multiplicative interaction models, such as Goodman's (1981) RC(M) association models, can be a useful tool for analyzing the content of interaction effects. However, most models for interaction effects are suitable only for data sets with two or three predictor variables. Here, we discuss an optimal scaling model for analyzing the content of…

  4. RPC Production at General Tecnica: a mass scale production

    International Nuclear Information System (INIS)

    Della Volpe, D.; Morganti, S.

    2006-01-01

    The construction of LHC has deeply changed the RPC production. The enormous amount of detector needed and the strong requirements on gas volume quality had a deep impact on the production chain and on the QC and QA at the production site. This basically has brought the RPC from an almost hand-crafted detector to a medium scale mass product. The most critical aspects of the production chain have been modified and/or improved introducing new and more rigorous QC and QA procedures to guarantee the detector quality and improve the management of storage and the procurement on materials. Here it will be presented the work carried on in the last four year at the production site to improve and check the quality and the results achieved. Something like 10000 RPC were produced between 2002 and 2005. Also a preliminary and rough analysis on the efficiencies of the various phases in the chain production based on ATLAS production will be presented

  5. A Reliability Generalization Study of Scores on Rotter's and Nowicki-Strickland's Locus of Control Scales

    Science.gov (United States)

    Beretvas, S. Natasha; Suizzo, Marie-Anne; Durham, Jennifer A.; Yarnell, Lisa M.

    2008-01-01

    The most commonly used measures of locus of control are Rotter's Internality-Externality Scale (I-E) and Nowicki and Strickland's Internality-Externality Scale (NSIE). A reliability generalization study is conducted to explore variability in I-E and NSIE score reliability. Studies are coded for aspects of the scales used (number of response…

  6. Assessment of adherence to the CONSORT statement for quality of reports on randomized controlled trial abstracts from four high-impact general medical journals.

    Science.gov (United States)

    Ghimire, Saurav; Kyung, Eunjung; Kang, Wonku; Kim, Eunyoung

    2012-06-07

    The extended Consolidated Standards of Reporting Trials (CONSORT) Statement for Abstracts was developed to improve the quality of reports of randomized controlled trials (RCTs) because readers often base their assessment of a trial solely on the abstract. To date, few data exist regarding whether it has achieved this goal. We evaluated the extent of adherence to the CONSORT for Abstract statement for quality of reports on RCT abstracts by four high-impact general medical journals. A descriptive analysis of published RCT abstracts in The New England Journal of Medicine (NEJM), The Lancet, The Journal of American Medical Association (JAMA), and the British Medical Journal (BMJ) in the year 2010 was conducted by two reviewers, independently extracting data from a MEDLINE/PubMed search. We identified 271 potential RCT abstracts meeting our inclusion criteria. More than half of the abstracts identified the study as randomized in the title (58.7%; 159/271), reported the specific objective/hypothesis (72.7%; 197/271), described participant eligibility criteria with settings for data collection (60.9%; 165/271), detailed the interventions for both groups (90.8%; 246/271), and clearly defined the primary outcome (94.8%; 257/271). However, the methodological quality domains were inadequately reported: allocation concealment (11.8%; 32/271) and details of blinding (21.0%; 57/271). Reporting the primary outcome results for each group was done in 84.1% (228/271). Almost all of the abstracts reported trial registration (99.3%; 269/271), whereas reports of funding and of harm or side effects from the interventions were found in only 47.6% (129/271) and 42.8% (116/271) of the abstracts, respectively. These findings show inconsistencies and non-adherence to the CONSORT for abstract guidelines, especially in the methodological quality domains. Improvements in the quality of RCT reports can be expected by adhering to existing standards and guidelines as expressed by the CONSORT group.

  7. [The validity and reliability of the general self-efficacy scale-Turkish form].

    Science.gov (United States)

    Yildirim, Fatma; Ilhan, Inci Ozgür

    2010-01-01

    Self-efficacy, which is a basic construct in social cognitive theory, has been defined as one's belief in his/her ability to start, continue, and complete an action in a manner that has an impact on his/her environment. This study aimed to investigate the psychometric properties of the General Self-Efficacy Scale-Turkish Form. The General Self-Efficacy Scale-Turkish Form was administered to 895 individuals ?18 years of age that had at least 5 years of education. Exploratory factor analysis, criterion validity testing (using the Beck Depression Scale, Spielberger Trait Anxiety Inventory, Locus of Control Scale, Learned Resourcefulness Scale, and Coopersmith Self Esteem Inventory), internal consistency analysis, and test-retest reliability analysis were performed. The 3-factor structure of the scale explained 41.5% of the observed variance. Correlations between the General Self-Efficacy Scale-Turkish Form and the other measures were statistically significant. The Cronbach's alpha coefficient for the entire scale was 0.80 and the test-retest reliability coefficient estimated from data for 236 individuals that were contacted for follow-up was 0.69. The General Self-Efficacy Scale-Turkish Form is a valid and reliable instrument for the assessment of general self-efficacy in individuals ?18 years of age with at least 5 years of education.

  8. Implementation of the Alarm Distress Baby Scale as a universal screening instrument in primary care: feasibility, acceptability, and predictors of professionals' adherence to guidelines.

    Science.gov (United States)

    Smith-Nielsen, Johanne; Lønfeldt, Nicole; Guedeney, Antoine; Væver, Mette Skovgaard

    2018-03-01

    Infant socioemotional development is often held under informal surveillance, but a formal screening program is needed to ensure systematic identification of developmental risk. Even when screening programs exist, they are often ineffective because health care professionals do not adhere to screening guidelines, resulting in low screening prevalence rates. To examine feasibility and acceptability of implementing universal screening for infant socioemotional problems with the Alarm Distress Baby Scale in primary care. The following questions were addressed: Is it possible to obtain acceptable screening prevalence rates within a 1-year period? How do the primary care workers (in this case, health visitors) experience using the instrument? Are attitudes toward using the instrument related to screening prevalence rates? A longitudinal mixed-method study (surveys, data from the health visitors' digital filing system, and qualitative coding of answers to open-ended questions) was undertaken. Health visitors in three of five districts of the City of Copenhagen, Denmark (N=79). We describe and evaluate the implementation process from the date the health visitors started the training on how to use the Alarm Distress Baby Scale to one year after they began using the instrument in practice. To monitor screening prevalence rates and adherence to guidelines, we used three data extractions (6, 9, and 12 months post-implementation) from the electronic filing system. Surveys including both quantitative and open-ended questions (pre- and post-implementation) were used to examine experiences with and attitudes towards the instrument. Descriptive and inferential statistical and qualitative content analyses were used. Screening prevalence rates increased during the first year: Six months after implementation 47% (n=405) of the children had been screened; 12 months after implementation 79% (n=789) of the children were screened (the same child was not counted more than once). Most (92

  9. The effectiveness of face to face education using catharsis education action (CEA) method in improving the adherence of private general practitioners to national guideline on management of tuberculosis in Bandung, Indonesia.

    Science.gov (United States)

    Arisanti, Nita

    2012-03-27

    In many countries, private general practitioners are the first contact in health services for people with symptoms of tuberculosis. Targeting the private sector has been recommended in previous studies to improve tuberculosis control. A brief face-to-face intervention using Catharsis Education Action (CEA) method, repeated at periodic intervals, seems to change physicians' attitudes, beliefs and practice.The objective of the study was to determine the effectiveness of CEA method in improving the private general practitioners' (PPs) adherence to the national guideline on the management of tuberculosis patients in Bandung District, Indonesia. A randomized controlled trial was done. For the intervention group, a session of the CEA method was delivered to PPs while brief reminder with provision of pamphlet was used for the comparative group. A total of 82 PPs were included in the analysis. The intervention group showed some positive trends in adherence especially in the use of sputum as first laboratory examination (RR = 1.24) and follow up (RR = 1.37), though not reaching statistical significance. After intervention PPs in CEA group maintained the adherence, but PPs in pamphlets group showed deterioration (score before to after: -12.5). Face to face education using CEA method seems to be as effective as brief reminder with provision of pamphlet in improving the adherence. CEA offers additional information that can be useful in designing intervention programs to improve the adherence to guideline.

  10. New parametrization for the scale dependent growth function in general relativity

    International Nuclear Information System (INIS)

    Dent, James B.; Dutta, Sourish; Perivolaropoulos, Leandros

    2009-01-01

    We study the scale-dependent evolution of the growth function δ(a,k) of cosmological perturbations in dark energy models based on general relativity. This scale dependence is more prominent on cosmological scales of 100h -1 Mpc or larger. We derive a new scale-dependent parametrization which generalizes the well-known Newtonian approximation result f 0 (a)≡(dlnδ 0 /dlna)=Ω(a) γ (γ=(6/11) for ΛCDM) which is a good approximation on scales less than 50h -1 Mpc. Our generalized parametrization is of the form f(a)=(f 0 (a)/1+ξ(a,k)), where ξ(a,k)=(3H 0 2 Ω 0m )/(ak 2 ). We demonstrate that this parametrization fits the exact result of a full general relativistic evaluation of the growth function up to horizon scales for both ΛCDM and dynamical dark energy. In contrast, the scale independent parametrization does not provide a good fit on scales beyond 5% of the horizon scale (k≅0.01h -1 Mpc).

  11. Classification of shoulder complaints in general practice by means of nonmetric multidimensional scaling

    NARCIS (Netherlands)

    Groenier, KH; Winters, JC; Meyboom-de Jong, B

    Objectives: To determine if a classification of shoulder complaints in general practice can be made from variables of medical history and physical examination with nonmetric multidimensional scaling and to investigate the reproducibility of results from an earlier hierarchical cluster analysis.

  12. New ISR and SPS collider multiplicity data and the Golokhvastov generalization of the KNO scaling

    International Nuclear Information System (INIS)

    Szwed, R.; Wrochna, G.

    1985-01-01

    The generalization of KNO scaling proposed by Golokhvastov (KNO-G scaling) is tested using pp multiplicity data, in particular results of the new high precision ISR measurements. Since the data obey KNO-G scaling over the full energy range √s=2.51-62.2 GeV with the scaling function psi(z), having only one free parameter, the superiority of the KNO-G over the standard approach is clearly demonstrated. The extrapolation within KNO-G scaling to the SPS Collider energy range and a comparison with the recent UA5 multiplicity results is presented. (orig.)

  13. Generalized Simplified Variable-Scaled Min Sum LDPC decoder for irregular LDPC Codes

    OpenAIRE

    Emran, Ahmed A.; Elsabrouty, Maha

    2015-01-01

    In this paper, we propose a novel low complexity scaling strategy of min-sum decoding algorithm for irregular LDPC codes. In the proposed method, we generalize our previously proposed simplified Variable Scaled Min-Sum (SVS-min-sum) by replacing the sub-optimal starting value and heuristic update for the scaling factor sequence by optimized values. Density evolution and Nelder-Mead optimization are used offline, prior to the decoding, to obtain the optimal starting point and per iteration upd...

  14. Generalized Huberman-Rudnick scaling law and robustness of q-Gaussian probability distributions

    Science.gov (United States)

    Afsar, Ozgur; Tirnakli, Ugur

    2013-01-01

    We generalize Huberman-Rudnick universal scaling law for all periodic windows of the logistic map and show the robustness of q-Gaussian probability distributions in the vicinity of chaos threshold. Our scaling relation is universal for the self-similar windows of the map which exhibit period-doubling subharmonic bifurcations. Using this generalized scaling argument, for all periodic windows, as chaos threshold is approached, a developing convergence to q-Gaussian is numerically obtained both in the central regions and tails of the probability distributions of sums of iterates.

  15. Feelings of indebtedness and guilt toward donor and immunosuppressive medication adherence among heart transplant (HTx) patients, as assessed in a cross-sectional study with the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS).

    Science.gov (United States)

    Shemesh, Yedida; Peles-Bortz, Anat; Peled, Yael; HarZahav, Yedael; Lavee, Jacob; Freimark, Dov; Melnikov, Semyon

    2017-10-01

    Nonadherence (NA) to immunosuppressive (IS) medications after organ transplant is a major risk factor for transplant failure, morbidity, and treatment costs. This study examined the association between feelings of indebtedness and guilt toward the donor, and IS medication adherence among HTx patients. In this cross-sectional, descriptive, correlational study, a convenience sample of 102 HTx patients, from the outpatient facility of a tertiary medical center in Israel, completed the BAASIS, a validated instrument for assessing adherence, and reported their feelings of indebtedness and guilt toward the donor. Missing a dose or skipping two or more doses, taking medication >2 hours before or after the recommended dosing time, altering the prescribed amount, or completely stopping the IS treatment in the last 4 weeks, characterized 64 patients (64%). The highest score received the item "timing nonadherence," characterizing 58 patients (56.9%). Age, waiting time, and time since transplant, guilt feelings, and indebtedness to donor explained 17% (R 2 =.17) of the variance in adherence (χ 2 (5) =13.22, P=.021), with age, time since transplant, and guilt feelings significantly explaining adherence. Physicians and nurses should inquire about the presence of guilt feelings, as they might be associated with NA to medications after HTx. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Applying the Collaborative Study Psychotherapy Rating Scale to Rate Therapist Adherence in Cognitive-Behavior Therapy, Interpersonal Therapy, and Clinical Management.

    Science.gov (United States)

    Hill, Clara E.; And Others

    1992-01-01

    Studied adherence of therapists to behaviors specified in cognitive-behavior therapy, interpersonal therapy, and clinical management manuals. Rated therapist adherence in each of 4 sessions from 180 patients in treatment phase of National Institute of Mental Health Treatment of Depression Collaborative Research Program. Therapists exhibited more…

  17. Social and structural barriers for adherence to methadone maintenance treatment among Vietnamese opioid dependence patients.

    Science.gov (United States)

    Tran, Bach Xuan; Nguyen, Long Hoang; Tran, Tung Thanh; Latkin, Carl A

    2018-01-01

    Methadone maintenance treatment (MMT) services may reduce the risk of HIV transmission if patients completely adhere to the treatment. Identifying adherence patterns and potential related factors is vital for the sustainability of MMT program in Vietnam. This study examined social and structural factors associated with adherence to MMT among patients in different service delivery models. A total of 510 patients at three MMT clinics in Hanoi were interviewed. Measures of self-reported adherence included the number of missed doses in the past 7 days and the level of adherence in the past 30 days using a visual analog scale (VAS) scoring from 0 (non-adherence) to 100 (perfect adherence). Multivariate regressions were employed to identify factors associated with non-adherence to MMT. A total of 17.7% of participants reported incomplete MMT adherence in the last 30 days and 8.3% reported missing a dose in the last seven days, respectively. Living with HIV/AIDS, poor self-care and usual activities, and disclosure of health issues to spouses or intimate partners were associated with non-adherence. Those patients with pain or depression were more likely to report better adherence. Disclosing health status to spouse/partner increased the risk of incomplete adherence, while disclosing to friends reduced the number of missed dose in the last seven days. Patients attending clinics with comprehensive services had a lower VAS score of adherence compared to those enrolling in clinics with only MMT and general health care. Sustaining the compliance of patients to MMT is principal in the rapid expansion of this service in Vietnam. It is necessary to address the complexity of health care demands of drug users, their difficulties to be rehabilitated into workforce and society, and the stigmatization to maximize the outcomes of MMT program.

  18. Rule-base Generalization Method on Large-Scale Topographic Map

    Science.gov (United States)

    Xiao, Z.; Yang, B.; Zhang, H.

    2014-04-01

    Map generalization is a procedure involving much intellective reasoning action, with very wide domain. It is also a difficult problem in the field of cartography in the world. This paper makes a study on the interactive and rulebased digital generalization, and a map generalization environment for large scale topographic map is designed and realized. A number of tests have proved that map generalization can be successfully and interactively done with the cooperation of human and computer if the procedures of map generalization are wisely decomposed. Compared with the traditional manual method, this map generalization can shorten the working time to 1/4 or even. Besides, the work will become less intensive with higher precision.

  19. A Measurement Invariance Analysis of the General Self-Efficacy Scale on Two Different Cultures

    Science.gov (United States)

    Teo, Timothy; Kam, Chester

    2014-01-01

    The 10-item General Self-Efficacy Scale (GSES) was developed to assess an individual's beliefs to cope with a variety of situations in life. Despite the GSES being used in numerous research from researchers in different countries and presented in different languages, little is known about the use of its validity in an Asian culture. The aim of the…

  20. ML-Estimation in the Location-Scale-Shape Model of the Generalized Logistic Distribution

    OpenAIRE

    Abberger, Klaus

    2002-01-01

    A three parameter (location, scale, shape) generalization of the logistic distribution is fitted to data. Local maximum likelihood estimators of the parameters are derived. Although the likelihood function is unbounded, the likelihood equations have a consistent root. ML-estimation combined with the ECM algorithm allows the distribution to be easily fitted to data.

  1. Multiple scales and singular limits for compressible rotating fluids with general initial data

    Czech Academy of Sciences Publication Activity Database

    Feireisl, Eduard; Novotný, A.

    2014-01-01

    Roč. 39, č. 6 (2014), s. 1104-1127 ISSN 0360-5302 Keywords : compressible Navier-Stokes equations * multiple scales * oscillatory integrals Subject RIV: BA - General Mathematics Impact factor: 1.013, year: 2014 http://www.tandfonline.com/doi/full/10.1080/03605302.2013.856917

  2. Structural validation of the Self-Compassion Scale with a German general population sample

    NARCIS (Netherlands)

    Coroiu, A.; Kwakkenbos, C.M.C.; Moran, C.; Thombs, B.D.; Albani, C.; Bourkas, S.; Zenger, M.; Brahler, E.; Körner, A.

    2018-01-01

    Background: Published validation studies have reported different factor structures for the Self-Compassion Scale (SCS). The objective of this study was to assess the factor structure of the SCS in a large general population sample representative of the German population. Methods: A German population

  3. An observational study of health literacy and medication adherence in adult kidney transplant recipients.

    Science.gov (United States)

    Demian, Maryam N; Shapiro, R Jean; Thornton, Wendy Loken

    2016-12-01

    There is a high prevalence of non-adherence to immunosuppressants in kidney transplant recipients. Although limited health literacy is common in kidney recipients and is linked to adverse outcomes in other medical populations, its effect on medication adherence in kidney transplant recipients remains poorly understood. The objective was to investigate the effect of lower health literacy on immunosuppressant adherence. Kidney recipients who were at least 6 months post-transplant and outpatients of Vancouver General Hospital in B.C., Canada were recruited through invitation letters. A total of 96 recipients completed the Health Literacy Questionnaire, which provides a multifactorial profile of self-reported health literacy and the Transplant Effects Questionnaire-Adherence subscale measuring self-reported immunosuppressant adherence. Hierarchical linear regression was used to analyze the association between health literacy and adherence after controlling for identified risk factors of non-adherence. Our sample was on average 53 years old, 56% male and 9 years post-transplant. Kidney recipients reported low levels of health literacy on scales measuring active health management and critical appraisal of information and 75% reported non-perfect adherence. Worse adherence was associated with poorer overall health literacy (Δ R 2 = 0.08, P = 0.004) and lower scores on six of nine of the health literacy factors. Poorer health literacy is associated with lower immunosuppressant adherence in adult kidney transplant recipients suggesting the importance of considering a recipient's level of health literacy in research and clinical contexts. Medication adherence interventions can target the six factors of health literacy identified as being risk factors for lower medication adherence.

  4. Progressive Amalgamation of Building Clusters for Map Generalization Based on Scaling Subgroups

    Directory of Open Access Journals (Sweden)

    Xianjin He

    2018-03-01

    Full Text Available Map generalization utilizes transformation operations to derive smaller-scale maps from larger-scale maps, and is a key procedure for the modelling and understanding of geographic space. Studies to date have largely applied a fixed tolerance to aggregate clustered buildings into a single object, resulting in the loss of details that meet cartographic constraints and may be of importance for users. This study aims to develop a method that amalgamates clustered buildings gradually without significant modification of geometry, while preserving the map details as much as possible under cartographic constraints. The amalgamation process consists of three key steps. First, individual buildings are grouped into distinct clusters by using the graph-based spatial clustering application with random forest (GSCARF method. Second, building clusters are decomposed into scaling subgroups according to homogeneity with regard to the mean distance of subgroups. Thus, hierarchies of building clusters can be derived based on scaling subgroups. Finally, an amalgamation operation is progressively performed from the bottom-level subgroups to the top-level subgroups using the maximum distance of each subgroup as the amalgamating tolerance instead of using a fixed tolerance. As a consequence of this step, generalized intermediate scaling results are available, which can form the multi-scale representation of buildings. The experimental results show that the proposed method can generate amalgams with correct details, statistical area balance and orthogonal shape while satisfying cartographic constraints (e.g., minimum distance and minimum area.

  5. Confirmation of general relativity on large scales from weak lensing and galaxy velocities.

    Science.gov (United States)

    Reyes, Reinabelle; Mandelbaum, Rachel; Seljak, Uros; Baldauf, Tobias; Gunn, James E; Lombriser, Lucas; Smith, Robert E

    2010-03-11

    Although general relativity underlies modern cosmology, its applicability on cosmological length scales has yet to be stringently tested. Such a test has recently been proposed, using a quantity, E(G), that combines measures of large-scale gravitational lensing, galaxy clustering and structure growth rate. The combination is insensitive to 'galaxy bias' (the difference between the clustering of visible galaxies and invisible dark matter) and is thus robust to the uncertainty in this parameter. Modified theories of gravity generally predict values of E(G) different from the general relativistic prediction because, in these theories, the 'gravitational slip' (the difference between the two potentials that describe perturbations in the gravitational metric) is non-zero, which leads to changes in the growth of structure and the strength of the gravitational lensing effect. Here we report that E(G) = 0.39 +/- 0.06 on length scales of tens of megaparsecs, in agreement with the general relativistic prediction of E(G) approximately 0.4. The measured value excludes a model within the tensor-vector-scalar gravity theory, which modifies both Newtonian and Einstein gravity. However, the relatively large uncertainty still permits models within f(R) theory, which is an extension of general relativity. A fivefold decrease in uncertainty is needed to rule out these models.

  6. The effects of psychological factors in sports medicine rehabilitation adherence.

    Science.gov (United States)

    Lampton, C C; Lambert, M E; Yost, R

    1993-09-01

    This study investigated the influence of achievement motivation and self-esteem on injury treatment adherence in a general sample of injured patients receiving treatment in a sports medicine clinic. Subjects consisted of both injured athletes and workers who had incurred an on-the-job injury. Based on scales of self-esteem and achievement motivation, patients were categorized as either high or low in self-esteem certainty, self-esteem level, tendency to be task-involved, and tendency to ego-involved in tasks. Treatment adherence was measured by number of missed appointments and by physical therapist ratings of effort and progress. It was found that patients low in self-esteem certainty and high in ego-involvement tended to miss the most treatment appointments. Contrary to previous findings, task-involvement was not found to be related to treatment adherence.

  7. Implementation of a Novel Adherence Monitoring Strategy in a Phase III, Blinded, Placebo-Controlled, HIV-1 Prevention Clinical Trial.

    Science.gov (United States)

    Husnik, Marla J; Brown, Elizabeth R; Marzinke, Mark; Livant, Edward; Palanee-Phillips, Thesla; Hendrix, Craig W; Matovu Kiweewa, Flavia; Nair, Gonasagrie; Soto-Torres, Lydia E; Schwartz, Katie; Hillier, Sharon L; Baeten, Jared M

    2017-11-01

    Placebo-controlled HIV-1 prevention trials of pre-exposure prophylaxis (PrEP) have not generally used concurrent measurement of adherence because of the potential risk of unblinding. However, several pre-exposure prophylaxis trials for HIV-1 prevention among women failed to show effectiveness because of low product adherence. Evaluation of product adherence objectively during a study provides the opportunity for strengthening adherence activities at sites having low adherence. During MTN-020/ASPIRE, a phase III, placebo-controlled trial of the dapivirine intravaginal ring, we implemented an adherence monitoring system. Monitoring began in quarter 1 (Q1) 2013 and continued through the conclusion of the trial. Blood plasma was collected quarterly and tested for dapivirine concentrations while maintaining blinding among study team members involved in participant management. Dapivirine concentrations >95 pg/mL, reflecting >8 hours of continuous use, were assessed as signaling product use. Study leadership monitored results on a monthly basis and provided feedback to site investigators. Experiences were shared across sites to motivate staff and counsel participants to strive toward higher adherence levels. An upward trend in adherence was observed (P 95 pg/mL increased from 63% in Q1 2013 to 84% by Q1 2015. Ongoing drug level testing as a marker of adherence in MTN-020/ASPIRE demonstrates the feasibility of real-time adherence monitoring while maintaining study blinding at the level of participants, sites, and study leadership. This approach is novel for large-scale effectiveness studies for HIV-1 prevention.

  8. Scaling Limit for a Generalization of the Nelson Model and its Application to Nuclear Physics

    Science.gov (United States)

    Suzuki, Akito

    We study a mathematically rigorous derivation of a quantum mechanical Hamiltonian in a general framework. We derive such a Hamiltonian by taking a scaling limit for a generalization of the Nelson model, which is an abstract interaction model between particles and a Bose field with some internal degrees of freedom. Applying it to a model for the field of the nuclear force with isospins, we obtain a Schrödinger Hamiltonian with a matrix-valued potential, the one pion exchange potential, describing an effective interaction between nucleons.

  9. The minimal N=4 no-scale model from generalized dimensional reduction

    CERN Document Server

    Villadoro, Giovanni; Villadoro, Giovanni; Zwirner, Fabio

    2004-01-01

    We consider the generalized dimensional reduction of pure ungauged N=4, D=5 supergravity, where supersymmetry is spontaneously broken to N=2 or N=0 with identically vanishing scalar potential. We explicitly construct the resulting gauged D=4 theory coupled to a single vector multiplet, which provides the minimal N=4 realization of a no-scale model. We discuss its relation with the standard classification of N=4 gaugings, extensions to non-compact twists and to higher dimensions, the N=2 theories obtained via consistent Z_2 orbifold projections and prospects for further generalizations.

  10. The minimal N = 4 no-scale model from generalized dimensional reduction

    Science.gov (United States)

    Villadoro, Giovanni; Zwirner, Fabio

    2004-07-01

    We consider the generalized dimensional reduction of pure ungauged Script N = 4, D = 5 supergravity, where supersymmetry is spontaneously broken to Script N = 2 or Script N = 0 with identically vanishing scalar potential. We explicitly construct the resulting gauged D = 4 theory coupled to a single vector multiplet, which provides the minimal Script N = 4 realization of a no-scale model. We discuss its relation with the standard classification of Script N = 4 gaugings, extensions to non-compact twists and to higher dimensions, the Script N = 2 theories obtained via consistent Script Z2 orbifold projections and prospects for further generalizations.

  11. A general scaling law reveals why the largest animals are not the fastest.

    Science.gov (United States)

    Hirt, Myriam R; Jetz, Walter; Rall, Björn C; Brose, Ulrich

    2017-08-01

    Speed is the fundamental constraint on animal movement, yet there is no general consensus on the determinants of maximum speed itself. Here, we provide a general scaling model of maximum speed with body mass, which holds across locomotion modes, ecosystem types and taxonomic groups. In contrast to traditional power-law scaling, we predict a hump-shaped relationship resulting from a finite acceleration time for animals, which explains why the largest animals are not the fastest. This model is strongly supported by extensive empirical data (474 species, with body masses ranging from 30 μg to 100 tonnes) from terrestrial as well as aquatic ecosystems. Our approach unravels a fundamental constraint on the upper limit of animal movement, thus enabling a better understanding of realized movement patterns in nature and their multifold ecological consequences.

  12. Measuring and Validating a General Cancer Predisposition Perception Scale: An Adaptation of the Revised-IPQ-Genetic Predisposition Scale.

    Directory of Open Access Journals (Sweden)

    Wendy Wing Tak Lam

    Full Text Available Illness perceptions are linked to individual help-seeking and preventive behaviors. Previous illness perception studies have identified five dimensions of illness-related experience and behaviour. The Revised Illness Perception Questionnaire (IPQ-R for genetic predisposition (IPQ-R-GP was developed to measure illness perceptions in those genetically-predisposed to blood disease. We adapted the IPQ-R-GP to measure perceptions of generalized cancer predisposition. This paper describes the development and validation of the Cancer Predisposition Perception Scale (CPPS.The draft CPPS scale was first administered to 167 well Hepatitis B carriers and 123 other healthy individuals and the factor structure was examined using Exploratory Factor Analysis. Then the factor structure was confirmed in a second sample comprising 148 healthy controls, 150 smokers and 152 passive smokers using Confirmatory Factor Analysis (CFA.Six-factors comprising 26 items provided optimal fit by eigen and scree-plot methods, accounting for 58.9% of the total variance. CFA indicated good fit of the six-factor model after further excluding three items. The six factors, Emotional representation (5 items, Illness coherence (4 items, Treatment control (3 items, Consequences (5 items, Internal locus of control (2 items and External locus of control (4 items demonstrated adequate-to-good subscale internal consistency (Cronbach's α = 0.63-0.90. Divergent validity was suggested by low correlations with optimism, self-efficacy, and scales for measuring physical and psychological health symptoms.The CPPS appears to be a valid measure of perceived predisposition to generic cancer risks and can be used to examine cancer-risk-related cognitions in individuals at higher and lower cancer risk.

  13. Measuring and Validating a General Cancer Predisposition Perception Scale: An Adaptation of the Revised-IPQ-Genetic Predisposition Scale.

    Science.gov (United States)

    Lam, Wendy Wing Tak; Liao, Qiuyan; Wong, Jennifer Hiu Fai; Lai, Ching Lung; Yuen, Man Fung; Tsang, Janice Wing Hang; Fielding, Richard

    2015-01-01

    Illness perceptions are linked to individual help-seeking and preventive behaviors. Previous illness perception studies have identified five dimensions of illness-related experience and behaviour. The Revised Illness Perception Questionnaire (IPQ-R) for genetic predisposition (IPQ-R-GP) was developed to measure illness perceptions in those genetically-predisposed to blood disease. We adapted the IPQ-R-GP to measure perceptions of generalized cancer predisposition. This paper describes the development and validation of the Cancer Predisposition Perception Scale (CPPS). The draft CPPS scale was first administered to 167 well Hepatitis B carriers and 123 other healthy individuals and the factor structure was examined using Exploratory Factor Analysis. Then the factor structure was confirmed in a second sample comprising 148 healthy controls, 150 smokers and 152 passive smokers using Confirmatory Factor Analysis (CFA). Six-factors comprising 26 items provided optimal fit by eigen and scree-plot methods, accounting for 58.9% of the total variance. CFA indicated good fit of the six-factor model after further excluding three items. The six factors, Emotional representation (5 items), Illness coherence (4 items), Treatment control (3 items), Consequences (5 items), Internal locus of control (2 items) and External locus of control (4 items) demonstrated adequate-to-good subscale internal consistency (Cronbach's α = 0.63-0.90). Divergent validity was suggested by low correlations with optimism, self-efficacy, and scales for measuring physical and psychological health symptoms. The CPPS appears to be a valid measure of perceived predisposition to generic cancer risks and can be used to examine cancer-risk-related cognitions in individuals at higher and lower cancer risk.

  14. A general model for metabolic scaling in self-similar asymmetric networks.

    Directory of Open Access Journals (Sweden)

    Alexander Byers Brummer

    2017-03-01

    Full Text Available How a particular attribute of an organism changes or scales with its body size is known as an allometry. Biological allometries, such as metabolic scaling, have been hypothesized to result from selection to maximize how vascular networks fill space yet minimize internal transport distances and resistances. The West, Brown, Enquist (WBE model argues that these two principles (space-filling and energy minimization are (i general principles underlying the evolution of the diversity of biological networks across plants and animals and (ii can be used to predict how the resulting geometry of biological networks then governs their allometric scaling. Perhaps the most central biological allometry is how metabolic rate scales with body size. A core assumption of the WBE model is that networks are symmetric with respect to their geometric properties. That is, any two given branches within the same generation in the network are assumed to have identical lengths and radii. However, biological networks are rarely if ever symmetric. An open question is: Does incorporating asymmetric branching change or influence the predictions of the WBE model? We derive a general network model that relaxes the symmetric assumption and define two classes of asymmetrically bifurcating networks. We show that asymmetric branching can be incorporated into the WBE model. This asymmetric version of the WBE model results in several theoretical predictions for the structure, physiology, and metabolism of organisms, specifically in the case for the cardiovascular system. We show how network asymmetry can now be incorporated in the many allometric scaling relationships via total network volume. Most importantly, we show that the 3/4 metabolic scaling exponent from Kleiber's Law can still be attained within many asymmetric networks.

  15. Explaining adherence success in sub-Saharan Africa: an ethnographic study.

    Directory of Open Access Journals (Sweden)

    Norma C Ware

    2009-01-01

    Full Text Available Individuals living with HIV/AIDS in sub-Saharan Africa generally take more than 90% of prescribed doses of antiretroviral therapy (ART. This number exceeds the levels of adherence observed in North America and dispels early scale-up concerns that adherence would be inadequate in settings of extreme poverty. This paper offers an explanation and theoretical model of ART adherence success based on the results of an ethnographic study in three sub-Saharan African countries.Determinants of ART adherence for HIV-infected persons in sub-Saharan Africa were examined with ethnographic research methods. 414 in-person interviews were carried out with 252 persons taking ART, their treatment partners, and health care professionals at HIV treatment sites in Jos, Nigeria; Dar es Salaam, Tanzania; and Mbarara, Uganda. 136 field observations of clinic activities were also conducted. Data were examined using category construction and interpretive approaches to analysis. Findings indicate that individuals taking ART routinely overcome economic obstacles to ART adherence through a number of deliberate strategies aimed at prioritizing adherence: borrowing and "begging" transport funds, making "impossible choices" to allocate resources in favor of treatment, and "doing without." Prioritization of adherence is accomplished through resources and help made available by treatment partners, other family members and friends, and health care providers. Helpers expect adherence and make their expectations known, creating a responsibility on the part of patients to adhere. Patients adhere to promote good will on the part of helpers, thereby ensuring help will be available when future needs arise.Adherence success in sub-Saharan Africa can be explained as a means of fulfilling social responsibilities and thus preserving social capital in essential relationships.

  16. Validation of a functional remission threshold for the Functional Remission of General Schizophrenia (FROGS) scale.

    Science.gov (United States)

    Boyer, Laurent; Richieri, Raphaëlle; Guedj, Eric; Faget-Agius, Catherine; Loundou, Anderson; Llorca, Pierre-Michel; Auquier, Pascal; Lançon, Christophe

    2013-10-01

    The aim of this study was to develop a functional remission threshold for the Functional Remission Of General Schizophrenia (FROGS) scale, and test its validity regarding clinical and quality of life outcomes. Cross-sectional study. Schizophrenia according to DSM-IV-TR criteria. Functioning was assessed using the FROGS and the Global Assessment of Functioning (GAF) scales; psychotic symptoms using the Positive and Negative Syndrome Scale; memory, attention, and executive functions were assessed using the California Verbal Learning Test, the D2 attention task, the Stroop color-word test, the verbal fluency test, the Trail Making Test A and B and the Wechsler Adult Intelligence Scale; and quality of life using the schizophrenia quality of life (S-QoL 18) scale. A logistic regression analysis including the different dimensions of the FROGS was used to create a composite score to classify patients into remitted and non-remitted according a gold standard (cut-off: GAF>= 61). Receiver operating characteristics analyses were then performed to determine the area under the curve (AUC). Of 137 patients enrolled, 26 were functionally remitted and 111 were not remitted according to GAF score. The AUC for the combination of the FROGS's dimensions to detect functional remission was 0.903 (pspecificity for the combination of the FROGS dimensions using the Youden index were 88.5 [69.8; 97.6] and 81.1 [72.5; 87.9], respectively. Validity of this combination was satisfactory. Patients in functional remission had a lower severity of the disease, especially for PANSS negative (p<0.001) and general psychopathology (p<0.001) symptoms. Only two cognitive functions (i.e. fluency and episodic memory) were improved in remitted patients. Higher quality of life levels were globally associated with better functioning. These findings provide for first accurate FROGS thresholds to detect functional remission in schizophrenia. Copyright © 2013 Elsevier Inc. All rights reserved.

  17. Influence of intention to adhere, beliefs and satisfaction about medicines on adherence in solid organ transplant recipients.

    Science.gov (United States)

    Hugon, Amélie; Roustit, Matthieu; Lehmann, Audrey; Saint-Raymond, Christel; Borrel, Elisabeth; Hilleret, Marie-Noëlle; Malvezzi, Paolo; Bedouch, Pierrick; Pansu, Pascal; Allenet, Benoît

    2014-07-27

    Nonadherence to immunosuppressive (IS) therapy is associated with poor outcomes. Identifying factors predicting poor adherence is therefore essential. The primary objective of this study was to test whether parameters of a model adapted from the theory of planned behavior, and more specifically attitudes that are influenced by beliefs and satisfaction with medication, could predict adherence in solid organ transplant patients. Adherence was assessed with a self-reported medication adherence scale and IS blood trough concentrations over 6 months, in four transplant units. Satisfaction and beliefs were assessed using the Treatment Satisfaction with Medicines Questionnaire (SATMED-Q) and Beliefs about Medicines Questionnaire (BMQ), respectively. Theory of planned behavior was assessed with a specific questionnaire exploring intentions, subjective norms, attitudes and perceived behavioral control. Treatment characteristics and socioeconomic data were also collected. One hundred and fifty-three solid organ transplant patients were enrolled, including lung (n=33), heart (n=43), liver (n=42), and kidney (n=44) patients. Satisfaction and positive beliefs about medication were higher in adherent than those in nonadherent patients. Factors independently associated with an increased risk of nonadherence were negative general beliefs about medications (odds ratio [OR]=0.89 [0.83-0.97]), living alone (OR=2.78 [1.09-7.09]), heart transplantation (OR=3.49 [1.34-9.09]), and being on everolimus (OR=5.02 [1.21-20.8]). Negative beliefs toward medications were shown to be an independent risk factor of poor adherence. Therefore, the BMQ could be an effective, easy to implement tool, for use in everyday practice, to identify patients needing interventions to improve adherence to IS.

  18. Hospital Anxiety and Depression Scale (HADS: validation in a Greek general hospital sample

    Directory of Open Access Journals (Sweden)

    Patapis Paulos

    2008-03-01

    Full Text Available Abstract Background The Hospital Anxiety and Depression Scale (HADS has been used in several languages to assess anxiety and depression in general hospital patients with good results. Methods The HADS was administered to 521 participants (275 controls and 246 inpatients and outpatients of the Internal Medicine and Surgical Departments in 'Attikon' General Hospital in Athens. The Beck Depression Inventory (BDI and the State-Trait Anxiety Inventory (STAI were used as 'gold standards' for depression and anxiety respectively. Results The HADS presented high internal consistency; Cronbach's α cofficient was 0.884 (0.829 for anxiety and 0.840 for depression and stability (test-retest intraclass correlation coefficient 0.944. Factor analysis showed a two-factor structure. The HADS showed high concurrent validity; the correlations of the scale and its subscales with the BDI and the STAI were high (0.722 – 0.749. Conclusion The Greek version of HADS showed good psychometric properties and could serve as a useful tool for clinicians to assess anxiety and depression in general hospital patients.

  19. Moment problem quantization within a generalized scalet-Wigner (auto-scaling) transform representation

    CERN Document Server

    Handy, C R; Okbagabir, S; Yarahmad, T

    2003-01-01

    For one-dimensional Schroedinger quantum systems, the correlation expression S(x, tau, a) ident to PSI*(x - tau/2/a)PSI(x + tau/2) satisfies a fourth-order linear differential equation with regard to x. This generalizes the result previously derived by Handy (2001 J. Phys. A: Math. Gen. 34 L271), and Handy and Wang (2001 J. Phys. A: Math. Gen. 34 8297), with regard to S(x, 0, 1). We are then able to incorporate this within a generalized Wigner transform representation, through the use of scalets (Handy C R and Brooks H A 2001 J. Phys. A: Math. Gen. 34 3577). Energy quantization is achieved through a moment problem positivity analysis (focusing on the moments of the probability density, vertical bar PSI vertical bar sup 2) at a=1, tau=0. The wavefunction, PSI, is then generated through a multiscale analysis proceeding from the unity scale, extended into the zero scale limit. The power moments, mu sub p =integral dx x sup p PSI(x), can be generated through a similar procedure. We present the general formalism a...

  20. The little things that run: a general scaling of invertebrate exploratory speed with body mass.

    Science.gov (United States)

    Hirt, Myriam R; Lauermann, Tobias; Brose, Ulrich; Noldus, Lucas P J J; Dell, Anthony I

    2017-11-01

    Speed is a key trait of animal movement, and while much is already known about vertebrate speed and how it scales with body mass, studies on invertebrates are sparse, especially across diverse taxonomic groups. Here, we used automated image-based tracking to characterize the exploratory (voluntary) speed of 173 invertebrates comprising 57 species across six taxonomic groups (Arachnida, Chilopoda, Diplopoda, Entognatha, Insecta, Malacostraca) and four feeding types (carnivore, detritivore, herbivore, omnivore). Across all individuals, exploratory speed (mm/s) scaled with body mass (g) following a power-law relationship with a scaling exponent of 0.19 ± 0.04 (mean ± SE) and an intercept of 14.33 ± 1.2. These parameters varied substantially with taxonomic group and feeding type. For the first time, we provide general empirically derived allometric scaling relationships of exploratory speed across broad taxonomic groups of invertebrates. As exploratory speed drives key components of species interactions, such as encounter and attack rates, or competition, our study contributes to a deeper understanding of the role of individual movement in population and community level processes. © 2017 by the Ecological Society of America.

  1. Monitoring improvement using a patient-rated depression scale during treatment with anti-depressants in general practice. A validation study on the Goldberg Depression Scale.

    Science.gov (United States)

    Holm, J; Holm, L; Bech, P

    2001-12-01

    To perform a pilot study on the value of the Goldberg Depression Scale as an instrument for monitoring improvement in depressed patients treated with anti-depressants in general practice. A comparative study using simultaneous ratings on the observer-based 17-item Hamilton Depression Scale and the patient-rated Goldberg Depression Scale. General practice. Twenty-one patients meeting the ICD-10 criteria of a moderate depressive episode were assessed at the time of inclusion and through three follow-up visits. Scores on the Goldberg Depression Scale compared to the Hamilton Depression Scale. An acceptable internal and external validity of the Goldberg Depression Scale was demonstrated. The Loevinger coefficient varied from 0.25 at the time of diagnosis to 0.57, 0.65 and 0.69 by visits two, three and four. Factor analysis identified only one general factor explaining 50% or more of the variants, except at visit 1. When the Goldberg Depression Scale was correlated to the Hamilton Depression Scales, a coefficient of 0.74 was obtained (p Depression Scale is suitable for monitoring improvement in depressed patients treated in general practice. Further studies are recommended.

  2. A generalized 2D pencil beam scaling algorithm for proton dose calculation in heterogeneous slab geometries.

    Science.gov (United States)

    Westerly, David C; Mo, Xiaohu; Tomé, Wolfgang A; Mackie, Thomas R; DeLuca, Paul M

    2013-06-01

    Pencil beam algorithms are commonly used for proton therapy dose calculations. Szymanowski and Oelfke ["Two-dimensional pencil beam scaling: An improved proton dose algorithm for heterogeneous media," Phys. Med. Biol. 47, 3313-3330 (2002)] developed a two-dimensional (2D) scaling algorithm which accurately models the radial pencil beam width as a function of depth in heterogeneous slab geometries using a scaled expression for the radial kernel width in water as a function of depth and kinetic energy. However, an assumption made in the derivation of the technique limits its range of validity to cases where the input expression for the radial kernel width in water is derived from a local scattering power model. The goal of this work is to derive a generalized form of 2D pencil beam scaling that is independent of the scattering power model and appropriate for use with any expression for the radial kernel width in water as a function of depth. Using Fermi-Eyges transport theory, the authors derive an expression for the radial pencil beam width in heterogeneous slab geometries which is independent of the proton scattering power and related quantities. The authors then perform test calculations in homogeneous and heterogeneous slab phantoms using both the original 2D scaling model and the new model with expressions for the radial kernel width in water computed from both local and nonlocal scattering power models, as well as a nonlocal parameterization of Molière scattering theory. In addition to kernel width calculations, dose calculations are also performed for a narrow Gaussian proton beam. Pencil beam width calculations indicate that both 2D scaling formalisms perform well when the radial kernel width in water is derived from a local scattering power model. Computing the radial kernel width from a nonlocal scattering model results in the local 2D scaling formula under-predicting the pencil beam width by as much as 1.4 mm (21%) at the depth of the Bragg peak for a 220

  3. Development of a large-scale general purpose two-phase flow analysis code

    International Nuclear Information System (INIS)

    Terasaka, Haruo; Shimizu, Sensuke

    2001-01-01

    A general purpose three-dimensional two-phase flow analysis code has been developed for solving large-scale problems in industrial fields. The code uses a two-fluid model to describe the conservation equations for two-phase flow in order to be applicable to various phenomena. Complicated geometrical conditions are modeled by FAVOR method in structured grid systems, and the discretization equations are solved by a modified SIMPLEST scheme. To reduce computing time a matrix solver for the pressure correction equation is parallelized with OpenMP. Results of numerical examples show that the accurate solutions can be obtained efficiently and stably. (author)

  4. Determining the minimal length scale of the generalized uncertainty principle from the entropy-area relationship

    International Nuclear Information System (INIS)

    Kim, Wontae; Oh, John J.

    2008-01-01

    We derive the formula of the black hole entropy with a minimal length of the Planck size by counting quantum modes of scalar fields in the vicinity of the black hole horizon, taking into account the generalized uncertainty principle (GUP). This formula is applied to some intriguing examples of black holes - the Schwarzschild black hole, the Reissner-Nordstrom black hole, and the magnetically charged dilatonic black hole. As a result, it is shown that the GUP parameter can be determined by imposing the black hole entropy-area relationship, which has a Planck length scale and a universal form within the near-horizon expansion

  5. Childhood bullying and healthcare adherence in adulthood.

    Science.gov (United States)

    Sansone, Randy A; Bohinc, R Jordan; Wiederman, Michael W

    2015-12-01

    The relationship between childhood bullying and healthcare adherence in adulthood has been rarely studied, but one published study suggests that being bullied in childhood is related to lower healthcare adherence among adolescents. This previous study examined few adherence variables and was limited to youths. In this study, we assessed five variables for childhood bullying as related to seven measures of healthcare adherence among a cohort of adult primary care outpatients. Using a cross-sectional, self-report survey methodology in a sample of 263 consecutive internal medicine outpatients, we examined five aspects of bullying and seven aspects of adherence with general healthcare. Being a victim of bullying, type of bullying (emotional, physical), number of years bullied and number of bullies each evidenced no statistical relationships with healthcare adherence. However, being a bully demonstrated several statistical relationships with healthcare adherence, indicating less adherence to instructions provided by healthcare professionals. Despite all of the deleterious psychological and physical effects of being bullied in childhood, there was no evidence that non-adherence with healthcare in adulthood is one of them. In contrast, bullies evidenced several areas of reduced healthcare adherence. © The Author(s) 2015.

  6. Planimetric Features Generalization for the Production of Small-Scale Map by Using Base Maps and the Existing Algorithms

    Directory of Open Access Journals (Sweden)

    M. Modiri

    2014-10-01

    Full Text Available Cartographic maps are representations of the Earth upon a flat surface in the smaller scale than it’s true. Large scale maps cover relatively small regions in great detail and small scale maps cover large regions such as nations, continents and the whole globe. Logical connection between the features and scale map must be maintained by changing the scale and it is important to recognize that even the most accurate maps sacrifice a certain amount of accuracy in scale to deliver a greater visual usefulness to its user. Cartographic generalization, or map generalization, is the method whereby information is selected and represented on a map in a way that adapts to the scale of the display medium of the map, not necessarily preserving all intricate geographical or other cartographic details. Due to the problems facing small-scale map production process and the need to spend time and money for surveying, today’s generalization is used as executive approach. The software is proposed in this paper that converted various data and information to certain Data Model. This software can produce generalization map according to base map using the existing algorithm. Planimetric generalization algorithms and roles are described in this article. Finally small-scale maps with 1:100,000, 1:250,000 and 1:500,000 scale are produced automatically and they are shown at the end.

  7. A generalized scaling law for the ignition energy of inertial confinement fusion capsules

    International Nuclear Information System (INIS)

    Herrmann, M.C.

    2001-01-01

    The minimum energy needed to ignite an inertial confinement fusion capsule is of considerable interest in the optimization of an inertial fusion driver. Recent computational work investigating this minimum energy has found that it depends on the capsule implosion history, in particular, on the capsule drive pressure. This dependence is examined using a series of LASNEX simulations to find ignited capsules which have different values of the implosion velocity, fuel adiabat and drive pressure. It is found that the main effect of varying the drive pressure is to alter the stagnation of the capsule, changing its stagnation adiabat, which, in turn, affects the energy required for ignition. To account for this effect a generalized scaling law has been devised for the ignition energy, E ign ∝α if 1.88±0.05 υ -5.89±0.12 P -0.77±0.03 . This generalized scaling law agrees with the results of previous work in the appropriate limits. (author)

  8. Confirmatory factor analysis of the generalized self-efficacy scale in Brazil and Portugal.

    Science.gov (United States)

    Leme, Vanessa B R; Coimbra, Susana; Gato, Jorge; Fontaine, Anne Marie; Del Prette, Zilda A P

    2013-01-01

    This study aims to evaluate the construct validity, internal consistency and cross-cultural invariance of the Generalized Self-Efficacy Scale-Portuguese version (GSE) in a Brazilian and Portuguese sample. The GSE is composed of 10 items, designed to parsimoniously and comprehensively assess self-efficacy beliefs to deal with a wide range of stress-inducing situations. The construct validity (factorial, convergent and discriminant) and internal consistency of the instrument were established within a sample of 304 Portuguese adolescents (study 1) and a sample of 477 Brazilian adolescents (study 2). Then, the invariance of the GSE was tested in a sample of Brazilian adolescents (study 3), using Multigroup Confirmatory Factor Analysis (MGCFA). In the first two studies, the construct validity of the GSE was demonstrated in its three components and the reliability of the scales was confirmed based on satisfactory levels of internal consistency. In the third study, the cross-cultural invariance of the instrument was established. This work adds to previous research on generalized self-efficacy instruments, with good psychometric qualities. Moreover, comparisons can now be made with confidence using this instrument among adolescent samples from Portugal and Brazil.

  9. Development of a Corrosion Potential Measuring System Based on the Generalization of DACS Physical Scale Modeling

    Directory of Open Access Journals (Sweden)

    Song Dalei

    2015-01-01

    Full Text Available A feasible method in evaluating the protection effect and corrosion state of marine cathodic protection (CP systems is collecting sufficient electric potential data around a submarine pipeline and then establishing the mapping relations between these data and corrosion states of pipelines. However, it is difficult for scientists and researchers to obtain those data accurately due to the harsh marine environments and absence of dedicated potential measurement device. In this paper, to alleviate these two problems, firstly, the theory of dimension and conductivity scaling (DACS physical scale modeling of marine impressed current cathodic protection (ICCP systems is generalized to marine CP systems, secondly, a potential measurement device is developed specially and analogue experiment is designed according to DACS physical scale modeling to verify the feasibility of the measuring system. The experimental results show that 92 percent of the measurement errors are less than 0.25mv, thereby providing an economical and feasible measuring system to get electric potential data around an actual submarine pipeline under CP.

  10. A General Framework for Multivariate Analysis with Optimal Scaling: The R Package aspect

    Directory of Open Access Journals (Sweden)

    Patrick Mair

    2009-11-01

    Full Text Available In a series of papers De Leeuw developed a general framework for multivariate analysis with optimal scaling. The basic idea of optimal scaling is to transform the observed variables (categories in terms of quantifications. In the approach presented here the multivariate data are collected into a multivariable. An aspect of a multivariable is a function that is used to measure how well the multivariable satisfies some criterion. Basically we can think of two different families of aspects which unify many well-known multivariate methods: Correlational aspects based on sums of correlations, eigenvalues and determinants which unify multiple regression, path analysis, correspondence analysis, nonlinear PCA, etc. Non-correlational aspects which linearize bivariate regressions and can be used for SEM preprocessing with categorical data. Additionally, other aspects can be established that do not correspond to classical techniques at all. By means of the R package aspect we provide a unified majorization-based implementation of this methodology. Using various data examples we will show the flexibility of this approach and how the optimally scaled results can be represented using graphical tools provided by the package.

  11. Development of the General Parenting Observational Scale to assess parenting during family meals.

    Science.gov (United States)

    Rhee, Kyung E; Dickstein, Susan; Jelalian, Elissa; Boutelle, Kerri; Seifer, Ronald; Wing, Rena

    2015-04-10

    There is growing interest in the relationship between general parenting and childhood obesity. However, assessing general parenting via surveys can be difficult due to issues with self-report and differences in the underlying constructs being measured. As a result, different aspects of parenting have been associated with obesity risk. We developed a more objective tool to assess general parenting by using observational methods during a mealtime interaction. The General Parenting Observational Scale (GPOS) was based on prior work of Baumrind, Maccoby and Martin, Barber, and Slater and Power. Ten dimensions of parenting were included; 4 were classified in the emotional dimension of parenting (warmth and affection, support and sensitivity, negative affect, detachment), and 6 were classified in the behavioral dimension of parenting (firm discipline and structure, demands for maturity, psychological control, physical control, permissiveness, neglect). Overweight children age 8-12 years old and their parent (n = 44 dyads) entering a weight control program were videotaped eating a family meal. Parents were coded for their general parenting behaviors. The Mealtime Family Interaction Coding System (MICS) and several self-report measures of general parenting were also used to assess the parent-child interaction. Spearman's correlations were used to assess correlation between measures. The emotional dimensions of warmth/affection and support/sensitivity, and the behavioral dimension of firm discipline/structure were robustly captured during the family meals. Warmth/affection and support/sensitivity were significantly correlated with affect management, interpersonal involvement, and communication from the MICS. Firm discipline/structure was inversely correlated with affect management, behavior control, and task accomplishment. Parents who were older, with higher educational status, and lower BMIs were more likely to display warmth/affection and support/sensitivity. Several

  12. Understanding the Effect of Statins and Patient Adherence in Atherosclerosis via a Quantitative Systems Pharmacology Model Using a Novel, Hybrid, and Multi-Scale Approach

    Directory of Open Access Journals (Sweden)

    Cesar Pichardo-Almarza

    2017-09-01

    Full Text Available Background and Objective: Statins are one of the most prescribed drugs to treat atherosclerosis. They inhibit the hepatic HMG-CoA reductase, causing a reduction of circulating cholesterol and LDL levels. Statins have had undeniable success; however, the benefits of statin therapy crystallize only if patients adhere to the prescribed treatment, which is far away from reality since adherence decreases with time with around half of patients discontinue statin therapy within the first year. The objective of this work is to; firstly, demonstrate a formal in-silico methodology based on a hybrid, multiscale mathematical model used to study the effect of statin treatment on atherosclerosis under different patient scenarios, including cases where the influence of medication adherence is examined and secondly, to propose a flexible simulation framework that allows extensions or simplifications, allowing the possibility to design other complex simulation strategies, both interesting features for software development.Methods: Different mathematical modeling paradigms are used to present the relevant dynamic behavior observed in biological/physiological data and clinical trials. A combination of continuous and discrete event models are coupled to simulate the pharmacokinetics (PK of statins, their pharmacodynamic (PD effect on lipoproteins levels (e.g., LDL and relevant inflammatory pathways whilst simultaneously studying the dynamic effect of flow-related variables on atherosclerosis progression.Results: Different scenarios were tested showing the impact of: (1 patient variability: a virtual population shows differences in plaque growth for different individuals could be as high as 100%; (2 statin effect on atherosclerosis: it is shown how a patient with a 1-year statin treatment will reduce his plaque growth by 2–3% in a 2-year period; (3 medical adherence: we show that a patient missing 10% of the total number of doses could increase the plaque growth

  13. Patterns and obstacles to oral antidiabetic medications adherence ...

    African Journals Online (AJOL)

    Data concerning adherence to drugs was assessed using measure treatment adherence scale (MTA). Results: a total of 372 (55.59 % males and 44.41% females) patients with type-2 diabetes fulfilled the inclusion criteria and included in the study. Among the participants, 26.1% were found to have good adherence, 47.9% ...

  14. Self-efficacy beliefs, locus of control, religiosity and non-adherence to immunosuppressive medications in kidney transplant patients.

    Science.gov (United States)

    Silva, Andresa Nascimento; Moratelli, Lucas; Tavares, Paula Liziero; Marsicano, Elisa De Oliveira; Pinhati, Renata Romanholi; Colugnati, Fernando Antonio Basile; Lucchetti, Giancarlo; Sanders-Pinheiro, Helady

    2016-11-01

    Adherence to immunosuppressive medication is essential for favourable kidney transplant outcomes. The present study aims to investigate how self-efficacy beliefs, health locus of control and religiosity are associated with adherence to immunosuppressives in post kidney transplant recipients. This is a cross-sectional study with 88 recipients with more than 1 year after transplantation. Three methods were used to classify patients as adherent or non-adherent: Basel Assessment of Adherence Scale for Immunosuppressives - BAASIS, the collateral report and blood levels of immunosuppressive medications. Self-efficacy, health locus of control, and religiosity were evaluated applying General Perceived Self-Efficacy Scale, Multidimensional Health Locus of Control Scale and Duke University Religion Index, respectively. Non-adherence was modelled by uni- and multivariated analysis. Sixty-three percent of the patients were male, age 47.2 ± 12.9 years, and median post-transplant time 108.71 (49.0-266.0) months. We found 70.5% of patients were non-adherent through at least one method. Adherent patients presented higher self-efficacy scores (45.1 ± 4.9 vs 38.3 ± 8.6; P locus of control (OR 1.23, IC 1.04-1.45, P = 0.016) and lower intrinsic religiosity (OR 0.56, IC 0.38-0.84, P = 0.006). Our study showed that self-efficacy, chance locus of control, and intrinsic religiosity were associated with non-adherence to immunosuppressives. A broader perception of the kidney transplant patient´s integrality can help health professionals to design strategies to promote adherence in this population. © 2015 Asian Pacific Society of Nephrology.

  15. Better physician-patient relationships are associated with higher reported adherence to antiretroviral therapy in patients with HIV infection.

    Science.gov (United States)

    Schneider, John; Kaplan, Sherrie H; Greenfield, Sheldon; Li, Wenjun; Wilson, Ira B

    2004-11-01

    There is little evidence to support the widely accepted assertion that better physician-patient relationships result in higher rates of adherence with recommended therapies. To determine whether and which aspects of a better physician-patient relationship are associated with higher rates of adherence with antiretroviral therapies for persons with HIV infection. Cross-sectional analysis. Twenty-two outpatient HIV practices in a metropolitan area. Five hundred fifty-four patients with HIV infection taking antiretroviral medications. We measured adherence using a 4-item self-report scale (alpha= 0.75). We measured core aspects of physician-patient relationships using 6 previously tested scales (general communication, HIV-specific information, participatory decision making, overall satisfaction, willingness to recommend physician, and physician trust; alpha > 0.70 for all) and 1 new scale, adherence dialogue (alpha= 0.92). For adherence dialogue, patients rated their physician at understanding and solving problems with antiretroviral therapy regimens. Mean patient age was 42 years, 15% were female, 73% were white, and 57% reported gay or bisexual sexual contact as their primary HIV risk factor. In multivariable models that accounted for the clustering of patients within physicians' practices, 6 of the 7 physician-patient relationship quality variables were significantly (P < .05) associated with adherence. In all 7 models worse adherence was independently associated (P < .05) with lower age, not believing in the importance of antiretroviral therapy, and worse mental health. This study showed that multiple, mutable dimensions of the physician-patient relationship were associated with medication adherence in persons with HIV infection, suggesting that physician-patient relationship quality is a potentially important point of intervention to improve patients' medication adherence. In addition, our data suggest that it is critical to investigate and incorporate patients

  16. Treatment adherence in patients with headache: a systematic review.

    Science.gov (United States)

    Ramsey, Rachelle R; Ryan, Jamie L; Hershey, Andrew D; Powers, Scott W; Aylward, Brandon S; Hommel, Kevin A

    2014-05-01

    To review and critically evaluate the extant research literature pertaining to adherence in youth and adults with headache and to provide recommendations for future research. This article provides the first systematic review of pediatric headache adherence and updates a previous review of treatment adherence in adults with headache. Systematic review of empirical literature. A literature search with no date restriction was conducted using PubMed and PsycINFO electronic databases and bibliographies of relevant articles. Adherence rates in adults with headache range considerably from 25% to 94% across treatment, assessment method, and definition of adherence utilized. Methods to assess adherence included retrospective prescription claims data, paper or electronic diaries, follow-up appointment attendance, written and verbal self-report of general adherence, verbal self-report of adherence over a specific amount of time via in person interview or telephone, validated adherence measures, adherence questionnaires without validation, and counselor ratings of homework. Each methodology and assessment tool demonstrated strengths and weaknesses. No studies have systematically examined medication adherence in children with headache, and the few available studies examining adherence to behavioral treatment have documented adherence rates ranging from 52% to 86%. Adherence research in adults with headache is growing, but studies demonstrate a number of methodological shortcomings. Adherence research in children with headache, and adherence intervention research in both adults and children, is scant. Future research should use objective measures of adherence, consider over-the-counter medications and medication overuse, examine demographic, psychological, and behavioral correlates of adherence, assess adherence to botulinum toxin type A, and examine the efficacy of adherence interventions in individuals with headache. © 2014 American Headache Society.

  17. Labour intensity of guidelines may have a greater effect on adherence than GPs' workload

    Directory of Open Access Journals (Sweden)

    Westert Gert P

    2009-11-01

    Full Text Available Abstract Background Physicians' heavy workload is often thought to jeopardise the quality of care and to be a barrier to improving quality. The relationship between these has, however, rarely been investigated. In this study quality of care is defined as care 'in accordance with professional guidelines'. In this study we investigated whether GPs with a higher workload adhere less to guidelines than those with a lower workload and whether guideline recommendations that require a greater time investment are less adhered to than those that can save time. Methods Data were used from the Second Dutch National survey of General Practice (DNSGP-2. This nationwide study was carried out between April 2000 and January 2002. A multilevel logistic-regression analysis was conducted of 170,677 decisions made by GPs, referring to 41 Guideline Adherence Indicators (GAIs, which were derived from 32 different guidelines. Data were used from 130 GPs, working in 83 practices with 98,577 patients. GP-characteristics as well as guideline characteristics were used as independent variables. Measures include workload (number of contacts, hours spent on continuing medical education, satisfaction with available time, practice characteristics and patient characteristics. Outcome measure is an indicator score, which is 1 when a decision is in accordance with professional guidelines or 0 when the decision deviates from guidelines. Results On average, 66% of the decisions GPs made were in accordance with guidelines. No relationship was found between the objective workload of GPs and their adherence to guidelines. Subjective workload (measured on a five point scale was negatively related to guideline adherence (OR = 0.95. After controlling for all other variables, the variation between GPs in adherence to guideline recommendations showed a range of less than 10%. 84% of the variation in guideline adherence was located at the GAI-level. Which means that the differences in

  18. Factors associated with suboptimal adherence to antiretroviral therapy in Asia

    Science.gov (United States)

    Jiamsakul, Awachana; Kumarasamy, Nagalingeswaran; Ditangco, Rossana; Li, Patrick CK; Phanuphak, Praphan; Sirisanthana, Thira; Sungkanuparph, Somnuek; Kantipong, Pacharee; Lee, Christopher KC; Mustafa, Mahiran; Merati, Tuti; Kamarulzaman, Adeeba; Singtoroj, Thida; Law, Matthew

    2014-01-01

    Introduction Adherence to antiretroviral therapy (ART) plays an important role in treatment outcomes. It is crucial to identify factors influencing adherence in order to optimize treatment responses. The aim of this study was to assess the rates of, and factors associated with, suboptimal adherence (SubAdh) in the first 24 months of ART in an Asian HIV cohort. Methods As part of a prospective resistance monitoring study, the TREAT Asia Studies to Evaluate Resistance Monitoring Study (TASER-M) collected patients’ adherence based on the World Health Organization-validated Adherence Visual Analogue Scale. SubAdh was defined in two ways: (i) 14 days. Time was divided into four intervals: 0–6, 6–12, 12–18 and 18–24 months. Factors associated with SubAdh were analysed using generalized estimating equations. Results Out of 1316 patients, 32% ever reported 2 assessments per patient per year had an odds ratio (OR)=0.7 (95% confidence interval (CI) (0.55 to 0.90), p=0.006), compared to sites with ≤2 assessments per patient per year. Compared to heterosexual exposure, SubAdh was higher in injecting drug users (IDUs) (OR=1.92, 95% CI (1.23 to 3.00), p=0.004) and lower in homosexual exposure (OR=0.52, 95% CI (0.38 to 0.71), p<0.001). Patients taking a nucleoside transcriptase inhibitor and protease inhibitor (NRTI+PI) combination were less likely to report adherence <100% (OR=0.36, 95% CI (0.20 to 0.67), p=0.001) compared to patients taking an NRTI and non-nucleoside transcriptase inhibitor (NRTI+NNRTI) combination. SubAdh decreased with increasing time on ART (all p<0.001). Similar associations were found with adherence <95% as the outcome. Conclusions We found that SubAdh, defined as either <100% and <95%, was associated with mode of HIV exposure, ART regimen, time on ART and frequency of adherence measurement. The more frequently sites assessed patients, the lower the SubAdh, possibly reflecting site resourcing for patient counselling. Although social

  19. Impact of adherence to GOLD guidelines on 6-minute walk distance, MRC dyspnea scale score, lung function decline, quality of life, and quality-adjusted life years in a Shanghai suburb.

    Science.gov (United States)

    Jiang, Y Q; Zhu, Y X; Chen, X L; Xu, X; Li, F; Fu, H J; Shen, C Y; Lu, Y Y; Zhuang, Q J; Xu, G; Cai, Y Y; Zhang, Y; Liu, S S; Zhu, M Y; Li, S H

    2015-08-03

    We performed a 1-year cluster-randomized field trial to assess the effect of standardized management of chronic obstructive pulmonary disease (COPD) on lung function and quality of life (QOL) measures in patients in China. We used the Global Initiative for Chronic Obstructive Lung Disease (GOLD) treatment guidelines and assessed indexes including pulmonary function, QOL, quality-adjusted life years (QALY), Medical Research Council (MRC) dyspnea scale, 6-min walk distance (6-MWD), number of emergency visits, and frequency of hospitalization. Of a total of 711 patients with chronic cough and asthma, 132 were diagnosed as having COPD and 102 participated in this study [intervention group (N = 47); control group (N = 55)]. We found that adherence to GOLD guidelines had a perceivable impact on 6-MWD, MRC dyspnea scale score, and QOL. The average QALY increased by 1.42/person/year in the intervention group, but declined by 0.95/person/year in the control group. We conclude that standardized management improves disease severity, QOL, and QALY in COPD patients when treatment protocols adhere to GOLD guidelines.

  20. Centering, Scale Indeterminacy, and Differential Item Functioning Detection in Hierarchical Generalized Linear and Generalized Linear Mixed Models

    Science.gov (United States)

    Cheong, Yuk Fai; Kamata, Akihito

    2013-01-01

    In this article, we discuss and illustrate two centering and anchoring options available in differential item functioning (DIF) detection studies based on the hierarchical generalized linear and generalized linear mixed modeling frameworks. We compared and contrasted the assumptions of the two options, and examined the properties of their DIF…

  1. Adherence to Antiretrovirals Among US Women During and After Pregnancy

    Science.gov (United States)

    Bardeguez, Arlene D.; Lindsey, Jane C.; Shannon, Maureen; Tuomala, Ruth E.; Cohn, Susan E.; Smith, Elizabeth; Stek, Alice; Buschur, Shelly; Cotter, Amanda; Bettica, Linda; Read, Jennifer S.

    2009-01-01

    Background Antiretrovirals (ARVs) are recommended for maternal health and to reduce HIV-1 mother-to-child transmission, but suboptimal adherence can counteract its benefits. Objectives To describe antepartum and postpartum adherence to ARV regimens and factors associated with adherence. Methods We assessed adherence rates among subjects enrolled in Pediatric AIDS Clinical Trials Group Protocol 1025 from August 2002 to July 2005 on tablet formulations with at least one self-report adherence assessment. Perfectly adherent subjects reported no missed doses 4 days before their study visit. Generalized estimating equations were used to compare antepartum with postpartum adherence rates and to identify factors associated with perfect adherence. Results Of 519 eligible subjects, 334/445 (75%) reported perfect adherence during pregnancy. This rate significantly decreased 6, 24, and 48 weeks postpartum [185/284 (65%), 76/118 (64%), and 42/64 (66%), respectively (P pregnancy (P pregnancy are needed. PMID:18614923

  2. Medicine non-adherence in kidney transplantation.

    Science.gov (United States)

    Williams, Allison Fiona; Manias, Elizabeth; Gaskin, Cadeyrn J; Crawford, Kimberley

    2014-06-01

    The increasing prevalence of chronic kidney disease, the relative shortage of kidney donors and the economic- and health-related costs of kidney transplant rejection make the prevention of adverse outcomes following transplantation a healthcare imperative. Although strict adherence to immunosuppressant medicine regimens is key to preventing kidney rejection, evidence suggests that adherence is sub-optimal. Strategies need to be developed to help recipients of kidney transplants adhere to their prescribed medicines. This review has found that a number of factors contribute to poor adherence, for example, attitudes towards medicine taking and forgetfulness. Few investigations have been conducted, however, on strategies to enhance medicine adherence in kidney transplant recipients. Strategies that may improve adherence include pharmacist-led interventions (incorporating counselling, medicine reviews and nephrologist liaison) and nurse-led interventions (involving collaboratively working with recipients to understand their routines and offering solutions to improve adherence). Strategies that have shown to have limited effectiveness include supplying medicines free of charge and providing feedback on a participant's medicine adherence without any educational or behavioural interventions. Transplantation is the preferred treatment option for people with end-stage kidney disease. Medicine non-adherence in kidney transplantation increases the risk of rejection, kidney loss and costly treatments. Interventions are needed to help the transplant recipient take all their medicines as prescribed to improve general well-being, medicine safety and reduce healthcare costs. © 2014 European Dialysis and Transplant Nurses Association/European Renal Care Association.

  3. Data collapse, scaling functions, and analytical solutions of generalized growth models.

    Science.gov (United States)

    Cabella, Brenno Caetano Troca; Martinez, Alexandre Souto; Ribeiro, Fabiano

    2011-06-01

    We consider a nontrivial one-species population dynamics model with finite and infinite carrying capacities. Time-dependent intrinsic and extrinsic growth rates are considered in these models. Through the model per capita growth rate we obtain a heuristic general procedure to generate scaling functions to collapse data into a simple linear behavior even if an extrinsic growth rate is included. With this data collapse, all the models studied become independent from the parameters and initial condition. Analytical solutions are found when time-dependent coefficients are considered. These solutions allow us to perceive nontrivial transitions between species extinction and survival and to calculate the transition's critical exponents. Considering an extrinsic growth rate as a cancer treatment, we show that the relevant quantity depends not only on the intensity of the treatment, but also on when the cancerous cell growth is maximum.

  4. Improved anomaly detection using multi-scale PLS and generalized likelihood ratio test

    KAUST Repository

    Madakyaru, Muddu

    2017-02-16

    Process monitoring has a central role in the process industry to enhance productivity, efficiency, and safety, and to avoid expensive maintenance. In this paper, a statistical approach that exploit the advantages of multiscale PLS models (MSPLS) and those of a generalized likelihood ratio (GLR) test to better detect anomalies is proposed. Specifically, to consider the multivariate and multi-scale nature of process dynamics, a MSPLS algorithm combining PLS and wavelet analysis is used as modeling framework. Then, GLR hypothesis testing is applied using the uncorrelated residuals obtained from MSPLS model to improve the anomaly detection abilities of these latent variable based fault detection methods even further. Applications to a simulated distillation column data are used to evaluate the proposed MSPLS-GLR algorithm.

  5. Predictors of Vitamin Adherence After Bariatric Surgery.

    Science.gov (United States)

    Sunil, Supreet; Santiago, Vincent A; Gougeon, Lorraine; Warwick, Katie; Okrainec, Allan; Hawa, Raed; Sockalingam, Sanjeev

    2017-02-01

    Vitamin supplementation in bariatric aftercare is essential to prevent nutrient deficiencies; however, rates of vitamin adherence have been as low as 30 % 6 months post-surgery. Preliminary literature suggests non-adherence to prescribed treatments can be linked to demographic and psychological factors. We aimed to determine the relationship between these factors to vitamin adherence in post-bariatric surgery patients. A total of 92 bariatric patients were assessed 6 months post-surgery. Patients were administered a questionnaire collecting demographic information, psychological scores, and self-reported adherence. Nutrient deficiencies were analyzed through serum vitamin levels measured 3 and 6 months after surgery. Wilcoxon rank-sum and chi-square tests were used for analysis. Non-adherence was associated with male sex and full-time employment (p = 0.027, p = 0.015). There were no differences with respect to living situation, education level, or relationship type. Non-adherent patients did not have significantly higher scores for generalized anxiety, depressive symptoms, or avoidant behaviors. However, non-adherent patients displayed greater attachment anxiety than their adherent counterparts (p = 0.0186). Non-adherence was also associated with lower vitamin B12 levels 6 months post-surgery (p = 0.001). Male gender and full-time work have previously been shown to be associated with non-adherence. This is the first study to demonstrate that attachment anxiety is associated with poor multivitamin adherence in the post-surgical bariatric population. This result is concordant with recent literature that has demonstrated attachment anxiety is associated with poor adherence to dietary recommendations in bariatric patients 6 months postoperatively. Presurgical screening for attachment anxiety could facilitate early interventions to promote better bariatric aftercare in this group.

  6. Modeling and Simulation of Multi-scale Environmental Systems with Generalized Hybrid Petri Nets

    Directory of Open Access Journals (Sweden)

    Mostafa eHerajy

    2015-07-01

    Full Text Available Predicting and studying the dynamics and properties of environmental systems necessitates the construction and simulation of mathematical models entailing different levels of complexities. Such type of computational experiments often require the combination of discrete and continuous variables as well as processes operating at different time scales. Furthermore, the iterative steps of constructing and analyzing environmental models might involve researchers with different background. Hybrid Petri nets may contribute in overcoming such challenges as they facilitate the implementation of systems integrating discrete and continuous dynamics. Additionally, the visual depiction of model components will inevitably help to bridge the gap between scientists with distinct expertise working on the same problem. Thus, modeling environmental systems with hybrid Petri nets enables the construction of complex processes while keeping the models comprehensible for researchers working on the same project with significantly divergent education path. In this paper we propose the utilization of a special class of hybrid Petri nets, Generalized Hybrid Petri Nets (GHPN, to model and simulate environmental systems exposing processes interacting at different time-scales. GHPN integrate stochastic and deterministic semantics as well as other types of special basic events. Moreover, a case study is presented to illustrate the use of GHPN in constructing and simulating multi-timescale environmental scenarios.

  7. Geographical Pattern and Environmental Correlates of Regional-Scale General Flowering in Peninsular Malaysia

    Science.gov (United States)

    Numata, Shinya; Yasuda, Masatoshi; Suzuki, Ryo O.; Hosaka, Tetsuro; Noor, Nur Supardi Md.; Fletcher, Christine D.; Hashim, Mazlan

    2013-01-01

    In South-East Asian dipterocarp forests, many trees synchronize their reproduction at the community level, but irregularly, in a phenomenon known as general flowering (GF). Several proximate cues have been proposed as triggers for the synchronization of Southeast Asian GF, but the debate continues, as many studies have not considered geographical variation in climate and flora. We hypothesized that the spatial pattern of GF forests is explained by previously proposed climatic cues if there are common cues for GF among regions. During the study, GF episodes occurred every year, but the spatial occurrence varied considerably from just a few forests to the whole of Peninsular Malaysia. In 2001, 2002 and 2005, minor and major GF occurred widely throughout Peninsular Malaysia (GF2001, GF2002, and GF2005), and the geographical patterns of GF varied between the episodes. In the three regional-scale GF episodes, most major events occurred in regions where prolonged drought (PD) had been recorded prior, and significant associations between GF scores and PD were found in GF2001 and GF2002. However, the frequency of PD was higher than that of GF throughout the peninsula. In contrast, low temperature (LT) was observed during the study period only before GF2002 and GF2005, but there was no clear spatial relationship between GF and LT in the regional-scale episodes. There was also no evidence that last GF condition influenced the magnitude of GF. Thus, our results suggest that PD would be essential to trigger regional-scale GF in the peninsula, but also that PD does not fully explain the spatial and temporal patterns of GF. The coarse relationships between GF and the proposed climatic cues may be due to the geographical variation in proximate cues for GF, and the climatic and floristic geographical variations should be considered to understand the proximate factors of GF. PMID:24260159

  8. "Non-cold" dark matter at small scales: a general approach

    Science.gov (United States)

    Murgia, R.; Merle, A.; Viel, M.; Totzauer, M.; Schneider, A.

    2017-11-01

    Structure formation at small cosmological scales provides an important frontier for dark matter (DM) research. Scenarios with small DM particle masses, large momenta or hidden interactions tend to suppress the gravitational clustering at small scales. The details of this suppression depend on the DM particle nature, allowing for a direct link between DM models and astrophysical observations. However, most of the astrophysical constraints obtained so far refer to a very specific shape of the power suppression, corresponding to thermal warm dark matter (WDM), i.e., candidates with a Fermi-Dirac or Bose-Einstein momentum distribution. In this work we introduce a new analytical fitting formula for the power spectrum, which is simple yet flexible enough to reproduce the clustering signal of large classes of non-thermal DM models, which are not at all adequately described by the oversimplified notion of WDM . We show that the formula is able to fully cover the parameter space of sterile neutrinos (whether resonantly produced or from particle decay), mixed cold and warm models, fuzzy dark matter, as well as other models suggested by effective theory of structure formation (ETHOS). Based on this fitting formula, we perform a large suite of N-body simulations and we extract important nonlinear statistics, such as the matter power spectrum and the halo mass function. Finally, we present first preliminary astrophysical constraints, based on linear theory, from both the number of Milky Way satellites and the Lyman-α forest. This paper is a first step towards a general and comprehensive modeling of small-scale departures from the standard cold DM model.

  9. PARSEC-SCALE FARADAY ROTATION MEASURES FROM GENERAL RELATIVISTIC MAGNETOHYDRODYNAMIC SIMULATIONS OF ACTIVE GALACTIC NUCLEUS JETS

    International Nuclear Information System (INIS)

    Broderick, Avery E.; McKinney, Jonathan C.

    2010-01-01

    It is now possible to compare global three-dimensional general relativistic magnetohydrodynamic (GRMHD) jet formation simulations directly to multi-wavelength polarized VLBI observations of the pc-scale structure of active galactic nucleus (AGN) jets. Unlike the jet emission, which requires post hoc modeling of the nonthermal electrons, the Faraday rotation measures (RMs) depend primarily upon simulated quantities and thus provide a direct way to confront simulations with observations. We compute RM distributions of a three-dimensional global GRMHD jet formation simulation, extrapolated in a self-consistent manner to ∼10 pc scales, and explore the dependence upon model and observational parameters, emphasizing the signatures of structures generic to the theory of MHD jets. With typical parameters, we find that it is possible to reproduce the observed magnitudes and many of the structures found in AGN jet RMs, including the presence of transverse RM gradients. In our simulations, the RMs are generated in the circum-jet material, hydrodynamically a smooth extension of the jet itself, containing ordered toroidally dominated magnetic fields. This results in a particular bilateral morphology that is unlikely to arise due to Faraday rotation in distant foreground clouds. However, critical to efforts to probe the Faraday screen will be resolving the transverse jet structure. Therefore, the RMs of radio cores may not be reliable indicators of the properties of the rotating medium. Finally, we are able to constrain the particle content of the jet, finding that at pc scales AGN jets are electromagnetically dominated, with roughly 2% of the comoving energy in nonthermal leptons and much less in baryons.

  10. Psychometric properties of the Dental Hygienist Anxiety Scale in a group of general dental patients.

    Science.gov (United States)

    Andersson, Pia; Hakeberg, Magnus; Abrahamsson, Kajsa H

    2013-01-01

    The aim of the present study was to evaluate the psychometric properties of the Dental Hygienist Anxiety Scale (DHAS) in a sample of adult general dental patients. The DHAS is a questionnaire adapted to assess fear and anxiety of dental hygienist (DH) treatment. The DHAS contains four items and the sum of scores range from 4 (no anxiety) to 20 (extreme fear). A convenient sample of 80 patients in treatment at two DH programs in Sweden were consecutively included in the study. The DHAS was distributed together with questions regarding self-perceived oral health and experience of dental care at the first visit after a clinical examination performed by a DH. Re-test assessments of DHAS were conducted ≈ 2 weeks later in conjunction with the next visit to the DH before treatment (scaling session). The results verified a significant positive correlation between the average DHAS sum of scores and global fear of DH and dentist treatment, perceived pain during the last DH treatment and female gender. The DHAS sum of scores had a high internal consistency, Cronbach's coefficient of 0.89 and 0.87 at the first and at the second assessment, respectively. The test-re-test reliability of the DHAS sum of scores was acceptable, with an intra-class coefficient of 0.82 and Kappa coefficients between 0.49-0.78 for the four single items in the DHAS. These results suggest that the DHAS has acceptable psychometric proprieties and is a valid and reliable scale to assess anxiety in DH treatment.

  11. Phase space volume scaling of generalized entropies and anomalous diffusion scaling governed by corresponding non-linear Fokker-Planck equations.

    Science.gov (United States)

    Czégel, Dániel; Balogh, Sámuel G; Pollner, Péter; Palla, Gergely

    2018-01-30

    Many physical, biological or social systems are governed by history-dependent dynamics or are composed of strongly interacting units, showing an extreme diversity of microscopic behaviour. Macroscopically, however, they can be efficiently modeled by generalizing concepts of the theory of Markovian, ergodic and weakly interacting stochastic processes. In this paper, we model stochastic processes by a family of generalized Fokker-Planck equations whose stationary solutions are equivalent to the maximum entropy distributions according to generalized entropies. We show that at asymptotically large times and volumes, the scaling exponent of the anomalous diffusion process described by the generalized Fokker-Planck equation and the phase space volume scaling exponent of the generalized entropy bijectively determine each other via a simple algebraic relation. This implies that these basic measures characterizing the transient and the stationary behaviour of the processes provide the same information regarding the asymptotic regime, and consequently, the classification of the processes given by these two exponents coincide.

  12. How well are national guidelines relating to the general sales of aspirin and paracetamol, adhered to by retail stores: a mystery shopper study.

    Science.gov (United States)

    Molloy, Phillip; Chambers, Ruth; Cork, Tania

    2016-01-18

    To determine whether non-pharmaceutical retail outlets are aboding to the current Medicines and Healthcare products Regulatory Agency (MHRA) national guidelines for over-the-counter (OTC) sales of aspirin and paracetamol. Stages 1 and 2 of the study deployed eight and four medical students, respectively, to undertake a mystery shopper style investigation. Stage 1: eight medical students attempted to buy ≥ 96 tablets/capsules aspirin or paracetamol in one transaction in 62 shops. Stage 2: four medical students attempted to purchase 32 paracetamol 500 mg along with a 'flu remedy preparation also containing paracetamol, in 54 shops. Stage 1 data revealed that 58% and 57% retailers sold more than the MHRA guidelines recommended for paracetamol and aspirin, respectively. We observed that 23% and 28% retailers were willing to sell ≥ 96 tablets of paracetamol or aspirin with no questions asked. Stage 2 results showed that 57% retailers sold 32 × 500 mg paracetamol in conjunction with a paracetamol-containing 'flu preparation; while 98% shops sold 16 × paracetamol 500 mg along with a paracetamol-containing 'flu remedy, with no questions asked of the shopper or advice given. MHRA national guidelines for OTC medicines sales appear to be poorly adhered to in non-pharmacy shops. Sales of aspirin and paracetamol OTC must be better regulated in the UK to ultimately reduce morbidity and mortality rates of deliberate and accidental overdoses. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  13. Beyond heat baths: Generalized resource theories for small-scale thermodynamics.

    Science.gov (United States)

    Yunger Halpern, Nicole; Renes, Joseph M

    2016-02-01

    Thermodynamics has recently been extended to small scales with resource theories that model heat exchanges. Real physical systems exchange diverse quantities: heat, particles, angular momentum, etc. We generalize thermodynamic resource theories to exchanges of observables other than heat, to baths other than heat baths, and to free energies other than the Helmholtz free energy. These generalizations are illustrated with "grand-potential" theories that model movements of heat and particles. Free operations include unitaries that conserve energy and particle number. From this conservation law and from resource-theory principles, the grand-canonical form of the free states is derived. States are shown to form a quasiorder characterized by free operations, d majorization, the hypothesis-testing entropy, and rescaled Lorenz curves. We calculate the work distillable from-and we bound the work cost of creating-a state. These work quantities can differ but converge to the grand potential in the thermodynamic limit. Extending thermodynamic resource theories beyond heat baths, we open diverse realistic systems to modeling with one-shot statistical mechanics. Prospective applications such as electrochemical batteries are hoped to bridge one-shot theory to experiments.

  14. Working memory training mostly engages general-purpose large-scale networks for learning.

    Science.gov (United States)

    Salmi, Juha; Nyberg, Lars; Laine, Matti

    2018-03-21

    The present meta-analytic study examined brain activation changes following working memory (WM) training, a form of cognitive training that has attracted considerable interest. Comparisons with perceptual-motor (PM) learning revealed that WM training engages domain-general large-scale networks for learning encompassing the dorsal attention and salience networks, sensory areas, and striatum. Also the dynamics of the training-induced brain activation changes within these networks showed a high overlap between WM and PM training. The distinguishing feature for WM training was the consistent modulation of the dorso- and ventrolateral prefrontal cortex (DLPFC/VLPFC) activity. The strongest candidate for mediating transfer to similar untrained WM tasks was the frontostriatal system, showing higher striatal and VLPFC activations, and lower DLPFC activations after training. Modulation of transfer-related areas occurred mostly with longer training periods. Overall, our findings place WM training effects into a general perception-action cycle, where some modulations may depend on the specific cognitive demands of a training task. Copyright © 2018 Elsevier Ltd. All rights reserved.

  15. Large-scale general collection of wild-plant DNA in Mustang, Nepal.

    Science.gov (United States)

    Tsukaya, Hirokazu; Iokawa, Yu; Kondo, Makiko; Ohba, Hideaki

    2005-02-01

    The deposit of DNA samples of wild plants that correspond to voucher specimens is highly informative and greatly enhances the value of the herbarium specimens. The Society of Himalayan Botany (SHB), Tokyo, has assembled general collections of flowering plants of the Sino-Himalayan region for more than 40 years. In a trial of the collection of these types of bioresources for use in basic research, we adopted FTA cards, which have recently been used for large-scale collection of DNA of humans, microorganisms and viruses, for the general collection of DNA samples of wild plants during a botanical expedition in Mustang, Nepal, in 2003. Three hundred and fifty-five plant specimens from Mustang, Nepal, were collected along with the corresponding DNA samples. Examination of the quality of the DNA samples by PCR demonstrated the utility of the collection system. The identification of all of the specimens collected, as well as data from the specimens, will be presented on the Flora of Nepal Database website (http://ti.um.u-tokyo.ac.jp/default.htm), which is open to the public. The DNA resources will be identified on the website and distributed openly by the SHB to researchers worldwide for basic research.

  16. On the factor structure of the Rosenberg (1965) General Self-Esteem Scale.

    Science.gov (United States)

    Alessandri, Guido; Vecchione, Michele; Eisenberg, Nancy; Łaguna, Mariola

    2015-06-01

    Since its introduction, the Rosenberg General Self-Esteem Scale (RGSE, Rosenberg, 1965) has been 1 of the most widely used measures of global self-esteem. We conducted 4 studies to investigate (a) the goodness-of-fit of a bifactor model positing a general self-esteem (GSE) factor and 2 specific factors grouping positive (MFP) and negative items (MFN) and (b) different kinds of validity of the GSE, MFN, and MFP factors of the RSGE. In the first study (n = 11,028), the fit of the bifactor model was compared with those of 9 alternative models proposed in literature for the RGSE. In Study 2 (n = 357), the external validities of GSE, MFP, and MFN were evaluated using objective grade point average data and multimethod measures of prosociality, aggression, and depression. In Study 3 (n = 565), the across-rater robustness of the bifactor model was evaluated. In Study 4, measurement invariance of the RGSE was further supported across samples in 3 European countries, Serbia (n = 1,010), Poland (n = 699), and Italy (n = 707), and in the United States (n = 1,192). All in all, psychometric findings corroborate the value and the robustness of the bifactor structure and its substantive interpretation. (c) 2015 APA, all rights reserved).

  17. Claustrophobia and adherence to CPAP treatment.

    Science.gov (United States)

    Chasens, Eileen R; Pack, Allan I; Maislin, Greg; Dinges, David F; Weaver, Terri E

    2005-04-01

    This study evaluated the effect of claustrophobia, an abnormal dread or fear of closed spaces, on adherence to continuous positive airway pressure (CPAP) therapy. The design was a secondary analysis of data from a prospective study of participants (N = 153) that completed 3 months of CPAP therapy from seven sleep disorders centers in the United States and Canada. A 15-item subscale adapted from the Fear and Avoidance Scale measured claustrophobic tendencies pre-CPAP treatment and again after 3 months. An overt monitor attached to the CPAP machines recorded mask-on CPAP adherence. There was a statistically significant difference in claustrophobia scores by adherence group ( or = 5 hours) and time period (pre-CPAP and after 3 months CPAP). Poor CPAP adherence (claustrophobia score > or = 25. Identification of persons with increased claustrophobia tendencies and targeted interventions may increase adherence.

  18. Deep graphs—A general framework to represent and analyze heterogeneous complex systems across scales

    Science.gov (United States)

    Traxl, Dominik; Boers, Niklas; Kurths, Jürgen

    2016-06-01

    Network theory has proven to be a powerful tool in describing and analyzing systems by modelling the relations between their constituent objects. Particularly in recent years, a great progress has been made by augmenting "traditional" network theory in order to account for the multiplex nature of many networks, multiple types of connections between objects, the time-evolution of networks, networks of networks and other intricacies. However, existing network representations still lack crucial features in order to serve as a general data analysis tool. These include, most importantly, an explicit association of information with possibly heterogeneous types of objects and relations, and a conclusive representation of the properties of groups of nodes as well as the interactions between such groups on different scales. In this paper, we introduce a collection of definitions resulting in a framework that, on the one hand, entails and unifies existing network representations (e.g., network of networks and multilayer networks), and on the other hand, generalizes and extends them by incorporating the above features. To implement these features, we first specify the nodes and edges of a finite graph as sets of properties (which are permitted to be arbitrary mathematical objects). Second, the mathematical concept of partition lattices is transferred to the network theory in order to demonstrate how partitioning the node and edge set of a graph into supernodes and superedges allows us to aggregate, compute, and allocate information on and between arbitrary groups of nodes. The derived partition lattice of a graph, which we denote by deep graph, constitutes a concise, yet comprehensive representation that enables the expression and analysis of heterogeneous properties, relations, and interactions on all scales of a complex system in a self-contained manner. Furthermore, to be able to utilize existing network-based methods and models, we derive different representations of

  19. Injured Athletes' Attitudes and Judgments Toward Rehabilitation Adherence

    Science.gov (United States)

    Fisher, A. Craig; Hoisington, Linda L.

    1993-01-01

    In a follow-up study to certified athletic trainers' (ATCs') attitudes and judgments toward injury rehabilitation adherence, previously injured and rehabilitated athletes (n=36) were administered the Athletic Injury Rehabilitation Adherence Questionnaire. The purpose of the study was to compare the results collected from athletes with those collected previously from ATCs. The questionnaire consisted of 60 statements, categorized into seven scales: athletic trainers' influence, environmental influences, athlete's personality, pain tolerance, self-motivation, goals and incentives, and significant others. Four additional open-ended questions dealing with successful and unsuccessful rehabilitation strategies also were completed. Athletes' responses were generally similar to those of ATCs. Factors deemed significant to rehabilitation adherence were: (a) good rapport and communication between athletic trainers and injured athletes, (b) support from athletic trainers and coaches, (c) self-motivation on the part of athletes, and (d) convenience, accessibility, and flexibility of the rehabilitation facility and staff. The greatest deviations between athletes' and ATCs' responses were in the areas of self-motivation, pain tolerance, education about injury and rehabilitation exercises, and degree of realistic feedback. Analyses of open-ended question responses reinforced the aforementioned results. The strongest findings derived from these questions were the importance of rapport, communication, and support to rehabilitation adherence. Also, athletes' distastes for threats and scare tactics were quite evident. ImagesINGING PMID:16558204

  20. Patient and Clinician Characteristics Associated with Adherence. A Cohort Study of Veterans with Incidental Pulmonary Nodules.

    Science.gov (United States)

    Moseson, Erika M; Wiener, Renda Soylemez; Golden, Sara E; Au, David H; Gorman, John D; Laing, Amber D; Deffebach, Mark E; Slatore, Christopher G

    2016-05-01

    Many patients are diagnosed with small pulmonary nodules for which professional societies recommend subsequent imaging surveillance. Adherence to these guidelines involves many steps from both clinicians and patients but has not been well studied. In a health care setting with a nodule tracking system, we evaluated the association of communication processes and distress with patient and clinician adherence to recommended follow up and Fleischner Society guidelines, respectively. We conducted a prospective, longitudinally assessed, cohort study of patients with incidentally detected nodules who received care at one Veterans Affairs Medical Center. We measured patient-centered communication with the Consultation Care Measure and distress with the Impact of Event Scale. We abstracted data regarding participant adherence to clinician recommendations (defined as receiving the follow-up scan within 30 d of the recommended date) and clinician adherence to Fleischner guidelines (defined as planning the follow-up scan within 30 d of the recommended interval) from the electronic medical record. We measured associations of communication and distress with adherence using multivariable-adjusted generalized estimating equations. Among 138 veterans, 39% were nonadherent at least once during follow up. Clinicians were nonadherent to Fleischner guidelines for 27% of follow-up scans. High-quality communication (adjusted odds ratio, 3.65; P = 0.02) and distress (adjusted odds ratio, 0.38; P = 0.02) were associated with increased and decreased participant adherence, respectively. Neither was associated with clinician adherence. Patients and clinicians often do not adhere to nodule follow-up recommendations. Interventions designed to improve communication quality and decrease distress may also improve patient adherence to nodule follow-up recommendations.

  1. Investigating self-efficacy, disease knowledge and adherence to treatment in adolescents with cystic fibrosis.

    Science.gov (United States)

    Faint, Nicholas R; Staton, Janelle M; Stick, Stephen M; Foster, Juliet M; Schultz, André

    2017-05-01

    Patient adherence is integral to the effectiveness of prescribed treatment, and is associated with beneficial disease outcomes, yet in adolescents with cystic fibrosis, adherence is often sub-optimal. Multiple factors may contribute to treatment adherence, including disease knowledge and self-efficacy. In adolescents with cystic fibrosis: (i) to compare the disease knowledge of adolescents and their parents before transition to adult care; (ii) to determine the relationship between disease knowledge (adolescent, parent) and adherence; and (iii) to evaluate self-efficacy and its association with disease knowledge and adherence. Adolescents with cystic fibrosis and their parents were recruited from a tertiary children's hospital. Disease knowledge and self-efficacy was assessed using the Knowledge of Disease Management-CF and General Self-Efficacy Scales respectively. Using pharmacy records, medication possession ratio was calculated to measure treatment adherence in the preceding year. Thirty-nine adolescent (aged 12-17 (median 14) years) and parent pairs were recruited. Adherence to hypertonic saline, but not other medications, was significantly associated with disease knowledge in adolescents (r 2  = 0.40, P = 0.029). Mean (SD) adolescent self-efficacy was 30.8 (4.0), and not associated with disease knowledge or adherence. Mean (SD) disease knowledge was less in adolescents than parents (55 (16)% and 72 (14)% respectively, P < 0.001). Disease knowledge is sub-optimal in adolescents with cystic fibrosis, even in the 2 years immediately before transition to adult care. Given that adherence with some treatments has been associated with disease knowledge our results suggest the need for educational interventions in adolescents with cystic fibrosis to optimise self-management and health outcomes. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  2. Adherence to antidepressants

    Directory of Open Access Journals (Sweden)

    Abimbola Farinde

    2013-01-01

    Full Text Available While major depression is considered a frequent mental illness there are ongoing reports of high non-adherence to antidepressant medications which places suffers at high risk for relapse, recurrence, or greater impairment,. The World Health Organization (WHO defines adherence as the extent to which a person′s behavior (e.g. taking medications can align with the agreed recommendations of a health care provider. Unfortunately while patient may recognize the importance of adherence to antidepressant medications the majority of patients do not adhere to their prescribed antidepressants. Some of the factors that may contribute to or lead to non-adherence include knowingly or unknowingly missing doses, taking extra doses, delaying administration times, or taking drug holidays. Pharmacists have the unique ability to deter non-adherence through the performance of continuous assessment and monitoring of adherence in this population given these accessibility. Additionally, pharmacists are able to develop therapeutic alliances with patients that can help to increase the likelihood of achieving positive patient outcomes. Antidepressant non-adherence can be viewed as a significant public health concern so it is important for patients to be educated about the importance of adherence, and health care professionals should be aware of factors or patient characteristics that can serve as barriers to non-adherence.

  3. Recognition of dementia in general practice: comparison of general practitioners' opinions with assessments using the mini-mental state examination and the Blessed dementia rating scale.

    Science.gov (United States)

    Mant, A; Eyland, E A; Pond, D C; Saunders, N A; Chancellor, A H

    1988-09-01

    In a study of 226 elderly residents in a retirement village in Sydney, Australia, general practitioners' opinions about dementia status had high positive and negative predictive values and high specificity, but low sensitivity when evaluated against the mini-mental state examination and the Blessed dementia rating scale. General practitioners were found to disagree with these two measures more often when patients were in advanced old age, and when they considered the patients to be depressed. We conclude that the general practitioner can increase his or her sensitivity to dementia in the elderly by use of either measure.

  4. The relationship of gender and gender identity to treatment adherence among individuals with bipolar disorder.

    Science.gov (United States)

    Sajatovic, Martha; Micula-Gondek, Weronika; Tatsuoka, Curtis; Bialko, Christopher

    2011-08-01

    It has been demonstrated that 46% to 48% of individuals with bipolar disorder (BD) are at least partially nonadherent with prescribed medication. Reports of whether male gender is a predictor of treatment nonadherence in BD have been inconsistent. The construct of gender may also be a matter of cultural orientation, and psychological gender, as a component of self-perception, may affect the experience of mental illness. Gender identity is the subjective experience of one's individuality as male or female. This cross-sectional study evaluated gender and gender identity among men and women with BD as they relate to self-reported medication treatment adherence. This secondary analysis of a larger study on treatment adherence evaluated men and women with BD being treated with mood-stabilizing medications in a community mental health clinic. Gender identity and treatment adherence were evaluated using the Bem Sex Role Inventory (BSRI) and the Tablets Routine Questionnaire, respectively. Other measures included assessing BD symptoms using the Hamilton Depression Rating Scale and mania symptoms using the Young Mania Rating Scale, as well as psychosocial support with the Interpersonal Support Evaluation List and locus of control with the Multidimensional Health Locus of Control Scale. Mean age of the 70 men and 70 women with type I BD was 43.1 years for adherent patients and 40.8 years for nonadherent patients. Women with BD had mean scores on the BSRI consistent with general population norms, whereas men with BD had scores suggesting lower levels of self-perceived masculinity than population norms. There were no differences between men and women on adherence; however, men with high BSRI masculinity scores had less adherence than other men in the sample (P = 0.04). Lower scores on the "powerful others" dimension of locus of control were associated with lower adherence. For women, there was no relationship between BSRI masculinity scores and adherence. Gender identity in

  5. Recognition of depression in the elderly: a comparison of general practitioner opinions and the Geriatric Depression Scale.

    Science.gov (United States)

    Pond, C D; Mant, A; Bridges-Webb, C; Purcell, C; Eyland, E A; Hewitt, H; Saunders, N A

    1990-09-01

    As part of a larger study, 133 subjects aged 70 years and over were screened for depression using the Geriatric Depression Scale, a 30-item questionnaire, as the screening instrument. Cognitive status was assessed using the Mini Mental State Examination. The subject's own general practitioner was asked his/her opinion as to whether the subject was depressed. Poor agreement was found between depression as measured by the Geriatric Depression Scale and the general practitioner's assessment. Possible reasons for this include the difficulty of finding a satisfactory operational definition of depression for use by general practitioners, the problems of identifying depression in the elderly, the arbitrary definition provided by the scale and the confounding of depression, as measured by the scale, with cognitive status.

  6. A comparison of electronic monitoring vs. clinician rating of antipsychotic adherence in outpatients with schizophrenia.

    Science.gov (United States)

    Byerly, Matthew; Fisher, Robert; Whatley, Katrina; Holland, Rhiannon; Varghese, Femina; Carmody, Thomas; Magouirk, Brianne; Rush, A John

    2005-02-28

    Antipsychotic non-adherence rates of outpatients with schizophrenia or schizoaffective disorder was assessed by electronic monitoring and clinician rating. Antipsychotic adherence was determined monthly over 3 consecutive months with (1) the Medication Event Monitoring System (MEMS) cap and (2) the Clinician Rating Scale. Non-adherence was defined as daily adherence of <70% during any one of three monthly evaluations for MEMS and ratings of scale of 1-7) on the Clinician Rating Scale. Non-adherence was detected in 12 of 25 patients (48%) by MEMS and 0% by the Clinician Rating Scale. Clinician assessment dramatically underestimated antipsychotic non-adherence.

  7. Cross-Cultural adaptation of the General Functioning Scale of the Family.

    Science.gov (United States)

    Pires, Thiago; Assis, Simone Gonçalves de; Avanci, Joviana Quintes; Pesce, Renata Pires

    2016-06-27

    To describe the process of cross-cultural adaptation of the General Functioning Scale of the Family, a subscale of the McMaster Family Assessment Device, for the Brazilian population. The General Functioning Scale of the Family was translated into Portuguese and administered to 500 guardians of children in the second grade of elementary school in public schools of Sao Gonçalo, Rio de Janeiro, Southeastern Brazil. The types of equivalences investigated were: conceptual and of items, semantic, operational, and measurement. The study involved discussions with experts, translations and back-translations of the instrument, and psychometric assessment. Reliability and validity studies were carried out by internal consistency testing (Cronbach's alpha), Guttman split-half correlation model, Pearson correlation coefficient, and confirmatory factor analysis. Associations between General Functioning of the Family and variables theoretically associated with the theme (father's or mother's drunkenness and violence between parents) were estimated by odds ratio. Semantic equivalence was between 90.0% and 100%. Cronbach's alpha ranged from 0.79 to 0.81, indicating good internal consistency of the instrument. Pearson correlation coefficient ranged between 0.303 and 0.549. Statistical association was found between the general functioning of the family score and the theoretically related variables, as well as good fit quality of the confirmatory analysis model. The results indicate the feasibility of administering the instrument to the Brazilian population, as it is easy to understand and a good measurement of the construct of interest. Descrever o processo de adaptação transcultural da escala de Funcionamento Geral da Família, subescala da McMaster Family Assessment Device, para a população brasileira. A escala de Funcionamento Geral da Família, original no idioma inglês, foi traduzida para o português e aplicada a 500 responsáveis de crianças do segundo ano do ensino

  8. Evaluation of scaling and root planing effect in generalized chronic periodontitis by fractal and multifractal analysis.

    Science.gov (United States)

    Pârvu, A E; Ţălu, Ş; Crăciun, C; Alb, S F

    2014-04-01

    Fractal and multifractal analysis are useful additional non-invasive methods for quantitative description of complex morphological features. However, the quantitative and qualitative assessment of morphologic changes within human gingival cells and tissues are still unexplored. The aim of this work is to assess the structural gingival changes in patients with generalized chronic periodontitis (GCP), before and after scaling and root planing (SRP) by using fractal and multifractal analysis. Twelve adults with untreated chronic periodontitis were treated only by SRP. At baseline and after SRP, gingivomucosal biopsies were collected for histopathological examination. Fractal and multifractal analysis of digital images of the granular, spinous and basal and conjunctive layers structure, using the standard box-counting method was performed. The fractal dimension was determined for cell membrane, nuclear membrane of cell and nucleolus membrane of cell. In GCP a higher fractal dimension corresponds to a higher geometric complexity of cells contour, as its values increase when the contour irregularities increase. The generalized fractal dimensions were determined for the conjunctive layer structure of patients with GCP and patients with GCP and SRP. The fractal and multifractal analysis of gingival biopsies confirmed earlier findings that SRP reduces gingival injury in patients with GCP. It has been shown that fractal and multifractal analysis of tissue images as a non-invasive technique could be used to measure contrasting morphologic changes within human gingival cells and tissues and can provide detailed information for investigation of healthy and diseased gingival mucosa from patients with GCP. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. General

    Indian Academy of Sciences (India)

    Page S20: NMR compound 4i. Page S22: NMR compound 4j. General: Chemicals were purchased from Fluka, Merck and Aldrich Chemical Companies. All the products were characterized by comparison of their IR, 1H NMR and 13C NMR spectroscopic data and their melting points with reported values. General procedure ...

  10. Bariatric surgery patients’ perceptions of weight-related stigma in healthcare settings impair post-surgery dietary adherence

    Directory of Open Access Journals (Sweden)

    Danielle M. Raves

    2016-10-01

    Full Text Available Background: Weight-related stigma is reported frequently by higher body-weight patients in healthcare settings. Bariatric surgery triggers profound weight loss. This weight loss may therefore alleviate patients’ experiences of weight-related stigma within healthcare settings. In non-clinical settings, weight-related stigma is associated with weight-inducing eating patterns. Dietary adherence is a major challenge after bariatric surgery.Objectives: (1 Evaluate the relationship between weight-related stigma and post-surgical dietary adherence; (2 understand if weight loss reduces weight-related stigma, thereby improving post-surgical dietary adherence; and (3 explore provider and patient perspectives on adherence and stigma in healthcare settings. Design: This mixed methods study contrasts survey responses from 300 postoperative bariatric patients with ethnographic data based on interviews with 35 patients and extensive multi-year participant-observation within a clinic setting. The survey measured experiences of weight-related stigma, including from healthcare professionals, on the Interpersonal Sources of Weight Stigma scale and internalized stigma based on the Weight Bias Internalization Scale. Dietary adherence measures included patient self-reports, non-disordered eating patterns reported on the Disordered Eating after Bariatric Surgery scale, and food frequencies. Regression was used to assess the relationships among post-surgical stigma, dietary adherence, and weight loss. Qualitative analyses consisted of thematic analysis.Results: The quantitative data show that internalized stigma and general experiences of weight-related stigma predict worse dietary adherence, even after weight is lost. The qualitative data show patients did not generally recognize this connection, and health professionals explained it as poor patient compliance.Conclusion: Reducing perceptions of weight-related stigma in healthcare settings and weight bias

  11. Bariatric Surgery Patients' Perceptions of Weight-Related Stigma in Healthcare Settings Impair Post-surgery Dietary Adherence

    Science.gov (United States)

    Raves, Danielle M.; Brewis, Alexandra; Trainer, Sarah; Han, Seung-Yong; Wutich, Amber

    2016-01-01

    Background: Weight-related stigma is reported frequently by higher body-weight patients in healthcare settings. Bariatric surgery triggers profound weight loss. This weight loss may therefore alleviate patients' experiences of weight-related stigma within healthcare settings. In non-clinical settings, weight-related stigma is associated with weight-inducing eating patterns. Dietary adherence is a major challenge after bariatric surgery. Objectives: (1) Evaluate the relationship between weight-related stigma and post-surgical dietary adherence; (2) understand if weight loss reduces weight-related stigma, thereby improving post-surgical dietary adherence; and (3) explore provider and patient perspectives on adherence and stigma in healthcare settings. Design: This mixed methods study contrasts survey responses from 300 postoperative bariatric patients with ethnographic data based on interviews with 35 patients and extensive multi-year participant-observation within a clinic setting. The survey measured experiences of weight-related stigma, including from healthcare professionals, on the Interpersonal Sources of Weight Stigma scale and internalized stigma based on the Weight Bias Internalization Scale. Dietary adherence measures included patient self-reports, non-disordered eating patterns reported on the Disordered Eating after Bariatric Surgery scale, and food frequencies. Regression was used to assess the relationships among post-surgical stigma, dietary adherence, and weight loss. Qualitative analyses consisted of thematic analysis. Results: The quantitative data show that internalized stigma and general experiences of weight-related stigma predict worse dietary adherence, even after weight is lost. The qualitative data show patients did not generally recognize this connection, and health professionals explained it as poor patient compliance. Conclusion: Reducing perceptions of weight-related stigma in healthcare settings and weight bias internalization could

  12. The impact of new forms of large-scale general practice provider collaborations on England's NHS: a systematic review.

    Science.gov (United States)

    Pettigrew, Luisa M; Kumpunen, Stephanie; Mays, Nicholas; Rosen, Rebecca; Posaner, Rachel

    2018-03-01

    Over the past decade, collaboration between general practices in England to form new provider networks and large-scale organisations has been driven largely by grassroots action among GPs. However, it is now being increasingly advocated for by national policymakers. Expectations of what scaling up general practice in England will achieve are significant. To review the evidence of the impact of new forms of large-scale general practice provider collaborations in England. Systematic review. Embase, MEDLINE, Health Management Information Consortium, and Social Sciences Citation Index were searched for studies reporting the impact on clinical processes and outcomes, patient experience, workforce satisfaction, or costs of new forms of provider collaborations between general practices in England. A total of 1782 publications were screened. Five studies met the inclusion criteria and four examined the same general practice networks, limiting generalisability. Substantial financial investment was required to establish the networks and the associated interventions that were targeted at four clinical areas. Quality improvements were achieved through standardised processes, incentives at network level, information technology-enabled performance dashboards, and local network management. The fifth study of a large-scale multisite general practice organisation showed that it may be better placed to implement safety and quality processes than conventional practices. However, unintended consequences may arise, such as perceptions of disenfranchisement among staff and reductions in continuity of care. Good-quality evidence of the impacts of scaling up general practice provider organisations in England is scarce. As more general practice collaborations emerge, evaluation of their impacts will be important to understand which work, in which settings, how, and why. © British Journal of General Practice 2018.

  13. Conscientiousness and adherence to the oral contraceptive pill: a cross-sectional analysis of the facets of conscientiousness.

    Science.gov (United States)

    Eustace, Neidin; Sarma, Kiran M; Murphy, Jane; Molloy, Gerard J

    2018-03-13

    We examine the association between a six-facet model of conscientiousness and adherence to the Oral Contraceptive Pill (OCP), to investigate if these 6 facets can account for variation in adherence to the OCP. Cross-sectional data were collected from an opportunity sample of 243 female participants who were current users of the OCP, via online survey. Data were analysed using correlation and standard regression. The 60-item Chernyshenko Conscientiousness Scale (CCS), the 10-item IPIP Conscientiousness (IPIP C) subscale and the 5-item OCP Medication Adherence Report Scale (MARS) were employed. Both the total CCS (ρ = -0.26, p IPIP C scale (ρ = -0.22, p  -0.18 and r < -0.23, p < 0.05) with OCP adherence with the exception of traditionalism. Within a multivariable model, the six facets accounted for 7.1% of variance (p < 0.01) in adherence to the OCP. No one facet made a significant unique contribution to the model. These findings replicate and extend previous links between conscientiousness and OCP adherence. Further research should be conducted to establish the reliability of these findings in a general population of OCP users. Future interventions should focus on the development of interventions which take conscientiousness into consideration.

  14. Crowdsourcing the General Public for Large Scale Molecular Pathology Studies in Cancer.

    Science.gov (United States)

    Candido Dos Reis, Francisco J; Lynn, Stuart; Ali, H Raza; Eccles, Diana; Hanby, Andrew; Provenzano, Elena; Caldas, Carlos; Howat, William J; McDuffus, Leigh-Anne; Liu, Bin; Daley, Frances; Coulson, Penny; Vyas, Rupesh J; Harris, Leslie M; Owens, Joanna M; Carton, Amy F M; McQuillan, Janette P; Paterson, Andy M; Hirji, Zohra; Christie, Sarah K; Holmes, Amber R; Schmidt, Marjanka K; Garcia-Closas, Montserrat; Easton, Douglas F; Bolla, Manjeet K; Wang, Qin; Benitez, Javier; Milne, Roger L; Mannermaa, Arto; Couch, Fergus; Devilee, Peter; Tollenaar, Robert A E M; Seynaeve, Caroline; Cox, Angela; Cross, Simon S; Blows, Fiona M; Sanders, Joyce; de Groot, Renate; Figueroa, Jonine; Sherman, Mark; Hooning, Maartje; Brenner, Hermann; Holleczek, Bernd; Stegmaier, Christa; Lintott, Chris; Pharoah, Paul D P

    2015-07-01

    Citizen science, scientific research conducted by non-specialists, has the potential to facilitate biomedical research using available large-scale data, however validating the results is challenging. The Cell Slider is a citizen science project that intends to share images from tumors with the general public, enabling them to score tumor markers independently through an internet-based interface. From October 2012 to June 2014, 98,293 Citizen Scientists accessed the Cell Slider web page and scored 180,172 sub-images derived from images of 12,326 tissue microarray cores labeled for estrogen receptor (ER). We evaluated the accuracy of Citizen Scientist's ER classification, and the association between ER status and prognosis by comparing their test performance against trained pathologists. The area under ROC curve was 0.95 (95% CI 0.94 to 0.96) for cancer cell identification and 0.97 (95% CI 0.96 to 0.97) for ER status. ER positive tumors scored by Citizen Scientists were associated with survival in a similar way to that scored by trained pathologists. Survival probability at 15 years were 0.78 (95% CI 0.76 to 0.80) for ER-positive and 0.72 (95% CI 0.68 to 0.77) for ER-negative tumors based on Citizen Scientists classification. Based on pathologist classification, survival probability was 0.79 (95% CI 0.77 to 0.81) for ER-positive and 0.71 (95% CI 0.67 to 0.74) for ER-negative tumors. The hazard ratio for death was 0.26 (95% CI 0.18 to 0.37) at diagnosis and became greater than one after 6.5 years of follow-up for ER scored by Citizen Scientists, and 0.24 (95% CI 0.18 to 0.33) at diagnosis increasing thereafter to one after 6.7 (95% CI 4.1 to 10.9) years of follow-up for ER scored by pathologists. Crowdsourcing of the general public to classify cancer pathology data for research is viable, engages the public and provides accurate ER data. Crowdsourced classification of research data may offer a valid solution to problems of throughput requiring human input.

  15. Consistency between kinetics and thermodynamics: general scaling conditions for reaction rates of nonlinear chemical systems without constraints far from equilibrium.

    Science.gov (United States)

    Vlad, Marcel O; Popa, Vlad T; Ross, John

    2011-02-03

    We examine the problem of consistency between the kinetic and thermodynamic descriptions of reaction networks. We focus on reaction networks with linearly dependent (but generally kinetically independent) reactions for which only some of the stoichiometric vectors attached to the different reactions are linearly independent. We show that for elementary reactions without constraints preventing the system from approaching equilibrium there are general scaling relations for nonequilibrium rates, one for each linearly dependent reaction. These scaling relations express the ratios of the forward and backward rates of the linearly dependent reactions in terms of products of the ratios of the forward and backward rates of the linearly independent reactions raised to different scaling powers; the scaling powers are elements of the transformation matrix, which relates the linearly dependent stoichiometric vectors to the linearly independent stoichiometric vectors. These relations are valid for any network of elementary reactions without constraints, linear or nonlinear kinetics, far from equilibrium or close to equilibrium. We show that similar scaling relations for the reaction routes exist for networks of nonelementary reactions described by the Horiuti-Temkin theory of reaction routes where the linear dependence of the mechanistic (elementary) reactions is transferred to the overall (route) reactions. However, in this case, the scaling conditions are valid only at the steady state. General relationships between reaction rates of the two levels of description are presented. These relationships are illustrated for a specific complex reaction: radical chlorination of ethylene.

  16. The influence of traditional and complementary and alternative medicine on medication adherence in Honduras.

    Science.gov (United States)

    Catalino, Michael Paul; Durón, Reyna Maria; Bailey, Julia Nancy; Holden, Kenton Roy

    2015-01-01

    Adherence to medication is a worldwide problem and deserves country-specific attention. Honduras, like many other countries, has allopathic providers, traditional medicine (TM), and complementary and alternative medicine (CAM). Understanding a population's health behaviors is essential to satisfactory integration of these systems and successful patient care. The objective was to identify factors that influence medication adherence in Honduras. The research team administered a cross-sectional, 25-item questionnaire to various neighborhoods based on national demographic statistics in order to obtain a quota sample. Setting • The survey took place in Tegucigalpa, Honduras, Central America. The research team surveyed 614 Hondurans, aged ≥ 18 y, within the general population of Tegucigalpa, the largest and capital city of Honduras, in neighborhoods representing areas where primarily the lower and middle classes lived. The primary outcome measure was a modified Medication Adherence Report Scale (MARS). Results • The research team collected 610 surveys that had complete answers to questions about adherence (610/614, 99.3%) total complete responses to other items varied. The prevalence of use of TM was 62.8% (381/607). Nearly one-half, 47.3% (287/607), of all the respondents had used herbs or teas for health in the prior year, and 26.1% (159/607) of all respondents had received a sobada (therapeutic rubbing). Respondents with daily private spiritual devotions (OR = 0.610, P = .018) and diabetes (OR = 0.154, P = .004) were less likely to report low adherence. Receiving a sobada and a history of fever were independently associated with low adherence (OR = 1.718, P = .017 and OR = 2.226, P < .001, respectively). Hondurans use both allopathic and TM. Although private spiritual devotion may help improve adherence to medication, only use of traditional massage therapy, the sobada, was associated with decreased adherence. Effective integration of alternative therapies in

  17. Psychometric evaluation of the general health questionnaire-12 and Rosenberg self-esteem scale in Hungarian and Slovak early adolescents

    NARCIS (Netherlands)

    Sarkova, M.; Nagyova, I.; Katreniakova, Z.; Geckova, A.M.; Orosova, O.; Middel, B.; van Dijk, J.P.; van den Heuvel, W.

    2006-01-01

    The reliability and factor structure of the General Health Questionnaire-12 (GHQ-12) and the Rosenberg Self-Esteem scale (RSE) were evaluated in samples of Hungarian and Slovak early adolescents. The principal component analyses support the two-factor solution for GHQ-12 with subscales

  18. Development of the General Parenting Observational Scale to assess parenting during family meals

    OpenAIRE

    Rhee, Kyung E; Dickstein, Susan; Jelalian, Elissa; Boutelle, Kerri; Seifer, Ronald; Wing, Rena

    2015-01-01

    © 2015 Rhee et al.; licensee BioMed Central. Background: There is growing interest in the relationship between general parenting and childhood obesity. However, assessing general parenting via surveys can be difficult due to issues with self-report and differences in the underlying constructs being measured. As a result, different aspects of parenting have been associated with obesity risk. We developed a more objective tool to assess general parenting by using observational methods during a ...

  19. On the sub-model errors of a generalized one-way coupling scheme for linking models at different scales

    Science.gov (United States)

    Zeng, Jicai; Zha, Yuanyuan; Zhang, Yonggen; Shi, Liangsheng; Zhu, Yan; Yang, Jinzhong

    2017-11-01

    Multi-scale modeling of the localized groundwater flow problems in a large-scale aquifer has been extensively investigated under the context of cost-benefit controversy. An alternative is to couple the parent and child models with different spatial and temporal scales, which may result in non-trivial sub-model errors in the local areas of interest. Basically, such errors in the child models originate from the deficiency in the coupling methods, as well as from the inadequacy in the spatial and temporal discretizations of the parent and child models. In this study, we investigate the sub-model errors within a generalized one-way coupling scheme given its numerical stability and efficiency, which enables more flexibility in choosing sub-models. To couple the models at different scales, the head solution at parent scale is delivered downward onto the child boundary nodes by means of the spatial and temporal head interpolation approaches. The efficiency of the coupling model is improved either by refining the grid or time step size in the parent and child models, or by carefully locating the sub-model boundary nodes. The temporal truncation errors in the sub-models can be significantly reduced by the adaptive local time-stepping scheme. The generalized one-way coupling scheme is promising to handle the multi-scale groundwater flow problems with complex stresses and heterogeneity.

  20. Validation of the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) in French psychiatric and general populations.

    Science.gov (United States)

    Trousselard, Marion; Steiler, Dominique; Dutheil, Frédéric; Claverie, Damien; Canini, Frédéric; Fenouillet, Fabien; Naughton, Geraldine; Stewart-Brown, Sarah; Franck, Nicolas

    2016-11-30

    The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) has been validated in general population samples in many countries. Interest in using this measure in clinical populations is growing, particularly for tertiary prevention and mental health promotion. This paper reports validation of the French WEMWBS in healthy and chronic remitted schizophrenia populations. The French WEMWBS was administered to 319 workers, 75 students and 121 patients. For non-patients, self-reported Trait- and State-Anxiety, Mindfulness, Positive and Negative Affect and the General Health Questionnaire were completed. For patients, the Positive and Negative Syndrome Scale, Clinical Global Impression Severity Scale, Birchwood Insight Scale, Social Adjustment Scale, and Global Assessment of Functioning scale were completed. Test-retest reliability and responsiveness to intervention was assessed at 6 months. Whatever the sample, response frequencies showed normal distributions, and internal consistency was good (Cronbach's α). Scree plots of eigenvalues suggested a single factor in the samples. The one-dimensional solution yielded suboptimal fit indices. Construct validity was confirmed. Significant improvement in scores was observed before and after intervention. Test-retest variation was non-significant. Impairment of insight and cognition in the assessed patients implies that attention must be paid before applying WEMWBS to all patients. Nevertheless, WEMWBS proved valid and reliable in a further European population, suggesting transcultural validity for both monitoring and evaluation of interventions in healthy as well as chronic remitted schizophrenia populations. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  1. The Hamburg large scale geostrophic ocean general circulation model. Cycle 1

    International Nuclear Information System (INIS)

    Maier-Reimer, E.; Mikolajewicz, U.

    1992-02-01

    The rationale for the Large Scale Geostrophic ocean circulation model (LSG-OGCM) is based on the observations that for a large scale ocean circulation model designed for climate studies, the relevant characteristic spatial scales are large compared with the internal Rossby radius throughout most of the ocean, while the characteristic time scales are large compared with the periods of gravity modes and barotropic Rossby wave modes. In the present version of the model, the fast modes have been filtered out by a conventional technique of integrating the full primitive equations, including all terms except the nonlinear advection of momentum, by an implicit time integration method. The free surface is also treated prognostically, without invoking a rigid lid approximation. The numerical scheme is unconditionally stable and has the additional advantage that it can be applied uniformly to the entire globe, including the equatorial and coastal current regions. (orig.)

  2. Scaled Model Technology for Flight Research of General Aviation Aircraft, Phase II

    Data.gov (United States)

    National Aeronautics and Space Administration — Our proposed future Phase II activities are aimed at developing a scientifically based "tool box" for flight research using scaled models. These tools will be of...

  3. HIV Medication Adherence

    Science.gov (United States)

    ... AIDS Drugs Clinical Trials Apps skip to content HIV Treatment Home Understanding HIV/AIDS Fact Sheets HIV ... 4 p.m. ET) Send us an email HIV Medication Adherence Last Reviewed: January 17, 2018 Key ...

  4. Medication adherence and beliefs about medication in elderly patients living alone with chronic diseases

    Directory of Open Access Journals (Sweden)

    Park HY

    2018-01-01

    Full Text Available Hwa Yeon Park,1,2,* Sin Ae Seo,2,* Hyeyoung Yoo,2 Kiheon Lee1–3 1Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; 2Department of Community Health Research, Seongnam Center for Home Health Care, Seongnam, Republic of Korea; 3Department of Family Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea *These authors contributed equally to this work Purpose: The aim of this study was to assess medication adherence and its related factors among elderly people living alone with chronic diseases using a conceptual framework with the Belief about Medicines Questionnaire and the Adherence to Refills and Medication Scale-Korean version.Participants and methods: This was a cross-sectional study conducted in 3,326 elderly people living alone, who were enrolled in Seongnam Center for Home Health Care in South Korea. They completed validated questionnaires assessing their adherence and beliefs about medication in general.Results: In attitudinal analysis using Belief about Medicines Questionnaire, 37.0% of patients were accepting of medication (high necessity with low concerns, 49.7% were ambivalent (high necessity with high concerns, 1.9% were skeptical (low necessity with high concerns, and 11.4% were indifferent (low necessity and low concerns. In multivariable analysis, we found that adherence was related to patients’ beliefs about medication; compared with patients who were accepting of medication, those in the other three attitudinal groups had significantly lower adherence (indifferent, p=0.003; skeptical, p=0.001; ambivalent, p<0.001. Also, low adherence was associated with heavy burden of drug costs (β=0.109; 95% CI 0.03, 0.19, presence of drug side effects (β=0.431; 95% CI 0.11, 0.75, dissatisfaction with medication (β=−0.626; 95% CI −0.77, −0.48, perceiving health status as poor (β=−0.151; 95% CI −0.27, −0.03, and receiving medical aid (β=0

  5. Recent advances toward a general purpose linear-scaling quantum force field.

    Science.gov (United States)

    Giese, Timothy J; Huang, Ming; Chen, Haoyuan; York, Darrin M

    2014-09-16

    Conspectus There is need in the molecular simulation community to develop new quantum mechanical (QM) methods that can be routinely applied to the simulation of large molecular systems in complex, heterogeneous condensed phase environments. Although conventional methods, such as the hybrid quantum mechanical/molecular mechanical (QM/MM) method, are adequate for many problems, there remain other applications that demand a fully quantum mechanical approach. QM methods are generally required in applications that involve changes in electronic structure, such as when chemical bond formation or cleavage occurs, when molecules respond to one another through polarization or charge transfer, or when matter interacts with electromagnetic fields. A full QM treatment, rather than QM/MM, is necessary when these features present themselves over a wide spatial range that, in some cases, may span the entire system. Specific examples include the study of catalytic events that involve delocalized changes in chemical bonds, charge transfer, or extensive polarization of the macromolecular environment; drug discovery applications, where the wide range of nonstandard residues and protonation states are challenging to model with purely empirical MM force fields; and the interpretation of spectroscopic observables. Unfortunately, the enormous computational cost of conventional QM methods limit their practical application to small systems. Linear-scaling electronic structure methods (LSQMs) make possible the calculation of large systems but are still too computationally intensive to be applied with the degree of configurational sampling often required to make meaningful comparison with experiment. In this work, we present advances in the development of a quantum mechanical force field (QMFF) suitable for application to biological macromolecules and condensed phase simulations. QMFFs leverage the benefits provided by the LSQM and QM/MM approaches to produce a fully QM method that is able to

  6. Asymptotic scaling properties and estimation of the generalized Hurst exponents in financial data

    Science.gov (United States)

    Buonocore, R. J.; Aste, T.; Di Matteo, T.

    2017-04-01

    We propose a method to measure the Hurst exponents of financial time series. The scaling of the absolute moments against the aggregation horizon of real financial processes and of both uniscaling and multiscaling synthetic processes converges asymptotically towards linearity in log-log scale. In light of this we found appropriate a modification of the usual scaling equation via the introduction of a filter function. We devised a measurement procedure which takes into account the presence of the filter function without the need of directly estimating it. We verified that the method is unbiased within the errors by applying it to synthetic time series with known scaling properties. Finally we show an application to empirical financial time series where we fit the measured scaling exponents via a second or a fourth degree polynomial, which, because of theoretical constraints, have respectively only one and two degrees of freedom. We found that on our data set there is not clear preference between the second or fourth degree polynomial. Moreover the study of the filter functions of each time series shows common patterns of convergence depending on the momentum degree.

  7. [Detecting and measuring functional and organic disease in general population: Development and validation of TOPYPS clinical scale].

    Science.gov (United States)

    Pailhez, Guillem; Castaño, Juan; Rosado, Silvia; Ballester, M Del Mar; Vendrell, Cristina; Canale, Francisco; Bulbena, Antonio

    2017-12-01

    To develop and validate the TOPYPS scale, an instrument designed to: (i)detect with a high degree of suspicion the most frequent functional pathologies according to standard diagnostic criteria, and (ii)to assess the physical health in the general population quickly, comprehensive and reliable. Validation of a scale. Primary Care Centre, Barcelona. The scale was administered to 67 randomly selected adults. TOPYPS scale was administered to 67 adults randomly selected from a primary care setting in Barcelona, Spain. TOPYPS has six sections based on body systems, each one scored according to the degree of interference in daily activity, type of treatment received, and prognostic of the reported illnesses in each section. Test-retest reliability completions were on two separate occasions one week apart. Validity was then tested by comparing the results with the clinical examination conducted by two different specialists in general practice (gold standard). Repeatability (test-retest) and inter-rater agreement for each of the six sections and for the total score were satisfactory. Validity was acceptable both for content and construct, according to their correlation with the gold standard. TOPYPS displayed good psychometrical properties. It is a suitable tool to detect and measure functional and organic diseases in general population. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  8. Scales

    Science.gov (United States)

    Scales are a visible peeling or flaking of outer skin layers. These layers are called the stratum ... Scales may be caused by dry skin, certain inflammatory skin conditions, or infections. Examples of disorders that ...

  9. Crowdsourcing the General Public for Large Scale Molecular Pathology Studies in Cancer

    Directory of Open Access Journals (Sweden)

    Francisco J. Candido dos Reis

    2015-07-01

    Interpretation: Crowdsourcing of the general public to classify cancer pathology data for research is viable, engages the public and provides accurate ER data. Crowdsourced classification of research data may offer a valid solution to problems of throughput requiring human input.

  10. General scaling limitations of ground-plane and isolated-object cloaks

    Energy Technology Data Exchange (ETDEWEB)

    Hashemi, Hila; Johnson, Steven G. [Department of Mathematics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139 (United States); Oskooi, A. [Department of Electronic Science and Engineering, Kyoto University (Japan); Joannopoulos, J. D. [Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139 (United States)

    2011-08-15

    We prove that, for arbitrary three-dimensional transformation-based invisibility cloaking of an object above a ground plane or of isolated objects, there are practical constraints that increase with the object size. In particular, we show that the cloak thickness must scale proportionally to the thickness of the object being cloaked, assuming bounded refractive indices, and that absorption discrepancies and other imperfections must scale inversely with the object thickness. For isolated objects, we also show that bounded refractive indices imply a lower bound on the effective cross section.

  11. German National Proficiency Scales in Biology: Internal Structure, Relations to General Cognitive Abilities and Verbal Skills

    Science.gov (United States)

    Kampa, Nele; Köller, Olaf

    2016-01-01

    National and international large-scale assessments (LSA) have a major impact on educational systems, which raises fundamental questions about the validity of the measures regarding their internal structure and their relations to relevant covariates. Given its importance, research on the validity of instruments specifically developed for LSA is…

  12. Crowdsourcing the General Public for Large Scale Molecular Pathology Studies in Cancer

    NARCIS (Netherlands)

    F.J. Candido dos Reis (Francisco J.); S. Lynn (Stuart); H.R. Ali (Hamid Raza); D. Eccles (Diana); A. Hanby (Andrew); E. Provenzano (Elena); C. Caldas (Carlos); W.J. Howat (Will); L.-A. McDuffus (Leigh-Anne); B. Liu (Bin); F. Daley (Frances); P. Coulson (Penny); R.J. Vyas (Rupesh J.); L.M. Harris (Leslie M.); J.M. Owens (Joanna M.); A.F.M. Carton (Amy F.M.); J.P. McQuillan (Janette P.); A.M. Paterson (Andy M.); Z. Hirji (Zohra); S.K. Christie (Sarah K.); A.R. Holmes (Amber R.); M.K. Schmidt (Marjanka); M. García-Closas (Montserrat); D.F. Easton (Douglas); M.K. Bolla (Manjeet); Q. Wang (Qing); J. Benítez (Javier); R.L. Milne (Roger L.); A. Mannermaa (Arto); F.J. Couch (Fergus); P. Devilee (Peter); R.A.E.M. Tollenaar (Rob); C.M. Seynaeve (Caroline); A. Cox (Angela); S.S. Cross (Simon); F. Blows (Fiona); J. Sanders (Joyce); R. de Groot (Renate); J.D. Figueroa (Jonine); M. Sherman (Mark); M.J. Hooning (Maartje); H. Brenner (Hermann); B. Holleczek (Bernd); C. Stegmaier (Christa); C. Lintott (Chris); P.D.P. Pharoah (Paul)

    2015-01-01

    textabstractBackground: Citizen science, scientific research conducted by non-specialists, has the potential to facilitate biomedical research using available large-scale data, however validating the results is challenging. The Cell Slider is a citizen science project that intends to share images

  13. Time-sliced perturbation theory for large scale structure I: general formalism

    Energy Technology Data Exchange (ETDEWEB)

    Blas, Diego; Garny, Mathias; Sibiryakov, Sergey [Theory Division, CERN, CH-1211 Genève 23 (Switzerland); Ivanov, Mikhail M., E-mail: diego.blas@cern.ch, E-mail: mathias.garny@cern.ch, E-mail: mikhail.ivanov@cern.ch, E-mail: sergey.sibiryakov@cern.ch [FSB/ITP/LPPC, École Polytechnique Fédérale de Lausanne, CH-1015, Lausanne (Switzerland)

    2016-07-01

    We present a new analytic approach to describe large scale structure formation in the mildly non-linear regime. The central object of the method is the time-dependent probability distribution function generating correlators of the cosmological observables at a given moment of time. Expanding the distribution function around the Gaussian weight we formulate a perturbative technique to calculate non-linear corrections to cosmological correlators, similar to the diagrammatic expansion in a three-dimensional Euclidean quantum field theory, with time playing the role of an external parameter. For the physically relevant case of cold dark matter in an Einstein-de Sitter universe, the time evolution of the distribution function can be found exactly and is encapsulated by a time-dependent coupling constant controlling the perturbative expansion. We show that all building blocks of the expansion are free from spurious infrared enhanced contributions that plague the standard cosmological perturbation theory. This paves the way towards the systematic resummation of infrared effects in large scale structure formation. We also argue that the approach proposed here provides a natural framework to account for the influence of short-scale dynamics on larger scales along the lines of effective field theory.

  14. Generalized Scaling of Urban Heat Island Effect and Its Applications for Energy Consumption and Renewable Energy

    Directory of Open Access Journals (Sweden)

    T.-W. Lee

    2014-01-01

    Full Text Available In previous work from this laboratory, it has been found that the urban heat island intensity (UHI can be scaled with the urban length scale and the wind speed, through the time-dependent energy balance. The heating of the urban surfaces during the daytime sets the initial temperature, and this overheating is dissipated during the night-time through mean convection motion over the urban surface. This may appear to be in contrast to the classical work by Oke (1973. However, in this work, we show that if the population density is used in converting the population data into urbanized area, then a good agreement with the current theory is found. An additional parameter is the “urban flow parameter,” which depends on the urban building characteristics and affects the horizontal convection of heat due to wind. This scaling can be used to estimate the UHI intensity in any cities and therefore predict the required energy consumption during summer months. In addition, all urbanized surfaces are expected to exhibit this scaling, so that increase in the surface temperature in large energy-consumption or energy-producing facilities (e.g., solar electric or thermal power plants can be estimated.

  15. General Factor Loadings and Specific Effects of the Differential Ability Scales, Second Edition Composites

    Science.gov (United States)

    Maynard, Jennifer L.; Floyd, Randy G.; Acklie, Teresa J.; Houston, Lawrence, III

    2011-01-01

    The purpose of this study was to investigate the "g" loadings and specific effects of the core and diagnostic composite scores from the Differential Abilities Scales, Second Edition (DAS-II; Elliott, 2007a). Scores from a subset of the DAS-II standardization sample for ages 3:6 to 17:11 were submitted to principal factor analysis. Four…

  16. Converting three general-cognitive function scales into Persian and assessment of their validity and reliability

    Directory of Open Access Journals (Sweden)

    Payam Moin

    2011-01-01

    Full Text Available Objectives: Glasgow Outcome Scale Extended (GOSE, Galveston Amnesia and orientation Test (GOAT and Disability Rating Scale (DRS are three popular outcome measure tools used principally in traumatic brain injury (TBI patients. We conducted this study to provide a Farsi version of these outcome scales for use in Iran. Methods: Following a comprehensive literature review, Farsi transcripts were prepared by "forward-backward" translation and reviewed by subject experts. After a pretest on a few patients, the final versions were obtained. 38 patients with closed head injury were interviewed simultaneously by two interviewers. Main statistics used to assess validity and reliability included "Factor analysis" for construct validity, Cronbach′s alpha for internal consistency, and Pearson Correlation and Kappa Coefficient for inter-rater agreement. Results: Factor analysis for Farsi-GOAT (FGOAT revealed 5 independent factors with a total distribution variance of 80.2%. For Farsi-DRS (FDRS, 3 independent factors were found with a 92.3% variance. The Cronbach′s alpha (95% confidence interval was 0.84 (0.763- 0.919 and 0.91 (0.901-0.919 for FGOAT and FDRS, respectively. Pearson Correlation between total scores of two raters was 0.98 and 0.97 for FGOAT and FDRS, in order. Kappa coefficient (95% CI between outcome rankings of raters was 0.73 (0.618-0.852 and 0.68 (0.594-0.770 for FGOAT and FDRS, respectively. As for Farsi-GOSE scale, Kappa value was 0.4 (0.285-0.507 for 8-level outcome ranking and improved to 0.7 (0.585-0.817 for 5-level scale. We found a good correlation between FDRS and FGOSE predicted prognoses (Spearman′s rho= 0.74, 95% CI: 0.676-0.802. Conclusions: FDRS and FGOAT had appropriate validity and reliability. The 8-level outcome FGOSE scale disclosed a low inter-rater agreement, but a suitable observer agreement was achieved when the 5-level outcome was applied.

  17. Illness perceptions and medication adherence in adolescents with ...

    African Journals Online (AJOL)

    They completed self-report questionnaires about their demographic and medical data, their illness perception using the Illness Perception Questionnaire-Revised (IPQ-R) and their medication adherence using the Medication Adherence Report Scale-5 (MARS5). The outcome of the analysis using the Pearson Product ...

  18. Psychological distress and adherence to highly active anti-retroviral ...

    African Journals Online (AJOL)

    Background: Mental health related risk factors for non-adherence to highly active anti-retroviral therapy (HAART) have not been investigated in Uganda and yet adherence is critical to the success of the current scale up in the provision of HAART to HIV positive individuals in rural areas of Uganda. Objective: To determine ...

  19. Expanding binge eating assessment: Validity and screening value of the Binge Eating Scale in women from the general population

    OpenAIRE

    Duarte, Cristiana; Pinto-Gouveia, José; Ferreira, Cláudia

    2015-01-01

    There is growing recognition that binge eating is a prevalent problem with serious implications for both clinical and nonclinical samples. The current study aimed at examining the factor structure, psychometric properties and the screening usefulness of the Binge Eating Scale (BES) in a large sample of female college students and women from the Portuguese general population. A sample of 1008 participants was collected to conduct a confirmatory factor analysis and test the BES psychometric pro...

  20. The significance of cloud-radiative forcing to the general circulation on climate time scales - A satellite interpretation

    Science.gov (United States)

    Sohn, Byung-Ju; Smith, Eric A.

    1992-01-01

    This paper focuses on the role of cloud- and surface-atmosphere forcing on the net radiation balance and their potential impact on the general circulation at climate time scales. The globally averaged cloud-forcing estimates and cloud sensitivity values taken from various recent studies are summarized. It is shown that the net radiative heating over the tropics is principally due to high clouds, while the net cooling in mid- and high latitudes is dominated by low and middle clouds.

  1. Scaling the Fractal Plain: Towards a General View of Knowledge Management

    Science.gov (United States)

    Griffiths, David; Evans, Peter

    2011-01-01

    Purpose: The purpose of the paper is to explore coherence across key disciplines of knowledge management (KM) for a general model as a way to address performance dissatisfaction in the field. Design/methodology/approach: Research employed an evidence-based meta-analysis (287 aspects of literature), triangulated through an exploratory survey (91…

  2. Size-extensive wave functions for quantum Monte Carlo: A linear scaling generalized valence bond approach

    NARCIS (Netherlands)

    Fracchia, F.; Filippi, Claudia; Amovilli, C.

    2012-01-01

    We propose a new class of multideterminantal Jastrow–Slater wave functions constructed with localized orbitals and designed to describe complex potential energy surfaces of molecular systems for use in quantum Monte Carlo (QMC). Inspired by the generalized valence bond formalism, we elaborate a

  3. Validation of the Oral Hygiene Habits Scale: Relationships with sociodemographic variables in the general and clinical population of Monterrey, Mexico.

    Directory of Open Access Journals (Sweden)

    Norma Rodríguez

    2016-12-01

    Full Text Available Several socioeconomic factors are associated with poor oral hygiene habits. A version of the Oral Hygiene Habits Scale (OHHS was developed in Mexico to measure these factors; however, its relationship with sociodemographic variables has not been studied. The verification of these relationships could contribute to the validation of the scale. Objective: To evaluate the relationship between oral hygiene habits and sociodemographic variables of sex, age, schooling, self-defined socioeconomic stratum, occupation and marital status in the general and clinical population of Monterrey, Mexico. Materials and Methods: A general population sample (GPS of 256 participants and a clinical sample (CPS of 240 participants were studied. The OHHS consisted of an eight-item Likert scale of 4 points ranging from 0 to 4. A descriptive correlational study was performed with a cross-sectional design. Data were analyzed using the Mann-Whitney U test, Kruskal-Wallis test, Spearman correlation coefficient, Cramer's V coefficient, and multivariate aligned rank test. Results: In GPS and CPS groups, OHHS was related to sex, schooling, socioeconomic stratum, occupation and marital status, but not to age. There were no significant interactions between the samples (GPS and CPS and sociodemographic variables. Conclusion: There is a statistically significant relationship between oral hygiene habits and some sociodemographic variables in the general and clinical population. This relationship supports the validity of the OHHS.

  4. Latent class analysis of the Apathy Scale does not identify subtypes of apathy in general population-based older persons.

    Science.gov (United States)

    Groeneweg-Koolhoven, Isis; Huitema, Lotte J; de Waal, Margot W M; Stek, Max L; Gussekloo, Jacobijn; van der Mast, Roos C; Rhebergen, Didi

    2016-09-01

    To identify clinically relevant subtypes of apathy in older persons using latent class analysis (LCA) and investigate the distribution of different characteristics across these subtypes. Cross-sectional data of 122 older persons (mean age 84 years, 60% female) participating in the general population-based PROactive Management Of Depression in the Elderly study, with apathy according to a score of 14 or higher on the Apathy Scale, were included for LCA. All 14 items of the Apathy Scale were used as indicator variables. Several characteristics were examined including sociodemographics, depressive, and anxiety symptoms; global cognitive function; quality of life indicators; hazardous alcohol intake (drinking ≥ 14 consumptions per week); and perceived chronic pain. Three distinct LCA classes were found classifying 17%, 7%, and 76% of the participants respectively. Individuals in the first class had a higher level of education and were less likely to live alone. Those in the second class had higher apathy and depression scores, lived more frequently alone and used more alcohol. Individuals in the third class showed a lower level of education and worse cognitive function. In multivariable multinomial analyses, only a lower educational level and higher scores on the Apathy Scale were significant predictors for class membership. Differences between LCA-derived classes were minimal, suggesting that in a general population-based cohort the Apathy Scale measures a homogeneous construct. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  5. Adherence to treatment in men with hypogonadotrophic hypogonadism.

    Science.gov (United States)

    Dwyer, Andrew A; Tiemensma, Jitske; Quinton, Richard; Pitteloud, Nelly; Morin, Diane

    2017-03-01

    Men with congenital hypogonadotrophic hypogonadism (CHH) typically require lifelong hormonal therapy, and discontinuing treatment can have negative health consequences. Little is known about adherence to treatment or the psychosocial impact of CHH. A sequential, multiple methods approach was used. A quantitative online survey assessed adherence to treatment, depressive symptoms and illness perceptions. Subsequently, qualitative focus groups explored patient-reported factors for adherence. Adult men with CHH on at least 1 year of treatment were recruited internationally. Adherence (Morisky medication adherence scale), depressive symptoms (Zung self-rating depression scale) and patient perception of CHH (revised illness perception questionnaire) were assessed in an online survey, and comparisons were made to reference groups. Patient focus group discussions were conducted and thematic analysis was employed to identify patient-reported factors for adherence. In total, 101 men on long-term treatment were included (mean age 37 ± 11 years). Forty three percent (43/101) exhibited low medication adherence and a significantly elevated prevalence of mild, moderate or severe depressive symptoms (27%, 17%, 20%, respectively, all P hypogonadism men are challenged to adhere to long-term treatment. Poor adherence may contribute to adverse effects on bone, sexual and psychological health. The psychosocial morbidity of CHH is significant and appears to be underappreciated by healthcare providers. © 2016 John Wiley & Sons Ltd.

  6. Generalized Additive Models for Location Scale and Shape (GAMLSS) in R

    OpenAIRE

    D. Mikis Stasinopoulos; Robert A. Rigby

    2007-01-01

    GAMLSS is a general framework for fitting regression type models where the distribution of the response variable does not have to belong to the exponential family and includes highly skew and kurtotic continuous and discrete distribution. GAMLSS allows all the parameters of the distribution of the response variable to be modelled as linear/non-linear or smooth functions of the explanatory variables. This paper starts by defining the statistical framework of GAMLSS, then describes the curren...

  7. Impact of SCALE-UP on science teaching self-efficacy of students in general education science courses

    Science.gov (United States)

    Cassani, Mary Kay Kuhr

    The objective of this study was to evaluate the effect of two pedagogical models used in general education science on non-majors' science teaching self-efficacy. Science teaching self-efficacy can be influenced by inquiry and cooperative learning, through cognitive mechanisms described by Bandura (1997). The Student Centered Activities for Large Enrollment Undergraduate Programs (SCALE-UP) model of inquiry and cooperative learning incorporates cooperative learning and inquiry-guided learning in large enrollment combined lecture-laboratory classes (Oliver-Hoyo & Beichner, 2004). SCALE-UP was adopted by a small but rapidly growing public university in the southeastern United States in three undergraduate, general education science courses for non-science majors in the Fall 2006 and Spring 2007 semesters. Students in these courses were compared with students in three other general education science courses for non-science majors taught with the standard teaching model at the host university. The standard model combines lecture and laboratory in the same course, with smaller enrollments and utilizes cooperative learning. Science teaching self-efficacy was measured using the Science Teaching Efficacy Belief Instrument - B (STEBI-B; Bleicher, 2004). A science teaching self-efficacy score was computed from the Personal Science Teaching Efficacy (PTSE) factor of the instrument. Using non-parametric statistics, no significant difference was found between teaching models, between genders, within models, among instructors, or among courses. The number of previous science courses was significantly correlated with PTSE score. Student responses to open-ended questions indicated that students felt the larger enrollment in the SCALE-UP room reduced individual teacher attention but that the large round SCALE-UP tables promoted group interaction. Students responded positively to cooperative and hands-on activities, and would encourage inclusion of more such activities in all of the

  8. Normal people in clinical practice: a general factor of personality in biproportional scaling and its practical relevance.

    Science.gov (United States)

    Mosterman, Regina M

    2013-01-01

    To investigate the clinical relevance of absolute scaling in personality assessment, Hofstee and Ten Berge's (2004) biproportional scaling method was applied to 3 clinical samples and compared with relative scaling in traditional analyses. In the first sample, 80 psychotherapy clients provided self-reports as well as reports by 3 informants, resulting in 320 ratings of the Dutch short form of the MMPI (NVM). In the second sample, 96 psychotherapy clients provided self-reports and informant reports, resulting in 384 Five-Factor Personality Inventory (FFPI) ratings. In the third sample, 95 clients provided self-reports and informant reports, resulting in 380 ratings of the NEO Five-Factor Inventory (NEO-FFI). In Part I of the study, the personality structure based on biproportional scaling was examined by replicating Hofstee, Barelds, and Ten Berge (2006). In Part II, this personality structure as well as self-informant distances and self-informant likenesses were related to symptoms, personality pathology, and level of functioning. The results confirmed the presence of a general factor of personality in absolute scaling, which appears to reflect social fitness and the absence of severe psychopathology. This factor was significantly associated with fewer symptoms and better functioning in all 3 samples. The personality pathology results were only significant in the FFPI sample. Self-informant distance and self-informant likeness were primarily associated with symptoms. A relationship between poor social fitness and insecure early attachment was suggested in 3 case studies.

  9. Adherence to the DASH diet in relation to psychological profile of Iranian adults.

    Science.gov (United States)

    Valipour, Ghazaleh; Esmaillzadeh, Ahmad; Azadbakht, Leila; Afshar, Hamid; Hassanzadeh, Ammar; Adibi, Peyman

    2017-02-01

    Although empirically derived dietary patterns have been examined in relation to depression, limited data are available linking theory-based dietary patterns and psychological health. We aimed to investigate the association between adherence to DASH-style diet and psychological health among Iranian adults. This cross-sectional study was done among 3846 general public adults in Isfahan, Iran. Dietary assessment was conducted using a validated 106-item dish-based semiquantitative food frequency questionnaire. To investigate participants' adherence to DASH-style diet, we created DASH score based on earlier publications focusing on eight components (fruits, vegetables, nuts and legumes, dairy products, grains, sweetened beverages and sweets, sodium, and red and processed meats). Participants were classified into three categories based on their DASH score [low (≤40), moderate (41-50), and high adherence (≥51)]. This categorization, instead of distribution-based classification, was used due to low adherence to the DASH dietary pattern in the study population. Psychological health was examined by means of validated Hospital Anxiety and Depression Scale and General Health Questionnaire. Depression, anxiety, and psychological distress were defined based on standard criteria. We found that moderate adherence to DASH-style diet was associated with lower odds of depression (OR 0.73; 95 % CI 0.59-0.90, P trend  = 0.63) compared with those with the lowest adherence. In our stratified analyses, these associations remained significant for women (0.70; 0.54-0.91) and for normal-weight participants (0.70; 0.52-0.92). Moreover, after controlling for potential confounders, an inverse association was observed between high adherence to DASH-style diet and anxiety in normal-weight participants (0.61; 0.37-0.98). Such associations were also seen between moderate adherence to DASH-eating style and anxiety in overweight or obese individuals (0.63; 0.42-0.95). We failed to find any

  10. Statistical scaling, Shannon entropy, and Generalized space-time q-entropy of rainfall fields in tropical South America.

    Science.gov (United States)

    Poveda, Germán; Salas, Hernán D

    2015-07-01

    We study diverse scaling and information theory characteristics of Mesoscale Convective Systems (MCSs) as seen by the Tropical Rainfall Measuring Mission (TRMM) over continental and oceanic regions of tropical South America, and 2-D radar rainfall fields from Amazonia. The bi-dimensional Fourier spectra of MCSs exhibit inverse power laws with respect to the spatial scale, whose scaling exponents, β, capture the type of spatial correlation of rainfall among the study regions, including those over the Andes of Colombia as well as over oceanic and Amazonian regions. The moment-scaling analysis evidences that the structure function deviates from simple scaling at order q > 1.0, thus signaling the multi-scaling nature of rainfall fields within MCSs in tropical South America, with departures from simple scaling associated with the physical characteristics of MCSs over the different study regions. Entropy is estimated for a large set of radar rainfall fields during the distinctive atmospheric regimes (Easterly and Westerly events) in this part of Amazonia. Results evidence that there are significant differences in the dynamics of rainfall among regimes. No clear-cut relationship is found between entropy and the first two statistical moments, but power fits in space and time, S(γ) ∼ γ(-η) for skewness and, S(κ) ∼ κ(-ϵ) for kurtosis. The exponents η and ϵ are statistically different between Easterly and Westerly events, although the significance of fits is less when L-moments are used to estimate skewness and kurtosis. Interesting differences are identified between the time and space generalized q-entropy functions of Amazonian rainfall fields. In both cases, the functions are a continuous set of power laws (analogous to the structure function in turbulence), S(T, q) ∼ T(β), and, S(λ, q) ∼ λ(β), covering a broad range of temporal and spatial scales. Both time and space generalized q-entropy functions exhibit linear growth in the

  11. Generalized Additive Models for Location Scale and Shape (GAMLSS in R

    Directory of Open Access Journals (Sweden)

    D. Mikis Stasinopoulos

    2007-11-01

    Full Text Available GAMLSS is a general framework for fitting regression type models where the distribution of the response variable does not have to belong to the exponential family and includes highly skew and kurtotic continuous and discrete distribution. GAMLSS allows all the parameters of the distribution of the response variable to be modelled as linear/non-linear or smooth functions of the explanatory variables. This paper starts by defining the statistical framework of GAMLSS, then describes the current implementation of GAMLSS in R and finally gives four different data examples to demonstrate how GAMLSS can be used for statistical modelling.

  12. Magnetic field measurements of Fermilab/General Dynamics built full scale SSC collider dipole magnets

    International Nuclear Information System (INIS)

    Delchamps, S.; Bleadon, M.; Bossert, R.; Carson, J.; Gourlay, S.; Hanft, R.; Koska, W.; Kuchnir, M.; Lamm, M.J.; Mazur, P.O.; Mokhtarani, A.; Orris, D.; Strait, J.; Wake, M.; Devred, A.; DiMarco, J.; Kuzminski, J.; Ogitsu, T.; Puglisi, M.; Tompkins, J.C.; Yu, Y.; Zhao, Y.; Zheng, H.

    1992-01-01

    This paper presents preliminary results of magnetic field measurements made on a series of 50 mm aperture 15 m long SSC collider dipole magnets designed and manufactured at Fermi National Accelerator Laboratory (Fermilab) for use in the Superconducting Super Collider Laboratory (SSCL) Accelerator System String Test. The magnets were assembled by Fermilab and General Dynamics personnel, and were tested at the Magnet Test Facility (MTF) at Fermilab. Measurements of the dipole field angle, dipole field strength, and field shape parameters at various stages in magnet construction and testing are described

  13. 14 CFR 1260.72 - Adherence to original budget estimates.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Adherence to original budget estimates... COOPERATIVE AGREEMENTS General Post-Award Requirements § 1260.72 Adherence to original budget estimates. (a) Although NASA assumes no responsibility for budget overruns, the recipient may spend grant funds without...

  14. Time-Sliced Perturbation Theory for Large Scale Structure I: General Formalism

    CERN Document Server

    Blas, Diego; Ivanov, Mikhail M.; Sibiryakov, Sergey

    2016-01-01

    We present a new analytic approach to describe large scale structure formation in the mildly non-linear regime. The central object of the method is the time-dependent probability distribution function generating correlators of the cosmological observables at a given moment of time. Expanding the distribution function around the Gaussian weight we formulate a perturbative technique to calculate non-linear corrections to cosmological correlators, similar to the diagrammatic expansion in a three-dimensional Euclidean quantum field theory, with time playing the role of an external parameter. For the physically relevant case of cold dark matter in an Einstein--de Sitter universe, the time evolution of the distribution function can be found exactly and is encapsulated by a time-dependent coupling constant controlling the perturbative expansion. We show that all building blocks of the expansion are free from spurious infrared enhanced contributions that plague the standard cosmological perturbation theory. This pave...

  15. Interpolating a consumption variable for scaling and generalizing potential population pressure on urbanizing natural areas

    Science.gov (United States)

    Varanka, Dalia; Jiang, Bin; Yao, Xiaobai

    2010-01-01

    Measures of population pressure, referring in general to the stress upon the environment by human consumption of resources, are imperative for environmental sustainability studies and management. Development based on resource consumption is the predominant factor of population pressure. This paper presents a spatial model of population pressure by linking consumption associated with regional urbanism and ecosystem services. Maps representing relative geographic degree and extent of natural resource consumption and degree and extent of impacts on surrounding areas are new, and this research represents the theoretical research toward this goal. With development, such maps offer a visualization tool for planners of various services, amenities for people, and conservation planning for ecologist. Urbanization is commonly generalized by census numbers or impervious surface area. The potential geographical extent of urbanism encompasses the environmental resources of the surrounding region that sustain cities. This extent is interpolated using kriging of a variable based on population wealth data from the U.S. Census Bureau. When overlayed with land-use/land-cover data, the results indicate that the greatest estimates of population pressure fall within mixed forest areas. Mixed forest areas result from the spread of cedar woods in previously disturbed areas where further disturbance is then suppressed. Low density areas, such as suburbanization and abandoned farmland are characteristic of mixed forest areas.

  16. Smallest detectable change and test-retest reliability of a self-reported outcome measure: Results of the Center for Epidemiologic Studies Depression Scale, General Self-Efficacy Scale, and 12-item General Health Questionnaire.

    Science.gov (United States)

    Ohno, Shotaro; Takahashi, Kana; Inoue, Aimi; Takada, Koki; Ishihara, Yoshiaki; Tanigawa, Masaru; Hirao, Kazuki

    2017-12-01

    This study aims to examine the smallest detectable change (SDC) and test-retest reliability of the Center for Epidemiologic Studies Depression Scale (CES-D), General Self-Efficacy Scale (GSES), and 12-item General Health Questionnaire (GHQ-12). We tested 154 young adults at baseline and 2 weeks later. We calculated the intra-class correlation coefficients (ICCs) for test-retest reliability with a two-way random effects model for agreement. We then calculated the standard error of measurement (SEM) for agreement using the ICC formula. The SEM for agreement was used to calculate SDC values at the individual level (SDC ind ) and group level (SDC group ). The study participants included 137 young adults. The ICCs for all self-reported outcome measurement scales exceeded 0.70. The SEM of CES-D was 3.64, leading to an SDC ind of 10.10 points and SDC group of 0.86 points. The SEM of GSES was 1.56, leading to an SDC ind of 4.33 points and SDC group of 0.37 points. The SEM of GHQ-12 with bimodal scoring was 1.47, leading to an SDC ind of 4.06 points and SDC group of 0.35 points. The SEM of GHQ-12 with Likert scoring was 2.44, leading to an SDC ind of 6.76 points and SDC group of 0.58 points. To confirm that the change was not a result of measurement error, a score of self-reported outcome measurement scales would need to change by an amount greater than these SDC values. This has important implications for clinicians and epidemiologists when assessing outcomes. © 2017 John Wiley & Sons, Ltd.

  17. A cluster randomised controlled trial protocol of an adapted intervention for alcohol use disorders in people living with HIV and AIDS: impact on alcohol use, general functional ability, quality of life and adherence to HAART.

    Science.gov (United States)

    Madhombiro, Munyaradzi; Dube-Marimbe, Bazondlile; Dube, Michelle; Chibanda, Dixon; Zunza, Moleen; Rusakaniko, Simbarashe; Stewart, David; Seedat, Soraya

    2017-01-28

    Interventions for alcohol use disorders (AUDs) in HIV infected individuals have been primarily targeted at HIV risk reduction and improved antiretroviral treatment adherence. However, reduction in alcohol use is an important goal. Alcohol use affects other key factors that may influence treatment course and outcome. In this study the authors aim to administer an adapted intervention for AUDs to reduce alcohol use in people living with HIV/AIDS (PLWHA). This study is a cluster randomised controlled trial at 16 HIV care clinics. A motivational interviewing and cognitive behavioural therapy based intervention for AUDs, developed through adaptation and piloted in Zimbabwe, will be administered to PLWHA with AUDs recruited at HIV clinics. The intervention will be administered over 16 sessions at 8 HIV clinics. This intervention will be compared with an equal attention control in the form of the World Health Organization Mental Health Gap Action Programme (WHO mhGAP) guide, adapted for the Zimbabwean context. General function, quality of life, and adherence to highly active antiretroviral treatment (HAART) will be secondary outcomes. Booster sessions will be administered to both groups at 3 and 6 months respectively. The primary outcome measure will be the Alcohol Use Disorder Identification Test (AUDIT) score. The World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0), World Health Organisation Quality of Life (WHOQoL) HIV, viral load, and CD4 counts will be secondary outcome measures. Outcome assessments will be administered at baseline, 3, 6, and 12 months. Moderating factors such as perceived social support, how people cope with difficult situations and post-traumatic exposure and experience will be assessed at baseline. Trained research assistants will recruit participants. The outcome assessors who will be trained in administering the outcome and moderating tools will be blinded to the treatment arms allocated to the participants. However, the

  18. adherence to antiretroviral regimens

    African Journals Online (AJOL)

    to macro- and microeconomic costs.' What soon became evident, however, was the vital importance of patient adherence with prescribed medication in order to garner the benefits that were so rapidly becoming available. As a result, much attention has recently been paid to this aspect of management. Both clinicians and ...

  19. DEPENDENCY ON EXERCISE IN COMPETITIVE BODYBUILDERS ASSESSED BY MEANS OF THE RAMÓN Y CAJAL GENERAL ADDICTION SCALE

    Directory of Open Access Journals (Sweden)

    JOSÉ CARLOS CARACUEL TUBÍO

    2007-11-01

    Full Text Available We plan to bring forward data which will enable us to carry out an approximation of the addiction to training in agroup of bodybuilding competitors about which there has been no information up to now in Spain. 116 malesubjects filled in the Ramón y Cajal General Addiction Scale. 64 (55.17% of these were considered new to musculartraining and 52 (44.83% were competitors. The competitor bodybuilders have shown a significantly better punctuationin all the dimensions of the general addiction scale (craving: t = 2.81, p = 0.006; withdrawal: t = 3.59, p = 0.000; lackof control: t = 3.59, p = 0.000; total: t = 3.88, p = 0.000 except that of tolerance (t = 1.44, p = 0.153. In the same way,in the analysis of variables related to training we have been able to see that those who normally stay training longer thanplanned, or who usually feel bad the days they don’t train, have tried to lower the level of training, without success, or who usually look bad after comparing themselves physically to other gym mates, tend to show higher values both inthe total punctuation and in the majority of the dimensions of the scale.

  20. Expanding binge eating assessment: Validity and screening value of the Binge Eating Scale in women from the general population.

    Science.gov (United States)

    Duarte, Cristiana; Pinto-Gouveia, José; Ferreira, Cláudia

    2015-08-01

    There is growing recognition that binge eating is a prevalent problem with serious implications for both clinical and nonclinical samples. The current study aimed at examining the factor structure, psychometric properties and the screening usefulness of the Binge Eating Scale (BES) in a large sample of female college students and women from the Portuguese general population. A sample of 1008 participants was collected to conduct a confirmatory factor analysis and test the BES psychometric properties; 150 participants were further evaluated through the Eating Disorder Examination 16.0D to assess the discriminant validity of the BES. Results confirmed that the BES presents a sound one-dimensional factorial structure, with very good construct reliability and convergent validity. Also, the scale presented very good retest-reliability. Findings also offered evidence that the BES is positively associated with measures of eating and general psychopathology, and BMI. Furthermore, the BES revealed an excellent performance (96.7%) on discriminating clinically significant cases of binge eating, showing a sensitivity of 81.8% and a specificity of 97.8%. Results support the validity and usefulness of the BES as an assessment and screening tool for binge eating in women from the general population. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Cultural adaptation into Spanish of the generalized anxiety disorder-7 (GAD-7 scale as a screening tool

    Directory of Open Access Journals (Sweden)

    Pérez-Páramo María

    2010-01-01

    Full Text Available Abstract Background Generalized anxiety disorder (GAD is a prevalent mental health condition which is underestimated worldwide. This study carried out the cultural adaptation into Spanish of the 7-item self-administered GAD-7 scale, which is used to identify probable patients with GAD. Methods The adaptation was performed by an expert panel using a conceptual equivalence process, including forward and backward translations in duplicate. Content validity was assessed by interrater agreement. Criteria validity was explored using ROC curve analysis, and sensitivity, specificity, predictive positive value and negative value for different cut-off values were determined. Concurrent validity was also explored using the HAM-A, HADS, and WHO-DAS-II scales. Results The study sample consisted of 212 subjects (106 patients with GAD with a mean age of 50.38 years (SD = 16.76. Average completion time was 2'30''. No items of the scale were left blank. Floor and ceiling effects were negligible. No patients with GAD had to be assisted to fill in the questionnaire. The scale was shown to be one-dimensional through factor analysis (explained variance = 72%. A cut-off point of 10 showed adequate values of sensitivity (86.8% and specificity (93.4%, with AUC being statistically significant [AUC = 0.957-0.985; p 0.001. Limitations Elderly people, particularly those very old, may need some help to complete the scale. Conclusion After the cultural adaptation process, a Spanish version of the GAD-7 scale was obtained. The validity of its content and the relevance and adequacy of items in the Spanish cultural context were confirmed.

  2. Distributed cerebellar plasticity implements generalized multiple-scale memory components in real-robot sensorimotor tasks

    Directory of Open Access Journals (Sweden)

    Claudia eCasellato

    2015-02-01

    Full Text Available The cerebellum plays a crucial role in motor learning and it acts as a predictive controller. Modeling it and embedding it into sensorimotor tasks allows us to create functional links between plasticity mechanisms, neural circuits and behavioral learning. Moreover, if applied to real-time control of a neurorobot, the cerebellar model has to deal with a real noisy and changing environment, thus showing its robustness and effectiveness in learning. A biologically inspired cerebellar model with distributed plasticity, both at cortical and nuclear sites, has been used. Two cerebellum-mediated paradigms have been designed: an associative Pavlovian task and a vestibulo-ocular reflex, with multiple sessions of acquisition and extinction and with different stimuli and perturbation patterns. The cerebellar controller succeeded to generate conditioned responses and finely tuned eye movement compensation, thus reproducing human-like behaviors. Through a productive plasticity transfer from cortical to nuclear sites, the distributed cerebellar controller showed in both tasks the capability to optimize learning on multiple time-scales, to store motor memory and to effectively adapt to dynamic ranges of stimuli.

  3. Serial Palliative Performance Scale Assessment in a University General Hospital: A Pilot Study.

    Science.gov (United States)

    de Medeiros, Rafael Barone; Stamm, Ana Maria Nunes de Faria; Moritz, Rachel Duarte; Freitas, Paulo Fontoura; Kretzer, Lara Patrícia; Gomes, Juliana Vieira

    2018-01-19

    Serial Palliative Performance Scale (PPS) assessments may predict functional decline and prognosis in cancer and noncancer patients and help with end-of-life decision making. To evaluate the functional status of using serial PPS assessments of patients being assisted in collaboration with the palliative care team (PCT). Prospective cohort pilot study. The sample consisted of 64 cancer and noncancer inpatients being assisted in collaboration with the PCT during the period from 2012 to 2016 (included 12 months). Patients' PPS scores were assessed in three sequential stages: prehospital, first PCT assessment, and outcome (discharge, transference to another unit or death). Functional performance was classified in categories as stable (PPS scores between 70% and 100%), transitional (PPS scores between 40% and 60%), and end of life (PPS scores between 10% and 30%). The mean PPS score during the three assessment stages (respectively, 60.5%, 38.9%, and 25.9%) was significantly different (p PPS scores than noncancer patients; however, both groups exhibited a functional decline along the hospital stay. In both groups there was a negative correlation between the time frame between the different assessment stages and PPS scores (respectively, Pearson -0.4 and -0.6; p PPS assessments are feasible and predicted functional decline in cancer and noncancer patients in this sample. Cancer patients exhibited higher initial functional scores but both cancer and noncancer patients declined in functionality along hospitalization. Earlier deaths occurred in the terminal PPS category than in the transitional PPS category.

  4. The Revised Child Anxiety and Depression Scale: A systematic review and reliability generalization meta-analysis.

    Science.gov (United States)

    Piqueras, Jose A; Martín-Vivar, María; Sandin, Bonifacio; San Luis, Concepción; Pineda, David

    2017-08-15

    Anxiety and depression are among the most common mental disorders during childhood and adolescence. Among the instruments for the brief screening assessment of symptoms of anxiety and depression, the Revised Child Anxiety and Depression Scale (RCADS) is one of the more widely used. Previous studies have demonstrated the reliability of the RCADS for different assessment settings and different versions. The aims of this study were to examine the mean reliability of the RCADS and the influence of the moderators on the RCADS reliability. We searched in EBSCO, PsycINFO, Google Scholar, Web of Science, and NCBI databases and other articles manually from lists of references of extracted articles. A total of 146 studies were included in our meta-analysis. The RCADS showed robust internal consistency reliability in different assessment settings, countries, and languages. We only found that reliability of the RCADS was significantly moderated by the version of RCADS. However, these differences in reliability between different versions of the RCADS were slight and can be due to the number of items. We did not examine factor structure, factorial invariance across gender, age, or country, and test-retest reliability of the RCADS. The RCADS is a reliable instrument for cross-cultural use, with the advantage of providing more information with a low number of items in the assessment of both anxiety and depression symptoms in children and adolescents. Copyright © 2017. Published by Elsevier B.V.

  5. A Real-time Generalization and Multi-scale Visualization Method for POI Data in Volunteered Geographic Information

    Directory of Open Access Journals (Sweden)

    YANG Min

    2015-02-01

    Full Text Available With the development of mobile and Web technologies, there has been an increasing number of map-based mushups which display different kinds of POI data in volunteered geographic information. Due to the lack of suitable mechanisms for multi-scale visualization, the display of the POI data often result in the icon clustering problem with icons touching and overlapping each other. This paper introduces a multi-scale visualization method for urban facility POI data by combing the classic methods of generalization and on-line environment. Firstly, we organize the POI data into hierarchical structure by preprocessing in the server-side; the POI features then will be obtained based on the display scale in the client-side and the displacement operation will be executed to resolve the local icon conflicts. Experiments show that this approach can not only achieve the requirements of real-time online, but also can get better multi-scale representation of POI data.

  6. Measuring compulsive buying behaviour: psychometric validity of three different scales and prevalence in the general population and in shopping centres.

    Science.gov (United States)

    Maraz, Aniko; Eisinger, Andrea; Hende, Borbála; Urbán, Róbert; Paksi, Borbála; Kun, Bernadette; Kökönyei, Gyöngyi; Griffiths, Mark D; Demetrovics, Zsolt

    2015-02-28

    Due to the problems of measurement and the lack of nationally representative data, the extent of compulsive buying behaviour (CBB) is relatively unknown. The validity of three different instruments was tested: Edwards Compulsive Buying Scale (ECBS; Edwards, E.A., 1993. Development of a new scale for measuring compulsive buying behaviour. Financial Counseling and Planning. 4, 67-85), Questionnaire About Buying Behavior (QABB; Lejoyeux, M., Ades, J., 1994. Les achats pathologiques: une addiction comportementale. Neuro-Psy. 9, 25-32.) and Richmond Compulsive Buying Scale (RCBS; Ridgway, N.M., Kukar-Kinney, M., Monroe, K.B., 2008. An expanded conceptualization and a new measure of compulsive buying. Journal of Consumer Research. 35, 622-639.) using two independent samples. One was nationally representative of the Hungarian population (N=2710) while the other comprised shopping mall customers (N=1447). As a result, a new, four-factor solution for the ECBS was developed (Edwards Compulsive Buying Scale Revised (ECBS-R)), and confirmed the other two measures. Additionally, cut-off scores were defined for all measures. Results showed that the prevalence of CBB is 1.85% (with QABB) in the general population but significantly higher in shopping mall customers (8.7% with ECBS-R, 13.3% with QABB and 2.5% with RCBS-R). Conclusively, due to the diversity of content, each measure identifies a somewhat different CBB group. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  7. Therapist adherence is associated with outcome in cognitive–behavioral therapy for bulimia nervosa

    DEFF Research Database (Denmark)

    Folke, Sofie; Daniel, Sarah Ingrid Franksdatter; Gondan, Matthias

    2017-01-01

    Studies of therapist adherence in relation to treatment outcome have produced mixed results. The aim of the present study was to investigate change in therapist adherence to cognitive–behavioral therapy (CBT) for bulimia nervosa over time, and to investigate the relationship between adherence......) of treatment using the Cognitive–Behavioral Therapy Treatment Protocol Adherence Scale. Change in adherence across the 3 treatment phases was examined using multilevel analysis. The relationship between early, middle, and late adherence levels and end-of-treatment binging frequency was examined using...

  8. Emergency Locator Transmitter System Performance During Three Full-Scale General Aviation Crash Tests

    Science.gov (United States)

    Littell, Justin D.; Stimson, Chad M.

    2016-01-01

    Full-scale crash tests were conducted on three Cessna 172 aircraft at NASA Langley Research Center's Landing and Impact Research facility during the summer of 2015. The purpose of the three tests was to evaluate the performance of commercially available Emergency Locator Transmitter (ELT) systems and support development of enhanced installation guidance. ELTs are used to provide location information to Search and Rescue (SAR) organizations in the event of an aviation distress situation, such as a crash. The crash tests simulated three differing severe but survivable crash conditions, in which it is expected that the onboard occupants have a reasonable chance of surviving the accident and would require assistance from SAR personnel. The first simulated an emergency landing onto a rigid surface, while the second and third simulated controlled flight into terrain. Multiple ELT systems were installed on each airplane according to federal regulations. The majority of the ELT systems performed nominally. In the systems which did not activate, post-test disassembly and inspection offered guidance for non-activation cause in some cases, while in others, no specific cause could be found. In a subset of installations purposely disregarding best practice guidelines, failure of the ELT-to-antenna cabling connections were found. Recommendations for enhanced installation guidance of ELT systems will be made to the Radio Technical Commission for Aeronautics (RTCA) Special Committee 229 for consideration for adoption in a future release of ELT minimum operational performance specifications. These recommendations will be based on the data gathered during this test series as well as a larger series of crash simulations using computer models that will be calibrated based on these data

  9. General Forced Oscillations in a Real Power Grid Integrated with Large Scale Wind Power

    Directory of Open Access Journals (Sweden)

    Ping Ju

    2016-07-01

    Full Text Available According to the monitoring of the wide area measurement system, inter-area oscillations happen more and more frequently in a real power grid of China, which are close to the forced oscillation. Applying the conventional forced oscillation theory, the mechanism of these oscillations cannot be explained well, because the oscillations vary with random amplitude and a narrow frequency band. To explain the mechanism of such oscillations, the general forced oscillation (GFO mechanism is taken into consideration. The GFO is the power system oscillation excited by the random excitations, such as power fluctuations from renewable power generation. Firstly, properties of the oscillations observed in the real power grid are analyzed. Using the GFO mechanism, the observed oscillations seem to be the GFO caused by some random excitation. Then the variation of the wind power measured in this power gird is found to be the random excitation which may cause the GFO phenomenon. Finally, simulations are carried out and the power spectral density of the simulated oscillation is compared to that of the observed oscillation, and they are similar with each other. The observed oscillation is thus explained well using the GFO mechanism and the GFO phenomenon has now been observed for the first time in real power grids.

  10. Large-Scale Description of Interacting One-Dimensional Bose Gases: Generalized Hydrodynamics Supersedes Conventional Hydrodynamics.

    Science.gov (United States)

    Doyon, Benjamin; Dubail, Jérôme; Konik, Robert; Yoshimura, Takato

    2017-11-10

    The theory of generalized hydrodynamics (GHD) was recently developed as a new tool for the study of inhomogeneous time evolution in many-body interacting systems with infinitely many conserved charges. In this Letter, we show that it supersedes the widely used conventional hydrodynamics (CHD) of one-dimensional Bose gases. We illustrate this by studying "nonlinear sound waves" emanating from initial density accumulations in the Lieb-Liniger model. We show that, at zero temperature and in the absence of shocks, GHD reduces to CHD, thus for the first time justifying its use from purely hydrodynamic principles. We show that sharp profiles, which appear in finite times in CHD, immediately dissolve into a higher hierarchy of reductions of GHD, with no sustained shock. CHD thereon fails to capture the correct hydrodynamics. We establish the correct hydrodynamic equations, which are finite-dimensional reductions of GHD characterized by multiple, disjoint Fermi seas. We further verify that at nonzero temperature, CHD fails at all nonzero times. Finally, we numerically confirm the emergence of hydrodynamics at zero temperature by comparing its predictions with a full quantum simulation performed using the NRG-TSA-abacus algorithm. The analysis is performed in the full interaction range, and is not restricted to either weak- or strong-repulsion regimes.

  11. ATD Occupant Responses from Three Full-Scale General Aviation Crash Tests

    Science.gov (United States)

    Littell, Justin D.; Annett, Martin S.

    2016-01-01

    During the summer of 2015, three Cessna 172 General Aviation (GA) aircraft were crash tested at the Landing and Impact Research (LandIR) Facility at NASA Langley Research Center (LaRC). Three different crash scenarios were represented. The first test simulated a flare-to-stall emergency or hard landing onto a rigid surface such as a road or runway. The second test simulated a controlled flight into terrain with a nose down pitch of the aircraft, and the third test simulated a controlled flight into terrain with an attempt to unsuccessfully recover the aircraft immediately prior to impact, resulting in a tail strike condition. An on-board data acquisition system (DAS) captured 64 channels of airframe acceleration, along with accelerations and loads in two onboard Hybrid II 50th percentile Anthropomorphic Test Devices (ATDs) representing the pilot and copilot. Each of the three tests contained different airframe loading conditions and different types of restraints for both the pilot and co-pilot ATDs. The results show large differences in occupant response and restraint performance with varying likelihoods of occupant injury.

  12. Large-Scale Description of Interacting One-Dimensional Bose Gases: Generalized Hydrodynamics Supersedes Conventional Hydrodynamics

    Science.gov (United States)

    Doyon, Benjamin; Dubail, Jérôme; Konik, Robert; Yoshimura, Takato

    2017-11-01

    The theory of generalized hydrodynamics (GHD) was recently developed as a new tool for the study of inhomogeneous time evolution in many-body interacting systems with infinitely many conserved charges. In this Letter, we show that it supersedes the widely used conventional hydrodynamics (CHD) of one-dimensional Bose gases. We illustrate this by studying "nonlinear sound waves" emanating from initial density accumulations in the Lieb-Liniger model. We show that, at zero temperature and in the absence of shocks, GHD reduces to CHD, thus for the first time justifying its use from purely hydrodynamic principles. We show that sharp profiles, which appear in finite times in CHD, immediately dissolve into a higher hierarchy of reductions of GHD, with no sustained shock. CHD thereon fails to capture the correct hydrodynamics. We establish the correct hydrodynamic equations, which are finite-dimensional reductions of GHD characterized by multiple, disjoint Fermi seas. We further verify that at nonzero temperature, CHD fails at all nonzero times. Finally, we numerically confirm the emergence of hydrodynamics at zero temperature by comparing its predictions with a full quantum simulation performed using the NRG-TSA-abacus algorithm. The analysis is performed in the full interaction range, and is not restricted to either weak- or strong-repulsion regimes.

  13. Effect of scaling and root planing on blood counts in patients with chronic generalized periodontitis

    Directory of Open Access Journals (Sweden)

    Devinder Singh Kalsi

    2017-01-01

    Full Text Available Background: Many systemic diseases have been implicated as risk factors in periodontal disease. Studies suggest that periodontal infection can adversely affect systemic health; by inference periodontal disease will also have an effect on blood values, but the data available is not conclusive. Aim: This clinical study was designed to evaluate the effect of treatment of plaque induced periodontitis on commonly assessed blood parameters. Materials and Method: 37 males and 31 females aged between 20 and 50 years in good general health but suffering from plaque induced chronic periodontitis were selected for the study. The selected patients were assessed for ESR, TLC, PMN count, lymphocyte count from DLC, HB, BT and their periodontal condition before the start of the study. SCRP was carried out and patients were reassessed for the same clinical and hematological parameters 21 days after the periodontal therapy (SCRP. Results: A highly significant reduction in the counts of PMNs and the values of ESI was seen after SCRP. Furthermore a significant reduction in TLC, lymphocytes count, and BT and a non significant decrease in Hb were also observed. Conclusion: SCRP done in patients of chronic periodontitis has a considerable affect on the assessed blood parameters.

  14. Accurate reporting of adherence to inhaled therapies in adults with cystic fibrosis: methods to calculate normative adherence

    Directory of Open Access Journals (Sweden)

    Hoo ZH

    2016-05-01

    Full Text Available Zhe Hui Hoo,1,2 Rachael Curley,1,2 Michael J Campbell,1 Stephen J Walters,1 Daniel Hind,3 Martin J Wildman1,2 1School of Health and Related Research (ScHARR, University of Sheffield, 2Sheffield Adult Cystic Fibrosis Centre, Northern General Hospital, 3Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK Background: Preventative inhaled treatments in cystic fibrosis will only be effective in maintaining lung health if used appropriately. An accurate adherence index should therefore reflect treatment effectiveness, but the standard method of reporting adherence, that is, as a percentage of the agreed regimen between clinicians and people with cystic fibrosis, does not account for the appropriateness of the treatment regimen. We describe two different indices of inhaled therapy adherence for adults with cystic fibrosis which take into account effectiveness, that is, “simple” and “sophisticated” normative adherence. Methods to calculate normative adherence: Denominator adjustment involves fixing a minimum appropriate value based on the recommended therapy given a person’s characteristics. For simple normative adherence, the denominator is determined by the person’s Pseudomonas status. For sophisticated normative adherence, the denominator is determined by the person’s Pseudomonas status and history of pulmonary exacerbations over the previous year. Numerator adjustment involves capping the daily maximum inhaled therapy use at 100% so that medication overuse does not artificially inflate the adherence level. Three illustrative cases: Case A is an example of inhaled therapy under prescription based on Pseudomonas status resulting in lower simple normative adherence compared to unadjusted adherence. Case B is an example of inhaled therapy under-prescription based on previous exacerbation history resulting in lower sophisticated normative adherence compared to unadjusted adherence and simple normative adherence

  15. Interpersonal Factors Are Associated with Lower Therapist Adherence in Cognitive-Behavioural Therapy for Panic Disorder.

    Science.gov (United States)

    Zickgraf, Hana F; Chambless, Dianne L; McCarthy, Kevin S; Gallop, Robert; Sharpless, Brian A; Milrod, Barbara L; Barber, Jacques P

    2016-05-01

    The contributions of disorder severity, comorbidity and interpersonal variables to therapists' adherence to a cognitive-behavioural treatment (CBT) manual were tested. Thirty-eight patients received panic control therapy (PCT) for panic disorder. Trained observers watching videotapes of the sixth session of a 24-session protocol rated therapists' adherence to PCT and their use of interventions from outside the CBT model. Different observers rated patients' behavioural resistance to therapy in the same session using the client resistance code. Interview measures obtained before treatment included the Panic Disorder Severity Scale, the anxiety disorders interview schedule for Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV and the structured clinical interview for DSM-IV, Axis II. Questionnaire measures were the anxiety sensitivity index at intake, and, at session 2, the therapist and client versions of the working alliance inventory-short form. The higher the patients' resistance and the more Axis II traits a patient had, the less adherent the therapist. Moreover, the more resistant the client, the more therapists resorted to interventions from outside the CBT model. Stronger therapist and patient alliance was also generally related to better adherence, but these results were somewhat inconsistent across therapists. Pretreatment disorder severity and comorbidity were not related to adherence. Interpersonal variables, particularly behavioural resistance to therapy, are related to therapists' ability to adhere to a treatment manual and to their use of interventions from outside of the CBT model. Copyright © 2015 John Wiley & Sons, Ltd. Patients' behavioural resistance to therapy may make it more difficult for cognitive-behavioural clinicians to adhere to a structured treatment protocol and more likely for them to borrow interventions from outside the CBT model. Patients' Axis II traits may make adherence to treatment CBT protocol more difficult

  16. Self-efficacy and adherence to treatment in people with type 2 diabetes mellitus

    OpenAIRE

    González-Cantero, Joel Omar; González Á., Ma. De Los Ángeles; Vázquez C., José; Galán C., Sergio

    2016-01-01

    Diabetes mellitus 2 (DM2) is exacerbated when people do not adhere to their treatment. It requires evaluating the factors that influence favorably the achievement of adherence to treatment. Objective. Evaluate the relationship between self-efficacy and adherence to treatment in patients with DM2 served in Family Medicine Unit No. 48 (UMF 48) of the Instituto Mexicano del Seguro Social (IMSS). Method. Descriptive-correlational with 314 participants. Were applied the Scale of Adherence to the T...

  17. Patient adherence with COPD therapy

    Directory of Open Access Journals (Sweden)

    C. S. Rand

    2005-12-01

    Full Text Available Although there are very few published studies on adherence to treatment regimens in chronic obstructive pulmonary disease (COPD, the evidence that exists suggests that, as with asthma therapy, adherence is poor. Patient beliefs about COPD, as well as their motivation and expectations about the likelihood of success of medical interventions, can influence adherence rates. Other critical factors include the patient's understanding of their illness and therapy, and the complexity of the prescribed treatment regimen. Incorrect inhaler technique is also a common failing. When prescribing in primary or specialist care, healthcare professionals should address adherence as a vital part of the patient consultation. Improved patient education may also increase adherence rates.

  18. The Adherence Estimator: a brief, proximal screener for patient propensity to adhere to prescription medications for chronic disease.

    Science.gov (United States)

    McHorney, Colleen A

    2009-01-01

    To conceptualize, develop, and provide preliminary psychometric evidence for the Adherence Estimator--a brief, three-item proximal screener for the likelihood of non-adherence to prescription medications (medication non-fulfillment and non-persistence) for chronic disease. Qualitative focus groups with 140 healthcare consumers and two internet-based surveys of adults with chronic disease, comprising a total of 1772 respondents, who were self-reported medication adherers, non-persisters, and non-fulfillers. Psychometric tests were performed on over 150 items assessing 14 patient beliefs and skills hypothesized to be related to medication non-adherence along a proximal-distal continuum. Psychometric tests included, but were not limited to, known-groups discriminant validity at the scale and item level. The psychometric analyses sought to identify: (1) the specific multi-item scales that best differentiated self-reported adherers from self-reported non-adherers (non-fulfillers and non-persisters) and, (2) the single best item within each prioritized multi-item scale that best differentiated self-reported adherers from self-reported non-adherers (non-fulfillers and non-persisters). The two rounds of psychometric testing identified and cross-validated three proximal drivers of self-reported adherence: perceived concerns about medications, perceived need for medications, and perceived affordability of medications. One item from each domain was selected to include in the Adherence Estimator using a synthesis of psychometric results gleaned from classical and modern psychometric test theory. By simple summation of the weights assigned to the category responses of the three items, a total score is obtained that is immediately interpretable and completely transparent. Patients can be placed into one of three segments based on the total score--low, medium, and high risk for non-adherence. Sensitivity was 88%--of the non-adherers, 88% would be accurately classified as medium

  19. Adherence to inhaled corticosteroids in children with asthma and their parents

    NARCIS (Netherlands)

    Dellen, Q.M. van; Stronks, K.; Bindels, P.J.E.; Öry, F.G.; Aalderen, W.M.C. van

    2006-01-01

    Poor adherence to inhaled corticosteroids (ICSs) may contribute to the recent rise in asthma morbidity. In general, appropriate adherence to ICSs is a complex process that is influenced by various determinants. The purpose of this study was to identify factors that were associated with adherence to

  20. Comparative efficacy of the generalized anxiety disorder 7-item scale and the Edinburgh Postnatal Depression Scale as screening tools for generalized anxiety disorder in pregnancy and the postpartum period.

    Science.gov (United States)

    Simpson, William; Glazer, Melanie; Michalski, Natalie; Steiner, Meir; Frey, Benicio N

    2014-08-01

    About 24.1% of pregnant women suffer from at least 1 anxiety disorder, 8.5% of whom suffer specifically from generalized anxiety disorder (GAD). GAD is often associated with major depressive disorder (MDD). During the perinatal period, the presence of physical and somatic symptoms often makes differentiation between depression and anxiety more challenging. To date, no screening tools have been developed to detect GAD in the perinatal population. We investigated the psychometric properties of the GAD 7-item Scale (GAD-7) as a screening tool for GAD in pregnant and postpartum women. Two hundred and forty perinatal women (n = 155 pregnant and n = 85 postpartum) referred for psychiatric consultation were enrolled. On the day of initial assessment, all women completed the GAD-7 and the Edinburgh Postnatal Depression Scale (EPDS). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-based diagnoses were made by experienced psychiatrists. Scores from the GAD-7 and EPDS were compared with the clinical diagnoses to evaluate the psychometric properties of the GAD-7 and EPDS when used as a screening tool for GAD. The GAD-7 yielded a sensitivity of 61.3% and specificity of 72.7% at an optimal cut-off score of 13. Compared with the EPDS and the EPDS-3A subscale, the GAD-7 displayed greater accuracy and specificity over a greater range of cut-off scores and more accurately identified GAD in patients with comorbid MDD. Our findings suggest that the GAD-7 represents a clinically useful scale for the detection of GAD in perinatal women.

  1. A generalized Fellner-Schall method for smoothing parameter optimization with application to Tweedie location, scale and shape models.

    Science.gov (United States)

    Wood, Simon N; Fasiolo, Matteo

    2017-12-01

    We consider the optimization of smoothing parameters and variance components in models with a regular log likelihood subject to quadratic penalization of the model coefficients, via a generalization of the method of Fellner (1986) and Schall (1991). In particular: (i) we generalize the original method to the case of penalties that are linear in several smoothing parameters, thereby covering the important cases of tensor product and adaptive smoothers; (ii) we show why the method's steps increase the restricted marginal likelihood of the model, that it tends to converge faster than the EM algorithm, or obvious accelerations of this, and investigate its relation to Newton optimization; (iii) we generalize the method to any Fisher regular likelihood. The method represents a considerable simplification over existing methods of estimating smoothing parameters in the context of regular likelihoods, without sacrificing generality: for example, it is only necessary to compute with the same first and second derivatives of the log-likelihood required for coefficient estimation, and not with the third or fourth order derivatives required by alternative approaches. Examples are provided which would have been impossible or impractical with pre-existing Fellner-Schall methods, along with an example of a Tweedie location, scale and shape model which would be a challenge for alternative methods, and a sparse additive modeling example where the method facilitates computational efficiency gains of several orders of magnitude. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2017, The Authors Biometrics published by Wiley Periodicals, Inc. on behalf of International Biometric Society.

  2. Euthanasia in patients dying at home in Belgium: interview study on adherence to legal safeguards

    Science.gov (United States)

    Smets, Tinne; Bilsen, Johan; Van den Block, Lieve; Cohen, Joachim; Van Casteren, Viviane; Deliens, Luc

    2010-01-01

    Background Euthanasia became legal in Belgium in 2002. Physicians must adhere to legal due care requirements when performing euthanasia; for example, consulting a second physician and reporting each euthanasia case to the Federal Review Committee. Aim To study the adherence and non-adherence of GPs to legal due care requirements for euthanasia among patients dying at home in Belgium and to explore possible reasons for non-adherence. Design of study Large scale, retrospective study. Setting General practice in Belgium. Method A retrospective mortality study was performed in 2005–2006 using the nationwide Belgian Sentinel Network of General Practitioners. Each week GPs reported medical end-of-life decisions taken in all non-sudden deaths of patients in their practice. GP interviews were conducted for each euthanasia case occurring at home. Results Interviews were conducted for nine of the 11 identified euthanasia cases. Requirements concerning the patient's medical condition were met in all cases. Procedural requirements such as consultation of a second physician were sometimes ignored. Euthanasia cases were least often reported (n = 4) when the physician did not regard the decision as euthanasia, when only opioids were used to perform euthanasia, or when no second physician was consulted. Factors that may contribute to explaining non-adherence to the euthanasia law included: being unaware of which practices are considered to be euthanasia; insufficient knowledge of the euthanasia law; and the fact that certain procedures are deemed burdensome. Conclusion Substantive legal due care requirements for euthanasia concerning the patient's request for euthanasia and medical situation were almost always met by GPs in euthanasia cases. Procedural consultation and reporting requirements were not always met. PMID:20353662

  3. Factors affecting medication adherence in elderly people

    Directory of Open Access Journals (Sweden)

    Jin HK

    2016-10-01

    Full Text Available Hyekyung Jin,1 Yeonhee Kim,2 Sandy Jeong Rhie1,3 1College of Pharmacy, 2Center for Excellence in Teaching & Learning, 3Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea Background: Little is known about the functional health literacy (FHL associated with medication adherence in elderly patients. The aim of this study was to examine the FHL among older adults and identify influencing factors that can predict medication adherence. Methods: This was a cross-sectional survey. Participants (n=160 aged 65 years and older were selected from outpatient clinics of 3 tertiary care hospitals, 6 community pharmacies, and 2 senior centers between November 1 and 30, 2014. The participants’ FHL was measured using the Korean Functional Health Literacy Test, which consists of 15 items including 8 numeracy and 7 reading comprehension items. Medication adherence was measured by the Adherence to Refills and Medication Scale. Descriptive statistics, chi-square or Fisher’s exact test, and multiple regression analyses were used to analyze the data. Results: The mean score of the total FHL was 7.72±3.51 (range 0–15. The percentage of the total number of correct answers for the reading comprehension subtest and numeracy subtest were 48.1% and 54.4%, respectively. Among 160 participants, 52.5% showed low adherence to medication. The factors affecting medication adherence included the patient’s degree of satisfaction with the service (β=-0.215, P=0.022, sufficient explanation of medication counseling (β=-0.335, P=0.000, education level (β=-0.153, P=0.045, health-related problems (β=-0.239, P=0.004, and dosing frequency (β=0.189, P=0.018. Conclusion: In this study, we found medication adherence of elderly patients was associated with education level, health-related problems, dosing frequency, satisfaction with patient counseling, and explanation of medication, but no association was found with FHL. Pharmacists

  4. Full-scale crash-test evaluation of two load-limiting subfloors for general aviation airframes

    Science.gov (United States)

    Carden, H. D.

    1984-01-01

    Three six place, low wing, twin engine general aviation airplane test specimens were crash tested at the Langley Impact Dynamics Research Facility under controlled free flight conditions. One structurally unmodified airplane was the base line specimen for the test series. The other two airplanes were structurally modified to incorporate load limiting (energy absorbing) subfloor concepts into the structure for full scale crash test evaluation and for comparison with the unmodified airplane test results. Typically, the lowest floor accelerations, the lowest anthropomorphic dummy responses, and the least seat crushing of standard and load limiting seats occurred in the airplanes modified with load limiting subfloors, wherein the greatest structural crushing of the subfloor took place. The better performing of the two load limiting subfloor concepts reduced the peak airplane floor accelerations to -25g to -30g as compared with approximately -40g to -55g for the unmodified airplane structure.

  5. Performance of two load-limiting subfloor concepts in full-scale general aviation airplane crash tests

    Science.gov (United States)

    Carden, H. D.

    1984-01-01

    Three six-place, low wing, twin-engine general aviation airplane test specimens were crash tested at the langley Impact Dynamics research Facility under controlled free-flight conditions. One structurally unmodified airplane was the baseline airplane specimen for the test series. The other airplanes were structurally modified to incorporate load-limiting (energy-absorbing) subfloor concepts into the structure for full scale crash test evaluation and comparison to the unmodified airplane test results. Typically, the lowest floor accelerations and anthropomorphic dummy occupant responses, and the least seat crushing of standard and load-limiting seats, occurred in the modified load-limiting subfloor airplanes wherein the greatest structural crushing of the subfloor took place. The better performing of the two load-limiting subfloor concepts reduced the peak airplane floor accelerations at the pilot and four seat/occupant locations to -25 to -30 g's as compared to approximately -50 to -55 g's acceleration magnitude for the unmodified airplane structure.

  6. Quantum, classical, and hybrid QM/MM calculations in solution: General implementation of the ddCOSMO linear scaling strategy

    Energy Technology Data Exchange (ETDEWEB)

    Lipparini, Filippo, E-mail: flippari@uni-mainz.de [Sorbonne Universités, UPMC Univ. Paris 06, UMR 7598, Laboratoire Jacques-Louis Lions, F-75005 Paris (France); Sorbonne Universités, UPMC Univ. Paris 06, UMR 7616, Laboratoire de Chimie Théorique, F-75005 Paris (France); Sorbonne Universités, UPMC Univ. Paris 06, Institut du Calcul et de la Simulation, F-75005 Paris (France); Scalmani, Giovanni; Frisch, Michael J. [Gaussian, Inc., 340 Quinnipiac St. Bldg. 40, Wallingford, Connecticut 06492 (United States); Lagardère, Louis [Sorbonne Universités, UPMC Univ. Paris 06, Institut du Calcul et de la Simulation, F-75005 Paris (France); Stamm, Benjamin [Sorbonne Universités, UPMC Univ. Paris 06, UMR 7598, Laboratoire Jacques-Louis Lions, F-75005 Paris (France); CNRS, UMR 7598 and 7616, F-75005 Paris (France); Cancès, Eric [Université Paris-Est, CERMICS, Ecole des Ponts and INRIA, 6 and 8 avenue Blaise Pascal, 77455 Marne-la-Vallée Cedex 2 (France); Maday, Yvon [Sorbonne Universités, UPMC Univ. Paris 06, UMR 7598, Laboratoire Jacques-Louis Lions, F-75005 Paris (France); Institut Universitaire de France, Paris, France and Division of Applied Maths, Brown University, Providence, Rhode Island 02912 (United States); Piquemal, Jean-Philip [Sorbonne Universités, UPMC Univ. Paris 06, UMR 7616, Laboratoire de Chimie Théorique, F-75005 Paris (France); CNRS, UMR 7598 and 7616, F-75005 Paris (France); Mennucci, Benedetta [Dipartimento di Chimica e Chimica Industriale, Università di Pisa, Via Risorgimento 35, 56126 Pisa (Italy)

    2014-11-14

    We present the general theory and implementation of the Conductor-like Screening Model according to the recently developed ddCOSMO paradigm. The various quantities needed to apply ddCOSMO at different levels of theory, including quantum mechanical descriptions, are discussed in detail, with a particular focus on how to compute the integrals needed to evaluate the ddCOSMO solvation energy and its derivatives. The overall computational cost of a ddCOSMO computation is then analyzed and decomposed in the various steps: the different relative weights of such contributions are then discussed for both ddCOSMO and the fastest available alternative discretization to the COSMO equations. Finally, the scaling of the cost of the various steps with respect to the size of the solute is analyzed and discussed, showing how ddCOSMO opens significantly new possibilities when cheap or hybrid molecular mechanics/quantum mechanics methods are used to describe the solute.

  7. Large-scale parallel configuration interaction. I. Nonrelativisticand scalar-relativistic general active space implementationwith application to (Rb-Ba)+

    DEFF Research Database (Denmark)

    Knecht, Stefan; Jensen, Hans Jørgen Aagaard; Fleig, Timo

    2008-01-01

    discuss the parallel speedup with respect to machine-dependent aspects. The largest sample MRCI calculation includes 1.5x109 Slater determinants. Using the new code we determine for the first time the full short-range electronic potentials and spectroscopic constants for the ground state and for eight low......We present a parallel implementation of a string-driven general active space configuration interaction program for nonrelativistic and scalar-relativistic electronic-structure calculations. The code has been modularly incorporated in the DIRAC quantum chemistry program package. The implementation...... is based on the message passing interface and a distributed data model in order to efficiently exploit key features of various modern computer architectures. We exemplify the nearly linear scalability of our parallel code in large-scale multireference configuration interaction (MRCI) calculations, and we...

  8. [Children's intelligence quotient following general anesthesia for dental care: a clinical observation by Chinese Wechsler young children scale of intelligence].

    Science.gov (United States)

    Xia, B; Wang, J H; Xiao, Y M; Liu, K Y; Yang, X D; Ge, L H

    2016-04-18

    It has been demonstrated that anesthetics exposure may lead to neurocognitive impairment in developing brain of animal models. However, for the limitation that the animal models cannot fully mimic the dose and duration in clinical settings especially for dental general anesthesia, the clinical significance of anesthetics exposure on developing central nervous system remains undetermined. Therefore, we conducted the current study in order to observe the fluctuation of intelligence quotient (IQ) after the administration of dental general anesthesia comparing to that before surgery. We conducted the current study in order to observe the fluctuation of intelligence quotient (IQ) after the administration of dental general anesthesia compared with that before surgery. Thirty two patients, ASA I, who were exposed to dental general anesthesia in Department of Pediatric Dentistry Peking University School and Hospital of Stomatology, aged 4 to 6.5 years, were enrolled in this prospective study. Patients with severe learning difficulties or communication disorders were excluded. Written and informed consent was obtained from each patients' family which was fully explained of the purpose and method of study. Their intelligence quotients were evaluated with the Chinese Wechsler young children scale of intelligence (Urban version) before and 2 weeks after dental anesthesia. They were treated by experienced pediatric dentists and the sevoflurane, propofol and nitrous oxide were used for general anesthesia by anesthetist. Articaine hydrochloride and epinephrine tartrate injections were used for their pulp treatment or extraction. The examiners and scorers for IQ had technical training in the test administration. All the patients were tested by the same examiner and with standardized guide language. Each subtest was scored according to the tool review. Verbal IQ and performance IQ consisted of relevant 5 subtests and full scale IQ. Statistical analyses were performed by SPSS 18

  9. Predictors of medication non-adherence for vasculitis patients

    Science.gov (United States)

    Hogan, Susan L.; DeVellis, Robert F.

    2013-01-01

    The primary purpose of this article is to document whether demographic, clinical, regimen-related, intrapersonal, and interpersonal factors predict medication non-adherence for vasculitis patients. A secondary purpose is to explore whether adherence varies by medication type and whether patients experienced drug-related side effects. Vasculitis patients (n=228) completed online baseline and 3-month follow-up surveys. Demographic (age, gender, education, race, marital status, and insurance status), clinical (perceived vasculitis severity, disease duration, vasculitis type, and relapse/remission status), regimen-related (experience of side effects), intrapersonal (depressive symptoms), and interpersonal (adherence-related support from family and friends) factors were measured at baseline. Medication non-adherence was assessed at follow-up using the Vasculitis Self-Management Survey medication adherence sub-scale (α=0.89). Variables that significantly correlated (pvasculitis medication types, patients who experienced side effects were less adherent than patients who did not experience side effects. Multiple factors are associated with medication non-adherence for vasculitis patients. Providers should discuss medication adherence and drug-related side effects with vasculitis patients. Providers may want to particularly target younger patients and patients with clinical signs of depression. PMID:23314654

  10. A simple self-reported adherence tool as a predictor of viral rebound in people with viral suppression on antiretroviral therapy.

    Science.gov (United States)

    O'Connor, J L; Gardner, E M; Esser, S; Mannheimer, S B; Lifson, A R; Telzak, E E; Phillips, A N

    2016-02-01

    The aim of the study was to investigate the relationship between self-reported antiretroviral therapy (ART) adherence and virological outcomes in the multinational Strategies for Management of Antiretroviral Therapy (SMART) study. Eligible participants were from the continuous ART arm and had at least one viral load (VL) ≤ 50 HIV-1 RNA copies/mL and a subsequent VL value (VL pair). Self-reported adherence was measured at each visit using a five-point Likert scale which employed a 7-day recall. High adherence was defined as taking 'all pills every day' (level 1) for every regimen component; all others had suboptimal adherence (levels 2 - 5). In individuals with VL suppression (≤ 50 copies/mL), the association between adherence (at the time of VL suppression) and VL rebound (> 200 copies/mL at next visit) was assessed using multivariable logistic regression with generalized estimating equations. A total of 10 761 sets of VL pairs from 1986 participants were included in the study. For 1220 (11%) VL pairs, adherence was suboptimal. For 507 VL pairs (5%), VL rebound occurred. The risk of rebound generally increased as adherence decreased: 4.2% for level 1, 7.7% for level 2, 16.3% for level 3, 9.4% for level 4 and 12.9% for level 5. In multivariable analysis, suboptimal adherence at the time of suppression was associated with a 50% increased odds of experiencing subsequent VL rebound [odds ratio (OR) 1.51; 95% confidence interval (CI) 1.19-1.92; P = 0.0023], compared with high adherence. Self-reported suboptimal adherence in people with VL suppression is associated with an increased risk of VL rebound. Our findings highlight the importance of continued adherence counselling, even in people with VL suppression, and to ensure that people with HIV infection maintain excellent adherence in order to minimize the risk of VL rebound. © 2015 British HIV Association.

  11. RMAIS: RFID-based medication Adherence Intelligence System.

    Science.gov (United States)

    McCall, Corey; Maynes, Branden; Zou, Cliff C; Zhang, Ning J

    2010-01-01

    There has been compelling evidence that outpatients, especially those who are elderly or taking multiple complexly scheduled drugs, are not taking their medicines as directed, leading to unnecessary disease progression, complications, functional disabilities, lower quality of life, and even mortality. Existing technologies for monitoring and improving drug adherence are either costly or too complicated for general patients to use. In this paper, we introduce the detailed design and the complete prototype of a marketable Radio-Frequency Identification (RFID)-based Medication Adherence Intelligence System (RMAIS) that can be conveniently used at a residential home by ordinary patients. RMAIS is designed to maintain patients' independence and enable them to take multiple daily medicine dosages of the right amount at the right time. The system is patient-centered and user-friendly by reminding a patient of the prescribed time for medication and dispensing it in a fully automatic and fool-proof way. This is achieved mainly due to its novel design of a motorized rotation platform and the smooth integration of a scale, an RFID reader, and the rotation platform. In addition, this system has an Internet-based notification function that is used to alert the patient when it is time to take medicine as well as report deviations from the prescribed schedule to the primary care physicians or pharmacists.

  12. Distributional modeling and short-term forecasting of electricity prices by Generalized Additive Models for Location, Scale and Shape

    International Nuclear Information System (INIS)

    Serinaldi, Francesco

    2011-01-01

    In the context of the liberalized and deregulated electricity markets, price forecasting has become increasingly important for energy company's plans and market strategies. Within the class of the time series models that are used to perform price forecasting, the subclasses of methods based on stochastic time series and causal models commonly provide point forecasts, whereas the corresponding uncertainty is quantified by approximate or simulation-based confidence intervals. Aiming to improve the uncertainty assessment, this study introduces the Generalized Additive Models for Location, Scale and Shape (GAMLSS) to model the dynamically varying distribution of prices. The GAMLSS allow fitting a variety of distributions whose parameters change according to covariates via a number of linear and nonlinear relationships. In this way, price periodicities, trends and abrupt changes characterizing both the position parameter (linked to the expected value of prices), and the scale and shape parameters (related to price volatility, skewness, and kurtosis) can be explicitly incorporated in the model setup. Relying on the past behavior of the prices and exogenous variables, the GAMLSS enable the short-term (one-day ahead) forecast of the entire distribution of prices. The approach was tested on two datasets from the widely studied California Power Exchange (CalPX) market, and the less mature Italian Power Exchange (IPEX). CalPX data allow comparing the GAMLSS forecasting performance with published results obtained by different models. The study points out that the GAMLSS framework can be a flexible alternative to several linear and nonlinear stochastic models. - Research Highlights: ► Generalized Additive Models for Location, Scale and Shape (GAMLSS) are used to model electricity prices' time series. ► GAMLSS provide the entire dynamicaly varying distribution function of prices resorting to a suitable set of covariates that drive the instantaneous values of the parameters

  13. Optimizing adherence in HIV prevention product trials: Development and psychometric evaluation of simple tools for screening and adherence counseling.

    Science.gov (United States)

    Tolley, Elizabeth E; Guthrie, Kate Morrow; Zissette, Seth; Fava, Joseph L; Gill, Katherine; Louw, Cheryl E; Kotze, Philip; Reddy, Krishnaveni; MacQueen, Kathleen

    2018-01-01

    Low adherence in recent HIV prevention clinical trials highlights the need to better understand, measure, and support product use within clinical trials. Conventional self-reported adherence instruments within HIV prevention trials, often relying on single-item questions, have proven ineffective. While objective adherence measures are desirable, none currently exist that apply to both active and placebo arms. Scales are composed of multiple items in the form of questions or statements that, when combined, measure a more complex construct that may not be directly observable. When psychometrically validated, such measures may better assess the multiple factors contributing to adherence/non-adherence. This study aimed to develop and psychometrically evaluate tools to screen and monitor trial participants' adherence to HIV prevention products within the context of clinical trial research. Based on an extensive literature review and conceptual framework, we identified and refined 86 items assessing potential predictors of adherence and 48 items assessing adherence experience. A structured survey, including adherence items and other variables, was administered to former ASPIRE and Ring Study participants and similar non-trial participants (n = 709). We conducted exploratory factor analyses (EFA) to identify a reduced set of constructs and items that could be used at screening to predict potential adherence, and at follow-up to monitor and intervene on adherence. We examined associations with other variables to assess content and construct validity. The EFA of screener items resulted in a 6-factor solution with acceptable to very good internal reliability (α: .62-.84). Similar to our conceptual framework, factors represent trial-related commitment (Distrust of Research and Commitment to Research); alignment with trial requirements (Visit Adherence and Trial Incompatibility); Belief in Trial Benefits and Partner Disclosure. The EFA on monitoring items resulted in 4

  14. Supporting children to adhere to anti-retroviral therapy in urban Malawi: multi method insights

    Directory of Open Access Journals (Sweden)

    Phiri Sam

    2009-07-01

    Full Text Available Abstract Background Ensuring good adherence is critical to the success of anti-retroviral treatment (ART. However, in resource-poor contexts, where paediatric HIV burden is high there has been limited progress in developing or adapting tools to support adherence for HIV-infected children on ART and their caregivers. We conducted formative research to assess children's adherence and to explore the knowledge, perceptions and attitudes of caregivers towards children's treatment. Methods All children starting ART between September 2002 and January 2004 (when ART was at cost in Malawi were observed for at least 6 months on ART. Their adherence was assessed quantitatively by asking caregivers of children about missed ART doses during the previous 3 days at monthly visits. Attendance to clinic appointments was also monitored. In June and July 2004, four focus group discussions, each with 6 to 8 caregivers, and 5 critical incident narratives were conducted to provide complementary contextual data on caregivers' experiences on the challenges to and opportunities of paediatric ART adherence. Results We followed prospectively 47 children who started ART between 8 months and 12 years of age over a median time on ART of 33 weeks (2–91 weeks. 72% (34/47 never missed a single dose according to caregivers' report and 82% (327/401 of clinic visits were either as scheduled, or before or within 1 week after the scheduled appointment. Caregivers were generally knowledgeable about ART and motivated to support children to adhere to treatment despite facing multiple challenges. Caregivers were particularly motivated by seeing children begin to get better; but faced challenges in meeting the costs of medicine and transport, waiting times in clinic, stock outs and remembering to support children to adhere in the face of multiple responsibilities. Conclusion In the era of rapid scale-up of treatment for children there is need for holistic support strategies that focus

  15. Treatment Adherence in Psychiatric Disorders

    Directory of Open Access Journals (Sweden)

    Mehmet Emin Demirkol

    2016-03-01

    Full Text Available Despite developments in treatment options there is no significant increase in treatment adherence ratios. Inadherence in psychiatric disorders is higher than the other diseases. Loss of insight, drugs' side effects, sociodemographic features, personality traits are major factors affecting the treatment adherence. Determining and overcoming these factors for each disorder will help to improve adherence and reduce the treatment costs and hospitalization. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2016; 8(1: 85-93

  16. Cross-cultural validity of the Intuitive Eating Scale-2. Psychometric evaluation in a sample of the general French population.

    Science.gov (United States)

    Camilleri, Géraldine M; Méjean, Caroline; Bellisle, France; Andreeva, Valentina A; Sautron, Valérie; Hercberg, Serge; Péneau, Sandrine

    2015-01-01

    Intuitive eating is an adaptive dietary behavior that emphasizes eating in response to physiological hunger and satiety cues. The Intuitive Eating Scale-2 (IES-2) measures such attitudes and behaviors. The aim of the present study was to adapt the IES-2 to the French context and to test its psychometric properties in 335 women and 297 men participating in the NutriNet-Santé study. We evaluated the construct validity of the IES-2 by testing hypotheses with regard to its factor structure, relationships with scores of the revised 21-item Three Factor Eating Questionnaire and the Center for Epidemiologic Studies Depression scale, and differences between "a priori" relevant subgroups. First, the exploratory factor analysis revealed three main dimensions: Eating for Physical Rather than Emotional Reasons, Reliance on Hunger and Satiety Cues, and Unconditional Permission to Eat. Second-order confirmatory factor analysis upheld the 3-factor solution influenced by a broader intuitive eating dimension. IES-2 total score was negatively related to cognitive restraint (r = -0.31, P < 0.0001), emotional eating (r = -0.58, P < 0.0001), uncontrolled eating (r = -0.40, P < 0.0001), and depressive symptoms (r = -0.20, P < 0.0001). IES-2 subscales showed similar correlations. Women had lower scores than did men for the IES-2 total scale (3.3 in women vs. 3.5 in men, P < 0.0001), Eating for Physical Reasons, and Unconditional Permission to Eat subscales. Current or former dieters had lower scores on the IES-2 total scale and on all subscales than did those who had never dieted (all P < 0.01). Finally, results showed satisfactory reliability for the IES-2 total scores (internal consistency = 0.85 and test-retest reliability = 0.79 over a mean 8-week period) and for its subscales. Thus, the French IES-2 can be considered a useful instrument for assessing adult intuitive eating behaviors in empirical and epidemiological studies in the

  17. Optimal performance of generalized heat engines with finite-size baths of arbitrary multiple conserved quantities beyond independent-and-identical-distribution scaling

    Science.gov (United States)

    Ito, Kosuke; Hayashi, Masahito

    2018-01-01

    In quantum thermodynamics, effects of finiteness of the baths have been less considered. In particular, there is no general theory which focuses on finiteness of the baths of multiple conserved quantities. Then, we investigate how the optimal performance of generalized heat engines with multiple conserved quantities alters in response to the size of the baths. In the context of general theories of quantum thermodynamics, the size of the baths has been given in terms of the number of identical copies of a system, which does not cover even such a natural scaling as the volume. In consideration of the asymptotic extensivity, we deal with a generic scaling of the baths to naturally include the volume scaling. Based on it, we derive a bound for the performance of generalized heat engines reflecting finite-size effects of the baths, which we call fine-grained generalized Carnot bound. We also construct a protocol to achieve the optimal performance of the engine given by this bound. Finally, applying the obtained general theory, we deal with simple examples of generalized heat engines. As for an example of non-independent-and-identical-distribution scaling and multiple conserved quantities, we investigate a heat engine with two baths composed of an ideal gas exchanging particles, where the volume scaling is applied. The result implies that the mass of the particle explicitly affects the performance of this engine with finite-size baths.

  18. The psychometric properties of the generalized anxiety disorder-7 scale in Hispanic Americans with English or Spanish language preference.

    Science.gov (United States)

    Mills, Sarah D; Fox, Rina S; Malcarne, Vanessa L; Roesch, Scott C; Champagne, Brian R; Sadler, Georgia Robins

    2014-07-01

    The Generalized Anxiety Disorder-7 scale (GAD-7) is a self-report questionnaire that is widely used to screen for anxiety. The GAD-7 has been translated into numerous languages, including Spanish. Previous studies evaluating the structural validity of the English and Spanish versions indicate a unidimensional factor structure in both languages. However, the psychometric properties of the Spanish language version have yet to be evaluated in samples outside of Spain, and the measure has not been tested for use among Hispanic Americans. This study evaluated the reliability, structural validity, and convergent validity of the English and Spanish language versions of the GAD-7 for Hispanic Americans in the United States. A community sample of 436 Hispanic Americans with an English (n = 210) or Spanish (n = 226) language preference completed the GAD-7. Multiple-group confirmatory factor analysis (CFA) was used to examine the goodness-of-fit of the unidimensional factor structure of the GAD-7 across language-preference groups. Results from the multiple-group CFA indicated a similar unidimensional factor structure with equivalent response patterns and item intercepts, but different variances, across language-preference groups. Internal consistency was good for both English and Spanish language-preference groups. The GAD-7 also evidenced good convergent validity as demonstrated by significant correlations in expected directions with the Perceived Stress Scale, the Patient Health Questionnaire-9, and the Physical Health domain of the World Health Organization Quality of Life-BREF assessment. The unidimensional GAD-7 is suitable for use among Hispanic Americans with an English or Spanish language preference.

  19. Computable general equilibrium modelling of economic impacts from volcanic event scenarios at regional and national scale, Mt. Taranaki, New Zealand

    Science.gov (United States)

    McDonald, G. W.; Cronin, S. J.; Kim, J.-H.; Smith, N. J.; Murray, C. A.; Procter, J. N.

    2017-12-01

    The economic impacts of volcanism extend well beyond the direct costs of loss of life and asset damage. This paper presents one of the first attempts to assess the economic consequences of disruption associated with volcanic impacts at a range of temporal and spatial scales using multi-regional and dynamic computable general equilibrium (CGE) modelling. Based on the last decade of volcanic research findings at Mt. Taranaki, three volcanic event scenarios (Tahurangi, Inglewood and Opua) differentiated by critical physical thresholds were generated. In turn, the corresponding disruption economic impacts were calculated for each scenario. Under the Tahurangi scenario (annual probability of 0.01-0.02), a small-scale explosive (Volcanic Explosivity Index (VEI) 2-3) and dome forming eruption, the economic impacts were negligible with complete economic recovery experienced within a year. The larger Inglewood sub-Plinian to Plinian eruption scenario event (VEI > 4, annualised probability of 0.003) produced significant impacts on the Taranaki region economy of 207 million (representing 4.0% of regional gross domestic product (GDP) 1 year after the event, 2007 New Zealand dollars), that will take around 5 years to recover. The Opua scenario, the largest magnitude volcanic hazard modelled, is a major flank collapse and debris avalanche event with an annual probability of 0.00018. The associated economic impacts of this scenario were 397 million (representing 7.7% of regional GDP 1 year after the event) with the Taranaki region economy suffering permanent structural changes. Our dynamic analysis illustrates that different economic impacts play out at different stages in a volcanic crisis. We also discuss the key strengths and weaknesses of our modelling along with potential extensions.

  20. Biologic Influences on Exercise Adherence.

    Science.gov (United States)

    Dishman, Rod K.

    1981-01-01

    Diagnostic profiles of 362 male participants in an exercise program were analyzed to determine the biological variables between exercise adherence and symptoms of coronary disease. Findings indicated that individuals with lower metabolic capacity tended to adhere longer, to be less fit, were leaner, and began with more symptoms related to coronary…

  1. Scaling up close-range surveys, a challenge for the generalization of as-built data in industrial applications

    Directory of Open Access Journals (Sweden)

    J.-F. Hullo

    2014-06-01

    Full Text Available As-built CAD data reconstructed from Terrestrial Laser Scanner (TLS data are used for more than two decades by Electricité de France (EDF to prepare maintenance operations in its facilities. But today, the big picture is renewed: "as-built virtual reality" must address a huge scale-up to provide data to an increasing number of applications. In this paper, we first present a wide multi-sensor multi-purpose scanning campaign performed in a 10 floor building of a power plant in 2013: 1083 TLS stations (about 40.109 3D points referenced under a 2 cm tolerance and 1025 RGB panoramic images (340.106 pixels per point of view. As expected, this very large survey of high precision measurements in a complex environment stressed sensors and tools that were developed for more favourable conditions and smaller data sets. The whole survey process (tools and methods used from acquisition and processing to CAD reconstruction underwent a detailed follow-up in order to state on the locks to a possible generalization to other buildings. Based on these recent feedbacks, we have highlighted some of these current bottlenecks in this paper: sensors denoising, automation in processes, data validation tools improvements, standardization of formats and (meta- data structures.

  2. Reinforcing adherence to antihypertensive medications.

    Science.gov (United States)

    Petry, Nancy M; Alessi, Sheila M; Byrne, Shannon; White, William B

    2015-01-01

    This pilot study evaluated a reinforcement intervention to improve adherence to antihypertensive therapy. Twenty-nine participants were randomized to standard care or standard care plus financial reinforcement for 12 weeks. Participants in the reinforcement group received a cell phone to self-record videos of adherence, for which they earned rewards. These participants sent videos demonstrating on-time adherence 97.8% of the time. Pill count adherence differed significantly between the groups during treatment, with 98.8%±1.5% of pills taken during treatment in the reinforcement condition vs 92.6%±9.2% in standard care (PBenefits persisted throughout a 3-month follow-up, with 93.8%±9.3% vs 78.0%±18.5% of pills taken (Pphone technology and financial reinforcement holds potential to improve adherence. © 2014 Wiley Periodicals, Inc.

  3. PseAAC-General: Fast Building Various Modes of General Form of Chou’s Pseudo-Amino Acid Composition for Large-Scale Protein Datasets

    Directory of Open Access Journals (Sweden)

    Pufeng Du

    2014-02-01

    Full Text Available The general form pseudo-amino acid composition (PseAAC has been widely used to represent protein sequences in predicting protein structural and functional attributes. We developed the program PseAAC-General to generate various different modes of Chou’s general PseAAC, such as the gene ontology mode, the functional domain mode, and the sequential evolution mode. This program allows the users to define their own desired modes. In every mode, 544 physicochemical properties of the amino acids are available for choosing. The computing efficiency is at least 100 times that of existing programs, which makes it able to facilitate the extensive studies on proteins and peptides. The PseAAC-General is freely available via SourceForge. It runs on both Linux and Windows.

  4. Measuring insulin adherence among adults with type 2 diabetes.

    Science.gov (United States)

    Osborn, Chandra Y; Gonzalez, Jeffery S

    2016-08-01

    Non-adherence to insulin is common and associated with suboptimal health. We adapted the Morisky Medication Adherence Scale to specify insulin adherence (MIAS) and compared it to the Adherence to Refills and Medication Scale for Diabetes (ARMS-D) and the Summary of Diabetes Self-Care Activities medications subscale (SDSCA-MS) and an insulin-specific (SDSCA-IS) version. A sample of 144 insulin-treated adults (58 % African American/Black, 34 % Caucasian/White, 8 % Other/Mixed race; 6.9 % Hispanic) completed these measures along with a HbA1C test. The internal consistency and factor structure of the MIAS were adequate; 59 % of participants forgot to take insulin and 46 % reported non-adherence. The MIAS was associated with the ARMS-D, SDSCA-MS, and SDSCA-IS (p < 0.001), and higher MIAS scores were marginally associated with better self-rated health (p = 0.057), but significantly associated with fewer emergency room visits (p = 0.001), and better HbA1C (p = 0.001). The MIAS is a valid and reliable insulin adherence assessment tool for practice and research applications.

  5. Personality correlates of adherence with continuous positive airway pressure (CPAP).

    Science.gov (United States)

    Moran, Alicia M; Everhart, Daniel Erik; Davis, Claude Ervin; Wuensch, Karl L; Lee, Daniel O; Demaree, Heath A

    2011-12-01

    Adherence with continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA) has been problematic. Understanding the factors associated with nonadherence may assist with psychosocial interventions. The objective of this study was to examine the relationship between adherence and three measures of personality and coping strategies. Ratings on the behavioral inhibition system/behavioral activation system (BIS/BAS) scales, the ways of coping inventory, and a broad personality measure (mini-IPIP) were analyzed with a binary logistic regression among 63 subjects, adult men (31) and women (32), diagnosed with OSA. Data from the CPAP device was obtained following initial 30 days at minimum, with adherence defined as >4 h/night on 70% of nights. Elevated BIS was the strongest predictor of nonadherence (r = -.452, p < .01), followed by neuroticism. The regression correctly classified 73% of participants as adherent or nonadherent. Nonadherence is associated with elevated BIS scores and neuroticism, which indicates that personality factors play a role in determining adherence to CPAP. Although more research is needed to draw firm conclusions, the differences noted in BIS may also point toward differences in neurophysiological function. The BIS scale may be a useful tool for predicting nonadherence and assist with the development of intervention strategies that will increase adherence.

  6. Number of daily pills, dosing schedule, self-reported adherence and health status in 2010: a large cross-sectional study of HIV-infected patients on antiretroviral therapy.

    Science.gov (United States)

    Gianotti, N; Galli, L; Bocchiola, B; Cahua, T; Panzini, P; Zandonà, D; Salpietro, S; Maillard, M; Danise, A; Pazzi, A; Lazzarin, A; Castagna, A

    2013-03-01

    The aim of the study was to assess whether pill burden is associated with self-reported adherence to current combination antiretroviral regimens and health status in a large sample of unselected and chronically treated HIV-infected patients. An adherence and health status questionnaire was offered to all patients collecting their drugs between March and May 2010 at our clinic; both parameters were primarily evaluated using a visual analogue scale. Linear correlations were evaluated using Spearman's correlation coefficient. Wilcoxon's rank-sum test and the χ(2) test were used to compare quantitative and qualitative variables. The generalized linear model was used in multivariable analyses. Among 2763 subjects on treatment during the study period, 2114 (78.8% male; mean age 46.9 ± 8.84 years) were tested for adherence; 1803 (85.3%) had viral loads pill burden and dosing interval, adherence was higher in patients with undetectable HIV RNA (P pill burden (P = 0.019). In this highly adherent population, the number of daily pills was related to self-reported health status but not to self-reported adherence, whereas the dosing interval did not influence self-reported adherence or health status. © 2012 British HIV Association.

  7. Two character traits associated with adherence to long term therapies.

    Science.gov (United States)

    Reach, Gérard

    2012-10-01

    Adherence is defined as the adequacy between the behaviours of patients and their medical prescriptions. Adherence is a general behaviour, which can explain why patients in the placebo arm of randomised clinical trials have a lower mortality rate when they are adherent. We propose that this behaviour is related to two character traits: patience (capacity to give priority to the future) and, more provocatively, obedience. To support this claim, we bring arguments from the literature and from two published personal studies. We previously showed that type 2 diabetic patients who respond as non-adherers to a questionnaire on adherence to medication and to whom one proposes a fictitious monetary choice between receiving 500 euros today or waiting one year to receive 1500 euros never make the remote choice. We also showed that obese diabetic patients who declare that they do not fasten their seat belt when they are seated in the rear of a car are more often non-adherent concerning medication than those patients who claim that they follow this road safety recommendation. Thus, one of the roles of empowerment and patient education could be to encourage the patients, if they wish it, to replace passive adherence behaviours with conscious active choices. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  8. Adherence of fluid interfaces and colloidal aggregation in emulsions

    International Nuclear Information System (INIS)

    Poulin, Philippe

    1995-01-01

    This research thesis addresses some aspects of the behaviour of emulsions in which droplets are adhesive, and are thus characterised by their ability to stick to one another or on surfaces. The objective is also to identify various adhesive systems while describing their behaviour in order to start to build up a rationale of these phenomena. The author mainly focuses on the adherence of single layers of adsorbed surfactants: by inducing and controlling this adherence, it is possible to make the droplets stick. After a brief presentation of the wetting phenomenon and of the adherence of emulsion droplets, the author presents theoretical backgrounds of adherence, and describes the thermodynamics of liquid films. He presents the general approach which has been adopted to search for and control adherence phenomena in emulsions, and outlines challenges and difficulties related to the use of adhesive particles in industrial applications. A method of measurement of the contact angle between droplets of some tens of microns is described. In the next part, the author reports the characterisation of adherence properties of different emulsions: measurement of adherence energy with respect to some parameters by using contact angle measurements, study of mixed systems (mixtures of surfactants) to illustrate the applicability to industrial formulas. In a last part, the author reports measurements of film thickness between stuck droplets by using experiments of small angle neutron scattering [fr

  9. Adhered Supported Carbon Nanotubes

    International Nuclear Information System (INIS)

    Johnson, Dale F.; Craft, Benjamin J.; Jaffe, Stephen M.

    2001-01-01

    Carbon nanotubes (NTs) in excess of 200 μm long are grown by catalytic pyrolysis of hydrocarbon vapors. The nanotubes grow continuously without the typical extinction due to catalyst encapsulation. A woven metal mesh supports the nanotubes creating a metal supported nanotube (MSNT) structure. The 140 μm wide mesh openings are completely filled by 70 nm diameter multiwalled nanotubes (MWNTs). The MWNTs are straight, uniform and highly crystalline. Their wall thickness is about 10 nm (30 graphite layers). The adherent NTs are not removed from the support in a Scotch tape pull test. A 12.5 cm 2 capacitor made from two MSNT structures immersed in 1 M KCl has a capacitance of 0.35 F and an equivalent series resistance of 0.18 Ω. Water flows through the MSNT at a flow velocity of 1 cm/min with a pressure drop of 15 inches of water. With the support removed, the MWNTs naturally form a carbon nanocomposite (CNC) paper with a specific area of 80 m 2 /gm, a bulk density of 0.21 g/cm 3 , an open pore fraction of 0.81, and a resistivity of 0.16 Ω-cm

  10. A randomized-controlled trial with a Canadian electronic pill dispenser used to measure and improve medication adherence in patients with schizophrenia

    OpenAIRE

    Emmanuel eStip; Emmanuel eStip; Emmanuel eStip; Philippe D. Vincent; Philippe D. Vincent; Philippe D. Vincent; Catherine eGuevremont; Simon eZhornitsky; Constantin eTranulis; Constantin eTranulis; Constantin eTranulis; Juliette eSablier; Juliette eSablier

    2013-01-01

    Objective: Medication adherence is extremely important in preventing relapse and lowering symptoms in schizophrenic patients. However, estimates show that nearly half of these patients have poor adherence. The Brief Adherence Rating Scale (BARS) seems to be the most reliable tool assessing adherence in schizophrenia and shows that the antipsychotic adherence ratio (AAR) is about 49.5 % in schizophrenia. The aim of the study was to test if an electronic pill dispenser named DoPill® improv...

  11. A randomized controlled trial with a Canadian electronic pill dispenser used to measure and improve medication adherence in patients with schizophrenia

    OpenAIRE

    Stip, Emmanuel; Vincent, Philippe D.; Sablier, Juliette; Guevremont, Catherine; Zhornitsky, Simon; Tranulis, Constantin

    2013-01-01

    Objective: Medication adherence is extremely important in preventing relapse and lowering symptoms in schizophrenic patients. However, estimates show that nearly half of these patients have poor adherence. The Brief Adherence Rating Scale (BARS) seems to be the most reliable tool assessing adherence in schizophrenia and shows that the antipsychotic adherence ratio (AAR) is about 49.5% in schizophrenia. The aim of the study was to test if an electronic pill dispenser named DoPill® improved AAR...

  12. Validity and reliability of the Turkish version of the DSM-5 Generalized Anxiety Disorder Severity Scale for children aged 11–17 years

    Science.gov (United States)

    Yalın Sapmaz, Şermin; Özek Erkuran, Handan; Ergin, Dilek; Öztürk, Masum; Şen Celasin, Nesrin; Karaarslan, Duygu; Aydemir, Ömer

    2018-02-23

    Background/aim: This study aimed to assess the validity and reliability of the Turkish version of the DSM-5 Generalized Anxiety Disorder Severity Scale - Child Form. Materials and methods: The study sample consisted of 32 patients treated in a child psychiatry unit and diagnosed with generalized anxiety disorder and 98 healthy volunteers who were attending middle or high school during the study period. For the assessment, the Screen for Child Anxiety and Related Emotional Disorders (SCARED) was also used along with the DSM-5 Generalized Anxiety Disorder Severity Scale - Child Form. Results: Regarding reliability analyses, the Cronbach alpha internal consistency coefficient was calculated as 0.932. The test-retest correlation coefficient was calculated as r = 0.707. As for construct validity, one factor that could explain 62.6% of the variance was obtained and this was consistent with the original construct of the scale. As for concurrent validity, the scale showed a high correlation with SCARED. Conclusion: It was concluded that Turkish version of the DSM-5 Generalized Anxiety Disorder Severity Scale - Child Form could be utilized as a valid and reliable tool both in clinical practice and for research purposes.

  13. Suboptimal treatment adherence in bipolar disorder: impact on clinical outcomes and functioning

    Science.gov (United States)

    Montes, Jose Manuel; Maurino, Jorge; de Dios, Consuelo; Medina, Esteban

    2013-01-01

    Background The primary aim of this study was to assess drug treatment adherence in patients with bipolar disorder and to identify factors associated with adherence. The secondary aim was to analyze the impact of suboptimal adherence on clinical and functional outcomes. Methods A cross-sectional study was conducted in a sample of outpatients receiving an oral antipsychotic drug. Medication adherence was assessed combining the 10-item Drug Attitude Inventory, the Morisky Green Adherence Questionnaire, and the Compliance Rating Scale. Logistic regression was used to determine significant variables associated with suboptimal adherence to medication. Results Three hundred and three patients were enrolled into the study. The mean age was 45.9 ± 12.8 years, and 59.7% were females. Sixty-nine percent of patients showed suboptimal adherence. Disease severity and functioning were significantly worse in the suboptimal group than in the adherent group. Multivariate analysis showed depressive polarity of the last acute episode, presence of subsyndromal symptoms, and substance abuse/dependence to be significantly associated with suboptimal treatment adherence (odds ratios 3.41, 2.13, and 1.95, respectively). Conclusion A high prevalence of nonadherence was found in an outpatient sample with bipolar disorder. Identification of factors related to treatment adherence would give clinicians the opportunity to select more adequately patients who are eligible for potential adherence-focused interventions. PMID:23378745

  14. Improving adherence to antiretroviral therapy

    Directory of Open Access Journals (Sweden)

    Nischal K

    2005-01-01

    Full Text Available Antiretroviral therapy (ART has transformed HIV infection into a treatable, chronic condition. However, the need to continue treatment for decades rather than years, calls for a long-term perspective of ART. Adherence to the regimen is essential for successful treatment and sustained viral control. Studies have indicated that at least 95% adherence to ART regimens is optimal. It has been demonstrated that a 10% higher level of adherence results in a 21% reduction in disease progression. The various factors affecting success of ART are social aspects like motivation to begin therapy, ability to adhere to therapy, lifestyle pattern, financial support, family support, pros and cons of starting therapy and pharmacological aspects like tolerability of the regimen, availability of the drugs. Also, the regimen′s pill burden, dosing frequency, food requirements, convenience, toxicity and drug interaction profile compared with other regimens are to be considered before starting ART. The lack of trust between clinician and patient, active drug and alcohol use, active mental illness (e.g. depression, lack of patient education and inability of patients to identify their medications, lack of reliable access to primary medical care or medication are considered to be predictors of inadequate adherence. Interventions at various levels, viz. patient level, medication level, healthcare level and community level, boost adherence and overall outcome of ART.

  15. Improving diabetes medication adherence: successful, scalable interventions

    Directory of Open Access Journals (Sweden)

    Zullig LL

    2015-01-01

    Full Text Available Leah L Zullig,1,2 Walid F Gellad,3,4 Jivan Moaddeb,2,5 Matthew J Crowley,1,2 William Shrank,6 Bradi B Granger,7 Christopher B Granger,8 Troy Trygstad,9 Larry Z Liu,10 Hayden B Bosworth1,2,7,11 1Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA; 2Department of Medicine, Duke University, Durham, NC, USA; 3Center for Health Equity Research and Promotion, Pittsburgh Veterans Affairs Medical Center, Pittsburgh, PA, USA; 4Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA; 5Institute for Genome Sciences and Policy, Duke University, Durham, NC, USA; 6CVS Caremark Corporation; 7School of Nursing, Duke University, Durham, NC, USA; 8Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, NC, USA; 9North Carolina Community Care Networks, Raleigh, NC, USA; 10Pfizer, Inc., and Weill Medical College of Cornell University, New York, NY, USA; 11Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA Abstract: Effective medications are a cornerstone of prevention and disease treatment, yet only about half of patients take their medications as prescribed, resulting in a common and costly public health challenge for the US healthcare system. Since poor medication adherence is a complex problem with many contributing causes, there is no one universal solution. This paper describes interventions that were not only effective in improving medication adherence among patients with diabetes, but were also potentially scalable (ie, easy to implement to a large population. We identify key characteristics that make these interventions effective and scalable. This information is intended to inform healthcare systems seeking proven, low resource, cost-effective solutions to improve medication adherence. Keywords: medication adherence, diabetes mellitus, chronic disease, dissemination research

  16. Improving adherence to medication in adults with diabetes in the United Arab Emirates

    Directory of Open Access Journals (Sweden)

    Mohammed M. M. Al-Haj Mohd

    2016-08-01

    Full Text Available Abstract Background Diabetes is a chronic medical condition and adherence to medication in diabetes is important. Improving medication adherence in adults with diabetes would help prevent the chronic complications associated with diabetes. A case control trial was used to study the effects of an educational session on medication adherence among adults with diabetes as measured by the Morisky Medication adherence scale (MMAS-8©. Methods The study took place at the Dubai Police Health Centre between February 2015 and November 2015. Questionnaires were used to collect socio-demographic, clinical and disease related variables and the primary measure of outcome was adherence levels as measured by the Morisky Medication Adherence Scale (MMAS-8©. The intervention group involved a standardized thirty minute educational session focusing on the importance of adherence to medication. The change in MMAS-8© was measured at 6 months. Results Four hundred and forty six patients were enrolled. Mean age 61 year +/− 11. 48.4 % were male. The mean time since diagnosis of diabetes was 3.2 years (Range 1–15 years. At baseline two hundred and eighty eight (64.6 % patients were considered non-adherent (MMAS-8© adherence score < 6 while 118 (26.5 % and 40 (9.0 % had low adherence (MMAS-8© adherence score < 6 and medium adherence (MMAS-8© adherence scores of 6 to 7 to their medication respectively. The percentage of patients scoring low adherence MMAS-8 scores in the interventional group dropped from 64.60 % at baseline to 44.80 % at 6-months (p = 0.01. There was no obvious change in the adherence scores at baseline and at 6-months in the control group. Based on the study data, the Wilcoxon signed-rank test showed that at 6 months, the educational 30-min session on diabetes and adherence to medication did elicit a statistically significant change in adherence levels in adults with diabetes enrolled in the intervention arm (Z = −6

  17. One small step for MIP towards automated metaphor identification? Formulating general rules to determine basic meanings in large-scale approaches to metaphor

    NARCIS (Netherlands)

    Dorst, A.G.; Reijnierse, W.G.; Venhuizen, G.

    2013-01-01

    The manual annotation of large corpora is time-consuming and brings about issues of consistency. This paper aims to demonstrate how general rules for determining basic meanings can be formulated in large-scale projects involving multiple analysts applying MIP(VU) to authentic data. Three sets of

  18. Correction: General optimization procedure towards the design of a new family of minimal parameter spin-component-scaled double-hybrid density functional theory.

    Science.gov (United States)

    Roch, Loïc M; Baldridge, Kim K

    2018-02-07

    Correction for 'General optimization procedure towards the design of a new family of minimal parameter spin-component-scaled double-hybrid density functional theory' by Loïc M. Roch and Kim K. Baldridge, Phys. Chem. Chem. Phys., 2017, 19, 26191-26200.

  19. Evaluation of a pilot study to influence medication adherence of patients with diabetes mellitus type-2 by the pharmacy.

    Science.gov (United States)

    Adhien, Prem; van Dijk, Liset; de Vegter, Marinke; Westein, Marnix; Nijpels, Giel; Hugtenburg, Jacqueline G

    2013-12-01

    Interventions aimed to increase adherence to drug treatment usually are not tailored to the needs of individual patients. A modular pharmacy intervention, named 'Support for Diabetes', was developed to improve adherence to type 2 diabetes treatment. To evaluate the implementation of a new care intervention by using focus groups including pharmacy teams, and assess patient satisfaction. Community pharmacies in The Netherlands. The intervention comprises a structured patient interview, an intervention guide and modular interventions tailored to the underlying cause of non-adherence. Feasibility was studied in non-adherent type 2 diabetes mellitus patients, and evaluated by means of focus group interviews with pharmacists and pharmacy technicians. Topics included practicability of the patient selection procedure, patient interviews, materials developed for the intervention and general practitioner (GP) co-operation. Patients' experiences (n = 36) were assessed by means of a questionnaire. Feasibility of the intervention and patients' satisfaction. Pharmacists and pharmacy technicians considered the intervention feasible and appreciated its pro-active approach. Involvement of pharmacy technicians proved a stimulating factor. Poor co-operation with GPs and lack of time as well as financial compensation were interfering factors. Patients appreciated the intervention and reported to follow the advice of pharmacists. The 'Support for Diabetes' intervention is feasible to implement in pharmacy practice. Poor co-operation between pharmacists and GPs and lack of re-imbursement are obstructions for implementation on a wider scale. These issues should receive attention of pharmacists, policymakers and researchers.

  20. Mediterranean diet adherence in the Mediterranean healthy eating, aging and lifestyle (MEAL) study cohort.

    Science.gov (United States)

    Marventano, Stefano; Godos, Justyna; Platania, Alessio; Galvano, Fabio; Mistretta, Antonio; Grosso, Giuseppe

    2018-02-01

    A decline in adherence to the Mediterranean dietary pattern has been observed over the last years. The aim of this study was to assess the level of adherence to the Mediterranean diet and possible determinants in the Mediterranean healthy Eating, Aging and Lifestyle (MEAL) study cohort. Demographic and dietary data of 1937 individuals were collected in 2014-2015 from the general population of Catania, Sicily (Italy). Food frequency questionnaires and the MEDI-LITE score were used to assess adherence to the Mediterranean diet. The score well characterised consumption of major food groups, micro- and macro-nutrients. The cohort had a general good adherence, but only a minority was highly adherent. High adherence was directly associated with education, non-smoking and physical activity and inversely with high occupational status. In conclusions, Mediterranean diet is still followed in Sicily; however, nutrition education campaigns should promote healthy traditional dietary patterns in certain groups of individuals.

  1. Antiretroviral treatment adherence among HIV patients in KwaZulu-Natal, South Africa

    Directory of Open Access Journals (Sweden)

    Ramlagan Shandir

    2010-03-01

    Full Text Available Abstract Background Successful antiretroviral treatment is dependent on sustaining high rates of adherence. In the southern African context, only a handful of studies (both quantitative and qualitative have looked at the determinants including a health behaviour theory of adherence to antiretroviral therapy. The aim of this study is to assess factors including the information, motivation and behavioural skills model (IMB contributing to antiretroviral (ARV adherence six months after commencing ARVs at three public hospitals in KwaZulu-Natal, South Africa. Methods Using systematic sampling, 735 HIV-positive patients were selected prior to commencing on ART from outpatient departments from three hospitals and followed-up at six months and interviewed with a questionnaire. Results A good proportion of patients were found to be adherent using both adherence instruments (visual analog scale = VAS 82.9%; Adult AIDS Clinical Trials Group = AATCG 70.8%. After adjusting for significant socio-economic variables, both the VAS and the dose, schedule and food adherence indicator found levels of adherence amongst urban residents to be almost 3 times greater than that of rural residents. After adjusting for health-related variables, for both indicators better adherence was associated with low depression and poorer adherence was associated with poor environmental factors. Adjusted odds ratios for adherence when taking into account different behavioural variables were for both adherence indicators, discrimination experiences were associated with lower adherence, and higher scores in adherence information and behavioural skills were associated with higher adherence. For the VAS adherence indicator, higher social support scores were associated with higher adherence. For the dose, schedule and food adherence indicator, using herbal medicines for HIV was associated with lower adherence. Conclusion For the patients in this study, particularly those not living in

  2. Structural equation modeling of the proximal–distal continuum of adherence drivers

    Directory of Open Access Journals (Sweden)

    McHorney CA

    2012-11-01

    Full Text Available Colleen A McHorney,1 Ning Jackie Zhang,2 Timothy Stump,3 Xiaoquan Zhao41US Outcomes Research, Merck, North Wales, PA, 2University of Central Florida, Orlando, 3Indiana University School of Medicine, Indianapolis, 4George Mason University, Fairfax, USAObjectives: Nonadherence to prescription medications has been shown to be significantly influenced by three key medication-specific beliefs: patients' perceived need for the prescribed medication, their concerns about the prescribed medication, and perceived medication affordability. Structural equation modeling was used to test the predictors of these three proximal determinants of medication adherence using the proximal–distal continuum of adherence drivers as the organizing conceptual framework.Methods: In Spring 2008, survey participants were selected from the Harris Interactive Chronic Illness Panel, an internet-based panel of hundreds of thousands of adults with chronic disease. Respondents were eligible for the survey if they were aged 40 years and older, resided in the US, and reported having at least one of six chronic diseases: asthma, diabetes, hyperlipidemia, hypertension, osteoporosis, or other cardiovascular disease. A final sample size of 1072 was achieved. The proximal medication beliefs were measured by three multi-item scales: perceived need for medications, perceived medication concerns, and perceived medication affordability. The intermediate sociomedical beliefs and skills included four multi-item scales: perceived disease severity, knowledge about the prescribed medication, perceived immunity to side effects, and perceived value of nutraceuticals. Generic health beliefs and skills consisted of patient engagement in their care, health information-seeking tendencies, internal health locus of control, a single-item measure of self-rated health, and general mental health. Structural equation modeling was used to model proximal–distal continuum of adherence drivers.Results: The

  3. Gender fairness in self-efficacy? A Rasch-based validity study of the General Academic Self-efficacy scale (GASE)

    DEFF Research Database (Denmark)

    Nielsen, Tine; Vang, Maria Louison; Dammeyer, Jesper

    2018-01-01

    Studies have reported gender differences in academic self-efficacy. However, how and if academic self-efficacy questionnaires are gender-biased has not been psychometrically investigated. The psychometric properties of a general version of The Physics Self-Efficacy Questionnaire – the General...... Academic Self-Efficacy Scale (GASE) – were analyzed using Rasch measurement models, with data from 1018 Danish university students (psychology and technical), focusing on gender invariance and the sufficiency of the score. The short 4-item GASE scale was found to be essentially objective and construct...... valid and satisfactorily reliable, though differential item functioning was found relative to gender and academic discipline, and can be used to assess students’ general academic self-efficacy. Research on gender and self-efficacy needs to take gender into account and equate scores appropriately...

  4. Measuring compulsive buying behaviour: Psychometric validity of three different scales and prevalence in the general population and in shopping centres

    OpenAIRE

    Maraz, A; Eisinger, A; Henderson, B; Urbán, R; Paksi, B; Kun, B; Kökönyei, G; Griffiths, MD; Demetrovics, Z

    2015-01-01

    Due to the problems of measurement and the lack of nationally representative data, the extent of compulsive buying behaviour (CBB) is relatively unknown. Methods: The validity of three different instruments was tested: Edwards Compulsive Buying Scale (ECBS; Edwards, 1993), Questionnaire About Buying Behavior (QABB; Lejoyeux & Adès, 1994) and Richmond Compulsive Buying Scale (RCBS; Ridgway, et. al., 2008) using two independent samples. One was nationally representative of the Hungarian populat...

  5. Parental Depression and Pancreatic Enzymes Adherence in Children With Cystic Fibrosis.

    Science.gov (United States)

    Barker, David H; Quittner, Alexandra L

    2016-02-01

    Treatment adherence in cystic fibrosis (CF) is often poor, however, less is known about adherence to pancreatic enzymes, a critical component of the CF treatment regimen. Parent caregivers often report elevations in depression, and parental depression may adversely affect children's adherence. This prospective study evaluated adherence to pancreatic enzymes in 83 patients (1-13 years) . Adherence was measured across 3 months with electronic pill-caps . Weight was measured at baseline and a 3-month follow-up. Parental depressive symptoms were evaluated by using the Center for Epidemiologic Studies Depression Scale (CES-D). Adherence to pancreatic enzymes was 49.4% ± 3.4%. Adherence was higher at school (94.4% ± 6.1%) than at home (42.3% ± 3.1%), and higher for toddlers (50.6% ± 5.2%) than for school-aged children (37.5% ± 3.7%). Parents reported high rates of depressive symptoms (30% in the clinical range, 18% with moderate symptoms). Children of parents with symptoms of depression versus those without were less adherent (34.8% ± 4.5% vs 48.5% ± 4.1%), and adherence to enzymes was significantly related to 3-month weight outcomes. Average gain in weight z scores across 3 months was 0.5 ± 0.2for children who were >50% adherent and -0.1 ± 6.1for children who were <33% adherent. Parental depression had a signifcant, indirect effect on weight via adherence (-0.005 ± 0.003 gain in weight z score per CES-D unit ). High rates of parental depressive symptoms, coupled with its negative effects on adherence, suggest that measuring and treating parental depression may improve children's adherence to therapy. Copyright © 2016 by the American Academy of Pediatrics.

  6. The differences between medical trust and mistrust and their respective influences on medication beliefs and ART adherence among African-Americans living with HIV.

    Science.gov (United States)

    Pellowski, Jennifer A; Price, Devon M; Allen, Aerielle M; Eaton, Lisa A; Kalichman, Seth C

    2017-09-01

    The purpose of this study was to examine the relationships between medical mistrust and trust and to determine if these measures differentially predict antiretroviral therapy (ART) medication adherence for African-American adults living with HIV. A total of 458 HIV positive African-Americans completed a cross-sectional survey. Self-reported ART adherence was collected using the visual-analog scale. The Beliefs About Medicines Questionnaire was used to assess medication necessity and concern beliefs. All measures of medical mistrust and trust were significantly negatively correlated, ranging from r = -.339 to -.504. Race-based medical mistrust significantly predicted medication necessity and concern beliefs, whereas general medical mistrust only significantly predicted medication concerns. Both measures of trust significantly predicted medication necessity beliefs and medication concerns. Higher levels of race-based medical mistrust predicted lower medication adherence, whereas, neither trust in own physician nor trust in health care provider significantly predicted medication adherence. However, trust in own physician significantly predicted medication necessity beliefs, which predicted medication adherence. Trust and mistrust are not simply opposites of one another. These findings provide evidence for the complexity of understanding the relationship between health care trust, mistrust and patient-related health beliefs and behaviours.

  7. The effect of prebiotics on adherence of probiotics.

    Science.gov (United States)

    Kadlec, Robert; Jakubec, Martin

    2014-01-01

    Prebiotics are generally considered to promote the function or viability of probiotics via their fermentation, but their effect on the adherence of probiotics is still unclear. In this study, we examined the effect of 4 commercially available prebiotics [Orafti GR, Orafti P95, and Orafti Synergy (Beneo GmbH, Mannheim, Germany), and Vivinal (Friesland Foods Domo, Amersfoort, the Netherlands)] and 3 simple saccharides (glucose, galactose, and lactose) on the adherence of 5 probiotic type strains, 2 lactococci starter cultures, and 5 potential dairy probiotic strains from the Culture Collection of Dairy Microorganisms (Tábor, Czech Republic). Adherence was tested in microtiter plates on the following types of substrate: polystyrene alone and polystyrene coated with either porcine mucus or cocultures of the human colon cell lines Caco2 and HT29-MXT (1:9 ratio of HT29-MXT:Caco2). Adherence was evaluated as a change in fluorescence in the well of a microtiter plate. The most commonly observed effect (with a few exceptions) of prebiotics was decreased adherence of the tested strains observed on all types of substrate. The tested saccharides, which are part of the residual compounds of the used prebiotics, had a very similar effect-eliciting a decrease in adherence ability in the majority of the probiotic strains. Copyright © 2014 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

  8. Adherence to treatment in patients with ankylosing spondylitis.

    Science.gov (United States)

    Arturi, Pablo; Schneeberger, Emilce Edith; Sommerfleck, Fernando; Buschiazzo, Emilio; Ledesma, César; Maldonado Cocco, José Antonio; Citera, Gustavo

    2013-07-01

    This study aims to determine the level of adherence to treatment in ankylosing spondylitis (AS) patients and to identify possible factors associated to lack of adherence. We included consecutive AS patients (NY modified criteria). Sociodemographic and clinical data were collected. Patients answered auto-reported questionnaires: Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, Ankylosing Spondylitis Quality of Life, and Center for Epidemiological Studies Depression scale. Patients with rheumatoid arthritis (RA) (ACR'87 criteria) were assessed as the control group. The adherence of the studied groups to medical treatment and exercises was measured by means of two questionnaires: Compliance Questionnaire on Rheumatology (CQR) and Exercise Attitude Questionnaire-18 (EAQ-18). The study included 59 patients with AS and 53 patients with RA. Of the AS patients, 43 (72.9%) were male, median age 47 years (interquartile range (IQR) 33-57) and median disease duration of 120 months (IQR 33-57). Of the RA patients, 37 (69.8%) were female, had a median age of 56 years (IQR 43.5-60) and a median disease duration of 156 months (IQR 96-288). There were no significant differences in the results of the adherence questionnaires between both groups, with a total median of 68.42 for the CQR in both groups and of 40.7 in AS vs. 42.6 in RA for the EAQ. When dichotomizing patients as adherent and non-adherent, taking as good adherence a cut value in the CQR and EAQ higher than 60, adherence to pharmacological treatment was significantly higher in RA vs. AS (92.5 vs. 74.6%, p = 0.01) and there were no differences in the EAQ. On the uni- and multivariate analysis, lack of adherence to treatment was not associated to sex, age, disease duration, education, health insurance, depressive status, and disease activity parameters in neither group of patients. AS have an acceptable adherence to pharmacological treatment, although it is lower than RA

  9. Adherence to highly active antiretroviral therapy in depressed ...

    African Journals Online (AJOL)

    A sociodemographic and drug adherence questionnaire was administered. The Centre for Epidemiological Studies Depression Scale (CES-D) was used to screen for depressive symptoms while the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) was used to confirm the diagnosis of depressive disorder.

  10. Assessing Medication Adherence in Patients with Rheumatoid Arthritis (RA)

    Science.gov (United States)

    2017-04-26

    Background • Rheumatoid arthritis - Affecting 1-3 million Americans - Seventy percent are women - Associated with higher risk of heart disease and stroke ...Scale was developed to assess medication adherence intent and has been validated in several common diseases , including RA. A) True B) False fJ Assessment

  11. Chondrocyte deformations as a function of tibiofemoral joint loading predicted by a generalized high-throughput pipeline of multi-scale simulations.

    Directory of Open Access Journals (Sweden)

    Scott C Sibole

    Full Text Available Cells of the musculoskeletal system are known to respond to mechanical loading and chondrocytes within the cartilage are not an exception. However, understanding how joint level loads relate to cell level deformations, e.g. in the cartilage, is not a straightforward task. In this study, a multi-scale analysis pipeline was implemented to post-process the results of a macro-scale finite element (FE tibiofemoral joint model to provide joint mechanics based displacement boundary conditions to micro-scale cellular FE models of the cartilage, for the purpose of characterizing chondrocyte deformations in relation to tibiofemoral joint loading. It was possible to identify the load distribution within the knee among its tissue structures and ultimately within the cartilage among its extracellular matrix, pericellular environment and resident chondrocytes. Various cellular deformation metrics (aspect ratio change, volumetric strain, cellular effective strain and maximum shear strain were calculated. To illustrate further utility of this multi-scale modeling pipeline, two micro-scale cartilage constructs were considered: an idealized single cell at the centroid of a 100×100×100 μm block commonly used in past research studies, and an anatomically based (11 cell model of the same volume representation of the middle zone of tibiofemoral cartilage. In both cases, chondrocytes experienced amplified deformations compared to those at the macro-scale, predicted by simulating one body weight compressive loading on the tibiofemoral joint. In the 11 cell case, all cells experienced less deformation than the single cell case, and also exhibited a larger variance in deformation compared to other cells residing in the same block. The coupling method proved to be highly scalable due to micro-scale model independence that allowed for exploitation of distributed memory computing architecture. The method's generalized nature also allows for substitution of any macro-scale

  12. Chondrocyte Deformations as a Function of Tibiofemoral Joint Loading Predicted by a Generalized High-Throughput Pipeline of Multi-Scale Simulations

    Science.gov (United States)

    Sibole, Scott C.; Erdemir, Ahmet

    2012-01-01

    Cells of the musculoskeletal system are known to respond to mechanical loading and chondrocytes within the cartilage are not an exception. However, understanding how joint level loads relate to cell level deformations, e.g. in the cartilage, is not a straightforward task. In this study, a multi-scale analysis pipeline was implemented to post-process the results of a macro-scale finite element (FE) tibiofemoral joint model to provide joint mechanics based displacement boundary conditions to micro-scale cellular FE models of the cartilage, for the purpose of characterizing chondrocyte deformations in relation to tibiofemoral joint loading. It was possible to identify the load distribution within the knee among its tissue structures and ultimately within the cartilage among its extracellular matrix, pericellular environment and resident chondrocytes. Various cellular deformation metrics (aspect ratio change, volumetric strain, cellular effective strain and maximum shear strain) were calculated. To illustrate further utility of this multi-scale modeling pipeline, two micro-scale cartilage constructs were considered: an idealized single cell at the centroid of a 100×100×100 μm block commonly used in past research studies, and an anatomically based (11 cell model of the same volume) representation of the middle zone of tibiofemoral cartilage. In both cases, chondrocytes experienced amplified deformations compared to those at the macro-scale, predicted by simulating one body weight compressive loading on the tibiofemoral joint. In the 11 cell case, all cells experienced less deformation than the single cell case, and also exhibited a larger variance in deformation compared to other cells residing in the same block. The coupling method proved to be highly scalable due to micro-scale model independence that allowed for exploitation of distributed memory computing architecture. The method’s generalized nature also allows for substitution of any macro-scale and/or micro-scale

  13. Assessing educational priorities in genetics for general practitioners and specialists in five countries: factor structure of the Genetic-Educational Priorities (Gen-EP) scale.

    Science.gov (United States)

    Calefato, Jean-Marc; Nippert, Irma; Harris, Hilary J; Kristoffersson, Ulf; Schmidtke, Jorg; Ten Kate, Leo P; Anionwu, Elizabeth; Benjamin, Caroline; Challen, Kirsty; Plass, Anne-Marie; Harris, Rodney; Julian-Reynier, Claire

    2008-02-01

    A scale assessing primary care physicians' priorities for genetic education (The Gen-EP scale) was developed and tested in five European countries. The objective of this study was to determine its factor structure, to test scaling assumptions and to determine internal consistency. The sample consisted of 3686 practitioners (general practitioners, gyneco-obstetricians, pediatricians) sampled in France, Germany, the Netherlands, Sweden, and United Kingdom. We first determined the factor structure of the Gen-EP scale (30 items) on the whole sample. Scaling assumptions were then tested on each country using multitrait scaling analysis. Internal consistency was assessed across the five countries. Six factors were identified accounting for 63.3% of the variance of the items. They represented the following priorities for genetic education: "Genetics of Common Diseases"; "Ethical, Legal, and Public Health Issues"; "Approaching Genetic Risk Assessment in Clinical Practice"; "Basic Genetics and Congenital Malformations"; "Techniques and Innovation in Genetics" and "Psychosocial and Counseling Issues." In each country, convergent and discriminant validity were satisfactory. Internal-consistency reliability coefficients (Cronbach's alpha) were all above the acceptable threshold (0.70). The Gen-EP scale could be a helpful instrument in different countries to organize and evaluate the impact of genetic educational programs for primary care providers.

  14. Adherence to a predefined vaccination program in patients with inflammatory bowel disease.

    Science.gov (United States)

    Ruiz-Cuesta, Patricia; González-Alayón, Carlos; Jurado-García, Juan; Iglesias-Flores, Eva M; Barranco-Quintana, José L; García-García, Luisa; Salgueiro-Rodríguez, Isabel M; Benitez-Cantero, José M; García-Sánchez, Valle

    2016-01-01

    The application of vaccination programs in patients with inflammatory bowel disease (IBD) is heterogeneous and generally deficient. As a result, adherence in these patients to a predefined vaccination program has not been clearly established. The aim of this study was to estimate adherence to a predefined vaccination program among patients with IBD and to identify the factors that may predict poor adherence. All patients diagnosed with IBD and followed-up between January and March 2012 were referred to the Department of Preventive Medicine for evaluation of their immune status (with serological testing for hepatitis A, B and C viruses, varicella-zoster virus, mumps, rubella and measles), followed by vaccination based on the test results obtained and on the patient's vaccination history. The percentage of adherence to the vaccination program was determined, along with the factors associated with low adherence. A total of 153 patients with IBD (ulcerative colitis in 50.3% and Crohn's disease in 49.7%) were included (45.1% men and 54.9% women; mean age 43.30±14.19 years, range 17-83). The vaccination program adherence rate was 84.3%. The factors associated with poor adherence were drugs related to IBD (patients not receiving immunosuppressants and/or biological agents showed lower adherence than those receiving these treatments; p=0.021), adherence to medical treatment (poor adherence to treatment was also associated with poor adherence to vaccination; p=0.016), and marital status (single, divorced or separated patients showed lower adherence than married individuals; p=0.015). Adherence to vaccination is acceptable among patients with IBD. However, specific actions, such as optimization of patient information on the disease and emphasis on the need for adequate vaccination, are to improve adherence. Copyright © 2015 Elsevier España, S.L.U. y AEEH y AEG. All rights reserved.

  15. A pilot investigation of a mobile phone application and progressive reminder system to improve adherence to daily prevention treatment in adolescents and young adults with migraine.

    Science.gov (United States)

    Ramsey, Rachelle R; Holbein, Christina E; Powers, Scott W; Hershey, Andrew D; Kabbouche, Marielle A; O'Brien, Hope L; Kacperski, Joanne; Shepard, Jeffrey; Hommel, Kevin A

    2018-01-01

    Background Effective management of migraine requires adherence to treatment recommendations; however, adolescents with migraine take their daily medications only 75% of the time. Low-cost adherence-focused interventions using technology may improve adherence, but have not been investigated. Methods Thirty-five adolescents and young adults (13-21 years) with migraine participated in an AB-design pilot study to assess the use of a mobile phone adherence-promotion application ("app") and progressive reminder system. Adherence was calculated using electronic monitoring during the baseline period and medication adherence intervention. Results Relative to baseline, adherence significantly improved during the first month of the intervention. Specifically, improvements existed for older participants with lower baseline adherence. Self-reported app-based adherence rates were significantly lower than electronically monitored adherence rates. Participants rated the intervention as acceptable and easy to use. Conclusions "Apps" have the potential to improve medication adherence and are a promising intervention for adolescents and young adults with low adherence. Involving parents in the intervention is also helpful. Providers should assess barriers to adherence and use of technology-based interventions, encourage parents to incorporate behavioral incentives, and provide referrals for more intensive interventions to improve long-term outcomes. Further, tracking adherence in an app may result in an underestimation of adherence. Future full-scale studies should be conducted to examine adherence promotion app interventions.

  16. Factors influencing illness representations and perceived adherence in haemophilic patients: a pilot study.

    Science.gov (United States)

    Lamiani, G; Strada, I; Mancuso, M E; Coppola, A; Vegni, E; Moja, E A

    2015-09-01

    Illness representations of chronic patients are important to explain adherence and preventive behaviours. However, it is unclear if the patient's objective health status may influence illness representations and perceived adherence. This study explored if health status and socio-demographic characteristics influence illness representations and perceived adherence in haemophilic patients. Fifty patients (25 on-demand and 25 on prophylaxis) ageing from 13-73, completed the Illness Perceptions Questionnaire-Revised and the Morisky Medication Adherence Scale. Patients' cognitive illness representations were influenced by type of treatment, haemophilia severity, presence of inhibitor and co-morbidity. Perceived chronicity was influenced by patient's age (P = 0.021). Perceived adherence was not influenced by the health status, but was affected by the relationship status (P = 0.048). Perceived adherence was predicted by perceived chronicity (β = 0.412; P = 0.003) and by emotions (β = -0.308; P = 0.023). Patient's health status seems to affect cognitive illness representations but not perceived adherence. Perceived chronicity and negative emotions, which affected perceived adherence, were not influenced by the health status. Physician-patient communication addressing perceived chronicity and emotions rather than patients' health status may influence patient's adherence. Psycho-educational groups could be offered to promote patient's well-being and adjustment to haemophilia, and improve adherence. © 2015 John Wiley & Sons Ltd.

  17. Adherence and Quality of Life of Hypertension Patients in Gunung Jati Hospital, Cirebon, Indonesia

    Directory of Open Access Journals (Sweden)

    Dyah A.Perwitasari

    2015-12-01

    Full Text Available The treatment effectiveness of hypertension could be influenced by patients’ characteristics and patients’ adherence with medication. Besides reaching the goal of blood pressure decrease after the treatment, their quality of life has become the main concern regarding effectiveness of hypertension treatment. This study aimed to explore the hypertension patients’ adherence and quality of life. In addition, it was studied which factors associated with adherence and quality of life in hypertension patients treated with antihypertensive at Gunung Jati Hospital, Cirebon. We recruited 85 adult hypertension patients who were treated with antihypertensive agents for at least 6 months. The patients’ adherence was measured by Medication Adherence Report Scale and the patients’ quality of life was measured by Indonesian version of Short Form-36 questionnaire. The patients’ adherence was found as 24.03 (SD: 1.98 and there were no significant differences of patients’ adherence using monotherapy and combination therapy. The patients’ characteristics such as, age, gender and education level could not predict patients’ adherence (p>0.05. The average of Physical Component Summary (PCS and Mental Component Summary (MCS were 43.35 (SD: 9.4 and 52.13 (SD:5.59. Age and gender may predict PCS, however, education and comorbidity may predict MCS (p<0.05. Hypertension patients’ adherence in Gunung Jati hospital is good. The PCS and MCS scores in this study are comparable to the other previous studies. The patients’ characteristic could not be the predictor of patients’ adherence.

  18. Adherence to antiviral therapy in HIV or HBV-infected patients.

    Science.gov (United States)

    Wójcik, Kamila; Piekarska, Anna; Jabłonowska, Elżbieta

    2016-01-01

    Antiviral therapies in HIV and chronic HBV infection are lifelong and require strict adherence to medication to ensure therapeutic success. The aim of this study was to analyze adherence levels in HIV patients on antiretroviral regimen and in B-infected patients treated with nucleos(t)ide reverse transcriptase inhibitors. The study group consisted of 134 HIV-infected patients and 42 with chronic hepatitis B. The self-reported Morisky 8-Item Medication Adherence Scale (MMAS-8) was used to assess the adherence to medication. We analyzed potential predictors of optimal adherence to the antiretroviral therapy. Mean adherence levels according to MMAS-8 in HIV-infected patients on antiretroviral therapy was 6.64 (SD+/- 1.47) and was significant lower than in patients with chronic hepatitis B 7.48 (SD+/- 1.40) (p pill-Once a-day antiretroviral regimen were similar to patients with chronic hepatitis B (p>0.05). In univariante logistic regression alcohol abstinence, sexual route of HIV transmission, once daily dosing and reduced number of pills were significantly associated with high adherence. According to multivariante logistic regression analysis, only once-daily drug regimen was independent factor of high adherence (OR=2.89, p=0.038). Higher adherence had positive impact on the effectiveness of antiretroviral therapy (p=0.04). The implementation of once-daily antiretroviral regimen has improved adherence that had beneficial effect on the effectiveness of antiretroviral therapy.

  19. Beyond social support: Self-care confidence is key for adherence in patients with heart failure.

    Science.gov (United States)

    Hammash, Muna H; Crawford, Timothy; Shawler, Celeste; Schrader, Melanie; Lin, Chin-Yen; Shewekah, Deena; Moser, Debra K

    2017-10-01

    Adherence to treatment is crucial to improve outcomes in patients with heart failure. Good social support is associated with better adherence, but the mechanism for this association has not been well-explored. The aim of this secondary analysis was to examine whether self-care confidence mediates the relationship between social support and treatment adherence in heart failure patients hospitalized with acute exacerbation. A total of 157 inpatients with heart failure (63.5±13 years, 73% New York Heart Association class III/IV) were recruited from two hospitals located in urban areas in the USA. Participants completed the Self-Care of Heart Failure Index, the Multidimensional Perceived Social Support Scale, and the Medical Outcomes Study Specific Adherence Scale. A series of regression models were used to determine the mediation relationship. Controlling for marital status and hospital site, social support was associated with adherence ( p=0.03). When self-confidence was included in the model, the effect of social support became non-significant, indicating full mediation of the relationship between social support and adherence by self-care confidence. The indirect effect (0.04) of social support on adherence through self-confidence was significant (95% confidence interval: 0.01-0.09). Heart failure self-care confidence mediated the relationship between social support and treatment adherence. Thus interventions targeting patients' self-care confidence is essential to maximize patients' treatment adherence.

  20. Relationship of race-, sexual orientation-, and HIV-related discrimination with adherence to HIV treatment: a pilot study.

    Science.gov (United States)

    Boarts, Jessica M; Bogart, Laura M; Tabak, Melanie A; Armelie, Aaron P; Delahanty, Douglas L

    2008-10-01

    Adherence to highly active antiretroviral therapy (HAART) must be close to perfect in order to maintain suppression of HIV viral load, and to prevent the development of drug resistant strains of HIV. People living with HIV (PLWH) often report low levels of adherence. One variable that has been linked to poor adherence is perceived discrimination; however, research has generally not considered the possible unique effects of different types of discrimination on adherence. The present pilot study aimed to examine the association of three types of discrimination (due to HIV+ status, race, or sexual orientation) with adherence among 57 PLWH. Logistic regression analyses were conducted to demonstrate the relationships between each type of discrimination and self-reported adherence. Racial discrimination significantly predicted lower adherence levels, whereas sexual orientation- and HIV-related discrimination did not. Results underscore the importance of addressing discrimination issues, specifically racial, when designing interventions to improve adherence to HAART.

  1. A generalized power-law scaling law for a two-phase imbibition in a porous medium

    KAUST Repository

    El-Amin, Mohamed

    2013-11-01

    Dimensionless time is a universal parameter that may be used to predict real field behavior from scaled laboratory experiments in relation to imbibition processes in porous media. Researchers work to nondimensionalize the time has been through the use of parameters that are inherited to the properties of the moving fluids and the porous matrix, which may be applicable to spontaneous imbibition. However, in forced imbibition, the dynamics of the process depends, in addition, on injection velocity. Therefore, we propose the use of scaling velocity in the form of a combination of two velocities, the first of which (the characteristic velocity) is defined by the fluid and the porous medium parameters and the second is the injection velocity, which is a characteristic of the process. A power-law formula is suggested for the scaling velocity such that it may be used as a parameter to nondimensionalize time. This may reduce the complexities in characterizing two-phase imbibition through porous media and works well in both the cases of spontaneous and forced imbibition. The proposed scaling-law is tested against some oil recovery experimental data from the literature. In addition, the governing partial differential equations are nondimensionalized so that the governing dimensionless groups are manifested. An example of a one-dimensional countercurrent imbibition is considered numerically. The calculations are carried out for a wide range of Ca and Da to illustrate their influences on water saturation as well as relative water/oil permeabilities. © 2013 Elsevier B.V.

  2. Ontology-aided annotation, visualization and generalization of geological time scale information from online geological map services

    NARCIS (Netherlands)

    Ma, Marshal; Ma, X.; Carranza, E.J.M; Wu, C.; van der Meer, F.D.

    2012-01-01

    Geological maps are increasingly published and shared online, whereas tools and services supporting information retrieval and knowledge discovery are underdeveloped. In this study, we developed an ontology of geological time scale by using a Resource Description Framework model to represent the

  3. Ontology-aided annotation, visualization and generalization of geological time-scale information from online geological map services

    NARCIS (Netherlands)

    Ma, X.; Carranza, E.J.M.; Wu, C.; Meer, F.D. van der

    2012-01-01

    Geological maps are increasingly published and shared online, whereas tools and services supporting information retrieval and knowledge discovery are underdeveloped. In this study, we developed an ontology of geological time scale by using a RDF (Resource Description Framework) model to represent

  4. Transferring and implementing the general dynamic model of oceanic island biogeography at the scale of island fragments

    DEFF Research Database (Denmark)

    Otto, Rüdiger; Whittaker, Robert James; von Gaisberg, Markus

    2016-01-01

    ontogenies, featuring surfaces of varying age. Here, we extend the GDM to apply at a local scale within islands, and test the predictions analytically within individual islands. Location El Hierro, La Palma and Tenerife (Canary Islands). Methods Following the GDM logic, we derive predictions...

  5. A UK validation of a general measure of subjective well-being: the modified BBC subjective well-being scale (BBC-SWB).

    Science.gov (United States)

    Pontin, Eleanor; Schwannauer, Matthias; Tai, Sara; Kinderman, Peter

    2013-09-03

    The BBC Subjective Well-being scale (BBC-SWB) is a recently developed questionnaire designed to measure people's subjective experiences across the wide breadth of domains commonly included in definitions of well-being. Although it has previously been shown to be a reliable and valid measure of subjective well-being in the general population with good psychometric properties, a limitation of the initial version was that it was developed using responses on a 4-point Likert-style scale. This paper presents the psychometric properties, validity and reliability of a revised version of the scale conducted using 5-point Likert-style responses and tests the hypothesis that the scale measures three underlying dimensions of well-being; psychological; physical health; and relationships. A sample of 23,341 participants completed the revised BBC-SWB as part of an on-line open-access battery of self-report measures. Confirmatory factor analysis was used to test the pre-hypothesised three factor structure, and internal consistency was investigated using Cronbach's alpha. Concurrent validity was assessed through analysis of correlations with demographic variables, scores on the Goldberg Anxiety and Depression Scales, and the List of Threatening Experiences Questionnaire. Confirmatory factor analysis supported three factor structure of the measure in the whole sample and for subsamples of males and females. Both the total 24-item scale and the three subscales had good internal consistency, showed no evidence of floor and ceiling effects and correlated significantly with measures of concurrent validity. This study provided further confirmation of the validity and utility of the BBC Subjective Well-being scale. The modified version is a reliable and valid measure for the online assessment of subjective well-being in the general population with good psychometric properties.

  6. Evaluation of Adherence to Nutritional Intervention Through Trajectory Analysis.

    Science.gov (United States)

    Sevilla-Villanueva, B; Gibert, K; Sanchez-Marre, M; Fito, M; Covas, M I

    2017-05-01

    Classical pre-post intervention studies are often analyzed using traditional statistics. Nevertheless, the nutritional interventions have small effects on the metabolism and traditional statistics are not enough to detect these subtle nutrient effects. Generally, this kind of studies assumes that the participants are adhered to the assigned dietary intervention and directly analyzes its effects over the target parameters. Thus, the evaluation of adherence is generally omitted. Although, sometimes, participants do not effectively adhere to the assigned dietary guidelines. For this reason, the trajectory map is proposed as a visual tool where dietary patterns of individuals can be followed during the intervention and can also be related with nutritional prescriptions. The trajectory analysis is also proposed allowing both analysis: 1) adherence to the intervention and 2) intervention effects. The analysis is made by projecting the differences of the target parameters over the resulting trajectories between states of different time-stamps which might be considered either individually or by groups. The proposal has been applied over a real nutritional study showing that some individuals adhere better than others and some individuals of the control group modify their habits during the intervention. In addition, the intervention effects are different depending on the type of individuals, even some subgroups have opposite response to the same intervention.

  7. A comparison of measures used to describe adherence to glaucoma medication in a randomised controlled trial.

    Science.gov (United States)

    Cate, Heidi; Bhattacharya, Debi; Clark, Allan; Holland, Richard; Broadway, David C

    2015-12-01

    Understanding the magnitude of non-adherence in pre-marketing clinical trials and clinical practice is essential. However, accurately measuring non-adherence to medication is problematic, and the variety of adherence measures and/or calculation methods has led to highly variable results. To compare commonly used methods for measuring adherence to eye drop therapy in order to assess which methods achieve the most complete datasets over an 8-month monitoring period, to quantify the magnitude of variance in adherence estimations and to review the different methods used to calculate or interpret adherence data. Adherence was measured electronically for 8 months by participants administering eye drops using a Travalert® dosing aid. The mean number of Travalert dosing aid recorded doses administered over the monitoring period was used to calculate a percentage adherence score. In addition, the value of graphically presenting Travalert dosing aid data to classify patterns of adherence behaviour was explored. The validated Morisky Measure of Adherence Scale and questions requesting participants to report the Frequency of Missed Doses were two measures of self-reported adherence calculated for each participant. Finally, medication possession ratio was calculated from expected repeat prescription orders compared with actual repeat prescription orders. For the 208 recruited participants, self-reported adherence was the most reliable method of collecting complete datasets over the 8-month period; 16% of self-reported adherence data were missing compared with 45% of Travalert dosing aid data missing at 8 months. The mean adherence measured over the monitoring period by the Travalert dosing aid was 77%. When adherence measures were dichotomised into adherent and non-adherent groups, the Travalert dosing aid found 54% of participants were adherent, compared to 60% Morisky Measure of Adherence Scale and 57% Frequency of Missed Dose self-report measures. However, there was poor

  8. Generalized Temporal Acceleration Scheme for Kinetic Monte Carlo Simulations of Surface Catalytic Processes by Scaling the Rates of Fast Reactions.

    Science.gov (United States)

    Dybeck, Eric C; Plaisance, Craig P; Neurock, Matthew

    2017-04-11

    A novel algorithm is presented that achieves temporal acceleration during kinetic Monte Carlo (KMC) simulations of surface catalytic processes. This algorithm allows for the direct simulation of reaction networks containing kinetic processes occurring on vastly disparate time scales which computationally overburden standard KMC methods. Previously developed methods for temporal acceleration in KMC were designed for specific systems and often require a priori information from the user such as identifying the fast and slow processes. In the approach presented herein, quasi-equilibrated processes are identified automatically based on previous executions of the forward and reverse reactions. Temporal acceleration is achieved by automatically scaling the intrinsic rate constants of the quasi-equilibrated processes, bringing their rates closer to the time scales of the slow kinetically relevant nonequilibrated processes. All reactions are still simulated directly, although with modified rate constants. Abrupt changes in the underlying dynamics of the reaction network are identified during the simulation, and the reaction rate constants are rescaled accordingly. The algorithm was utilized here to model the Fischer-Tropsch synthesis reaction over ruthenium nanoparticles. This reaction network has multiple time-scale-disparate processes which would be intractable to simulate without the aid of temporal acceleration. The accelerated simulations are found to give reaction rates and selectivities indistinguishable from those calculated by an equivalent mean-field kinetic model. The computational savings of the algorithm can span many orders of magnitude in realistic systems, and the computational cost is not limited by the magnitude of the time scale disparity in the system processes. Furthermore, the algorithm has been designed in a generic fashion and can easily be applied to other surface catalytic processes of interest.

  9. Asthma and Adherence to Inhaled Corticosteroids

    DEFF Research Database (Denmark)

    Bårnes, Camilla Boslev; Ulrik, Charlotte Suppli

    2015-01-01

    -related hospitalizations could be attributed to poor adherence. Most studies have reported an increase in adherence following focused interventions, followed by an improvement in quality of life, symptoms, FEV1, and oral corticosteroid use. However, 2 studies found no difference in health-care utilization, one observed...... was found to be between 22 and 63%, with improvement up to and after an exacerbation. Poor adherence was associated with youth, being African-American, having mild asthma, care provider, whereas improved adherence was associated with being...... to improve adherence. A total of 19 studies met the inclusion criteria: 9 focusing on the level of adherence, 6 focusing on effects of poor adherence, and 7 focusing on interventions to improve adherence. Three of the studies focused on more than one of these end points. The mean level of adherence to ICS...

  10. Adherence with Preventive Medication in Childhood Asthma

    Directory of Open Access Journals (Sweden)

    Scott Burgess

    2011-01-01

    Full Text Available Suboptimal adherence with preventive medication is common and often unrecognised as a cause of poor asthma control. A number of risk factors for nonadherence have emerged from well-conducted studies. Unfortunately, patient report a physician's estimation of adherence and knowledge of these risk factors may not assist in determining whether non-adherence is a significant factor. Electronic monitoring devices are likely to be more frequently used to remind patients to take medication, as a strategy to motivate patients to maintain adherence, and a tool to evaluate adherence in subjects with poor disease control. The aim of this paper is to review non-adherence with preventive medication in childhood asthma, its impact on asthma control, methods of evaluating non-adherence, risk factors for suboptimal adherence, and strategies to enhance adherence.

  11. Community-Dwelling Older Adults' Adherence to Environmental Fall Prevention Recommendations.

    Science.gov (United States)

    Taylor, Suzänne F; Coogle, Constance L; Cotter, James J; Welleford, E Ayn; Copolillo, Al

    2017-08-01

    This study examined the impact of personalized versus generalized education about environmental fall prevention recommendations on older adults' adherence with recommendations. Secondary aims focused on the impact of recent falls and perceived susceptibility of future falls on adherence with recommendations. Twenty-four community-dwelling older adults aged 65 to 89 years were randomized into two groups to receive either personalized or generalized education intervention on environmental fall prevention recommendations. A significant difference was found in the mean total percentage of adherence with recommendations of those receiving personalized education (69%) compared with those receiving generalized education (37%). No statistically significant relationship was found between sustaining recent falls, nor perceived susceptibility to future falls, and their extent of adherence with environmental fall prevention recommendations. Providing personalized education for environmental fall prevention recommendations may improve older adults' adherence with the recommendations given.

  12. Micronutrient deficiency and treatment adherence in a randomized controlled trial of micronutrient supplementation in ART-naïve persons with HIV.

    Directory of Open Access Journals (Sweden)

    Louise Balfour

    Full Text Available The MAINTAIN study is an on-going RCT comparing high-dose micronutrient and anti-oxidant supplementation versus recommended daily allowance (RDA vitamins in slowing HIV immune deficiency progression in ART-naïve people with HIV infection.We planned analysis of the first 127 participants to determine the baseline prevalence of serum micronutrient deficiencies and correlates, as well as tolerance and adherence to study interventions.Participants receive eight capsules twice daily of 1 high-dose or 2 RDA supplements for two years and are followed-up quarterly for measures of immune deficiency progression, safety and tolerability. Regression analysis was used to identify correlates of micronutrient levels at baseline. Adherence was measured by residual pill count, self-report using the General Treatment Scale (GTS and short-term recall HIV Adherence Treatment Scale (HATS.Prior micronutrient supplementation (within 30 days was 27% at screening and 10% of study population, and was not correlated with baseline micronutrient levels. Low levels were frequent for carotene (24%80% in 75% of participants.Micronutrient levels in asymptomatic HIV+ persons are in keeping with population norms, but micronutrient deficiencies are frequent. Adherence levels are high, and will permit a valid evaluation of treatment effects.ClinicalTrials.gov NCT00798772.

  13. Letters to the Editor Adherence to iron supplementation in pregnancy

    African Journals Online (AJOL)

    2010 Malawi Demographic and Health Survey”.1. In this paper, the authors investigated the relationship between ... has advantages and limits. Many studies have shown that pill counting is more accurate than ... this generally applies to all cross-sectional surveys. There was no way our analysis on adherence could have.

  14. Strategies for improving adherence to antiepileptic drug treatment in people with epilepsy.

    Science.gov (United States)

    Al-Aqeel, Sinaa; Gershuni, Olga; Al-Sabhan, Jawza; Hiligsmann, Mickael

    2017-02-03

    Poor adherence to antiepileptic medication is associated with increased mortality, morbidity and healthcare costs. In this review, we focus on interventions designed and tested in randomised controlled trials and quasi-randomised controlled trials to assist people with adherence to antiepileptic medication. This is an updated version of the original Cochrane review published in the Cochrane Library, Issue 1, 2010. To determine the effectiveness of interventions aimed at improving adherence to antiepileptic medication in adults and children with epilepsy. For the latest update, on 4 February 2016 we searched the Cochrane Epilepsy Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Register of Studies Online (CRSO), MEDLINE (Ovid 1946 to 4 February 2016), CINAHL Plus (EBSCOhost 1937 to 4 February 2016), PsycINFO (EBSCOhost 1887 to 4 February 2016), ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform. We also searched the reference lists of relevant articles. Randomised and quasi-randomised controlled trials of adherence-enhancing interventions aimed at people with a clinical diagnosis of epilepsy (as defined in individual studies), of any age and treated with antiepileptic drugs in a primary care, outpatient or other community setting. All review authors independently assessed lists of potentially relevant citations and abstracts. At least two review authors independently extracted data and performed quality assessment of each study according to the Cochrane tool for assessing risk of bias. We graded the level of evidence for each outcome according to the GRADE working group scale.The studies differed widely according to the type of intervention and measures of adherence; therefore combining data was not appropriate. We included 12 studies reporting data on 1642 participants (intervention = 833, control = 809). Eight studies targeted adults with epilepsy, one study included participants

  15. Predictors of Adherence to Relaxation Guided Imagery During Pregnancy in Women with Preterm Labor.

    Science.gov (United States)

    Chuang, Li-Lan; Liu, Shu-Chen; Chen, Yi-Heng; Lin, Li-Chan

    2015-09-01

    To examine adherence to relaxation guided imagery in women experiencing preterm labor as well as predictors influencing adherence. This study used a longitudinal follow-up approach. Each of the 57 participating women received a mini-MP3 player containing a 13-minute relaxation guided imagery audio program that they were instructed to follow daily until giving birth. Follow-up interviews were conducted weekly. A generalized estimating equation was used to predict adherence. The total adherence rate was 58%. Higher adherence was predicted by the presence of at least a college degree (p=0.006), greater perceived stress (p=0.006), a higher risk of preterm delivery (pguided imagery. For women with a lower adherence to relaxation guided imagery, health care professionals may consider individual preferences regarding relaxation techniques.

  16. Antihypertensive Medications Adherence Among Nigerian ...

    African Journals Online (AJOL)

    stroke.[10] Hypertension among Nigerians is often associated with cluster of other cardiovascular risk factors, which often increase the cardiovascular risk of .... 65.7 [12.5] vs. 62.7 [11.5] years, respectively). Those with low adherence were also more likely to be using more antihypertensive medications than those with ...

  17. Physician reported adherence to immunosuppressants in renal transplant patients: Prevalence, agreement, and correlates.

    Science.gov (United States)

    Pabst, Selma; Bertram, Anna; Zimmermann, Tanja; Schiffer, Mario; de Zwaan, Martina

    2015-11-01

    Adherence to immunosuppressants (IS) is crucial to prevent allograft rejection. Even though there is evidence that non-adherence to IS among kidney transplant recipients is common, it is rarely routinely assessed in clinical practice. Especially, little is known about how physicians estimate patients' adherence to IS medication. In a single center, cross-sectional study adult patients at least 1 year after kidney transplantation were asked to complete measures of adherence (BAASIS©, Transplant Effect Questionnaire) and of general psychopathology (anxiety, depression, perceived social support). Also the physicians were asked to estimate their patients' adherence. Medical data (time since transplantation, treatment for rejection, IS serum trough levels and target levels) were taken from the patients' charts. Physicians rated 22 of 238 (9.2%) patients as non-adherent. Physicians' estimations of non-adherence were lower compared to the results of the self-ratings and biopsy-proven rejections. No association was found between physicians' estimates and the variability of IS through levels. Significantly more women and patients who reported that their native language was not German were rated as non-adherent by the physicians. Also, physician-rated non-adherent patients reported significantly higher depression and anxiety scores as well as less social support compared to adherent patients. Our results suggest that physicians tend to underestimate patient non-adherence to IS medication. They appear to use observable cues such as sex, language skills, and elevated anxiety and depression scores in particular, to make inferences about an individual patient's adherence. Underestimation of medication non-adherence may impede physicians' ability to provide high quality care. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Introducing Distance and Measurement in General Relativity: Changes for the Standard Tests and the Cosmological Large-Scale

    Directory of Open Access Journals (Sweden)

    Crothers S. J.

    2005-10-01

    Full Text Available Relativistic motion in the gravitational field of a massive body is governed by the external metric of a spherically symmetric extended object. Consequently, any solution for the point-mass is inadequate for the treatment of such motions since it pertains to a fictitious object. I therefore develop herein the physics of the standard tests of General Relativity by means of the generalised solution for the field external to a sphere of incompressible homogeneous fluid.

  19. The Spanish version of the Warwick-Edinburgh mental well-being scale (WEMWBS) is valid for use in the general population.

    Science.gov (United States)

    Castellví, Pere; Forero, Carlos G; Codony, Miquel; Vilagut, Gemma; Brugulat, Pilar; Medina, Antonia; Gabilondo, Andrea; Mompart, Anna; Colom, Joan; Tresserras, Ricard; Ferrer, Montse; Stewart-Brown, Sarah; Alonso, Jordi

    2014-04-01

    Mental well-being has aroused interest in Europe as an indicator of population health. The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) was developed in the United Kingdom showing good face validity and has been previously adapted into Spanish. The aim of this study is to assess the validity and reliability of the Spanish version of WEMWBS in the general population. Cross-sectional home face-to-face interview survey with computer-assisted personal interviewing was administered with the 2011 Catalan Health Interview Survey Wave 3, which is representative of the non-institutionalized general population of Catalonia, Spain. A total of 1,900 participants 15+ years of age were interviewed. The Spanish version of WEMWBS was administered together with socioeconomic and health-related variables, with a hypothesized level of association. Similar to the original, confirmatory factor analysis fits a one-factor model adequately (CFI = 0.974; TLI = 0.970; RMSEA = 0.059; χ (2) = 584.82; df = 77; p mental well-being was higher for the general population of Catalonia (average and whole distribution) than that for Scotland general population. The Spanish version of WEMWBS showed good psychometric properties similar to the UK original scale. Whether better mental well-being in Catalonia is due to methodological or substantive cultural, social, or environmental factors should be further researched.

  20. Factors affecting insulin adherence to type I glass bottles

    International Nuclear Information System (INIS)

    Mitrano, F.P.; Newton, D.W.

    1982-01-01

    Some physicochemical factors that could account for insulin adherence to type I glass bottles from admixtures of insulin with 5% dextrose (D5W) and 0.9% sodium chloride (NS) injections were studied. Samples of three volumes of NS or D5W containing insulin 125 I were mixed in three sizes of bottles to test the effect of surface area and volume. Appropriate volumes of insulin were combined with insulin 125 I and D5W or NS to yield solutions containing nine concentrations of insulin to test the effect of insulin concentration. Appropriate volumes of KCl injection to yield six concentrations were combined with insulin 125 I and NS or D5W to test the effect of KCl concentration. All samples were assayed by gamma scintillation. In general, there was a direct relationship between the percentage of insulin adhering and the container surface area. In D5W admixtures, as the fill volume at constant insulin 125 I concentration was doubled and quadrupled, the adherence of insulin decreased in all three bottle sizes (200, 250, and 500 ml). In NS admixtures, however, this effect was seen only with the 250-ml bottle. Increasing insulin concentrations over the range of 50-300 units/liter in D5W and 0-50 units/liter in NS resulted in decreased adherence. The addition of 1-60 meq/liter of KCl resulted in a significant decrease of insulin adhering from D5W and an insignificant decrease from NS admixtures. The percentage of insulin adhering to type I glass surfaces may be reduced to 25% or less by preparing i.v. admixtures in full bottles of D5W or NS at insulin concentrations of 25 to 300 units/liter. The addition of KCl, when therapeutically appropriate, will further decrease the extent of insulin adherence

  1. Towards anatomic scale agent-based modeling with a massively parallel spatially explicit general-purpose model of enteric tissue (SEGMEnT_HPC).

    Science.gov (United States)

    Cockrell, Robert Chase; Christley, Scott; Chang, Eugene; An, Gary

    2015-01-01

    Perhaps the greatest challenge currently facing the biomedical research community is the ability to integrate highly detailed cellular and molecular mechanisms to represent clinical disease states as a pathway to engineer effective therapeutics. This is particularly evident in the representation of organ-level pathophysiology in terms of abnormal tissue structure, which, through histology, remains a mainstay in disease diagnosis and staging. As such, being able to generate anatomic scale simulations is a highly desirable goal. While computational limitations have previously constrained the size and scope of multi-scale computational models, advances in the capacity and availability of high-performance computing (HPC) resources have greatly expanded the ability of computational models of biological systems to achieve anatomic, clinically relevant scale. Diseases of the intestinal tract are exemplary examples of pathophysiological processes that manifest at multiple scales of spatial resolution, with structural abnormalities present at the microscopic, macroscopic and organ-levels. In this paper, we describe a novel, massively parallel computational model of the gut, the Spatially Explicitly General-purpose Model of Enteric Tissue_HPC (SEGMEnT_HPC), which extends an existing model of the gut epithelium, SEGMEnT, in order to create cell-for-cell anatomic scale simulations. We present an example implementation of SEGMEnT_HPC that simulates the pathogenesis of ileal pouchitis, and important clinical entity that affects patients following remedial surgery for ulcerative colitis.

  2. Reliability and Construct Validity of Two Versions of Chalder Fatigue Scale among the General Population in Mainland China

    Directory of Open Access Journals (Sweden)

    Meng-Juan Jing

    2016-01-01

    Full Text Available The 14-item Chalder Fatigue Scale (CFS is widely used, while the 11-item version is seldom to be found in current research in mainland China. The objectives of the present study is to compare the reliability and construct validity between these two versions and to confirm which may be better for the mainland Chinese setting. Based on a cross-sectional health survey with a constructive questionnaire, 1887 individuals aged 18 years or above were selected. Socio-demographic, health-related, gynecological data were collected, and 11-item and 14-item Chalder Fatigue Scale (CFS were used to assess fatigue. Confirmatory factor analysis and exploratory structural equation modeling (ESEM were performed to test the fit of models of the two versions. Confirmatory factor analysis of the two versions of CFS did not support the two-factor theorized models. In addition, a three-factor ESEM model of the 11-item version, but not the 14-item version, showed better factor structure and fitness than the other models examined. Both the versions had good internal consistency reliability and a satisfactory internal consistency (Ω = 0.78–0.96, omega coefficient indicates the internal consistency reliability was obtained from the optimal model. This study provided evidence for satisfactory reliability and structural validity for the three-factor model of the 11-item version, which was proven to be superior to the 14-item version for this data.

  3. Staff Knowledge, Adherence to Infection Control Recommendations ...

    African Journals Online (AJOL)

    Staff Knowledge, Adherence to Infection Control Recommendations and Seroconversion Rates in Hemodialysis Centers in Khartoum. ... Adherence of staff members to infection control recommendations was evaluated by direct observation. Results: ... A structured training program for HD staff members is urgently required.

  4. Validating the Modified Drug Adherence Work-Up (M-DRAW Tool to Identify and Address Barriers to Medication Adherence

    Directory of Open Access Journals (Sweden)

    Sun Lee

    2017-09-01

    Full Text Available Barriers to medication adherence stem from multiple factors. An effective and convenient tool is needed to identify these barriers so that clinicians can provide a tailored, patient-centered consultation with patients. The Modified Drug Adherence Work-up Tool (M-DRAW was developed as a 13-item checklist questionnaire to identify barriers to medication adherence. The response scale was a 4-point Likert scale of frequency of occurrence (1 = never to 4 = often. The checklist was accompanied by a GUIDE that provided corresponding motivational interview-based intervention strategies for each identified barrier. The current pilot study examined the psychometric properties of the M-DRAW checklist (reliability, responsiveness and discriminant validity in patients taking one or more prescription medication(s for chronic conditions. A cross-sectional sample of 26 patients was recruited between December 2015 and March 2016 at an academic medical center pharmacy in Southern California. A priming question that assessed self-reported adherence was used to separate participants into the control group of 17 “adherers” (65.4%, and into the intervention group of nine “unintentional and intentional non-adherers” (34.6%. Comparable baseline characteristics were observed between the two groups. The M-DRAW checklist showed acceptable reliability (13 item; alpha = 0.74 for identifying factors and barriers leading to medication non-adherence. Discriminant validity of the tool and the priming question was established by the four-fold number of barriers to adherence identified within the self-selected intervention group compared to the control group (4.4 versus 1.2 barriers, p < 0.05. The current study did not investigate construct validity due to small sample size and challenges on follow-up with patients. Future testing of the tool will include construct validation.

  5. High cell density media for Escherichia coli are generally designed for aerobic cultivations – consequences for large-scale bioprocesses and shake flask cultures

    Directory of Open Access Journals (Sweden)

    Neubauer Peter

    2008-08-01

    Full Text Available Abstract Background For the cultivation of Escherichia coli in bioreactors trace element solutions are generally designed for optimal growth under aerobic conditions. They do normally not contain selenium and nickel. Molybdenum is only contained in few of them. These elements are part of the formate hydrogen lyase (FHL complex which is induced under anaerobic conditions. As it is generally known that oxygen limitation appears in shake flask cultures and locally in large-scale bioreactors, function of the FHL complex may influence the process behaviour. Formate has been described to accumulate in large-scale cultures and may have toxic effects on E. coli. Although the anaerobic metabolism of E. coli is well studied, reference data which estimate the impact of the FHL complex on bioprocesses of E. coli with oxygen limitation have so far not been published, but are important for a better process understanding. Results Two sets of fed-batch cultures with conditions triggering oxygen limitation and formate accumulation were performed. Permanent oxygen limitation which is typical for shake flask cultures was caused in a bioreactor by reduction of the agitation rate. Transient oxygen limitation, which has been described to eventually occur in the feed-zone of large-scale bioreactors, was mimicked in a two-compartment scale-down bioreactor consisting of a stirred tank reactor and a plug flow reactor (PFR with continuous glucose feeding into the PFR. In both models formate accumulated up to about 20 mM in the culture medium without addition of selenium, molybdenum and nickel. By addition of these trace elements the formate accumulation decreased below the level observed in well-mixed laboratory-scale cultures. Interestingly, addition of the extra trace elements caused accumulation of large amounts of lactate and reduced biomass yield in the simulator with permanent oxygen limitation, but not in the scale-down two-compartment bioreactor. Conclusion The

  6. Adherence of plaque components to different restorative materials.

    Science.gov (United States)

    Kawai, K; Urano, M

    2001-01-01

    This study compared the amount of artificial plaque synthesized in vitro by Streptococcus sobrinus on various dental materials using radioisotopes. In particular, plaque-retaining capacities of new types of ceramics were the focus of this study. Specimens were fabricated from the following materials (one amalgam alloy [Spherical-D], one casting gold alloy [Casting Gold TYPE I], one resin composite [Herculite XR] and three ceramics [Vita Celay Blanks, IPS Empress and Dicor MGC]). The amount of bacteria and glucans adhered on the specimens was measured after incubation for 24 hours at 37 degrees C with radio-labeled cariogenic bacteria and sucrose. This adhesion test was performed using two different surfaces with 600-grit roughness and clinical smoothness. Irrespective of the surface roughness, the least amount of plaque adhered to the ceramics. However, in the case of the resin composite and amalgam, the amount of bacteria and glucan adhesion decreased dramatically by polishing, though there were no statistically different changes in the amount of bacteria and glucans that adhered to the ceramics even after polishing. In general, the amount of adhered bacteria showed almost the same tendency as that of glucans. Although no statistical differences in the amount of bacteria and glucan adhesion were detected among the three ceramics investigated in this study, a lesser amount of bacteria and glucans adhered to them compared to the other materials.

  7. Medication adherence as a learning process: insights from cognitive psychology.

    Science.gov (United States)

    Rottman, Benjamin Margolin; Marcum, Zachary A; Thorpe, Carolyn T; Gellad, Walid F

    2017-03-01

    Non-adherence to medications is one of the largest contributors to sub-optimal health outcomes. Many theories of adherence include a 'value-expectancy' component in which a patient decides to take a medication partly based on expectations about whether it is effective, necessary, and tolerable. We propose reconceptualising this common theme as a kind of 'causal learning' - the patient learns whether a medication is effective, necessary, and tolerable, from experience with the medication. We apply cognitive psychology theories of how people learn cause-effect relations to elaborate this causal-learning challenge. First, expectations and impressions about a medication and beliefs about how a medication works, such as delay of onset, can shape a patient's perceived experience with the medication. Second, beliefs about medications propagate both 'top-down' and 'bottom-up', from experiences with specific medications to general beliefs about medications and vice versa. Third, non-adherence can interfere with learning about a medication, because beliefs, adherence, and experience with a medication are connected in a cyclic learning problem. We propose that by conceptualising non-adherence as a causal-learning process, clinicians can more effectively address a patient's misconceptions and biases, helping the patient develop more accurate impressions of the medication.

  8. Insulin adherence in patients with diabetes: risk factors for injection omission.

    Science.gov (United States)

    Farsaei, Shadi; Radfar, Mania; Heydari, Zahra; Abbasi, Farzaneh; Qorbani, Mostafa

    2014-12-01

    The purpose of this study was to evaluate adherence to insulin therapy in patients with diabetes. The underlying factors affecting insulin injection omission among patients with type 1 or 2 diabetes were also investigated. This cross-sectional study has been conducted on 507 patients with diabetes. Adherence to insulin therapy was measured by the 8-Item Moriskey Medication Adherence Scale (MMS) and the autocompliance method. Furthermore, socio-demographic, disease and injection-related barriers to insulin injection were assessed. Based on the Morisky Green test, 14.3% and 28.8% of patients with type 1 and 2 diabetes respectively had low adherence to insulin therapy. However, almost all patients were adherent according to the autocompliance method. Different factors showed a significant association with insulin compliance in both groups. The current study suggests acceptable adherence to insulin therapy among patients with type 1, and poor adherence in patients with type 2, diabetes. Our findings regarding barriers with significant effect on insulin adherence may be useful to identify patients at risk for low compliance, and to guide the design of proper strategies to improve adherence and the consequential clinical outcomes. Copyright © 2014 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  9. Adherence to the Treatment in Psychiatric Patients

    Directory of Open Access Journals (Sweden)

    Mehmet Emin Demirkol

    2015-09-01

    Conclusion: Although medical treatments and drug industry develop day by day, there have been no changes in the treatment adherence ratios in the past years. To generate possible solutions, treatment adherence should be assessed in all clinical interviews and if patient is non-adherent this issue should be handled seriously. [Cukurova Med J 2015; 40(3.000: 555-568

  10. Introducing the Adherence Strategy Engineering Framework (ASEF)

    DEFF Research Database (Denmark)

    Wagner, Stefan Rahr; Toftegaard, Thomas Skjødeberg; Bertelsen, Olav W.

    2013-01-01

    resulting in reduced data quality and suboptimal treatment. Objectives: The aim of this paper is to introduce the Adherence Strategy Engineering Framework (ASEF) as a method for developing novel technology-based adherence strategies to assess and improve patient adherence levels in the unsupervised setting...

  11. Barriers and facilitators to antiretroviral medication adherence ...

    African Journals Online (AJOL)

    Medication adherence is a complex behaviour with multiple determinants. Understanding the barriers and facilitators of adherence is invaluable for programme improvement, which assists the foundation of adherence intervention strategies. A qualitative study was conducted in six selected hospitals of Addis Ababa in 2008, ...

  12. Preliminary investigation of adherence to antiretroviral therapy ...

    African Journals Online (AJOL)

    Treatment of HIV with highly active antiretroviral therapy (HAART) has resulted in declining morbidity and mortality rates from HIV-associated diseases, but concerns regarding access and adherence are growing. To determine the adherence level and the reasons for non-adhering to antiretroviral therapy (ART) among ...

  13. The adherence of education reform to international education policy. A brief overview of the path from the General Law of the Education System (LOGSE of 1990 to the Law for the Improvement of Education Quality (LOMCE of 2013

    Directory of Open Access Journals (Sweden)

    Blas Cabrera Montoya

    2016-01-01

    Full Text Available The aim of this paper is to illustrate the continuities of educational reforms in the Spanish democracy, and especially between the General Law of the Education System (LOGSE of 1990 and the Law for the Improvement of Education Quality (LOMCE of 2013. In order to do so we will examine what we consider to be the three main concerns on which current educational patterns are based: first, the crisis of the traditional materials and symbolic functions of universal education systems under capitalism, which entails a slowtransformation in mentalities regarding the social importance of education; secondly, the inevitable dependence of virtually all Spanish education legislation in democracy to the provisions of Article 27 of the Spanish Constitution of 1978; and finally, the greater role that the laws attribute to international assessment and accountability in Spain. This last point is the most important new feature of educational policy in the last twenty five years.

  14. Skepticism and pharmacophobia toward medication may negatively impact adherence to psychiatric medications: a comparison among outpatient samples recruited in Spain, Argentina, and Venezuela

    Directory of Open Access Journals (Sweden)

    De las Cuevas C

    2018-02-01

    Full Text Available Carlos De las Cuevas,1 Mariano Motuca,2 Trino Baptista,3 Jose de Leon4–6 1Department of Internal Medicine, Dermatology and Psychiatry, Universidad de La Laguna, Canary Islands, Spain; 2Instituto Vilapriño, Center for Studies, Assistance and Research in Neurosciences, Mendoza, Argentina; 3Departament of Physiology, Facultad de Medicina, Universidad de Los Andes, Mérida, Venezuela; 4Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA; 5Psychiatry and Neurosciences Research Group (CTS-549, Institute of Neurosciences, University of Granada, Granada, Spain; 6Biomedical Research Centre in Mental Health Net (CIBERSAM, Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain Background: Cultural differences in attitudes toward psychiatric medications influence medication adherence but transcultural studies are missing. The objective of this study was to investigate how attitudes and beliefs toward psychotropic medications influence treatment adherence in psychiatric outpatients in Spain, Argentina, and Venezuela.Methods: A cross-sectional, cross-cultural psychopharmacology study was designed to assess psychiatric outpatients’ attitudes toward their prescribed medication. Patients completed the Drug Attitude Inventory – 10 Item (DAI-10, the Beliefs about Medicines Questionnaire – Specific Scale (BMQ-Specific, the Sidorkiewicz adherence tool, and sociodemographic and clinical questionnaires. The study included 1,291 adult psychiatric outpatients using 2,308 psychotropic drugs from three Spanish-speaking countries, the Canary Islands (Spain (N=588 patients, Argentina (N=508, and Venezuela (N=195.Results: The univariate analyses showed different mean scores on the DAI-10 and the BMQ – Necessity and Concerns subscales but, on the other hand, the percentages of non-adherent and skeptical patients were relatively similar in three countries. Argentinian patients had a very low level of pharmacophobia

  15. Psychosocial and demographic predictors of adherence and non-adherence to health advice accompanying air quality warning systems: a systematic review.

    Science.gov (United States)

    D'Antoni, Donatella; Smith, Louise; Auyeung, Vivian; Weinman, John

    2017-09-22

    Although evidence shows that poor air quality can harm human health, we have a limited understanding about the behavioural impact of air quality forecasts. Our aim was to understand to what extent air quality warning systems influence protective behaviours in the general public, and to identify the demographic and psychosocial factors associated with adherence and non-adherence to the health advice accompanying these warnings. In August 2016 literature was systematically reviewed to find studies assessing intended or actual adherence to health advice accompanying air quality warning systems, and encouraging people to reduce exposure to air pollution. Predictors of adherence to the health advice and/or self-reported reasons for adherence or non-adherence were also systematically reviewed. Studies were included only if they involved participants who were using or were aware of these warning systems. Studies investigating only protective behaviours due to subjective perception of bad air quality alone were excluded. The results were narratively synthesised and discussed within the COM-B theoretical framework. Twenty-one studies were included in the review: seventeen investigated actual adherence; three investigated intended adherence; one assessed both. Actual adherence to the advice to reduce or reschedule outdoor activities during poor air quality episodes ranged from 9.7% to 57% (Median = 31%), whereas adherence to a wider range of protective behaviours (e.g. avoiding busy roads, taking preventative medication) ranged from 17.7% to 98.1% (Median = 46%). Demographic factors did not consistently predict adherence. However, several psychosocial facilitators of adherence were identified. These include knowledge on where to check air quality indices, beliefs that one's symptoms were due to air pollution, perceived severity of air pollution, and receiving advice from health care professionals. Barriers to adherence included: lack of understanding of the indices

  16. Prevalence and correlates of medication non-adherence among kidney transplant recipients more than 6 months post-transplant: a cross-sectional study

    OpenAIRE

    Weng, Francis L; Chandwani, Sheenu; Kurtyka, Karen M; Zacker, Christopher; Chisholm-Burns, Marie A; Demissie, Kitaw

    2013-01-01

    Background Among kidney transplant recipients, non-adherence with immunosuppressive medications frequently precedes allograft loss. We sought to determine the prevalence and correlates of medication non-adherence among kidney transplant recipients. Methods We performed a single-center, cross-sectional study of kidney transplant recipients who were at least 6 months post-transplant. We measured self-reported adherence using the Immunosuppressive Therapy Adherence Scale (ITAS, which is scored f...

  17. A general explanation on the correlation of dark matter halo spin with the large-scale environment

    Science.gov (United States)

    Wang, Peng; Kang, Xi

    2017-06-01

    Both simulations and observations have found that the spin of halo/galaxy is correlated with the large-scale environment, and particularly the spin of halo flips in filament. A consistent picture of halo spin evolution in different environments is still lacked. Using N-body simulation, we find that halo spin with its environment evolves continuously from sheet to cluster, and the flip of halo spin happens both in filament and nodes. The flip in filament can be explained by halo formation time and migrating time when its environment changes from sheet to filament. For low-mass haloes, they form first in sheets and migrate into filaments later, so their mass and spin growth inside filament are lower, and the original spin is still parallel to filament. For high-mass haloes, they migrate into filaments first, and most of their mass and spin growth are obtained in filaments, so the resulted spin is perpendicular to filament. Our results well explain the overall evolution of cosmic web in the cold dark matter model and can be tested using high-redshift data. The scenario can also be tested against alternative models of dark matter, such as warm/hot dark matter, where the structure formation will proceed in a different way.

  18. Adherence and health care costs

    Directory of Open Access Journals (Sweden)

    Iuga AO

    2014-02-01

    Full Text Available Aurel O Iuga,1,2 Maura J McGuire3,4 1Johns Hopkins Bloomberg School of Public Health, 2Johns Hopkins University, 3Johns Hopkins Community Physicians, 4Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: Medication nonadherence is an important public health consideration, affecting health outcomes and overall health care costs. This review considers the most recent developments in adherence research with a focus on the impact of medication adherence on health care costs in the US health system. We describe the magnitude of the nonadherence problem and related costs, with an extensive discussion of the mechanisms underlying the impact of nonadherence on costs. Specifically, we summarize the impact of nonadherence on health care costs in several chronic diseases, such as diabetes and asthma. A brief analysis of existing research study designs, along with suggestions for future research focus, is provided. Finally, given the ongoing changes in the US health care system, we also address some of the most relevant and current trends in health care, including pharmacist-led medication therapy management and electronic (e-prescribing. Keywords: patient, medication, adherence, compliance, nonadherence, noncompliance, cost

  19. Feasibility of a Facebook Intervention for Exercise Motivation and Cardiac Rehabilitation Adherence: Study Protocol.

    Science.gov (United States)

    Siegmund, Lee Anne; Ahmed, Haitham M; Crawford, Michael Todd; Bena, James Frank

    2017-08-18

    While cardiac rehabilitation has been shown to be effective at improving coronary heart disease (CHD), participation is generally poor. Attempts to increase uptake and adherence often fail. Use of a Facebook intervention for this population may be a unique opportunity to support self-determined motivation and affect adherence. To evaluate the impact of a Facebook intervention on motivation for exercise and adherence to cardiac rehabilitation in patients with CHD during a 12-week, Phase II cardiac rehabilitation program. A prospective, randomized controlled pilot study, grounded in Self-Determination Theory, will be conducted. Participants will be recruited from inpatient, or the intake visit to outpatient, cardiac rehabilitation, and then randomly assigned to the intervention or comparison group. Participants in the intervention group will take part in a private Facebook group. Weekly posts will be designed to support self-determined motivation, measured at baseline and postcardiac rehabilitation by the Behavioral Regulation in Exercise Questionnaire-3 (BREQ-3). The Psychological Need Satisfaction for Exercise (PNSE) scale will measure fulfillment of needs that affect motivation. Participants in the comparison group will be given the same materials, but these will be supplied via handouts and email. The number of sessions attended will be tallied and analyzed using t tests. Overall motivation will be evaluated using analysis of covariance (ANCOVA) models. Multivariate analysis of variance models will be used to evaluate differences in the change across motivation subtypes. If significant, ANCOVA models for each subtype will be fit. ANCOVA models will be used to compare changes in needs satisfaction, overall and separately among the three subscales, between groups. Engagement in the Facebook group will be measured by number of "likes" and self-report of weekly visits to the group. This project was funded in July 2017 and recruitment is currently underway. The

  20. Measures and predictors of varenicline adherence in the treatment of nicotine dependence.

    Science.gov (United States)

    Peng, Annie R; Morales, Mark; Wileyto, E Paul; Hawk, Larry W; Cinciripini, Paul; George, Tony P; Benowitz, Neal L; Nollen, Nicole L; Lerman, Caryn; Tyndale, Rachel F; Schnoll, Robert

    2017-12-01

    While adherence to medication in smoking cessation clinical trials is strongly associated with clinical outcome, very few studies have evaluated the validity of pill count as a measure of adherence relative to a biological assay, and evaluated a broad range of correlates of adherence. In a smoking cessation clinical trial of varenicline, we compared pill counts collected over 4 different time periods to varenicline salivary levels taken after 2weeks of treatment, as well as evaluated predictors of adherence to varenicline. Using a binary measure of adherence based on salivary varenicline levels, adherence was higher among older, white, and more educated participants. Relative to 3, 7, and 14-day pill count, 12-week pill count was the only significant measure able to discriminate adherence as defined by salivary varenicline levels (assessed by area under the receiver operating characteristic curve; AUC=0.59, p=0.004). Seventy-two percent of participants who indicated adherence on 12-week pill count were classified as adherent based on varenicline saliva levels (sensitivity=0.80; specificity=0.40). There was modest variability in the relationship between 12-week pill count and varenicline levels across race and rate of nicotine metabolism. Lastly, General Estimating Equation models demonstrated that longitudinal changes in withdrawal, craving, negative and positive affect, and side effect count and severity were not related to adherence based on salivary varenicline levels. These results indicate that 12-week pill count was the best, albeit a relatively weak, measure of varenicline adherence; additional factors associated with treatment adherence need to be identified. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Prevalence and complications of hypouricemia in a general population: A large-scale cross-sectional study in Japan.

    Science.gov (United States)

    Kuwabara, Masanari; Niwa, Koichiro; Ohtahara, Akira; Hamada, Toshihiro; Miyazaki, Satoshi; Mizuta, Einosuke; Ogino, Kazuhide; Hisatome, Ichiro

    2017-01-01

    Hypouricemia was reported as a risk factor for exercise-induced acute renal injury (EIAKI) and urinary stones. However, the prevalence of kidney diseases among hypouricemic subjects has not been evaluated. This study was conducted to clarify the prevalence of hypouricemia and the association of hypouricemia with kidney diseases by using a large-scale Japanese population data. This study is a retrospective cross-sectional study at the Center for Preventive Medicine, St. Luke's International Hospital, Tokyo, Japan, and Sanin Rousai Hospital, Yonago, Japan. We analyzed the medical records of 90,143 Japanese subjects at the center in St. Luke's International Hospital, Tokyo, and 4,837 subjects in Sanin Rousai Hospital, Yonago, who underwent annual regular health check-up between January 2004 and June 2010. We defined hypouricemia as serum uric acid level of ≤2.0 mg/dL. We checked the medical history of all the study subjects and compared the rates of complications including urinary stones and kidney diseases among those with or without hypouricemia. The prevalence of hypouricemia was 0.19% in St. Luke's International Hospital, Tokyo, and 0.58% in Sanin Rousai Hospital, Yonago. The prevalence of hypouricemia in women was larger than that in men both in Tokyo (0.31% vs 0.068%, p<0.001) and in Yonago (1.237% vs 0.318%, p<0.001). Among 172 hypouricemic subjects (30 men), the rates of previous urinary stones and kidney diseases (including nephritis/nephrosis) were 1.2% (3.3% men, 0.7% women) and 2.3% (10% men, 0.7% women), respectively. Hypouricemic men had a 9-fold higher rate of previously having kidney diseases compared to non-hypouricemic men (p<0.001). However, the rates of other diseases including urinary stones were not significantly different between the two groups. Hypouricemia was associated with a history of kidney disease especially in men.

  2. Depression and medication adherence among older Korean patients with hypertension: Mediating role of self-efficacy.

    Science.gov (United States)

    Son, Youn-Jung; Won, Mi Hwa

    2017-06-01

    Many studies have reported the negative effects of depression on adherence to antihypertensive medication. However, little is known about the mechanism underlying this relationship in elderly patients with hypertension. The aim of this cross-sectional study is to examine the mediating role of self-efficacy in the relationship between depression and medication adherence among older patients with hypertension. The data were collected from October to December 2014. A total of 255 older patients with hypertension were assessed using the Geriatric Depression Scale, the Self-efficacy for Appropriate Medication Use Scale, and the Morisky Medication Adherence Scale. Hierarchical linear regression analysis and the Sobel test were used to examine the mediating role of self-efficacy in the relationship between depression and medication adherence. Depression and self-efficacy were statistically significant predictors of medication adherence in older patients with hypertension. Self-efficacy partially mediated the relationship between depression and medication adherence. Interventions targeting self-efficacy could increase the confidence of patients in their ability to actively take their medicines. Moreover, health care providers should be aware of the importance of early detection of depression in older patients with hypertension. Future studies with longitudinal data are warranted to clarify the multidirectional relationships between depression, self-efficacy, and medication adherence. © 2017 John Wiley & Sons Australia, Ltd.

  3. Adherence with Drug Therapy in Pregnancy

    Directory of Open Access Journals (Sweden)

    Doreen Matsui

    2012-01-01

    Full Text Available Available information suggests that nonadherence with medication is a common problem in pregnant women. Not taking prescribed drugs may have potentially negative consequences as patients may not achieve their therapeutic goal. In addition to the many factors that may influence medication-taking behaviour in the general population, unique challenges are encountered in pregnant women as both maternal health and fetal well-being must be considered. On the one hand, pregnant women may be motivated to keep their underlying disease under control, while, on the other hand, fear and anxiety regarding the potential harmful effects of their medication on their unborn child may result in poor adherence with needed medication. Providing evidence-based information, ideally preconceptually, regarding the effects of their medication during pregnancy may be important in avoiding misperceptions that lead to nonadherence.

  4. Medication non-adherence and uncertainty

    DEFF Research Database (Denmark)

    Kriegbaum, Margit; Lau, Sofie Rosenlund

    2017-01-01

    . This applied to information from both mass media and from general practitioners. There was no clear pattern of information seeking and statin non-adherence. CONCLUSIONS: The article point to the impact of information-seeking on the decision to take cholesterol-lowering medication. This included contributions...... discontinuation were analysed using multivariate logistical regression models. RESULTS: Experience of side effects and fear of side effects played an important role in the discontinuation of statin treatment. Feelings of uncertainty and confusion regarding information on statins predicted statin discontinuation...... from information disseminated by media outlets. Side effects and fear of side effects should be addressed in clinical practice. Health care professionals should pay attention to emotional aspects of how information is disseminated and perceived by statin users....

  5. Immunosuppressive medication adherence in kidney transplant patients.

    Science.gov (United States)

    Lalić, Jelena; Veličković-Radovanović, Radmila; Mitić, Branka; Paunović, Goran; Cvetković, Tatjana

    2014-01-01

    To assess the degree of immunosuppressive medication adherence in kidney transplant patients (KTPs) and to determine if there is a difference in the rate of adherence to tacrolimus (Tac), cyclosporine (CsA) and sirolimus (Sir). From a total of 63 KTPs treated at the Clinic of Nephrology, Clinical Centre Niš, Serbia, 60 participated in the study by responding to questionnaires. They were divided into the adherence group (n = 43) and the nonadherence group (n = 17) according to their degree of adherence which was measured using a validated survey form, the simplified medication adherence questionnaire. The KTP adherence to the different immunosuppressive regimens (Tac, CsA and Sir) was compared. Statistical analysis was performed using the Student t test. Adherence was observed in 43 (71.7%) patients, and only 17 (28.3%) did not follow the prescribed therapy. The estimated glomerular filtration rate was significantly lower in the nonadherence group (38.52 ± 18.22 ml/min) than in the adherence group (52.43 ± 16.91 ml/min, p adherers and the nonadherers (6.30 ± 2.06 vs. 5.0 ± 1.52 ng/ml, p adherence. Nonadherence was associated with worse graft function and a lower Tac level. Knowledge about the degree of adherence could help the early identification of nonadherent patients and the development of strategies to improve this. © 2014 S. Karger AG, Basel

  6. Adherence issues related to sublingual immunotherapy as perceived by allergists

    Directory of Open Access Journals (Sweden)

    Silvia Scurati

    2010-06-01

    Full Text Available Silvia Scurati1, Franco Frati1, Gianni Passalacqua2, Paola Puccinelli1, Cecile Hilaire1, Cristoforo Incorvaia3, Italian Study Group on SLIT Compliance 1Scientific and Medical Department, Stallergenes, Milan, Italy; 2Allergy and Respiratory Diseases, Department of Internal Medicine, Genoa; 3Allergy/Pulmonary Rehabilitation, ICP Hospital, Milan, ItalyObjectives: Sublingual immunotherapy (SLIT is a viable alternative to subcutaneous immunotherapy to treat allergic rhinitis and asthma, and is widely used in clinical practice in many European countries. The clinical efficacy of SLIT has been established in a number of clinical trials and meta-analyses. However, because SLIT is self-administered by patients without medical supervision, the degree of patient adherence with treatment is still a concern. The objective of this study was to evaluate the perception by allergists of issues related to SLIT adherence.Methods: We performed a questionnaire-based survey of 296 Italian allergists, based on the adherence issues known from previous studies. The perception of importance of each item was assessed by a VAS scale ranging from 0 to 10.Results: Patient perception of clinical efficacy was considered the most important factor (ranked 1 by 54% of allergists, followed by the possibility of reimbursement (ranked 1 by 34%, and by the absence of side effects (ranked 1 by 21%. Patient education, regular follow-up, and ease of use of SLIT were ranked first by less than 20% of allergists.Conclusion: These findings indicate that clinical efficacy, cost, and side effects are perceived as the major issues influencing patient adherence to SLIT, and that further improvement of adherence is likely to be achieved by improving the patient information provided by prescribers.Keywords: adherence, sublingual immunotherapy, efficacy, cost, side effects

  7. Factors associated with Mediterranean diet adherence in Huntington's disease.

    Science.gov (United States)

    Rivadeneyra, Jéssica; Cubo, Esther; Gil, Cecilia; Calvo, Sara; Mariscal, Natividad; Martínez, Asunción

    2016-04-01

    Little is known about the importance of the Mediterranean Diet (MeDi) and dietary intake as environmental neuroprotective factors in Huntington's disease (HD); so, we evaluated and analyzed the prevalence and factors associated with MeDi adherence, and dietary intake in HD. Spanish participants of the European Huntington Disease Network (EHDN) Registry study diagnosed with HD or premanifest HD gene carriers were included from June 2012 to August 2013. Self-reported dietary intake was collected by 3-day dietary record, MeDi adherence was assessed by 0-9 range (proposed by Trichopoulou et al.) and, other contributing factors related to nutrition were collected by telephone. Demographics and clinical variables were obtained from the EHDN Registry study database. Association of HD with MeDi adherence and nutritional characteristics were performed using logistic regression models. Ninety eight participants were included in the study, median age of 48 years (38-60 range), and median total functional capacity (TFC) 9 (5-13 range). HD severity was similar between participants with low vs moderate/high MeDi; however, quality of life (P = 0.009) was significantly higher among participants with moderate/high MeDi adherence. In terms of nutrients, higher MUFA/SFA intake was moderately correlated with better TFC and Unified HD Rating Scale (UHDRS) cognitive. Better TFC was associated with having a caregiver (OR = 11.86, P the moderate MeDi adherence is associated with better quality of life, lower comorbidity, lower motor impairment and lower risk for abdominal obesity compared to those participants with low MeDi adherence. Copyright © 2016 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

  8. Epidemiology of mental disability using Indian Disability Evaluation Assessment Scale among general population in an urban area of Puducherry, India.

    Science.gov (United States)

    Kumar, S G; Premarajan, K C; Kattimani, S; Kar, S S

    2018-01-01

    There is paucity of information on epidemiology of mental disability in India. The objective of this study was to assess mental disability, and to study the association between sociodemographic and comorbid chronic conditions with mental disability. This community-based cross-sectional study was conducted among ≥5 years age group in an urban area attached to a Tertiary Care Medical Institute in Puducherry, India. Mental disability was assessed using Indian Disability Evaluation and Assessment Scale. Chronic morbid conditions and other associated factors were collected using pretested questionnaire. Univariate and multiple logistic regression analysis. About 2537 subjects were covered with a response rate of 94.1%. Overall, the prevalence of mental disability was found to be 7.1% (181/2537). Among them, majority had mild mental disability (151, 83.4%), followed by moderate (21, 11.6%), severe (8, 4.4%), and profound (1, 0.6%) mental disability. Univariate analysis showed that age group status, marital status, education level, occupation, family type, religion, hypertension, joint pain, backache, current smoking, current alcohol use, and conflicts were associated with mental disability (P < 0.05). Multiple logistic regression analysis showed that male gender (adjusted odds ratio [AOR] =2.064), widowed status (AOR = 27.022), separated/divorced status (AOR = 16.674), currently married status (AOR = 18.487), being illiterate (AOR = 4.352), having 1st-10th standard education (AOR = 2.531), being in an unskilled (AOR = 0.287) or semiskilled/skilled occupation (AOR = 0.025), belonging to a nuclear family (AOR = 1.816), and absence of family conflicts (AOR = 0.259) were significantly associated with mental disability compared to their counterparts. Mental disability is more common in this area. Males, lesser education level, skilled or unskilled occupation, nuclear family, and conflicts were associated with mental disability after adjusting other variables. Multicentric

  9. Epidemiology of mental disability using Indian Disability Evaluation Assessment Scale among general population in an urban area of Puducherry, India

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    S G Kumar

    2018-01-01

    Full Text Available Background: There is paucity of information on epidemiology of mental disability in India. Objective: The objective of this study was to assess mental disability, and to study the association between sociodemographic and comorbid chronic conditions with mental disability. Materials and Methods: This community-based cross-sectional study was conducted among ≥5 years age group in an urban area attached to a Tertiary Care Medical Institute in Puducherry, India. Mental disability was assessed using Indian Disability Evaluation and Assessment Scale. Chronic morbid conditions and other associated factors were collected using pretested questionnaire. Statistical Analysis: Univariate and multiple logistic regression analysis. Results: About 2537 subjects were covered with a response rate of 94.1%. Overall, the prevalence of mental disability was found to be 7.1% (181/2537. Among them, majority had mild mental disability (151, 83.4%, followed by moderate (21, 11.6%, severe (8, 4.4%, and profound (1, 0.6% mental disability. Univariate analysis showed that age group status, marital status, education level, occupation, family type, religion, hypertension, joint pain, backache, current smoking, current alcohol use, and conflicts were associated with mental disability (P < 0.05. Multiple logistic regression analysis showed that male gender (adjusted odds ratio [AOR] =2.064, widowed status (AOR = 27.022, separated/divorced status (AOR = 16.674, currently married status (AOR = 18.487, being illiterate (AOR = 4.352, having 1st–10th standard education (AOR = 2.531, being in an unskilled (AOR = 0.287 or semiskilled/skilled occupation (AOR = 0.025, belonging to a nuclear family (AOR = 1.816, and absence of family conflicts (AOR = 0.259 were significantly associated with mental disability compared to their counterparts. Conclusion: Mental disability is more common in this area. Males, lesser education level, skilled or unskilled occupation, nuclear family, and

  10. Beliefs about medicines and non-adherence in patients with stroke, diabetes mellitus and rheumatoid arthritis: a cross-sectional study in China.

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    Wei, Li; Champman, Sarah; Li, Xiaomei; Li, Xin; Li, Sumei; Chen, Ruoling; Bo, Nie; Chater, Angel; Horne, Robert

    2017-10-05

    To investigate beliefs about medicines and their association with medicine adherence in patients with chronic diseases in China. A cross-sectional questionnaire-based study SETTING: Two large urban hospitals in Hefei and Tianjin, China PARTICIPANTS: Hospital inpatients (313 stroke patients) and outpatients (315 diabetic patients and 339 rheumatoid arthritis (RA) patients) were recruited between January 2014 and September 2014. The Beliefs about Medicines Questionnaire (BMQ), assessing patients' beliefs about the specific medicine (Specific-Necessity and Specific-Concerns) prescribed for their conditions (stroke/diabetes/RA) and more general background beliefs about pharmaceuticals as a class of treatment (BMQ-General Benefit, Harm and Overuse); the Perceived Sensitivity to Medicines scale (PSM) assessed patients' beliefs about how sensitive they were to the effects of medicines and the Medication Adherence Report Scale. The association between non-adherence and beliefs about medicines was assessed using a logistic regression model. Patients with diabetes mellitus had a stronger perceived need for treatment (mean (SD) Specific-Necessity score, 3.75 (0.40)) than patients with stroke (3.69 (0.53)) and RA (3.66 (0.44)) (p=0.049). Moderate correlations were observed between Specific-Concerns and General-Overuse, General-Harm and PSM (Pearson correlation coefficients, 0.39, 0.49 and 0.49, respectively, pmedicine (159 (51.0%) in the stroke group, 60 (26.7%) in the diabetes mellitus group and 62 (19.8%) in the RA group, pmedicines (OR, 1.35, 95% CI 1.07 to 1.71) and patients who believed that they were personally sensitive to the effects of medications (OR 1.44, 95% CI 1.16 to 1.85). The BMQ is a useful tool to identify patients at risk of non-adherence. In the future, adherence intervention studies may use the BMQ to screen for patients who are at risk of non-adherence and to map interventional support. © Article author(s) (or their employer(s) unless otherwise

  11. Importance of Quality of Life for Adherence to Sublingual Immunotherapy

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    Marie-Luise Lemberg

    2016-01-01

    Full Text Available Background. Nonperception of efficacy ranks among the most commonly cited causes for nonadherence to sublingual immunotherapy (SLIT. Quality of life (QoL in patients is a determining factor influencing adherence. We investigated QoL and adherence separately in SLIT patients at one pediatric practice in Germany. Methods. We conducted a noninterventional, cross-sectional, retrospective, quality-of-life survey among pediatric patients treated with SLIT. QoL was assessed using the generic SF-12 health survey in German. The items contained in the SF-12 health survey are weighted, added up, and converted to obtain a physical component score (PCS and a mental component score (MCS. Each component score ranges from 0 to 100; the higher the score, the better the QoL perceived. Results. 201 surveyed patients who had undergone SLIT showed PCS-12 of 49.3 (± 7.0 and MCS-12 of 52.6 (± 7.2. These figures correlate strongly with those reported for the German general population (n=2453: PCS-12 of 49.6 (± 8.7 and MCS-12 of 52.3 (± 8.0. 70.2% (73 of 104 patients were adherent at this practice. Conclusions. QoL in the SLIT patients surveyed here appears as good as that of the general population. Adherence to SLIT at this practice was remarkably better than that reported elsewhere.

  12. Patterns and obstacles to oral antidiabetic medications adherence among type 2 diabetics in Ismailia, Egypt: a cross section study.

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    Heissam, Khaled; Abuamer, Zeinab; El-Dahshan, Nahed

    2015-01-01

    Diabetes is a costly and increasingly common chronic disease. Effective management of diabetes to achieve glycemic control improves patient quality of life. Adherence rates to drug regimens in patients with type 2 diabetes are relatively low and vary widely between populations. There are many factors that could affect patient adherence to drug therapy. The aim of the present study was assessing patterns and obstacles to adherence of type 2 diabetic patients to their oral hypoglycemic drugs. The present work is a descriptive cross section study, carried on type 2 diabetic patients who were on oral hypoglycemic drugs. Data concerning adherence to drugs was assessed using measure treatment adherence scale (MTA). A total of 372 (55.59% males and 44.41% females) patients with type-2 diabetes fulfilled the inclusion criteria and included in the study. Among the participants, 26.1% were found to have good adherence, 47.9% had a fair adherence, and 26% had poor adherence. The overall rate of medication adherence among the diabetic patients population was suboptimal and non-acceptable. Evaluation of adherence is vital for patients with diabetes in order to determine factors and barriers affecting the adherence and to manage them.

  13. Adherence to oral bisphosphonates: 30 more minutes in dosing instructions matter.

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    Vytrisalova, M; Touskova, T; Ladova, K; Fuksa, L; Palicka, V; Matoulkova, P; Horak, P; Stepan, J

    2015-01-01

    Low adherence to treatment with bisphosphonates significantly impedes its effectiveness. The objectives were: (1) to compare adherence to oral weekly and monthly bisphosphonates with emphasis on dosing instructions; and (2) to study associations between adherence and beliefs about the bisphosphonate treatment among women ≥ 55 years. A multicenter survey was performed in secondary-care patients with osteoporosis. Osteoporosis Specific Morisky Medication Adherence Scale (OS-MMAS), questions on compliance with five dosing instructions and Beliefs about Medicines Questionnaire (BMQ) Specific were used. As many as 363 questionnaires (response rate 95%) were analyzed. Respondents (mean age 69 years) were treated with weekly bisphosphonates (37%) or monthly ibandronate (63%). Based on OS-MMAS, 67% of respondents showed high adherence with no differences between the subgroups. Only 44% of respondents were compliant with all dosing instructions. Compliance with dosing instructions concerning time interval (fasting and staying upright) was 71% in weekly and 52% in monthly subgroups, respectively (p bisphosphonates.

  14. Medical adherence to topical corticosteroid preparations prescribed for psoriasis

    DEFF Research Database (Denmark)

    Svendsen, Mathias Tiedemann; Andersen, Flemming; Hansen, Jakob

    2017-01-01

    OBJECTIVE: Topical corticosteroids and corticosteroid combinations are the principal treatments in psoriasis. The aim of this study was to investigate published literature dealing with medical adherence to topical corticosteroid or corticosteroid combinations in patients with psoriasis. MATERIALS...... health outcome in topical treatment of psoriasis, further studies should be conducted addressing determinants of nonadherence and test interventions to improve adherence. Validated measurements of medical nonadherence, prescription registers, or medication-weight are needed....... interventional study. Observation periods varied and rates of nonadherence ranged from 8% to 88.3%. The rates were reported by patients on eight nonvalidated scales and one validated scale, measured by medication weight in two studies, and in two studies rates of nonadherence were measured using prescription...

  15. Association of Continuity of Primary Care and Statin Adherence.

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    James R Warren

    Full Text Available Deficiencies in medication adherence are a major barrier to effectiveness of chronic condition management. Continuity of primary care may promote adherence. We assessed the association of continuity of primary care with adherence to long-term medication as exemplified by statins.We linked data from a prospective study of 267,091 Australians aged 45 years and over to national data sets on prescription reimbursements, general practice claims, hospitalisations and deaths. For participants having a statin dispense within 90 days of study entry, we computed medication possession ratio (MPR and usual provider continuity index (UPI for the subsequent two years. We used multivariate Poisson regression to calculate the relative risk (RR and 95% confidence interval (CI for the association between tertiles of UPI and MPR adjusted for socio-demographic and health-related patient factors, including age, gender, remoteness of residence, smoking, alcohol intake, fruit and vegetable intake, physical activity, prior heart disease and speaking a language other than English at home. We performed a comparison approach using propensity score matching on a subset of the sample.36,144 participants were eligible and included in the analysis among whom 58% had UPI greater than 75%. UPI was significantly associated with 5% increased MPR for statin adherence (95% CI 1.04-1.06 for highest versus lowest tertile. Dichotomised analysis using a cut-off of UPI at 75% showed a similar effect size. The association between UPI and statin adherence was independent of socio-demographic and health-related factors. Stratification analyses further showed a stronger association among those who were new to statins (RR 1.33, 95% CI 1.15-1.54.Greater continuity of care has a positive association with medication adherence for statins which is independent of socio-demographic and health-related factors.

  16. Adherence to therapies in patients with type 2 diabetes.

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    García-Pérez, Luis-Emilio; Alvarez, María; Dilla, Tatiana; Gil-Guillén, Vicente; Orozco-Beltrán, Domingo

    2013-12-01

    Adherence to therapy is defined as the extent to which a person's behavior in taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a healthcare provider. Patients presenting with type 2 diabetes mellitus are initially encouraged to maintain a healthy diet and exercise regimen, followed by early medication that generally includes one or more oral hypoglycemic agents and later may include an injectable treatment. To prevent the complications associated with type 2 diabetes, therapy frequently also includes medications for control of blood pressure, dyslipidemia and other disorders, since patients often have more than three or four chronic conditions. Despite the benefits of therapy, studies have indicated that recommended glycemic goals are achieved by less than 50% of patients, which may be associated with decreased adherence to therapies. As a result, hyperglycemia and long-term complications increase morbidity and premature mortality, and lead to increased costs to health services. Reasons for nonadherence are multifactorial and difficult to identify. They include age, information, perception and duration of disease, complexity of dosing regimen, polytherapy, psychological factors, safety, tolerability and cost. Various measures to increase patient satisfaction and increase adherence in type 2 diabetes have been investigated. These include reducing the complexity of therapy by fixed-dose combination pills and less frequent dosing regimens, using medications that are associated with fewer adverse events (hypoglycemia or weight gain), educational initiatives with improved patient-healthcare provider communication, reminder systems and social support to help reduce costs. In the current narrative review, factors that influence adherence to different therapies for type 2 diabetes are discussed, along with outcomes of poor adherence, the economic impact of nonadherence, and strategies aimed at improving

  17. Association of Continuity of Primary Care and Statin Adherence.

    Science.gov (United States)

    Warren, James R; Falster, Michael O; Tran, Bich; Jorm, Louisa

    2015-01-01

    Deficiencies in medication adherence are a major barrier to effectiveness of chronic condition management. Continuity of primary care may promote adherence. We assessed the association of continuity of primary care with adherence to long-term medication as exemplified by statins. We linked data from a prospective study of 267,091 Australians aged 45 years and over to national data sets on prescription reimbursements, general practice claims, hospitalisations and deaths. For participants having a statin dispense within 90 days of study entry, we computed medication possession ratio (MPR) and usual provider continuity index (UPI) for the subsequent two years. We used multivariate Poisson regression to calculate the relative risk (RR) and 95% confidence interval (CI) for the association between tertiles of UPI and MPR adjusted for socio-demographic and health-related patient factors, including age, gender, remoteness of residence, smoking, alcohol intake, fruit and vegetable intake, physical activity, prior heart disease and speaking a language other than English at home. We performed a comparison approach using propensity score matching on a subset of the sample. 36,144 participants were eligible and included in the analysis among whom 58% had UPI greater than 75%. UPI was significantly associated with 5% increased MPR for statin adherence (95% CI 1.04-1.06) for highest versus lowest tertile. Dichotomised analysis using a cut-off of UPI at 75% showed a similar effect size. The association between UPI and statin adherence was independent of socio-demographic and health-related factors. Stratification analyses further showed a stronger association among those who were new to statins (RR 1.33, 95% CI 1.15-1.54). Greater continuity of care has a positive association with medication adherence for statins which is independent of socio-demographic and health-related factors.

  18. Psoriasis in childhood: effective strategies to improve treatment adherence

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    Shah KN

    2015-03-01

    Full Text Available Kara N Shah,1 Sandra Cortina,2,3 Michelle M Ernst,2 Jessica C Kichler2 1Division of Pediatric Dermatology, 2Division of Behavioral Medicine and Clinical Psychology, 3Center for Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA Abstract: Psoriasis is a relatively common chronic inflammatory skin disease in children for which there is no cure. Most children have mild disease that can be managed with topical therapy as opposed to phototherapy or systemic therapy. Despite the mild presentation of psoriasis in most children, the disease can have a significant impact on quality of life due to the need for ongoing treatment, the frequently visible nature of the cutaneous manifestations, and the social stigma that is associated with psoriasis. Adherence to treatment, in particular topical therapy, is often poor in adults and compromises response to therapy and medical provider management strategies. Multiple factors that may contribute to nonadherence in adults with psoriasis have been identified, including lack of education on the disease and expectations for management, issues related to ease of use and acceptability of topical medications, and anxiety regarding possible medication side effects. There is currently no published data on adherence in the pediatric psoriasis population; however, poor adherence is often suspected when patients fail to respond to appropriate therapy. General strategies used to assess adherence in other pediatric disease populations can be applied to children with psoriasis, and interventions that reflect experience in other chronic dermatologic disorders such as atopic dermatitis may also be helpful for medical providers caring for children with psoriasis. Keywords: adherence, psoriasis, children

  19. Large scale comparative codon-pair context analysis unveils general rules that fine-tune evolution of mRNA primary structure.

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    Gabriela Moura

    Full Text Available BACKGROUND: Codon usage and codon-pair context are important gene primary structure features that influence mRNA decoding fidelity. In order to identify general rules that shape codon-pair context and minimize mRNA decoding error, we have carried out a large scale comparative codon-pair context analysis of 119 fully sequenced genomes. METHODOLOGIES/PRINCIPAL FINDINGS: We have developed mathematical and software tools for large scale comparative codon-pair context analysis. These methodologies unveiled general and species specific codon-pair context rules that govern evolution of mRNAs in the 3 domains of life. We show that evolution of bacterial and archeal mRNA primary structure is mainly dependent on constraints imposed by the translational machinery, while in eukaryotes DNA methylation and tri-nucleotide repeats impose strong biases on codon-pair context. CONCLUSIONS: The data highlight fundamental differences between prokaryotic and eukaryotic mRNA decoding rules, which are partially independent of codon usage.

  20. Highly active antiretroviral therapy adherence and its determinants in selected regions in Indonesia

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    Felix F. Widjaja

    2011-02-01

    Full Text Available Background: Highly active antiretroviral therapy (HAART can reduce morbidity and mortality of HIV-infected patients. However, it depends upon adherence to medication. The objective of this study was to examine the adherence to HAART and to evaluate individual patient characteristics i.e. self-efficacy, depression level, and social support and to finally determine HAART adherence in selected regions in Indonesia.Methods: This cross-sectional study was conducted in Jakarta, Malang, Bandung, Makasar and Banda Aceh. The subject of the study was HIV-infected patients who were older than 13 years old and had taken HAART for at least a month. They were recruited consecutively then asked how many pills they had missed during the previous month. Poor adherence can be stated if the percentage of adherence rate is below 95%. HIV treatment adherence self-efficacy scale  (HIVASES, Beck Depression Inventory (BDI-II and Interpersonal Support Evaluation List (ISEL was adapted to assess self-efficacy, depression level and social support, respectively.Results: We found that 96% (n=53 of the subjects adhered to HAART. There were no associations between adherence with self-efficacy, depression level, and social support. The main cause of non-adherence in this study was ‘simply  forget’.Conclusion: Adherence to HAART was found to be high and not associated with self-efficacy, depression level and social support in some central regions in Indonesia. (Med J Indones 2011; 20:50-5Keywords: adherence, depression, HAART, HIV, self-efficacy, social support

  1. Improving Post-Discharge Medication Adherence in Patients with CVD: A Pilot Randomized Trial

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    Alfredo D. Oliveira-Filho

    2014-12-01

    Full Text Available Background: Effective interventions to improve medication adherence are usually complex and expensive. Objective: To assess the impact of a low-cost intervention designed to improve medication adherence and clinical outcomes in post-discharge patients with CVD. Method: A pilot RCT was conducted at a teaching hospital. Intervention was based on the four-item Morisky Medication Adherence Scale (MMAS-4. The primary outcome measure was medication adherence assessed using the eight-item MMAS at baseline, at 1 month post hospital discharge and re-assessed 1 year after hospital discharge. Other outcomes included readmission and mortality rates. Results: 61 patients were randomized to intervention (n = 30 and control (n = 31 groups. The mean age of the patients was 61 years (SD 12.73, 52.5% were males, and 57.4% were married or living with a partner. Mean number of prescribed medications per patient was 4.5 (SD 3.3. Medication adherence was correlated to intervention (p = 0.04 and after 1 month, 48.4% of patients in the control group and 83.3% in the intervention group were considered adherent. However, this difference decreased after 1 year, when adherence was 34.8% and 60.9%, respectively. Readmission and mortality rates were related to low adherence in both groups. Conclusion: The intervention based on a validated patient self-report instrument for assessing adherence is a potentially effective method to improve adherent behavior and can be successfully used as a tool to guide adherence counseling in the clinical visit. However, a larger study is required to assess the real impact of intervention on these outcomes.

  2. The role of mental health in mediating the relationship between social support and optimal ART adherence.

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    Huynh, Alexis K; Kinsler, Janni J; Cunningham, William E; Sayles, Jennifer N

    2013-01-01

    Optimal adherence to antiretroviral therapy (ART) is essential for reducing mortality and morbidity in persons living with HIV/AIDS (PLWHA), as well as for reducing the risk of further HIV transmission. While studies have identified psychosocial factors such as lack of social support and poor mental health status as important barriers to optimal ART adherence, few studies have explored the potential of a mediation effect of psychosocial factors on the relationship between social support and optimal ART adherence. This paper assessed whether mental health status mediated the relationship between social support and optimal ART adherence among a cross-sectional sample of 202 persons living with HIV who were recruited from HIV clinical care sites and community-based organizations in Los Angeles County (LAC). Participants completed a survey that included social support items from the Medical Outcome Study: Social Support Survey (MOS-SSS) Instrument, mental health measures from the Medical Outcomes Study Short Form (SF-12), and ART adherence based on self-report. Among those currently taking ART, 61.7% reported having optimal adherence. Social support was significantly associated with a high score on the mental health status scale (AOR =2.90; 95% CI=1.14-5.78) and optimal ART adherence (AOR=1.81; 95% CI=1.81; 95% CI=1.18-2.79). When mental health status was introduced into the model, the association between social support and optimal ART adherence was no longer significant. Our findings suggest the HIV interventions targeting social support to improve ART adherence will likely be most successful if the support bolsters the mental health of the participants. Clearly, better understanding the relationships among social support, mental health, and ART adherence will be critical for development and implementation of future ART adherence interventions.

  3. Duloxetine treatment adherence across mental health and chronic pain conditions

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    Able SL

    2014-02-01

    Full Text Available Stephen L Able,1 Zhanglin Cui,2, Wei Shen2 1Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN, USA; 2Global Statistical Sciences, Eli Lilly and Company, Indianapolis, IN, USA Purpose: This study applied a uniform methodology for measuring and comparing duloxetine adherence in the treatment of multiple chronic medical conditions. Materials and methods: Study patients 18–64 years of age initiating duloxetine therapy during 2008 were identified from a large managed care database. The study was restricted to patients with continuous health plan eligibility for 12 months pre- and post-duloxetine initiation. Study patients had ≥1 medical claim with an inpatient or outpatient diagnosis of one (and only one of the following conditions: major depressive disorder (MDD; generalized anxiety disorder (GAD; fibromyalgia, diabetic peripheral neuropathic pain; or chronic musculoskeletal pain, as established in studies in patients with osteoarthritis and chronic lower back pain (CLBP. Patients initiating duloxetine who had two or more of the six studied conditions were not included in this study, thereby avoiding the need to differentiate between primary and secondary diagnoses from the claims records. Adherence rate was defined as the percentage of patients with a 365-day medication possession ratio ≥0.8. Results: A total of 20,490 patients initiated duloxetine treatment during 2008 with a diagnosis of one of the studied conditions during the study period. The adherence rate in our sample was 34.6% and was highest among patients with MDD (37.3% and lowest for patients with CLBP (29.9%. In general, adherence among patients with MDD and GAD was greater than among those with a chronic pain condition. Conclusion: Adherence among newly initiated duloxetine patients varied modestly across the medical conditions for which it was used. After adjusting for potential confounders, differences between the mental conditions (MDD and GAD and the chronic

  4. Does adherence therapy improve medication adherence among patients with schizophrenia? A systematic review.

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    Hegedüs, Anna; Kozel, Bernd

    2014-12-01

    Non-adherence to medication is highly prevalent in patients with schizophrenia. Adherence therapy aims to improve medication adherence of these patients by applying techniques of cognitive behavioural therapy, psycho-education, and motivational interviewing. Even though adherence therapy is frequently discussed and researched, its effectiveness is still uncertain. This paper aims to review the effectiveness of adherence therapy on the medication adherence of patients with schizophrenia. To this end, six electronic databases were systematically searched for randomized, controlled trials on adherence therapy from January 2002 to March 2013. Four trials met the inclusion criteria and were incorporated into the review. The findings suggest that adherence therapy does not improve patients' medication adherence in comparison to treatment as usual or a control intervention. However, all the studies reviewed showed high-adherence ratings at baseline. Thus, further well-designed studies that target adherence therapy to patients who are non-adherent to their medication are needed for a more profound understanding of its effectiveness. In addition, if adherence therapy is aimed not only at improving medication adherence, but also to reach an agreement whereby the patient's decision not to take his medication is accepted, the shared decision-making process needs to be assessed as well. © 2014 Australian College of Mental Health Nurses Inc.

  5. Treating depression in HIV-positive patients affects adherence

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    M Y H Moosa

    2012-08-01

    Full Text Available Aim. To determine changes in adherence to antiretroviral therapy (ART in HIV-positive patients with depression, following treatment with an antidepressant or psychotherapy. Methods. The study was prospective, randomised and controlled. Consenting volunteers aged ≥18 years and stable on ART for ≥6 months were included in the study. Sociodemographic data were obtained, and a clinical diagnostic evaluation and the Hamilton Depression rating scale (HAMD were performed on all subjects at entry to and at the end of the study. Participants found to be depressed were randomly assigned antidepressant treatment (20 mg citalopram or interpersonal psychotherapy (IPT (5 sessions. Medication was dispensed at each visit and patients were asked to return all unused medication to determine ART adherence. The study was approved by the University of the Witwatersrand. Results. Sixty-two HIV-positive persons receiving ART participated; 30 were not depressed (control group and 32 were depressed (patient group. No significant differences in demographic characteristics existed between the control and patient groups. Mean ART adherence at the start of the study was 99.5% (standard error (SE ±0.46 and 92.1% (SE ±1.69 in the control and patients groups, respectively. Mean ART adherence at the end of the study changed marginally in the control group (99.7%; SE ±0.46 and increased significantly in the patient group (99.5%; SE± 0.13 (p>0.05. The mean ART adherence rate of patients who received pharmacotherapy increased from 92.8% to 99.5%, and of those who received psychotherapy increased from 91.1% to 99.6% (p>0.05. There was no significant association between the increased adherence in the patient group and baseline demographic and clinical characteristics, irrespective of antidepressant therapy or IPT (p>0.05. Conclusion. Successful treatment of depression with an antidepressant or psychotherapy was associated with improved ART adherence, independent of the type

  6. Discrepancies between beliefs and behavior: a prospective study into immunosuppressive medication adherence after kidney transplantation.

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    Massey, Emma K; Tielen, Mirjam; Laging, Mirjam; Timman, Reinier; Beck, Denise K; Khemai, Roshni; van Gelder, Teun; Weimar, Willem

    2015-02-01

    Nonadherence to immunosuppressive medication after kidney transplantation is a behavioral issue and as such it is important to understand the psychological factors that influence this behavior. The aim of this study was to investigate the extent to which goal cognitions, illness perceptions, and treatment beliefs were related to changes in self-reported immunosuppressive medication adherence up to 18 months after transplantation. Interviews were conducted with patients in the outpatient clinic 6 weeks (T1; n=113), 6 months (T2; n=106), and 18 months (T3; n=84) after transplantation. Self-reported adherence was measured using the Basel Assessment of Adherence to Immunosuppressive Medications Scale Interview. Psychological concepts were measured using the Brief Illness Perceptions Questionnaire, Beliefs about Medicines Questionnaire, and questions on the importance of adherence as a personal goal, conflict with other goals, and self-efficacy for goal attainment. Nonadherence significantly increased over time to 31% at T3. Perceived necessity of medication, perceived impact of transplant on life (consequences) and emotional response to transplantation significantly decreased over time. Participants who reported low importance of medication adherence as a personal goal were more likely to become nonadherent over time. Illness perceptions can be described as functional and supportive of adherence which is inconsistent with the pervasive and increasing nonadherence observed. There appears therefore to be a discrepancy between beliefs about adherence and actual behavior. Promoting (intrinsic) motivation for adherence goals and exploring the relative importance in comparison to other personal goals is a potential target for interventions.

  7. The relationship among health literacy, health knowledge, and adherence to treatment in patients with rheumatoid arthritis.

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    Quinlan, Patricia; Price, Kwanza O; Magid, Steven K; Lyman, Stephen; Mandl, Lisa A; Stone, Patricia W

    2013-02-01

    Patients with poor health literacy often lack the knowledge needed to manage their treatment. The aim of this cross-sectional study is to determine whether health literacy is a predictor of health knowledge and/or adherence to medication treatment in patients with rheumatoid arthritis. The study was completed in an urban, outpatient rheumatology setting. Health literacy was measured using the Test of Functional Health Literacy in Adults. The Arthritis Knowledge Questionnaire was modified to measure medication specific health knowledge, and the Morisky Medication Adherence scale was used to measure adherence. Researchers used regression analyses to determine if health literacy was a predicator of knowledge and/or adherence. Participants (N = 125) had high mean health literacy scores. The average medication knowledge score was 0.73. Adherence to medication regimen was 0.84. Controlling for patient covariates, health literacy was positively associated with education, race, and age. In adjusted analyses, health literacy was a significant predictor of health knowledge but not adherence. Race, neighborhood income, and confidence with contacting provider about medications were predictors of adherence. Study findings indicate that health literacy is independently associated with medication knowledge but not medication adherence in patients with rheumatoid arthritis. These results provide useful information for planning initiatives to support individuals with disease self-management.

  8. Adherence to oral anti-diabetic drugs among patients attending a Ghanaian teaching hospital

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    Bruce SP

    2015-03-01

    Full Text Available Background: The burden of diabetes mellitus, especially Type-2, continues to increase across the world. Medication adherence is considered an integral component in its management. Poor glycemic controls due to medication nonadherence accelerates the development of long-term complications which consequently leads to increased hospitalization and mortality. Objective: This study examined the level of adherence to oral antidiabetic drugs among patients who visited the teaching hospital and explored the probable contributory factors to non-adherence. Methods: A cross-sectional descriptive study using systematic sampling to collect quantitative data was undertaken. Questionnaires were administered to out-patients of the medical department of a teaching hospital in Ghana. Logistic regression was performed with statistical significance determined at p<0.05. Results: A total of 200 diabetic patients participated in the study. Using the Morisky Medication Adherence scale, the level of adherence determined was 38.5%. There were significant correlations between level of adherence and educational level [(OR=1.508; (CI 0.805- 2.825, P=0.019, and mode of payment [(OR=1.631; (CI 0.997- 2.669, P=0.05. Conclusion: Adherence in diabetic patients was low among respondents and this can be improved through education, counseling and reinforcement of self-care. There were several possible factors that contributed to the low adherence rate which could benefit from further studies.

  9. Geriatric syndromes are potential determinants of the medication adherence status in prevalent dialysis patients

    Directory of Open Access Journals (Sweden)

    Chia-Ter Chao

    2016-06-01

    Full Text Available Background. Geriatric syndromes (GS exhibit high prevalence in patients with end-stage renal disease (ESRD under chronic dialysis irrespective of age. We sought to determine whether GS influences medication adherence in ESRD patients. Methods. A prospective cohort of chronic dialysis patients was assembled. The presence of GS components, including frailty/prefrailty, polypharmacy, and malnutrition, were ascertained through a validated questionnaire, electronic records and chart abstraction, and laboratory tests. The severity of medication non-adherence was defined using the eight-item Morisky Medication Adherence Scale (MMAS. Multiple logistic regression analysis was performed targeting MMAS results and incorporating relevant clinical features and GS. Results. The prevalence of frailty/pre-frailty, polypharmacy, and hypoalbuminemia/ malnutrition among the enrolled participants was 66.7%, 94%, and 14%, respectively. The average MMAS scores in these dialysis patients were 2 ± 1.7 (range, 0–6, with only 15.7% exhibiting high medication adherence. Multiple regression analyses showed that the absence of frailty/pre-frailty (P = 0.01 were significantly associated with poorer medication adherence, while the presence of polypharmacy (P = 0.02 and lower serum albumin, a potential sign of malnutrition (P = 0.03, were associated with poor adherence in another model. Conclusion. This study is among the very few reports addressing GS and medication adherence, especially in ESRD patients. Interventions targeting frailty, polypharmacy, and malnutrition might potentially improve the medication non-adherence and symptom control in these pill-burdened patients.

  10. eHealth Technologies as an Intervention to Improve Adherence to Topical Antipsoriatics

    DEFF Research Database (Denmark)

    Svendsen, Mathias Tiedemann; Andersen, Flemming; Andersen, Klaus Ejner

    2018-01-01

    BACKGROUND: Topical antipsoriatics are recommended first-line treatment of psoriasis, but rates of adherence are low. Patient support by use of electronic health (eHealth) services is suggested to improve medical adherence. OBJECTIVE: To review randomised controlled trials (RCTs) testing eHealth...... interventions designed to improve adherence to topical antipsoriatics and to review applications for smartphones (apps) incorporating the word psoriasis. MATERIAL AND METHODS: Literature review: Medline, Embase, Cochrane, PsycINFO, and Web of Science were searched using search terms for eHealth, psoriasis......' internet-reporting their status of psoriasis over a 12-month period. The rate of adherence was measured by Medication Event Monitoring System (MEMS®). An improvement in medical adherence and reduction of severity of psoriasis were reported. General analysis of apps: 184 apps contained the word psoriasis...

  11. A general technoeconomic and environmental procedure for assessment of small-scale cogeneration scheme installations: Application to a local industry operating in Thrace, Greece, using microturbines

    International Nuclear Information System (INIS)

    Katsigiannis, P.A.; Papadopoulos, D.P.

    2005-01-01

    The present paper describes a proposed general systematic procedure for small-scale combined heat and power (CHP) exploitation (where 'small-scale CHP' refers to CHP installations with electric capacities up to 1 MW). The mentioned systematic procedure is implemented through a developed computer code and may be applied to any such small-scale project in order to assess its suitability based on technoeconomic and environmental considerations. A dynamic database based on small-scale CHP units (available in the world market) and their pertinent technical, economical and environmental features is created and, in conjunction with the developed program, is used for determination of a suitable CHP unit (or system) size and the selection of the associated proper prime mover type for any project of interest. Using well-known economic criteria, the economic analysis is performed, including the sensitivity analysis of the considered project based on the main key system parameters. In terms of the socioeconomic analysis, a carbon tax (CT) scenario is considered, and its effect on the economic behavior of the project is investigated. Last, with respect to environmental considerations, the program calculates, for any such project, the avoided main pollutants and the fuel savings when a CHP system is applied. As a case study, a small textile industry operating in the Eastern Macedonia-Thrace Region of Greece is considered, and its associated (electrical and thermal) data are used as input data to the proposed computer program. In this application, two microturbine units are selected and thoroughly evaluated, and the pertinent simulation results are presented and discussed accordingly

  12. Adherence to Antitumor Necrosis Factor Use Recommendations in Spondyloarthritis: Measurement and Effect in the DESIR Cohort.

    Science.gov (United States)

    Harvard, Stephanie; Guh, Daphne; Bansback, Nick; Richette, Pascal; Saraux, Alain; Fautrel, Bruno; Anis, Aslam H

    2017-10-01

    To evaluate a classification system to define adherence to axial spondyloarthritis (axSpA) anti-tumor necrosis factor (anti-TNF) use recommendations and examine the effect of adherence on outcomes in the DESIR cohort (Devenir des Spondylarthropathies Indifférenciées Récentes). Using alternate definitions of adherence, patients were classified as adherent "timely" anti-TNF users, nonadherent "late" anti-TNF users, adherent nonusers ("no anti-TNF need"), non-adherent nonusers ("unmet anti-TNF need"). Multivariate models were fitted to examine the effect of adherence on quality-adjusted life-years (QALY), total costs, and nonbiologic costs 1 year following an index date. Generalized linear regression models assuming a γ-distribution with log link were used for costs outcomes and linear regression models for QALY outcomes. Using the main definition of adherence, there were no significant differences between late anti-TNF users and timely anti-TNF users in total costs (RR 0.86, 95% CI 0.54-1.36, p = 0.516) or nonbiologic costs (RR 0.72, 95% CI 0.44-1.18, p = 0.187). However, in the sensitivity analysis, late anti-TNF users had significantly increased nonbiologic costs compared with timely users (RR 1.58, 95% CI 1.06-2.36, p = 0.026). In the main analysis, there were no significant differences in QALY between timely anti-TNF users and late anti-TNF users, or between timely users and patients with unmet anti-TNF need. In the sensitivity analysis, patients with unmet anti-TNF need had significantly lower QALY than timely anti-TNF users (-0.04, 95% CI -0.07 to -0.01, p = 0.016). The effect of adherence to anti-TNF recommendations on outcomes was sensitive to the definition of adherence used, highlighting the need to validate methods to measure adherence.

  13. Determinants of adherence to antiretroviral therapy among HIV-positive adults in sub-Saharan Africa: a systematic review

    NARCIS (Netherlands)

    Heestermans, Tessa; Browne, Joyce L; Aitken, Susan C; Vervoort, Sigrid C; Klipstein-Grobusch, Kerstin

    2016-01-01

    Objective The rapid scale up of antiretroviral treatment (ART) in sub-Saharan Africa (SSA) has resulted in an increased focus on patient adherence. Non-adherence can lead to drug-resistant HIV caused by failure to achieve maximal viral suppression. Optimal treatment requires the identification of

  14. Effects of religiosity and religious coping on medication adherence and quality of life among people with epilepsy.

    Science.gov (United States)

    Lin, Chung-Ying; Saffari, Mohsen; Koenig, Harold G; Pakpour, Amir H

    2018-01-01

    The epidemiologic information demonstrates the importance of caring people with epilepsy (PWE). Indeed, the impaired quality of life (QoL) and medication nonadherence rate among PWE have been reported. However, religiosity and religious coping could be potential factors for clinicians to foster appropriate intervention on epileptic care. This study investigated two models to further understand the relationships between religiosity, religious coping (including positive and negative coping), medication adherence, and QoL in an Iranian sample with epilepsy. Eligible PWE (n=760) completed the religiosity scale (Duke University Religion Index; DUREL) at baseline; the religious coping scale (Brief Religious Coping Scale; Brief RCOPE) one month later; the medication adherence scale (Medication Adherence Report Scale; MARS-5) two months later; and the QoL scale (Quality of Life in Epilepsy; QOLIE-31) twelve months later. Their antiepileptic drug serum level was measured during the period they completed the MARS. Through structural equation modeling (SEM), we found that religiosity directly correlated with negative religious coping and medication adherence, and indirectly correlated with medication adherence through negative religious coping. Both positive and negative religious coping directly correlated with medication adherence and QoL. Therefore, religiosity and religious coping may be determinants of medication adherence and QoL in PWE; health professionals may consider asking PWE if religion is important to them and how they use it to cope with their epilepsy. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Developing a Stoma Acceptance Questionnaire to improve motivation to adhere to enterostoma self-care.

    Science.gov (United States)

    Bagnasco, A; Watson, R; Zanini, M; Catania, G; Aleo, G; Sasso, L

    2017-06-01

    In stoma care, patient education is often weak in terms of improving patients' level of acceptance of living with a stoma. Self-care educational interventions in enterostomal patients, which according to Orem's Theory should take into account these patients' specific needs, require instruments that measure patients' stoma acceptance to improve motivation based on the resumption of activities they used to carry out before having a stoma. The aim of the study was to develop an instrument that measures the level of stoma acceptance to improve motivation to adhere to enterostoma self-care. Aspects that improve stoma acceptance and consequently motivation to adhere to enterostoma self-care were identified through 10 focus groups. In the focus groups, the motivation indicators were grouped, categorised and results entered into a Stoma Acceptance Questionnaire (SAQ). The SAQ was then piloted with 104 enterostomal patients from three general hospitals. To assess the construct validity of the SAQ, Mokken Scaling was used to explore the latent structure of the SAQ. Mokken scaling is a non-parametric method that falls under the umbrella of methods described as item response theories (IRT). The theme "Living with a stoma"; "Autonomy"; "Support"; "Ability to deal with stoma", plus a common underlying theme: "Stoma acceptance" were dissussed by the Focus Groups. The experts identified the items of the (SAQ) through these themes. Mokken Scaling identified the "resumption of enterostomal patients' normal activities" as a measure of stoma acceptance, thus confirming the construct validity of the SAQ. The tool proposed affords a pioneering example of how this gap can be bridged. Indeed, the SAQ could enable nurses adopting a standardized approach for the assessment of enterostomal patients' motivation to resume their normal activities and identify needs linked to this. The SAQ could also be used to measure the effectiveness of psychosocial and educational interventions aimed at

  16. Tuberculosis Treatment Adherence of Patients in Kosovo

    OpenAIRE

    Krasniqi, Shaip; Jakupi, Arianit; Daci, Armond; Tigani, Bahri; Jupolli-Krasniqi, Nora; Pira, Mimoza; Zhjeqi, Valbona; Neziri, Burim

    2017-01-01

    Setting. The poor patient adherence in tuberculosis (TB) treatment is considered to be one of the most serious challenges which reflect the decrease of treatment success and emerging of the Multidrug Resistance-TB (MDR-TB). To our knowledge, the data about patients’ adherence to anti-TB treatment in our country are missing. Objective. This study was aimed to investigate the anti-TB treatment adherence rate and to identify factors related to eventual nonadherence among Kosovo TB patients. Desi...

  17. Association of Social Support and Medication Adherence in Chinese Patients with Type 2 Diabetes Mellitus.

    Science.gov (United States)

    Gu, Linni; Wu, Shaomin; Zhao, Shuliang; Zhou, Huixuan; Zhang, Shengfa; Gao, Min; Qu, Zhiyong; Zhang, Weijun; Tian, Donghua

    2017-12-06

    The prevalence of diabetes is steadily increasing in China. When diabetes is uncontrolled, it generates dire consequences for health and well-being. Numerous studies have shown that health outcomes were associated with social support and medication adherence. Previous study confirmed that social support was associated with medication adherence in patients with heart failure, HIV diseases, and first-episode psychosis. However, the relationship between social support and medication adherence in patients with type 2 diabetes mellitus (T2DM) is remains unclear. This study aims to examine whether social support is associated with medication adherence in patients with T2DM. This study was conducted in the First Affiliated Hospital of the General Hospital of the People's Liberation Army (PLA). In Beijing, a systematic random sample of 412 patients with T2DM over 18 years was recruited at baseline, and demographic characteristics, clinical data and their assessment of social support were collected from medical records and self-reported questionnaires. 330 of these patients completed a self-report measure of medication adherence at the sixth month after baseline data collection. Regression analysis showed that social support presented a positive effect on medication adherence, additionally, support utilization and the subscale of social support exhibited a significantly strong influence on medication adherence in patients with T2DM. Although medication adherence was influenced by multiple factors, this finding confirmed that social support must be recognized as a core element in interventions aimed at improving in the management of patients with T2DM.

  18. Role of spousal involvement in continuous positive airway pressure (CPAP adherence in patients with obstructive sleep apnea (OSA

    Directory of Open Access Journals (Sweden)

    Batool-Anwar S

    2017-05-01

    Full Text Available Introduction: Little is known about the impact of spousal involvement on continuous positive airway pressure (CPAP adherence. The aim of this study was to determine whether spouse involvement affects adherence with CPAP therapy, and how this association varies with gender. Methods: 194 subjects recruited from Apnea Positive Pressure Long Term Efficacy Study (APPLES completed the Dyadic Adjustment Scale (DAS. The majority of participants were Caucasian (83%, and males (73%, with mean age of 56 years, mean BMI of 31 kg/m2. & 62% had severe OSA. The DAS is a validated 32-item self-report instrument measuring dyadic consensus, satisfaction, cohesion, and affectional expression. A high score in the DAS is indicative of a person’s adjustment to the marriage. Additionally, questions related to spouse involvement with general health and CPAP use were asked. CPAP use was downloaded from the device and self-report, and compliance was defined as usage > 4 h per night. Results: There were no significant differences in overall marital quality between the compliant and noncompliant subjects. However, level of spousal involvement was associated with increased CPAP adherence at 6 months (p=0.01. After stratifying for gender these results were significant only among males (p=0.03. Three years after completing APPLES, level of spousal involvement was not associated with CPAP compliance even after gender stratification. Conclusion: Spousal involvement is important in determining CPAP compliance in males in the 1st 6 months after initiation of therapy but is not predictive of longer-term adherence. Involvement of the spouse should be considered an integral part of CPAP initiation procedures.

  19. Psoriasis in childhood: effective strategies to improve treatment adherence.

    Science.gov (United States)

    Shah, Kara N; Cortina, Sandra; Ernst, Michelle M; Kichler, Jessica C

    2015-01-01

    Psoriasis is a relatively common chronic inflammatory skin disease in children for which there is no cure. Most children have mild disease that can be managed with topical therapy as opposed to phototherapy or systemic therapy. Despite the mild presentation of psoriasis in most children, the disease can have a significant impact on quality of life due to the need for ongoing treatment, the frequently visible nature of the cutaneous manifestations, and the social stigma that is associated with psoriasis. Adherence to treatment, in particular topical therapy, is often poor in adults and compromises response to therapy and medical provider management strategies. Multiple factors that may contribute to nonadherence in adults with psoriasis have been identified, including lack of education on the disease and expectations for management, issues related to ease of use and acceptability of topical medications, and anxiety regarding possible medication side effects. There is currently no published data on adherence in the pediatric psoriasis population; however, poor adherence is often suspected when patients fail to respond to appropriate therapy. General strategies used to assess adherence in other pediatric disease populations can be applied to children with psoriasis, and interventions that reflect experience in other chronic dermatologic disorders such as atopic dermatitis may also be helpful for medical providers caring for children with psoriasis.

  20. Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults.

    Science.gov (United States)

    Jordan, Joanne L; Holden, Melanie A; Mason, Elizabeth Ej; Foster, Nadine E

    2010-01-20

    Chronic musculoskeletal pain (CMP) is a major health problem, accounting for approximately one-quarter of general practice (GP) consultations in the United Kingdom (UK). Exercise and physical activity is beneficial for the most common types of CMP, such as back and knee pain. However, poor adherence to exercise and physical activity may limit long-term effectiveness. To assess the effects of interventions to improve adherence to exercise and physical activity for people with chronic musculoskeletal pain. We searched the trials registers of relevant Cochrane Review Groups. In addition, we searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, AMED, PsycINFO, Science Citation Index and Social Science Citation Index and reference lists of articles to October 2007. We consulted experts for unpublished trials. Randomised or quasi-randomised trials evaluating interventions that aimed to improve adherence to exercise and physical activity in adults with pain for three months and over in the axial skeleton or large peripheral joints. Two of the four authors independently assessed the quality of each included trial and extracted data. We contacted study authors for missing information. We included 42 trials with 8243 participants, mainly with osteoarthritis and spinal pain. Methods used for improving and measuring adherence in the included trials were inconsistent. Two of the 17 trials that compared different types of exercise showed positive effects, suggesting that the type of exercise is not an important factor in improving exercise adherence. Six trials studied different methods of delivering exercise, such as supervising exercise sessions, refresher sessions and audio or videotapes of the exercises to take home. Of these, five trials found interventions improved exercise adherence. Four trials evaluated specific interventions targeting exercise adherence; three of these showed a positive effect on exercise adherence. In eight trials

  1. Might ART Adherence Estimates Be Improved by Combining Biomarker and Self-Report Data?

    Directory of Open Access Journals (Sweden)

    Rebecca Rhead

    Full Text Available As we endeavour to examine rates of viral suppression in PLHIV, reliable data on ART adherence are needed to distinguish between the respective contributions of poor adherence and treatment failure on high viral load. Self-reported data are susceptible to response bias and although biomarker data on drug presence and concentration can provide a superior, alternative method of measurement, complications due to drug-drug interactions and genetic variations can cause some inaccuracies. We investigate the feasibility of combining both biomarker and self-report data to produce a potentially more accurate measure of ART adherence.Data were taken from a large general-population survey in the Manicaland province, Zimbabwe, conducted in 2009-2011. HIV-infected adults who had initiated ART (N = 560 provided self-report data on adherence and dried blood spot samples that were analysed for traces of ART medication. A new three-category measure of ART adherence was constructed, based on biomarker data but using self-report data to adjust for cases with abnormally low and high drug concentrations due to possible drug-drug interactions and genetic factors, and was assessed for plausibility using survey data on socio-demographic correlates.94.3% (528/560 and 92.7% (519/560 of the sample reported faithful adherence to their medication and had traces of ART medication, respectively. The combined measure estimated good evidence of ART adherence at 69% and excellent evidence of adherence at 53%. The regression analysis results showed plausible patterns of ART adherence by socio-demographic status with men and younger participants being more likely to adhere poorly to medication, and higher socio-economic status individuals and those living in more urban locations being more likely to adhere well.Biomarker and self-reported measures of adherence can be combined in a meaningful way to produce a potentially more accurate measure of ART adherence. Results indicate that

  2. Generalized product

    OpenAIRE

    Greco, Salvatore; Mesiar, Radko; Rindone, Fabio

    2014-01-01

    Aggregation functions on [0,1] with annihilator 0 can be seen as a generalized product on [0,1]. We study the generalized product on the bipolar scale [–1,1], stressing the axiomatic point of view. Based on newly introduced bipolar properties, such as the bipolar increasingness, bipolar unit element, bipolar idempotent element, several kinds of generalized bipolar product are introduced and studied. A special stress is put on bipolar semicopulas, bipolar quasi-copulas and bipolar copulas.

  3. Understanding the relative valuation of research impact: a best–worst scaling experiment of the general public and biomedical and health researchers

    Science.gov (United States)

    Pollitt, Alexandra; Potoglou, Dimitris; Patil, Sunil; Burge, Peter; Guthrie, Susan; King, Suzanne; Wooding, Steven; Grant, Jonathan

    2016-01-01

    Objectives (1) To test the use of best–worst scaling (BWS) experiments in valuing different types of biomedical and health research impact, and (2) to explore how different types of research impact are valued by different stakeholder groups. Design Survey-based BWS experiment and discrete choice modelling. Setting The UK. Participants Current and recent UK Medical Research Council grant holders and a representative sample of the general public recruited from an online panel. Results In relation to the study's 2 objectives: (1) we demonstrate the application of BWS methodology in the quantitative assessment and valuation of research impact. (2) The general public and researchers provided similar valuations for research impacts such as improved life expectancy, job creation and reduced health costs, but there was less agreement between the groups on other impacts, including commercial capacity development, training and dissemination. Conclusions This is the second time that a discrete choice experiment has been used to assess how the general public and researchers value different types of research impact, and the first time that BWS has been used to elicit these choices. While the 2 groups value different research impacts in different ways, we note that where they agree, this is generally about matters that are seemingly more important and associated with wider social benefit, rather than impacts occurring within the research system. These findings are a first step in exploring how the beneficiaries and producers of research value different kinds of impact, an important consideration given the growing emphasis on funding and assessing research on the basis of (potential) impact. Future research should refine and replicate both the current study and that of Miller et al in other countries and disciplines. PMID:27540096

  4. Understanding the relative valuation of research impact: a best-worst scaling experiment of the general public and biomedical and health researchers.

    Science.gov (United States)

    Pollitt, Alexandra; Potoglou, Dimitris; Patil, Sunil; Burge, Peter; Guthrie, Susan; King, Suzanne; Wooding, Steven; Wooding, Steven; Grant, Jonathan

    2016-08-18

    (1) To test the use of best-worst scaling (BWS) experiments in valuing different types of biomedical and health research impact, and (2) to explore how different types of research impact are valued by different stakeholder groups. Survey-based BWS experiment and discrete choice modelling. The UK. Current and recent UK Medical Research Council grant holders and a representative sample of the general public recruited from an online panel. In relation to the study's 2 objectives: (1) we demonstrate the application of BWS methodology in the quantitative assessment and valuation of research impact. (2) The general public and researchers provided similar valuations for research impacts such as improved life expectancy, job creation and reduced health costs, but there was less agreement between the groups on other impacts, including commercial capacity development, training and dissemination. This is the second time that a discrete choice experiment has been used to assess how the general public and researchers value different types of research impact, and the first time that BWS has been used to elicit these choices. While the 2 groups value different research impacts in different ways, we note that where they agree, this is generally about matters that are seemingly more important and associated with wider social benefit, rather than impacts occurring within the research system. These findings are a first step in exploring how the beneficiaries and producers of research value different kinds of impact, an important consideration given the growing emphasis on funding and assessing research on the basis of (potential) impact. Future research should refine and replicate both the current study and that of Miller et al in other countries and disciplines. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  5. Drug adherence behavior among hypertensive out-patients at a tertiary health institution in Manicaland province, Zimbabwe, 2011

    Directory of Open Access Journals (Sweden)

    Mukora-Mutseyekwa FN

    2013-01-01

    Full Text Available Fadzai NN Mukora-Mutseyekwa, Elizabeth M ChadambukaFaculty of Health Sciences, Africa University, Mutare, ZimbabweObjectives: This study investigated the level of drug adherence among hypertensive outpatients at a tertiary hospital in Zimbabwe. Specific objectives included measurement of blood pressure (BP control achievement, estimating prevalence of drug adherence behavior, and establishing the association between drug adherence behavior and achievement of BP control.Methods and materials: An analytic cross sectional design was applied on a convenience sample of 102 participants using an interviewer administered questionnaire. Self-reported adherence was assessed using the Morisky Medication Adherence Scale.Findings: The median age of participants was 68.5 years (Q1 61; Q3 76. The majority were female (n = 71; 69.6%. BP control (<140/90 mmHg was achieved in 52% (n = 53. Self-reported drug adherence was 40.2% (n = 42. After multivariate logistic regression analysis, participants with normal BP measurements were more than three times as likely to report maximal adherence to prescribed drug schedules (odds ratio 3.37; 95% confidence interval: 1.38–8.24.Conclusion: Poor drug adherence behavior prevails among hypertensive outpatients. This contributes to poor achievement of BP control. The hospital is recommended to set up a specialized hypertension clinic in the Out-patients' Department where an intensified health education package can be introduced as well as community awareness programs on the importance of medication adherence.Keywords: drug adherence, behavior, hypertension

  6. Factors associated with adherence to highly active antiretroviral therapy in homeless or unstably housed adults living with HIV.

    Science.gov (United States)

    Royal, Scott W; Kidder, Daniel P; Patrabansh, Satyendra; Wolitski, Richard J; Holtgrave, David R; Aidala, Angela; Pals, Sherri; Stall, Ron

    2009-04-01

    The aim of this study is to investigate adherence to highly active antiretroviral therapy (HAART) in persons living with HIV/AIDS (PLWHA) who are homeless or unstably housed. We evaluated homeless or unstably housed PLWHA (n=644) in three US cities were enrolled in the Housing and Health Study. Using baseline data and controlling for gender, race, age, and education, we examined associations between self-reported two- and Seven-day adherence and access to healthcare, mental health, substance use, and attitudes toward HIV medical therapy. Of the 644 participants, 358 (55%) were currently on HAART. For two-day adherence, 280 (78%) reported missing no prescribed doses (100% adherence), and for seven-day adherence, 291 (81%) reported > or =90% adherence. Logistic regression analyses indicated being younger, not having health insurance, and drug use were associated with missing > or =1 dose over the past two days. Scoring lower on SF-36 mental component summary scale and having greater risk of depression (CES-D) and stress (Perceived Stress Scale) were associated with poorer adherence for both two- and seven-day outcomes. Negative attitudes toward HIV treatment were also associated with lower adherence. Adherence to HIV medications in this population is similar to other groups. Coexisting problems of access to healthcare, higher risk of mental health problems, along with poorer attitudes toward treatment are associated with increased likelihood of missing doses. Comprehensive models of HIV care that include a continuum of medical and social services are essential for treating this population.

  7. Disparity between General Symptom Relief and Remission Criteria in the Positive and Negative Syndrome Scale (PANSS): A Post-treatment Bifactor Item Response Theory Model.

    Science.gov (United States)

    Anderson, Ariana E; Reise, Steven P; Marder, Stephen R; Mansolf, Maxwell; Han, Carol; Bilder, Robert M

    2017-12-01

    Objective: Total scale scores derived by summing ratings from the 30-item PANSS are commonly used in clinical trial research to measure overall symptom severity, and percentage reductions in the total scores are sometimes used to document the efficacy of treatment. Acknowledging that some patients may have substantial changes in PANSS total scores but still be sufficiently symptomatic to warrant diagnosis, ratings on a subset of 8 items, referred to here as the "Remission set," are sometimes used to determine if patients' symptoms no longer satisfy diagnostic criteria. An unanswered question remains: is the goal of treatment better conceptualized as reduction in overall symptom severity, or reduction in symptoms below the threshold for diagnosis? We evaluated the psychometric properties of PANSS total scores, to assess whether having low symptom severity post-treatment is equivalent to attaining Remission. Design: We applied a bifactor item response theory (IRT) model to post-treatment PANSS ratings of 3,647 subjects diagnosed with schizophrenia assessed at the termination of 11 clinical trials. The bifactor model specified one general dimension to reflect overall symptom severity, and five domain-specific dimensions. We assessed how PANSS item discrimination and information parameters varied across the range of overall symptom severity (θ), with a special focus on low levels of symptoms (i.e., θgeneral symptom severity, and only 8% reflected secondary domain factors. This implies that a general factor may provide a good indicator of symptom severity, and that interpretation is not overly complicated by multidimensionality; (2) Post-treatment, 534 individuals (about 15% of the whole sample) scored in the "Relief" range of general symptom severity, but more than twice that number (n = 1351) satisfied Remission criteria (37%). 2 in 3 Remitted patients had scores that were not in a low symptom range (corresponding to Absent or Minimal item scores); (3) PANSS items

  8. Caregiver's Health Locus of Control and Medication Adherence in Sickle Cell Disease.

    Science.gov (United States)

    Viswanathan, Kusum; Swaminathan, Neeraja; Viswanathan, Ramaswamy; Lakkaraja, Madhavi

    2015-03-01

    The authors would like to thank Dr. Morisky for giving us permission to use the Morisky Medication Adherence Scale To explore caregivers' Health Locus of Control's relationship to self-reported adherence to penicillin prophylaxis or hydroxyurea in children with sickle cell disease (SCD). A questionnaire-based study was conducted of caregivers of children with SCD who visited a comprehensive sickle cell center in an inner city hospital, who were either on penicillin prophylaxis or hydroxyurea or both. Multidimensional Health Locus of Control Scale (MHLC) and the Morisky Medication Adherence Scale (MMAS-8) questionnaires were used for the study. Caregivers of 43 children (27 on penicillin prophylaxis, 13 on hydroxyurea, and 3 on both) completed the MHLC and the MMAS-8. There was no significant difference in adherence between the penicillin and the hydroxyurea groups. The mean Powerful Others score of caregivers of the hydroxyurea only group (25.5+5.6) was higher than that of the penicillin only group (21.2+6.1, p=0.043). Regression analysis revealed an inverse relationship of Chance Locus of Control to adherence in the entire group (Beta = -0.306, R2=0.093, F[1,40]=4.12, p=0.049). Chance Locus of control may identify caregivers of children with SCD at risk for non-adherence to treatment. © 2015 National Medical Association. Published by Elsevier Inc. All rights reserved.

  9. Adherence to acceptability and repeatability criteria for spirometry in complex lung function laboratories.

    Science.gov (United States)

    Borg, Brigitte M; Hartley, M Faizel; Bailey, Michael J; Thompson, Bruce R

    2012-12-01

    Few published data exist for adherence rates to spirometry acceptability and repeatability criteria in clinical respiratory laboratories. This study quantified adherence levels in this setting and observed changes in adherence levels as a result of feedback and ongoing training. Two tertiary hospital-based, lung function laboratories (L1 and L2) participated. Approximately 100 consecutive, FVC spirometry sessions were reviewed for each year from 2004 to 2008 at L1 and for years 2004 and 2008 at L2. Each spirometric effort and session was interrogated for adherence to the acceptability and repeatability criteria of international spirometry standards of the time. Feedback of audit results and refresher training were provided at L1 throughout the study; in addition, a quality rating scale was implemented in 2006. No formal feedback or follow-up training was provided at L2. We reviewed 707 test sessions over the 5 years. There was no difference in adherence rates to acceptability and repeatability criteria between sites in 2004 (L1 61%, L2 59%, P = .89). There was, however, a significant difference between sites in 2008 (L1 92%, L2 65%, P audit period. This improved with regular review, feedback, and implementation of a rating scale. Auditing of spirometry quality, feedback, and implementation of test rating scales need to be incorporated as an integral component of laboratory quality assurance programs to improve adherence to international acceptability and repeatability criteria.

  10. Logistic-AFT location-scale mixture regression models with nonsusceptibility for left-truncated and general interval-censored data.

    Science.gov (United States)

    Chen, Chen-Hsin; Tsay, Yuh-Chyuan; Wu, Ya-Chi; Horng, Cheng-Fang

    2013-10-30

    In conventional survival analysis there is an underlying assumption that all study subjects are susceptible to the event. In general, this assumption does not adequately hold when investigating the time to an event other than death. Owing to genetic and/or environmental etiology, study subjects may not be susceptible to the disease. Analyzing nonsusceptibility has become an important topic in biomedical, epidemiological, and sociological research, with recent statistical studies proposing several mixture models for right-censored data in regression analysis. In longitudinal studies, we often encounter left, interval, and right-censored data because of incomplete observations of the time endpoint, as well as possibly left-truncated data arising from the dissimilar entry ages of recruited healthy subjects. To analyze these kinds of incomplete data while accounting for nonsusceptibility and possible crossing hazards in the framework of mixture regression models, we utilize a logistic regression model to specify the probability of susceptibility, and a generalized gamma distribution, or a log-logistic distribution, in the accelerated failure time location-scale regression model to formulate the time to the event. Relative times of the conditional event time distribution for susceptible subjects are extended in the accelerated failure time location-scale submodel. We also construct graphical goodness-of-fit procedures on the basis of the Turnbull-Frydman estimator and newly proposed residuals. Simulation studies were conducted to demonstrate the validity of the proposed estimation procedure. The mixture regression models are illustrated with alcohol abuse data from the Taiwan Aboriginal Study Project and hypertriglyceridemia data from the Cardiovascular Disease Risk Factor Two-township Study in Taiwan. Copyright © 2013 John Wiley & Sons, Ltd.

  11. Psychometric properties of the 7-item Generalized Anxiety Disorder scale in antepartum women from Ghana and Côte d'Ivoire.

    Science.gov (United States)

    Barthel, Dana; Barkmann, Claus; Ehrhardt, Stephan; Bindt, Carola

    2014-12-01

    To explore the psychometric properties of the 7-item Generalized Anxiety Disorder scale (GAD-7) in West African pregnant women. In a cross-sectional study, the GAD-7, the PHQ-9 (depression module of the Patient Health Questionnaire) and the WHO-DAS II (12-item World Health Organization Disability Scale) were administered to n=647 Ivorian and n=395 Ghanaian antepartum women with low-risk pregnancies (third trimester; gestational age range: 28-40 weeks) in 2010-2011. Statistical analyses combined classical test theory (CTT) and item response theory (IRT). Cronbach׳s α was close to acceptable (α=.69 in Côte d'Ivoire; α=.67 in Ghana). Construct validity was demonstrated by correlations between the GAD-7 and both the PHQ-9 and the WHO-DAS II. Results regarding factorial validity were ambiguous: confirmatory and exploratory factor analyses indicated that the data fit the unidimensionality assumption; however, the explained variance was low. IRT methods suggested excellent item infit and outfit measures. Yet, residual principal component analyses showed a lack of unidimensionality. Rasch analyses revealed that the response options were not used as intended. Item-person-fit was not optimal since the items did not discriminate well on the range of the latent construct where most of the women drawn from the general population were located. Both samples were somewhat homogenous regarding gestational age and urban residence; test-retest reliability was not investigated. The GAD-7 met the requirements of CTT. However, applying the stricter criteria of IRT suggested areas for potential improvements. Cross-cultural adaption and a dichotomized response format might ameliorate the GAD-7 for the use in sub-Saharan countries. Copyright © 2014 Elsevier B.V. All rights reserved.

  12. Patient adherence to antihypertensive therapy and its individual psychological factors

    Directory of Open Access Journals (Sweden)

    Lidia Trachuk

    2016-09-01

    Full Text Available Background. In the treatment of chronic, especially asymptomatic pathology one of the main problem is the adherence to therapy. Patients with arterial hypertension need long-term, often lifelong medication, and how strictly they adhere to prescriptions often determines the course of the disease and the medical measures effectiveness. According to statistics, more than half of patients with hypertension are characterized by low compliance, which leads to complications of this disease. The objective of the research is to identify and analize the individual psychological factors that determine patient adherence to antihypertensive therapy. Methods and materials. This study was conducted during 2011-2013 at the cardiology departments of the Kyiv Alexander Hospital, polyclinics number 2 Shevchenko district in Kyiv, Desnyanskiy clinic №3 district in Kyiv, medical center "Adonis plus". We examined 203 patients with arterial hypertension (average age 53,5 ± 4,5 years. Methods: socio-demographic, clinical, clinical and psychological, psychodiagnostical, mathematical and statistical methods. Psychodiagnostical method included: 8-item Morisky medical adherence scale (Morisky D. E., 2008; self-assessment anxiety scale Charles D. Spielberger – Y.L Hanin (A.V. Batarshev, 2005; the Minnesota Multiphasic Personality Inventory questionnaire (MMRI (F.B. Berezin, 1994; "The level of subjective control" (A.A. Rean, 2001; "Index of attitudes to health" (S.D. Deryabo, VA Yasvin, 2000. Results. According to the results of 8-item Morisky medical adherence scale patients were divided into 3 groups according to the level of compliance - with high (26.11%, average (24.14% and low (49.75% levels of adherence to antihypertensive therapy. The individual-psychological predictors of poor adherence to antihypertensive therapy include the following personal characteristics of patients: a low level of intensity of attitude to health, internal type of subjective control, a

  13. Patient-reported adverse drug reactions and their influence on adherence and quality of life of chronic myeloid leukemia patients on per oral tyrosine kinase inhibitor treatment

    Directory of Open Access Journals (Sweden)

    Kekäle M

    2015-12-01

    Full Text Available Meri Kekäle,1 Marikki Peltoniemi,2 Marja Airaksinen1 1Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, 2Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland Purpose: To evaluate adverse drug reactions (ADRs experienced by chronic myeloid leukemia (CML patients during per oral tyrosine kinase inhibitor (TKI treatment and correlation of ADR symptoms with medication adherence and perceived quality of life (QoL.Patients and methods: Eighty-six adult, chronic-phase CML patients who had been on TKI treatment (79% on imatinib, 10.5% dasatinib, and 10.5% nilotinib for at least 6 months participated in the study (mean age: 57.8 years, 52% males. The mean time from diagnosis was 5.1 years. All patients were interviewed, and patient-reported ADRs were obtained using a structured list. Adherence was assessed using Morisky’s 8-item Medication Adherence Scale (MMAS. The symptoms’ interference with patient’s daily QoL was measured by asking patients about the influence of symptom(s on their mood, general condition, enjoyment of life, walking, relationships, and work.Results: Ninety-seven percent of the patients were suffering from at least one ADR. The mean number of different symptoms was seven (range: 0–15, median 6. The most commonly perceived ADRs were muscle soreness or cramp (69/86, 80%; swelling of hands, legs, feet, or around the eyes (59/86, 69%; and fatigue (43/86, 50%. No correlation was found between adherence and ADRs, because symptoms were equally common in each MMAS adherence class. Half of the patients felt that the ADRs had a negative influence on their daily QoL. A quarter of the patients reported that ADRs affected either their mood, general condition, or enjoyment of life. The incidence of almost all ADRs was much higher among patients reporting negative influence of ADRs on their daily life compared to total study population (P=0.016.Conclusion

  14. Adaptive Stochastic Resonance in Second-Order System with General Scale Transformation for Weak Feature Extraction and Its Application in Bearing Fault Diagnosis

    Science.gov (United States)

    Ma, Qiang; Huang, Dawen; Yang, Jianhua

    The theory of general scale transformation (GST) is put forward and used in the second-order underdamped bistable system to extract weak signal features submerged into strong noise. An adaptive stochastic resonance (SR) with GST is proposed and realized by the quantum particle swarm optimization (QPSO) algorithm. The harmonic signal and experimental signal are considered to compare GST with normalized scale transformation (NST) in the second-order system. The results show that detection effect of the adaptive SR with GST is better than the NST SR. In addition, the output signal-to-noise ratio (SNR) is significantly improved in the GST method. Meanwhile, the dependence of the signal extraction efficiency on the noise intensity is researched. The output SNR is decreased with the increase of the noise intensity in two methods. However, the proposed method is always superior to the NST. Moreover, the superiority of the Brown particle oscillation in the single well is discussed. The proposed method has certain reference value in the extraction of the weak signal under the strong noise background.

  15. Numerical analysis of a main crack interactions with micro-defects/inhomogeneities using two-scale generalized/extended finite element method

    Science.gov (United States)

    Malekan, Mohammad; Barros, Felício B.

    2017-12-01

    Generalized or extended finite element method (G/XFEM) models the crack by enriching functions of partition of unity type with discontinuous functions that represent well the physical behavior of the problem. However, this enrichment functions are not available for all problem types. Thus, one can use numerically-built (global-local) enrichment functions to have a better approximate procedure. This paper investigates the effects of micro-defects/inhomogeneities on a main crack behavior by modeling the micro-defects/inhomogeneities in the local problem using a two-scale G/XFEM. The global-local enrichment functions are influenced by the micro-defects/inhomogeneities from the local problem and thus change the approximate solution of the global problem with the main crack. This approach is presented in detail by solving three different linear elastic fracture mechanics problems for different cases: two plane stress and a Reissner-Mindlin plate problems. The numerical results obtained with the two-scale G/XFEM are compared with the reference solutions from the analytical, numerical solution using standard G/XFEM method and ABAQUS as well, and from the literature.

  16. An Evaluation of the Large-Scale Implementation of Ocean Thermal Energy Conversion (OTEC Using an Ocean General Circulation Model with Low-Complexity Atmospheric Feedback Effects

    Directory of Open Access Journals (Sweden)

    Yanli Jia

    2018-01-01

    Full Text Available Previous investigations of the large-scale deployment of Ocean Thermal Energy Conversions (OTEC systems are extended by allowing some atmospheric feedback in an ocean general circulation model. A modified ocean-atmosphere thermal boundary condition is used where relaxation corresponds to atmospheric longwave radiation to space, and an additional term expresses horizontal atmospheric transport. This produces lower steady-state OTEC power maxima (8 to 10.2 TW instead of 14.1 TW for global OTEC scenarios, and 7.2 to 9.3 TW instead of 11.9 TW for OTEC implementation within 100 km of coastlines. When power production peaks, power intensity remains practically unchanged, at 0.2 TW per Sverdrup of OTEC deep cold seawater, suggesting a similar degradation of the OTEC thermal resource. Large-scale environmental effects include surface cooling in low latitudes and warming elsewhere, with a net heat intake within the water column. These changes develop rapidly from the propagation of Kelvin and Rossby waves, and ocean current advection. Two deep circulation cells are generated in the Atlantic and Indo-Pacific basins. The Atlantic Meridional Overturning Circulation (AMOC is reinforced while an AMOC-like feature appears in the North Pacific, with deep convective winter events at high latitudes. Transport between the Indo-Pacific and the Southern Ocean is strengthened, with impacts on the Atlantic via the Antarctic Circumpolar Current (ACC.

  17. Is the relationship between race and continuous positive airway pressure adherence mediated by sleep duration?

    Science.gov (United States)

    Billings, Martha E; Rosen, Carol L; Wang, Rui; Auckley, Dennis; Benca, Ruth; Foldvary-Schaefer, Nancy; Iber, Conrad; Zee, Phyllis; Redline, Susan; Kapur, Vishesh K

    2013-02-01

    Black race has been associated with decreased continuous positive airway pressure (CPAP) adherence. Short sleep duration, long sleep latency, and insomnia complaints may affect CPAP adherence as they affect sleep and opportunity to use CPAP. We assessed whether self-reported sleep measures were associated with CPAP adherence and if racial variations in these sleep characteristics may explain racial differences in CPAP adherence. Analysis of data from a randomized controlled trial (HomePAP), which investigated home versus laboratory-based diagnosis and treatment of obstructive sleep apnea. Seven American Academy of Sleep Medicine-accredited sleep centers in five cities in the United States. Enrolled subjects (n = 191) with apnea-hypopnea index ≥ 15 and sleepiness (Epworth Sleepiness Scale > 12). N/A. Multivariable regression was used to assess if subjective sleep measures and symptoms predicted 3-mo CPAP use. Mediation analysis was used to assess if sleep measures mediated the association of race with CPAP adherence. Black participants reported shorter sleep duration and longer sleep latency at baseline than white and Hispanic participants. Shorter sleep duration and longer sleep latency predicted worse CPAP adherence. Sleep duration mediated the association of black race with lower CPAP adherence. However, insomnia symptoms were not associated with race or CPAP adherence. Among subjects with similar severity of obstructive sleep apnea and sleepiness, baseline self-reported sleep duration and latency, but not perceived insomnia, predicted CPAP adherence over 3 mo. Sleep duration explains some of the observed differences in CPAP use by race. Sleep duration and latency should be considered when evaluating poor CPAP adherence. PORTABLE MONITORING FOR DIAGNOSIS AND MANAGEMENT OF SLEEP APNEA (HOMEPAP) URL: http://clinicaltrials.gov/show/NCT00642486. NIH clinical trials registry number: NCT00642486.

  18. Medication adherence in the transition of adolescent kidney transplant recipients to the adult care.

    Science.gov (United States)

    Akchurin, Oleh M; Melamed, Michal L; Hashim, Becky L; Kaskel, Frederick J; Del Rio, Marcela

    2014-08-01

    Non-adherence is common in adolescent and young adult kidney transplant recipients, leading to adverse graft outcomes. The aim of this study was to determine whether adherence to immunosuppressant medications changes during transition from a pediatric to an adult program within the same transplant center. Adherence was assessed for a period of two yr before and two yr after the transfer. Subtherapeutic trough levels of serum tacrolimus and level variability were used as measures of adherence. Twenty-five patients were transitioned between 1996 and 2011 at the median age of 22.3 [IQR 21.6-23.0] yr. Young adults 21-25 yr of age (n = 26) and non-transitioned adolescents 17-21 yr of age (currently followed in the program, n = 24 and those that lost their grafts prior to the transfer, 22) formed the comparison groups. In the transitioned group, adherence prior to the transfer was not significantly different from the adherence after the transfer (p = 0.53). The rate of non-adherence in the group of non-transitioned adolescents who lost their grafts (68%) was significantly higher than in the transitioned group (32%, p = 0.01). In the group of young adults, adherence was not significantly different from the transitioned group (p = 0.27). Thus, transition was not associated with differences in medication adherence in this single-center study. Large-scale studies are needed to evaluate the national data on medication adherence after transfer. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  19. Social Ecology of Adherence to Hypertension Treatment in Latino Migrant and Seasonal Farmworkers.

    Science.gov (United States)

    Hall, Eleanor; Lee, Shih-Yu; Clark, Patricia C; Perilla, Julia

    2016-01-01

    This study explored Latino migrant/seasonal farmworkers' (MSFWs') adherence to hypertension treatment. A cross-sectional correlational study was conducted. Forty-five Latino MSFWs from two farmworker health clinics completed Spanish versions of the Morisky Medication Adherence Scale, the Blood Pressure Knowledge Scale and Blood Pressure Self-Care Scale, the Perceived Stress Scale, the Acculturation Rating Scale for Mexican Americans-II, the Short Assessment of Health Literacy for Spanish-Speaking Adults, health care access questions, and blood pressure measurements. MSFWs had poor medication adherence (51%). Blood pressure knowledge, perceived stress, acculturation, health literacy, and health care access accounted for 49% of the variance in blood pressure self-care. Higher acculturation level and health literacy were associated with better blood pressure control (p = .01). MSFWs had poor medication adherence and blood pressure control. Blood pressure knowledge and acculturation played a role in blood pressure self-care. Culturally appropriate educational programs are needed to help MSFWs' adherence to hypertension treatment. © The Author(s) 2014.

  20. The effects of yoga on psychosocial variables and exercise adherence: a randomized, controlled pilot study.

    Science.gov (United States)

    Bryan, Stephanie; Pinto Zipp, Genevieve; Parasher, Raju

    2012-01-01

    Physical inactivity is a serious issue for the American public. Because of conditions that result from inactivity, individuals incur close to $1 trillion USD in health-care costs, and approximately 250 000 premature deaths occur per year. Researchers have linked engaging in yoga to improved overall fitness, including improved muscular strength, muscular endurance, flexibility, and balance. Researchers have not yet investigated the impact of yoga on exercise adherence. The research team assessed the effects of 10 weeks of yoga classes held twice a week on exercise adherence in previously sedentary adults. The research team designed a randomized controlled pilot trial. The team collected data from the intervention (yoga) and control groups at baseline, midpoint, and posttest (posttest 1) and also collected data pertaining to exercise adherence for the yoga group at 5 weeks posttest (posttest 2). The pilot took place in a yoga studio in central New Jersey in the United States. The pretesting occurred at the yoga studio for all participants. Midpoint testing and posttesting occurred at the studio for the yoga group and by mail for the control group. Participants were 27 adults (mean age 51 y) who had been physically inactive for a period of at least 6 months prior to the study. Interventions The intervention group (yoga group) received hour-long hatha yoga classes that met twice a week for 10 weeks. The control group did not participate in classes during the research study; however, they were offered complimentary post research classes. Outcome Measures The study's primary outcome measure was exercise adherence as measured by the 7-day Physical Activity Recall. The secondary measures included (1) exercise self-efficacy as measured by the Multidimensional Self-Efficacy for Exercise Scale, (2) general well-being as measured by the General Well-Being Schedule, (3) exercise-group cohesion as measured by the Group Environment Questionnaire (GEQ), (4) acute feeling response

  1. Medication adherence in pediatric and adolescent liver transplant recipients.

    Science.gov (United States)

    Shemesh, Eyal; Shneider, Benjamin L; Savitzky, Jill K; Arnott, Lindsay; Gondolesi, Gabriel E; Krieger, Nancy R; Kerkar, Nanda; Magid, Margret S; Stuber, Margaret L; Schmeidler, James; Yehuda, Rachel; Emre, Sukru

    2004-04-01

    Nonadherence to medications is a leading cause of morbidity in children and adolescents who have had a transplant, yet there are no published data about the use of different methods for detecting whether these children are taking their medications. There are also no published data about the age of transition at which a child assumes responsibility over taking the medications. This information is important if interventions to improve adherence are contemplated. We present an analysis of data obtained in the first year of the implementation of an adherence assessment protocol at a pediatric liver transplant clinic in a tertiary medical care center. Data were obtained for children and adolescents who had a liver transplant at least 1 year before the assessments took place. We used 5 adherence detection methods. The 4 subjective methods were self-reported, scaled questionnaires answered by nurses, physicians, caregivers, and patients. For the objective method, a standard deviation (SD) was calculated for tacrolimus blood levels obtained from each patient over time. A higher SD suggests increased variation among patients' blood levels and hence more erratic medication taking. We also asked the patients and caregivers who is responsible for taking the medications and what are the reasons for not taking them. The medical outcome measures were biopsy-proven rejection episodes, number of biopsies regardless of the results, number of hospital admissions, and number of in-patient days. An analysis of 81 cases (258 assessments) revealed that the only method that predicted the medical outcome variables (biopsy-proven rejection and number of biopsies) was the SD of medication blood levels. Patients', clinicians', and caregivers' reports were not predictive. Clinicians' ratings of adherence were not correlated with patients' or caregivers'. The transition of responsibility for medication taking occurred approximately at the age of 12 years. Forgetfulness was cited as the most

  2. Prevalence and Modifiable Determinants of Non-Adherence in Adult Kidney Transplant Recipients in a German Sample.

    Science.gov (United States)

    Reber, Sandra; Morawa, Eva; Stößel, Lisa; Jank, Sabine; Vitinius, Frank; Eckardt, Kai-Uwe; Erim, Yesim

    2016-09-01

    The aim of this cross-sectional study was to investigate the prevalence and the modifiable determinants of non-adherence in adult kidney transplant patients in follow-up care. In 74 patients at least six months post-transplant, self-reported adherence (Basel Assessment of Adherence to ImmunosuppressiveMedications Scale, BAASIS©), subjective experience and attitudes after transplantation (Medication Experience Scale for Immunosuppressants, MESI), and depression and anxiety (Hospital Anxiety and Depression Scale,HADSD) were assessed. Non-adherence to any of the four BAASIS© items was 24.3%. For the sub-dimensions: dose taking, drug holidays, timing deviation more than two hours from prescribed time, and dose reduction, the non-adherence levelswere 9.5%, 0%,17.6% and 2.7%, respectively. Marital status, negative beliefs towards immunosuppressants, and prominent anxiety and depression were associated with non-adherence. Screening for adherence and its indicators is of substantial importance in communication with renal transplant recipients. After detecting non-adherence, supportive interventions can be offered to the patients.

  3. Predictors of non-adherence to follow-up visits and deferasirox chelation therapy among jordanian adolescents with Thalassemia major.

    Science.gov (United States)

    Al-Kloub, Manal Ibrahim; A Bed, Mona A; Al Khawaldeh, Omar A; Al Tawarah, Yasin M; Froelicher, Erika Sivarajan

    2014-10-01

    Poor adherence to treatment can have negative effects on outcomes and heath care cost. However, little is known about the factors that impact adherence to deferasirox chelation therapy. The aims of this study were to identify rates and predictors of non-adherence to medical regimen among thalassemia major adolescents on deferasirox oral chelation therapy by using subjective (self-reporting) and objective (serum ferritin and follow-up visits) measures. Convenient samples of 164 adolescents, aged 12-19 years were recruited from three National Thalassemia Centers in Jordan. Patients were interviewed using a four-section questionnaire and the medical records were checked. Results indicated that rate of adherence according to self-report was (73%); while to follow-up medical appointments and serum ferritin level rates was 57% and 47%, respectively. One-third of participant adolescents (n = 52) were psychologically impaired. Multivariate analysis showed that factors affecting adolescent non-adherence to deferasirox chelation therapy is different from that affecting adherence to follow-up visits. In general, adolescents more than 16 years old, presence of sibling with thalassemia, lack of parental monitoring, lower family income, decrease frequency of blood transfusion, and psychological impairment were found significant predictors of non-adherence among adolescents. Disease knowledge was not associated with adherence status of the adolescents. Clinician should be aware of high prevalence of low adherence to chelation therapy during adolescent years. Nurses need to regularly assess, monitor, and promote adherence behavior that might impact patients' outcomes.

  4. Assessing Medication Adherence in Patients with Rheumatoid Arthritis (RA)

    Science.gov (United States)

    2017-03-24

    the moat useful method Jn the dnlcal aetting The Morisky Medle1tion Adherence Scale ( MMAS ) waa developed to UHH medlcebon adherence Intent 1nd hll...been v1Ud11ed in sever.I common dl1HM but not In RA There ue several v1ri1tion1 of the MMAS but we used the MMA $a8 which hll eight qu11tion1 The...than 1 minute 1IO oomplei. lh• MMAS -3 OBJECTIVES The p.n.m1ry cbjec:trve i i to dtt1rm1ne tf there 11 a conellt>on between the COR Uil, COR5, and

  5. The hospital anxiety and depression rating scale: A cross-sectional study of psychometrics and case finding abilities in general practice

    Directory of Open Access Journals (Sweden)

    Mykletun Arnstein

    2005-12-01

    Full Text Available Abstract Background General practitioners' (GPs diagnostic skills lead to underidentification of generalized anxiety disorders (GAD and major depressive episodes (MDE. Supplement of brief questionnaires could improve the diagnostic accuracy of GPs for these common mental disorders. The aims of this study were to examine the usefulness of The Hospital Anxiety and Depression Rating Scale (HADS for GPs by: 1 Examining its psychometrics in the GPs' setting; 2 Testing its case-finding properties compared to patient-rated GAD and MDE (DSM-IV; and 3 Comparing its case finding abilities to that of the GPs using Clinical Global Impression-Severity (CGI-S rating. Methods In a cross-sectional survey study 1,781 patients in three consecutive days in September 2001 attended 141 GPs geographically spread in Norway. Sensitivity, specificity, optimal cut off score, and Area under the curve (AUC for the HADS and the CGI-S were calculated with Generalized Anxiety Questionnaire (GAS-Q as reference standard for GAD, and Depression Screening Questionnaire (DSQ for MDE. Results The HADS-A had optimal cut off ≥8 (sensitivity 0.89, specificity 0.75, AUC 0.88 and 76% of patients were correctly classified in relation to GAD. The HADS-D had by optimal cut off ≥8 (sensitivity 0.80 and specificity 0.88 AUC 0.93 and 87% of the patients were correctly classified in relation to MDE. Proportions of the total correctly classified at the CGI-S optimal cut-off ≥3 were 83% of patients for GAD and 81% for MDE. Conclusion The results indicate that addition of the patients' HADS scores to GPs' information could improve their diagnostic accuracy of GAD and MDE.

  6. Factors influencing adherence to routine iron supplementation ...

    African Journals Online (AJOL)

    Anemia in pregnancy is a common problem especially in developing countries. and has been linked with feotal and maternal complications. Taking iron supplements could reduce anaemia in pregnancy but some pregnant women do not adhere to this. The study identified some factors associated with non adherence ...

  7. Medication adherence in inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    Webber Chan

    2017-10-01

    Full Text Available Inflammatory bowel disease (IBD is a chronic idiopathic inflammatory condition with intestinal and extraintestinal manifestations. Medications are the cornerstone of treatment of IBD. However, patients often adhere to medication poorly. Adherence to medications is defined as the process by which patients take their medications as prescribed. Treatment non-adherence is a common problem among chronic diseases, averaging 50% in developed countries and is even poorer in developing countries. In this review, we will examine the adherence data in IBD which vary greatly depending on the study population, route of administration, and methods of adherence measurement used. We will also discuss the adverse clinical outcomes related to non-adherence to medical treatment including increased disease activity, flares, loss of response to anti-tumor necrosis factor therapy, and so forth. There are many methods to measure medication adherence namely direct and indirect methods, each with their advantages and drawbacks. Finally, we will explore different intervention strategies to improve adherence to medications.

  8. Determinants of Patient's Adherence to Hypertension Medications ...

    African Journals Online (AJOL)

    are effective in reducing high blood pressure and have been shown to significantly reduce the risk of cardiovascular illness.[7] It is further thought that patient's benefits to antihypertensive medication can be reduced because of low adherence,[8] whereas non-adherence can be unintentional. (such as forgetting) or can be ...

  9. An interdisciplinary framework for measuring and supporting adherence in HIV prevention trials of ARV-based vaginal rings.

    Science.gov (United States)

    MacQueen, Kathleen M; Tolley, Elizabeth E; Owen, Derek H; Amico, K Rivet; Morrow, Kathleen M; Moench, Thomas; Friend, David R; Friedland, Barbara

    2014-01-01

    Product adherence and its measurement have emerged as a critical challenge in the evaluation of new HIV prevention technologies. Long-acting ARV-based vaginal rings may simplify use instructions and require less user behaviour, thereby facilitating adherence. One ARV-based ring is in efficacy trials and others, including multipurpose rings, are in the pipeline. Participant motivations, counselling support and measurement challenges during ring trials must still be addressed. In previous HIV prevention trials, this has been done largely using descriptive and post-hoc methods that are highly variable and minimally evaluated. We outline an interdisciplinary framework for systematically investigating promising strategies to support product uptake and adherence, and to measure adherence in the context of randomized, blinded clinical trials. The interdisciplinary framework highlights the dual use of adherence measurement (i.e. to provide feedback during trial implementation and to inform interpretation of trial findings) and underscores the complex pathways that connect measurement, adherence support and enacted adherence behaviour. Three inter-related approaches are highlighted: 1) adherence support - sequential efforts to define motivators of study product adherence and to develop, test, refine and evaluate adherence support messages; 2) self-reported psychometric measures - creation of valid and generalizable measures based in easily administered scales that capture vaginal ring use with improved predictive ability at screening, baseline and follow-up that better engage participants in reporting adherence; and 3) more objective measurement of adherence - real-time adherence monitoring and cumulative measurement to correlate adherence with overall product effectiveness through innovative designs, models and prototypes using electronic and biometric technologies to detect ring insertion and/or removal or expulsion. Coordinating research along these three pathways will

  10. Using Home-Program Adherence App in Pediatric Therapy: Case Study of Sensory Processing Disorder.

    Science.gov (United States)

    Gal, Eynat; Steinberg, Oren

    2017-12-18

    Pediatric therapies adopt a family-centered approach that encourages a caregiver's involvement in therapy. Contextual interventions in the child's natural environment have been effective in generalization of skills and increasing of child participation in daily activities. The use of home programs is common across a variety of conditions, but adherence has been challenging. Apps have been demonstrated to promote medication adherence and physical activity maintenance. This study suggested and tested a construct for features required for caregivers' behavioral modification during home programs in pediatric therapy. SensoryTreat is an adherence promoting app for home-program treatments of children with sensory processing disorders. The app was evaluated by testing availability of desired features, usage frequency, impact on adherence with home programs, and parental sense of competence. Results suggest a strong significant correlation between SensoryTreat usage frequency and families' adherence with home programs, as well as a strong significant correlation between relevancy and usefulness of SensoryTreat's interventional content, and parental competence and their adherence with home programs. Using SensoryTreat twice or more per week increases parental adherence with home programs. Content plays an important role in promoting adherence and parental sense of competence, yet, as usage frequency grows the interventional content habituates, and other features as goal setting and feedback logs have significant impact on parental competence and adherence with home programs over time. These findings indicate that the content and features of SensoryTreat app have the potential to promote adherence of families with pediatric therapy home programs.

  11. [Assessment of guideline adherence and quality of care with routine outcome monitoring data].

    Science.gov (United States)

    van Fenema, E M

    Treatment guidelines are widely used nowadays but it is not really clear whether or to what extent patients in routine care benefit from these guidelines. AIM: To achieve a twofold objective: to measure in a routine clinical setting, the overall level of adherence to clinical guidelines by using a set of process indicators that are independent of the disorder under study, and to measure the clinical and psychosocial correlates of adherence among outpatients suffering from mood, anxiety and somatoform disorders. METHOD: We developed a set of quality indicators and tested the set over a period of three years in a randomly selected sample of 300 outpatients who were about to receive treatment for a mood, anxiety and somatoform disorder. We used routine outcome monitoring (ROM) data to determine risk factors for non-adherence and to identify patients whose treatment outcomes were likely poor. RESULTS: A high percentage of indicators were positive, indicating that many elements of treatment in this routine clinical practice had been carried out according to the guidelines. We observed that the combined treatment group showed significantly lower adherence than the two other treatment groups. Low-adherence was predicted independently by a low score on the vitality subscale of the SF-36. No significant differences relating to the degree of adherence were found in socio-demographic variables, comorbidity and the scores on the BSI subscales. Predictor indicators for poor treatment outcome included higher age, a comorbid axis I diagnosis, a number of dysfunctional personality traits and a (reported) poor general health status. CONCLUSION: It is possible to assess guideline adherence by means of our set of process indicators that were independent of all type of disorder involved. Most factors hampering adherence could be identified. An understanding of the factors that affect treatment adherence to treatment guidelines may help to prevent non-adherence and can contribute to

  12. Medication adherence for patients with mental illness.

    Science.gov (United States)

    Varshney, Upkar; Vetter, Ron

    2012-01-01

    Medication adherence has been studied for some time; however most research has focused on able-bodied patients or the elderly living independently. What has not been studied nearly as much is medication adherence for people with psychiatric or mental illnesses. In this paper, we present a framework that includes the specific challenges in medication adherence for patients with mental illness, algorithms and protocols for evaluating adherence, and some on-going work in developing effective solutions. The architectural framework and associated algorithms leverage the context-aware computing capabilities available on many mobile devices. The system is designed to be able to collect and offer situation-aware information on medication use and adherence for healthcare professionals and other designated persons.

  13. Transcultural adaptation and validation of the Celiac Dietary Adherence Test: a simple questionnaire to measure adherence to a gluten-free diet

    Directory of Open Access Journals (Sweden)

    Ricardo Fueyo-Díaz

    Full Text Available Background and aims: A gluten-free diet is to date the only treatment available to celiac disease sufferers. However, systematic reviews indicate that, depending on the method of evaluation used, only 42% to 91% of patients adhere to the diet strictly. Transculturally adapted tools that evaluate adherence beyond simple self-informed questions or invasive analyses are, therefore, of importance. The aim is to obtain a Spanish transcultural adaption and validation of Leffler's Celiac Dietary Adherence Test. Methods: A two-stage observational transversal study: translation and back translation by four qualified translators followed by a validation stage in which the questionnaire was administered to 306 celiac disease patients aged between 12 and 72 years and resident in Aragon. Factorial structure, criteria validity and internal consistency were evaluated. Results: The Spanish version maintained the 7 items in a 3-factor structure. Feasibility was very high in all the questions answered and the floor and ceiling effects were very low (4.3% and 1%, respectively. The Spearman correlation with the self-efficacy and life quality scales and the self-informed question were statistically significant (p < 0.01. According to the questionnaire criteria, adherence was 72.3%. Conclusion: The Spanish version of the Celiac Dietary Adherence Test shows appropriate psychometric properties and is, therefore, suitable for studying adherence to a gluten-free diet in clinical and research environments.

  14. How much elderly people of Isfahan are adherent to their drug therapy regimens?

    Science.gov (United States)

    Abazari, Parvaneh; Jafari, Tayebe Arab; Sabzghabaee, Ali Mohammad

    2017-01-01

    The need for a correct follow-up for medical advices of health givers is the cornerstone for avoiding drug-related complications in especial period of elderly people life. There isn't any data about drug therapy regimens adherence of elderly people of Isfahan. In this study, we aimed to cover this deficit. In this cross-sectional study which was carried out in Isfahan (Iran) in 2013 senior citizens (aged 65 or more) who were taking at least one medication and had no record of residency in nursing homes were included. We used Morisky medication adherence scale (after validation and reliability assessment for using this questionnaire in Persian language) to evaluate the level of adherence in the study population. A total of 200 elderly participants were fully studied ( n = 200, 61% females), and 52% of them had poor medication adherence. 77.5% of participants were suffered from at least four medical illnesses, and 18.5% of them were taking more than eight medications per day. We have not found any significant statistical relationship between vision or hearing loss disorders and the medication adherence of the participants). There was a significant positive relationship between the level of education and medication adherence ( P = 0.001), ( χ 2 = 0.29). Low Medication adherence is a common and important drug issue in the elderly in Isfahan. This issue can lead to medical complications and huge cost if it is not addressed appropriately.

  15. A test of an adherence-enhancing adjunct to physiotherapy steeped in the protection motivation theory.

    Science.gov (United States)

    Bassett, Sandra F; Prapavessis, Harry

    2011-07-01

    The primary aim of this study was to test the effect of a Protection Motivation Theory (PMT)-based patient education intervention on physiotherapy patients' beliefs about their injury and physiotherapy, intentions to adhere, rehabilitation adherence, and ankle function. A secondary aim was to explore the relationships between the patients' injury and physiotherapy beliefs, intentions, adherence behaviours, and ankle function. A randomized controlled trial was undertaken in New Zealand; 71 people with ankle sprains were allocated to either PMT present video information or two control groups (non-PMT information about ankle sprains and no formal information) before commencing their course of physiotherapy. The two information groups watched a video about ankle sprains and physiotherapy before answering the Beliefs about Ankle Sprains and Physiotherapy Scale and behavioural intentions questionnaires that measured the PMT constructs. Adherence was assessed at each treatment and ankle function was measured before and after the physiotherapy program. After viewing the video, the PMT present information group's beliefs about severity, vulnerability, and response efficacy were significantly higher than the other two groups. The groups did not differ significantly on their self-efficacy, intentions, rehabilitation adherence, and post-physiotherapy program ankle function. Significant correlations existed between the patients' PMT-based beliefs and intentions, intentions and adherence, and adherence and post-physiotherapy ankle function. With the exception of self-efficacy, the findings indicate that persuasive information grounded in PMT does enhance physiotherapy patients' beliefs about their injury and treatment.

  16. The adherence to medications in diabetic patients in rural Kerala, India.

    Science.gov (United States)

    Sankar, Uma V; Lipska, Kasia; Mini, G K; Sarma, P S; Thankappan, K R

    2015-03-01

    We conducted a study to determine medications adherence and factors associated with poor adherence in community-dwelling adults with diabetes in southern India. A cross-sectional survey was conducted among 346 diabetes patients selected using multistage cluster sampling. The 8-item Morisky Medication Adherence Scale was used to collect information on adherence. Prevalence of poor adherence was 74% (95% confidence interval = 69.2-78.3). Multiple regression analysis showed that patients using oral hypoglycemic agents, who had lower per capita monthly expenditure, those with irregular blood sugar monitoring, who received limited diabetes management instructions from health professionals, who resorted to only symptomatic management, and those who did not receive family member's help to remember medications were more likely to report poor adherence compared with their counterparts. Interventions for patients using oral hypoglycemic agents, with lower expenditure, with irregular blood sugar monitoring, and which focus on better education and enhanced family support, are likely to enhance adherence in this population. © 2013 APJPH.

  17. Self-motivation and adherence to therapeutic exercise.

    Science.gov (United States)

    Dishman, R K; Ickes, W

    1981-12-01

    Behavioral compliance or adherence is a fundamental problem in health care, and diagnosis of dropout proneness represents a first step in adherence facilitation. A paper-and-pencil scale was developed to assess self-motivation, conceptualized as a behavioral tendency to persevere independent of situational reinforcements. Scale refinement (N = 401) yielded a logically valid and reliable measure with a high internal consistency (alpha = 0.91). Repeated measurements (1 to 5 months) indicated a high degree of scale stability (r's ranged from 0.86 to 0.92), reinforcing the conception of self-motivation as relatively enduring and trait-like. Convergent evidence for construct validity was provided by the Self-Motivation Inventory's (SMI) relationship with the Thomas--Zander Ego-Strength Scale (r = 0.63) and other more behaviorally specific attitudes (r's ranged from 0.47 to 0.58). Discriminant validity was evidenced by minimal overlap with motivational measures of social desirability, health locus of control, and achievement tendency; in each case, less than 10% of the variance in self-motivation was explained. Predictive validity was demonstrated in a variety of naturalistic settings in which perseverant behavior was easily quantified. These included habitual exercise programs for exercise training (N = 64), preventive medicine (N = 66), and acute exercise (N = 48). The diversity of these settings supported the situational invariance of self-motivation. Collectively, these findings provide considerable support for the valid and reliable assessment of self-motivation and for its distinctive utility in enhancing the prediction of perseverant behavior, specifically, adherence to therapeutic exercise.

  18. Factors influencing adherence to standard precautions among nursing professionals in psychiatric hospitals

    Directory of Open Access Journals (Sweden)

    Thaís Helena Piai-Morais

    2015-06-01

    Full Text Available OBJECTIVE Evaluate and correlate individual, work-related and organizational factors that influence adherence to standard precautions among nursing professionals of psychiatric hospitals in São Paulo. METHOD An exploratory cross-sectional study conducted with 35 nursing professionals, using the assessment tool for adherence to standard precautions through the Likert scale, ranging from 1 to 5. RESULTS Knowledge of the precautions received a high score (4.69; adherence received (3.86 and obstacles (3.78, while intermediaries and the scales of organizational factors received low scores (2.61. There was a strong correlation between the magnitude adherence scale and the personal protective equipment availability (r = 0.643; p = 0.000. The training scale for prevention of HIV exposure (p = 0.007 was statistically different between the nurses and nursing assistants. CONCLUSION The organizational factors negatively contributed to adherence to standard precautions, indicating that psychiatric institutions lack safe working conditions, ongoing training and management actions to control infections.

  19. Prevalence and correlates of medication non-adherence among kidney transplant recipients more than 6 months post-transplant: a cross-sectional study.

    Science.gov (United States)

    Weng, Francis L; Chandwani, Sheenu; Kurtyka, Karen M; Zacker, Christopher; Chisholm-Burns, Marie A; Demissie, Kitaw

    2013-12-01

    Among kidney transplant recipients, non-adherence with immunosuppressive medications frequently precedes allograft loss. We sought to determine the prevalence and correlates of medication non-adherence among kidney transplant recipients. We performed a single-center, cross-sectional study of kidney transplant recipients who were at least 6 months post-transplant. We measured self-reported adherence using the Immunosuppressive Therapy Adherence Scale (ITAS, which is scored from 0 to 12, where higher scores indicate increased adherence) and barriers to adherence using the Immunosuppressive Therapy Barriers Scale (ITBS). We also used validated scales to measure perceived stress, health literacy, anxiety, depression, and interpersonal support. The 252 patients included in the study were 59.9% male, 27.0% Black, and at a median of 2.9 years post-transplant (interquartile range [IQR] 1.4-5.8). On the ITAS, 59.1% scored a perfect 12, 26.6% scored 10-11, and 14.3% scored 0-9. In univariate models, non-adherence (defined as ITAS score ≤9) was significantly associated with increased scores on scales for perceived stress (OR 1.12, 95% CI 1.01-1.25) and depression (OR 1.14, 95% CI 1.02-1.28), and with more self-reported barriers to adherence on the ITBS (OR 1.15, 95% CI 1.08-1.22). After adjusting for sociodemographic factors, stress and depression were not associated with non-adherence. Higher scores on the ITBS (corresponding to more self-described barriers to adherence) were associated with lower scores on the ITAS (P adherence. Among prevalent kidney transplant recipients, a minority is non-adherent. Practical barriers to adherence may serve as promising targets for future interventions.

  20. Prevalence and correlates of medication non-adherence among kidney transplant recipients more than 6 months post-transplant: a cross-sectional study

    Science.gov (United States)

    2013-01-01

    Background Among kidney transplant recipients, non-adherence with immunosuppressive medications frequently precedes allograft loss. We sought to determine the prevalence and correlates of medication non-adherence among kidney transplant recipients. Methods We performed a single-center, cross-sectional study of kidney transplant recipients who were at least 6 months post-transplant. We measured self-reported adherence using the Immunosuppressive Therapy Adherence Scale (ITAS, which is scored from 0 to 12, where higher scores indicate increased adherence) and barriers to adherence using the Immunosuppressive Therapy Barriers Scale (ITBS). We also used validated scales to measure perceived stress, health literacy, anxiety, depression, and interpersonal support. Results The 252 patients included in the study were 59.9% male, 27.0% Black, and at a median of 2.9 years post-transplant (interquartile range [IQR] 1.4-5.8). On the ITAS, 59.1% scored a perfect 12, 26.6% scored 10–11, and 14.3% scored 0–9. In univariate models, non-adherence (defined as ITAS score ≤9) was significantly associated with increased scores on scales for perceived stress (OR 1.12, 95% CI 1.01-1.25) and depression (OR 1.14, 95% CI 1.02-1.28), and with more self-reported barriers to adherence on the ITBS (OR 1.15, 95% CI 1.08-1.22). After adjusting for sociodemographic factors, stress and depression were not associated with non-adherence. Higher scores on the ITBS (corresponding to more self-described barriers to adherence) were associated with lower scores on the ITAS (P adherence. Conclusions Among prevalent kidney transplant recipients, a minority is non-adherent. Practical barriers to adherence may serve as promising targets for future interventions. PMID:24289809

  1. The Stability and Influence of Barriers to Medication Adherence on Seizure Outcomes and Adherence in Children With Epilepsy Over 2 Years.

    Science.gov (United States)

    Ramsey, Rachelle R; Zhang, Nanhua; Modi, Avani C

    2018-03-01

    To determine the stability and influence of adherence barriers on medication adherence and seizure control in pediatric epilepsy. Caregivers of 118 children aged 2-12 years old with epilepsy completed the Pediatric Epilepsy Medication Self-Management Questionnaire at nine time points over 2 years post diagnosis. Electronically monitored antiepileptic drug adherence and seizure outcome data were collected. Hierarchical linear modeling results for overall barriers remained stable over 2 years. Specific item-level barriers were also generally stable over time, with the exception of running out of medication becoming more of a barrier over time. No specific barriers were related to seizure control; however, difficulties swallowing medication, forgetting, and medication refusal were related to electronically monitored adherence over time. Assessing for specific adherence barriers over time may lead to identification of interventions that result in improved adherence and care. © The Author 2017. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  2. Medication non-adherence in the homeless population in an Intermountain West city

    Directory of Open Access Journals (Sweden)

    Elizabeth J. Unni

    2014-01-01

    Full Text Available Background: Homelessness happens when people or household are unable to acquire and/or maintain housing they can afford. Approximately 17% of homeless individuals are also chronically ill. Studies have often not objectively measured medication non- adherence among the homeless population, probably due to lack of consistent pharmacy records. This study proposed to objectively estimate medication non-adherence to chronic medications among the homeless population in Salt Lake City, Utah. Methods: A retrospective study design was used based on the pharmacy records from the Fourth Street Pharmacy based on four classes of chronic medications - asthma, diabetes, statins, and psychiatric medications. Data was collected between November 1, 2010 and February 28, 2011 on the variables: date of original prescription, number of refills on the original prescription, date of 1st, 2nd, 3rd, and 4th fills, age, gender, and race. Primary non-adherence and medication refill non-adherence based on Continuous Measure of Medication Gaps were calculated. Results: The medication refill non-adherence rate was 38.8% with asthma medications, 38.5% with diabetic medications, 27.2% with statins, and 47.1% with psychiatric medications. The primary non-adherence rate varied from zero percent to 20%. Conclusion: The study concluded that this population has comparable non-adherence rates with asthma, diabetes, cholesterol lowering, and certain psychiatric medications than the general population.   Type: Original Research

  3. LOW ADHERENCE TO TREATMENT AFTER MYOCARDIAL INFARCTION: CAUSES AND WAYS OF ADJUSTMENT CONSIDERING PSYCHO-EMOTIONAL STATE OF PATIENTS

    Directory of Open Access Journals (Sweden)

    E. A. Kuzheleva

    2016-01-01

    Full Text Available Aim. To study the reasons of low adherence to treatment in patients after myocardial infarction as well as methods of its correction considering the mental and emotional state of patients. Material and methods. Patients (n=115 after myocardial infarction registered in "Acute Myocardial Infarction Register» were enrolled into the study. The Moriscos-Green scale was used to determine the degree of adherence to treatment, and psycho-emotional state of patients was assessed by the Hospital Anxiety and Depression Scale (HADS. The special questionnaire was used to study the causes of poor adherence. Results. Only 45% of patients after myocardial infarction have a high commitment to the doctor's recommendations. The main reason for low adherence was forgetfulness (42%. Among other reasons were: fear of side effects (16%; lack of therapeutic effect according to patients' opinion (12%; doubts about the doctor's prescriptions (14%; a large number of prescribed drugs (12%; high cost of drugs (4%. The structure of the causes of poor adherence to treatment varied greatly depending on the psycho-emotional status. Adherence to treatment can be improved by specific physician’s actions (48.5% of patients. At the same time 14% of patients did not want to take drugs for a long time under any circumstances. Conclusion. Adherence to treatment of patients after myocardial infarction deserves attention from doctors. The personalized approach considering patient’s opinion, as well as their specific features, is essential for the development of ways to improve adherence.

  4. Drug Non-Adherence in Type 2 Diabetes Mellitus: Predictors and Associations

    International Nuclear Information System (INIS)

    Shams, N.; Ahmed, W.; Kumar, N.; Saleem, F.

    2016-01-01

    Background: Diabetes being a serious health issue faced by developing countries with drug adherence having pivot role for recommended glycaemic target. This study aims to determine drug non-adherence in type 2 diabetics and its predictors and associations. Methods: This cross sectional study was conducted after ethical approval at Medicine Dept. Rawal Institute of Health Sciences Islamabad over 10 months duration. Demographic details, duration of diabetes, education, socioeconomic class, glycaemic control, mode of anti-diabetic therapy, number of medications and other modes of therapy documented. Michigan Diabetes Knowledge Questionnaire applied with outcome as good, acceptable and poor knowledge. Drug adherence was assessed by Morisky Medication Adherence Scale (non-adherence at <6 points). Data analysed via SPSS version 17 with significant p-value <0.05. Results: Among 183 diabetics there were 43 (23.5 percent) males and 140 (76.5 percent) females. Mean age was 56.6±10.6 years and mean duration of diabetes 8.4±6.57 years. One hundred and fourteen (62 percent) cases were non-adherent. Diabetes knowledge was poor in 76 (41.5 percent), acceptable in 76 (41.5 percent) and good in 31 (16.9 percent). Un-satisfactory glycaemic control present in 149 (81.4 percent). Non-adherence was found to be associated with poor glycaemic control, poor dietary adherence, poly-pharmacy, illiteracy, practicing other modes of therapy and poor diabetes knowledge (p<0.05). Conclusion: Non-adherence to medication in type 2 diabetics needs to be addressed. Suggested contributory factors are illiteracy, practicing other modes of therapy, poor diabetes knowledge and poly-pharmacy. Public awareness programs, self-monitoring of blood sugars, regular follow-up visits with focus at patient education may improve glycaemic control and diabetes related complications. (author)

  5. Dietary adherence and acceptability of five different diets, including vegan and vegetarian diets, for weight loss: The New DIETs study.

    Science.gov (United States)

    Moore, Wendy J; McGrievy, Michael E; Turner-McGrievy, Gabrielle M

    2015-12-01

    The goal of the present study was to examine dietary adherence and acceptability among participants from the New DIETs study who were randomized to one of four plant-based diets (vegan, vegetarian, pesco-vegetarian, semi-vegetarian) or an omnivore diet. Primary outcomes at two- and six months included dietary adherence (24-hour dietary recalls), weight loss and changes in animal product intake (mg cholesterol) by adherence status, Three-Factor Eating Questionnaire (TFEQ), Power of Food Scale (PFS), dietary acceptability (Food Acceptability Questionnaire), and impact of diet preference on adherence. No differences were found in dietary adherence or changes in FAQ, TFEQ, or PFS among the groups. At six months, non-adherent vegan and vegetarian participants (n=16) had a significantly greater decrease in cholesterol intake (-190.2 ± 199.2 mg) than non-adherent pesco-vegetarian/semi-vegetarian (n=15, -2.3 ± 200.3 mg, P=0.02) or omnivore participants (n=7, 17.0 ± 36.0, P=0.04). Non-adherent vegan/vegetarian participants lost significantly more weight at six months (-6.0 ± 6.7%) than non-adherent omnivore participants (-0.4 ± 0.6%, P=0.04). Dietary preference had no impact on adherence at six months. Due to equal rates of adherence and acceptability among the diet groups, instructing participants to follow vegan or vegetarian diets may have a greater impact on weight loss and animal product intake than providing instruction in more moderate approaches even among non-adherent participants. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Subjective reasons for adherence to psychotropic medication and associated factors among older adults with schizophrenia.

    Science.gov (United States)

    Sapra, Mamta; Vahia, Ipsit V; Reyes, Pia N; Ramirez, Paul; Cohen, Carl I

    2008-12-01

    There are limited data examining subjective influences on medication adherence among older persons with schizophrenia. The subjective reasons for adherence to antipsychotic medication and associated clinical and psychosocial factors in this population are examined. The sample consisted of 198 community dwelling persons aged >or=55 who developed schizophrenia before age 45. Using the Rating of Medication Influences Scale (ROMI), a principal component factor analysis with varimax rotation yielded three subscales: Medication Affinity and Prevention, Influence of Others, and Impact of Authority. These subscales were dichotomized into high and low based on a median split. We also created an ordinal High Adherence measure based on the summed scores of each person's three dichotomized ROMI subscales. A modified Health Belief Model was used to examine the association between 18 predictor variables and the ROMI subscales and the adherence scale. The mean subscale rankings were Medication Affinity and Prevention > Impact of Authority > Influence of Others. In logistic regression, lower education, more side effects, higher depression scores, and more mental health services were associated with higher scores on Influence of Others subscale. More side effects and more entitlements were associated with higher scores on the Medication Affinity and Prevention subscale. The Impact of Authority subscale had no significant associations. More side effects and higher depression scores were associated with higher scores on High Adherence measure. We identified a three-dimensional model for explaining the subjective reasons for medication adherence in older persons with schizophrenia. Our findings suggest that cognitive approaches and use of authority figures may be useful for promoting adherence in older adults. Independent variables associated with these subscales may provide guidance for improving adherence in this population.

  7. Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis

    Science.gov (United States)

    Katz, Ingrid T; Ryu, Annemarie E; Onuegbu, Afiachukwu G; Psaros, Christina; Weiser, Sheri D; Bangsberg, David R; Tsai, Alexander C

    2013-01-01

    Introduction Adherence to HIV antiretroviral therapy (ART) is a critical determinant of HIV-1 RNA viral suppression and health outcomes. It is generally accepted that HIV-related stigma is correlated with factors that may undermine ART adherence, but its relationship with ART adherence itself is not well established. We therefore undertook this review to systematically assess the relationship between HIV-related stigma and ART adherence. Methods We searched nine electronic databases for published and unpublished literature, with no language restrictions. First we screened the titles and abstracts for studies that potentially contained data on ART adherence. Then we reviewed the full text of these studies to identify articles that reported data on the relationship between ART adherence and either HIV-related stigma or serostatus disclosure. We used the method of meta-synthesis to summarize the findings from the qualitative studies. Results Our search protocol yielded 14,854 initial records. After eliminating duplicates and screening the titles and abstracts, we retrieved the full text of 960 journal articles, dissertations and unpublished conference abstracts for review. We included 75 studies conducted among 26,715 HIV-positive persons living in 32 countries worldwide, with less representation of work from Eastern Europe and Central Asia. Among the 34 qualitative studies, our meta-synthesis identified five distinct third-order labels through an inductive process that we categorized as themes and organized in a conceptual model spanning intrapersonal, interpersonal and structural levels. HIV-related stigma undermined ART adherence by compromising general psychological processes, such as adaptive coping and social support. We also identified psychological processes specific to HIV-positive persons driven by predominant stigmatizing attitudes and which undermined adherence, such as internalized stigma and concealment. Adaptive coping and social support were critical

  8. Partial cross-validation of the Wechsler Memory Scale-Revised (WMS-R) General Memory-Attention/Concentration Malingering Index in a nonlitigating sample.

    Science.gov (United States)

    Hilsabeck, Robin C; Thompson, Matthew D; Irby, James W; Adams, Russell L; Scott, James G; Gouvier, Wm Drew

    2003-01-01

    The Wechsler Memory Scale-Revised (WMS-R) malingering indices proposed by Mittenberg, Azrin, Millsaps, and Heilbronner [Psychol Assess 5 (1993) 34.] were partially cross-validated in a sample of 200 nonlitigants. Nine diagnostic categories were examined, including participants with traumatic brain injury (TBI), brain tumor, stroke/vascular, senile dementia of the Alzheimer's type (SDAT), epilepsy, depression/anxiety, medical problems, and no diagnosis. Results showed that the discriminant function using WMS-R subtests misclassified only 6.5% of the sample as malingering, with significantly higher misclassification rates of SDAT and stroke/vascular groups. The General Memory Index-Attention/Concentration Index (GMI-ACI) difference score misclassified only 8.5% of the sample as malingering when a difference score of greater than 25 points was used as the cutoff criterion. No diagnostic group was significantly more likely to be misclassified. Results support the utility of the GMI-ACI difference score, as well as the WMS-R subtest discriminant function score, in detecting malingering.

  9. Continental scale analysis of bird migration timing: influences of climate and life history traits-a generalized mixture model clustering and discriminant approach.

    Science.gov (United States)

    Chambers, Lynda E; Beaumont, Linda J; Hudson, Irene L

    2014-08-01

    There is substantial evidence of climate-related shifts to the timing of avian migration. Although spring arrival has generally advanced, variable species responses and geographical biases in data collection make it difficult to generalise patterns. We advance previous studies by using novel multivariate statistical techniques to explore complex relationships between phenological trends, climate indices and species traits. Using 145 datasets for 52 bird species, we assess trends in first arrival date (FAD), last departure date (LDD) and timing of peak abundance at multiple Australian locations. Strong seasonal patterns were found, i.e. spring phenological events were more likely to significantly advance, while significant advances and delays occurred in other seasons. However, across all significant trends, the magnitude of delays exceeded that of advances, particularly for FAD (+22.3 and -9.6 days/decade, respectively). Geographic variations were found, with greater advances in FAD and LDD, in south-eastern Australia than in the north and west. We identified four species clusters that differed with respect to species traits and climate drivers. Species within bird clusters responded in similar ways to local climate variables, particularly the number of raindays and rainfall. The strength of phenological trends was more strongly related to local climate variables than to broad-scale drivers (Southern Oscillation Index), highlighting the importance of precipitation as a driver of movement in Australian birds.

  10. General optimization procedure towards the design of a new family of minimal parameter spin-component-scaled double-hybrid density functional theory.

    Science.gov (United States)

    Roch, Loïc M; Baldridge, Kim K

    2017-10-04

    A general optimization procedure towards the development and implementation of a new family of minimal parameter spin-component-scaled double-hybrid (mSD) density functional theory (DFT) is presented. The nature of the proposed exchange-correlation functional establishes a methodology with minimal empiricism. This new family of double-hybrid (DH) density functionals is demonstrated using the PBEPBE functional, illustrating the optimization procedure to the mSD-PBEPBE method, and the performance characteristics shown for a set of non-covalent complexes covering a broad regime of weak interactions. With only two parameters, mSD-PBEPBE and its cost-effective counterpart, RI-mSD-PBEPBE, show a mean absolute error of ca. 0.4 kcal mol -1 averaged over 66 weak interacting systems. Following a successive 2D-grid refinement for a CBS extrapolation of the coefficients, the optimization procedure can be recommended for the design and implementation of a variety of additional DH methods using any of the plethora of currently available functionals.

  11. Applicability of general grief theory to Swedish women's experience after early miscarriage, with factor analysis of Bonanno's taxonomy, using the Perinatal Grief Scale

    Science.gov (United States)

    2010-01-01

    Background Grief is a normal phenomenon but showing great variation depending on cultural and personal features. Bonanno and Kaltman have nonetheless proposed five aspects of normal grief. The aim of this study was to investigate if women with miscarriage experience normal grief. Material and methods Content analyses of 25 transcribed conversations with women 4 weeks after their early miscarriages were classified depending on the meaning-bearing units according to Bonanno and Kaltman's categories. In the factor analyses, these categories were compared with the Perinatal Grief Scale and women's age, number of children and number of miscarriages, and gestational weeks. Results Women with miscarriage fulfill the criteria for having normal grief according to Bonanno and Kaltman. All of the 25 women had meaning-bearing units that were classified as cognitive disorganization, dysphoria, and health deficits, whereas disrupted social and occupational functioning and positive aspects of bereavement were represented in 22 of 25 women. From the factor analysis, there are no differences in the expression of the intensity of the grief, irrespective of whether or not the women were primiparous, younger, or had suffered a first miscarriage. Conclusion Women's experience of grief after miscarriage is similar to general grief after death. After her loss, the woman must have the possibility of expressing and working through her grief before she can finish her pregnancy emotionally. The care-giver must facilitate this process and accept that the intensity of the grief is not dependent on the woman's age, or her number of earlier miscarriages. PMID:20636255

  12. Digital Health Technologies to Promote Lifestyle Change and Adherence.

    Science.gov (United States)

    Khan, Numan; Marvel, Francoise A; Wang, Jane; Martin, Seth S

    2017-08-01

    Cardiovascular disease is the leading cause of morbidity and mortality worldwide with an estimated 17.5 million deaths annually, or 31% of all global deaths, according to the World Health Organization. The majority of these deaths are preventable by addressing lifestyle modification (i.e., smoking cessation, diet, obesity, and physical inactivity) and promoting medication adherence. At present, initiatives to develop cost-effective modalities to support self-management, lifestyle modification, and medication adherence are a leading priority. Digital health has rapidly emerged as technology with the potential to address this gap in cardiovascular disease self-management and transform the way healthcare has been traditionally delivered. However, limited evidence exists about the type of technologies available and how they differ in functionality, effectiveness, and application. We aimed to review the most important and relevant recent studies addressing health technologies to promote lifestyle change and medication adherence including text messaging, applications ("apps"), and wearable devices. The current literature indicates that digital health technologies will likely play a prominent role in future cardiovascular disease management, risk reduction, and delivery of care in both resource-rich and resource-limited settings. However, there is limited large-scale evidence to support adoption of existing interventions. Further clinical research and healthcare policy change are needed to move the promise of new digital health technologies towards reality.

  13. An Instrument to Measure Adherence to Weight Loss Programs: The Compliance Praxis Survey-Diet (COMPASS-Diet

    Directory of Open Access Journals (Sweden)

    Gabriela Böhm

    2013-09-01

    Full Text Available Adherence to behavioral weight loss strategies is important for weight loss success. We aimed to examine the reliability and validity of a newly developed compliance praxis-diet (COMPASS-diet survey with participants in a 10-week dietary intervention program. During the third of five sessions, participants of the “slim-without-diet” weight loss program (n = 253 completed the COMPASS-diet survey and provided data on demographic and clinical characteristics, and general self-efficacy. Group facilitators completed the COMPASS-diet-other scale estimating participants’ likely adherence from their perspective. We calculated internal consistency, convergent validity, and predictive value for objectively measured weight loss. Mean COMPASS-diet-self score was 82.4 (SD 14.2 and COMPASS-diet-other score 80.9 (SD 13.6 (possible range 12–108, with lowest scores in the normative behavior subscale. Cronbach alpha scores of the COMPASS-diet-self and -other scale were good (0.82 and 0.78, respectively. COMPASS-diet-self scores (r = 0.31 correlated more highly with general self-efficacy compared to COMPASS-diet-other scores (r = 0.04 providing evidence for validity. In multivariable analysis adjusted for age and gender, both the COMPASS-diet-self (F = 10.8, p < 0.001, r2 = 0.23 and other (F = 5.5, p < 0.001, r2 = 0.19 scales were significantly associated with weight loss achieved at program conclusion. COMPASS-diet surveys will allow group facilitators or trainers to identify patients who need additional support for optimal weight loss.

  14. Longitudinal Analysis of Adherence to First-Line Antiretroviral Therapy: Evidence of Treatment Sustainability from an Indian HIV Cohort.

    Science.gov (United States)

    Shet, Anita; Kumarasamy, N; Poongulali, Selvamuthu; Shastri, Suresh; Kumar, Dodderi Sunil; Rewari, Bharath B; Arumugam, Karthika; Antony, Jimmy; De Costa, Ayesha; D'Souza, George

    2016-01-01

    Given the chronic nature of HIV infection and the need for life-long antiretroviral therapy (ART), maintaining long-term optimal adherence is an important strategy for maximizing treatment success. In order to understand better the dynamic nature of adherence behaviors in India where complex cultural and logistic features prevail, we assessed the patterns, trajectories and time-dependent predictors of adherence levels in relation to virological failure among individuals initiating first-line ART in India. Between July 2010 and August 2013, eligible ART-naïve HIV-infected individuals newly initiating first-line ART within the national program at three sites in southern India were enrolled and monitored for two years. ART included zidovudine/stavudine/tenofovir plus lamivudine plus nevirapine/efavirenz. Patients were assessed using clinical, laboratory and adherence parameters. Every three months, medication adherence was measured using pill count, and a structured questionnaire on adherence barriers was administered. Optimal adherence was defined as mean adherence ≥95%. Statistical analysis was performed using a bivariate and a multivariate model of all identified covariates. Adherence trends and determinants were modeled as rate ratios using generalized estimating equation analysis in a Poisson distribution. A total of 599 eligible ART-naïve patients participated in the study, and contributed a total of 921 person-years of observation time. Women constituted 43% and mean CD4 count prior to initiating ART was 192 cells/mm3. Overall mean adherence among all patients was 95.4%. The proportion of patients optimally adherent was 75.6%. Predictors of optimal adherence included older age (≥40 years), high school-level education and beyond, lower drug toxicity-related ART interruption, full disclosure, sense of satisfaction with one's own health and patient's perception of having good access to health-care services. Adherence was inversely proportional to virological

  15. Are carer attitudes toward medications related to self-reported medication adherence amongst people with mental illness?

    Science.gov (United States)

    Deane, Frank P; McAlpine, Elizabeth; Byrne, Mitchell K; Davis, Esther L; Mortimer, Christine

    2017-11-22

    Medication nonadherence among consumers with psychiatric disorders can significantly affect the health and wellbeing of the consumer and their family. Previous research has suggested that carers have an impact on consumer attitudes toward medication and adherence. Yet, how carer attitudes toward medication may be related to consumer attitudes and adherence has received little investigation. This exploratory study aimed to investigate the relationships between carer and consumer attitudes toward medication and consumer adherence behaviour. A cross-sectional survey assessing consumer and carer attitudes toward medication and consumer adherence was conducted amongst 42 consumer-carer dyads. Correlation analyses showed a positive association between consumer and carer attitudes toward medication and between consumer and carer attitudes with adherence. There was a general indication that the greater the difference between consumer and carer attitudes, the lower the level of adherence. Regression analyses revealed that while neither consumer nor carer attitudes were significant predictors of adherence, carer attitudes appeared to have a stronger role in adherence than consumer attitudes. These preliminary results highlight the importance of carer attitudes in relation to patient perceptions and behaviours toward medication, and thus the potential benefits of addressing both consumer and carer attitudes in any intervention for improving adherence. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. eHealth Technologies as an intervention to improve adherence to topical antipsoriatics: a systematic review.

    Science.gov (United States)

    Svendsen, Mathias Tiedemann; Andersen, Flemming; Andersen, Klaus Ejner

    2018-03-01

    Topical antipsoriatics are recommended first-line treatment of psoriasis, but rates of adherence are low. Patient support by use of electronic health (eHealth) services is suggested to improve medical adherence. To review randomised controlled trials (RCTs) testing eHealth interventions designed to improve adherence to topical antipsoriatics and to review applications for smartphones (apps) incorporating the word psoriasis. Literature review: Medline, Embase, Cochrane, PsycINFO and Web of Science were searched using search terms for eHealth, psoriasis and topical antipsoriatics. General analysis of apps: The operating systems (OS) for smartphones, iOS, Google Play, Microsoft Store, Symbian OS and Blackberry OS were searched for apps containing the word psoriasis. Literature review: Only one RCT was included, reporting on psoriasis patients' Internet reporting their status of psoriasis over a 12-month period. The rate of adherence was measured by Medication Event Monitoring System (MEMS ® ). An improvement in medical adherence and reduction of severity of psoriasis were reported. General analysis of apps: A total 184 apps contained the word psoriasis. There is a critical need for high-quality RCTs testing if the ubiquitous eHealth technologies, for example, some of the numerous apps, can improve psoriasis patients' rates of adherence to topical antipsoriatics.

  17. The impact of cognitive distortions, stress, and adherence on metabolic control in youths with type 1 diabetes.

    Science.gov (United States)

    Farrell, Stephanie P; Hains, Anthony A; Davies, W Hobart; Smith, Philip; Parton, Elaine

    2004-06-01

    To investigate the role of cognitive distortions in the relationship between adherence behavior, diabetes-specific stress, general stress, and metabolic control. Obtained questionnaire data, glucometer readings, and glycosylated hemoglobin (HbgA(1c)) assays from 143 youths (11-18 years old) with type 1 diabetes. Examined path model of relationships between cognitive distortions, stress, adherence behavior, and metabolic control. Data were analyzed using path analysis. Higher levels of negative cognitive distortions were associated with more stress (both diabetes-specific and general). Higher levels of general stress then led to less adherent behavior and subsequently poorer metabolic control (higher HbgA(1c)). More diabetes-specific stress also led to poorer metabolic control, as well as general stress. The findings indicate an indirect role of negative cognitive distortions in metabolic control. The current findings suggest that instead of the proposed direct link between cognitive distortions and adherence behavior, an indirect relationship may exist through stress.

  18. A systematic review of adherence in Indigenous Australians: an opportunity to improve chronic condition management.

    Science.gov (United States)

    de Dassel, Jessica Langloh; Ralph, Anna P; Cass, Alan

    2017-12-27

    Indigenous Australians experience high rates of chronic conditions. It is often asserted Indigenous Australians have low adherence to medication; however there has not been a comprehensive examination of the evidence. This systematic literature review presents data from studies of Indigenous Australians on adherence rates and identifies supporting factors and impediments from the perspective of health professionals and patients. Search strategies were used to identify literature in electronic databases and websites. The following databases were searched: Scopus, Medline, CINAHL Plus, PsycINFO, Academic Search Premier, Cochrane Library, Trove, Indigenous Health infonet and Grey Lit.org . Articles in English, reporting original data on adherence to long-term, self-administered medicines in Australia's Indigenous populations were included. Data were extracted into a standard template and a quality assessment was undertaken. Forty-seven articles met inclusion criteria. Varied study methodologies prevented the use of meta-analysis. health professionals believe adherence is a significant problem for Indigenous Australians; however, adherence rates are rarely measured. Health professionals and patients often reported the same barriers and facilitators, providing a framework for improvement. There is no evidence that medication adherence amongst Indigenous Australians is lower than for the general population. Nevertheless, the heavy burden of morbidity and mortality faced by Indigenous Australians with chronic conditions could be alleviated by enhancing medication adherence. Some evidence supports strategies to improve adherence, including the use of dose administration aids. This evidence should be used by clinicians when prescribing, and to implement and evaluate programs using standard measures to quantify adherence, to drive improvement in health outcomes.

  19. Associations between patients' risk attitude and their adherence to statin treatment

    DEFF Research Database (Denmark)

    Barfoed, Benedicte Lind; Paulsen, Maja Skov; Christensen, Palle Mark

    2016-01-01

    BACKGROUND: Poor adherence to medical treatment may have considerable consequences for the patients' health and for healthcare costs to society. The need to understand the determinants for poor adherence has motivated several studies on socio-demographics and comorbidity. Few studies focus......-based study on a sample of 6393 persons of the general. Danish population aged 20-79. Data on risk attitude were based on 4 items uncovering health-related as well as financial dimensions of risk attitude. They were collected through a web-based questionnaire and combined with register data on redeemed statin...... the risk-averse patients, OR 0.80 (95 %-CI 0.68-0.95) and OR 0.83 (95 %-CI 0.71-0.98), respectively. No significant association was found between adherence and financial risk attitude. Further, patients in the youngest age group and patients with no CVD were less adherent to statin treatment. CONCLUSION...

  20. Medical mistrust is related to lower longitudinal medication adherence among African-American males with HIV

    Science.gov (United States)

    Dale, Sannisha K; Bogart, Laura M; Wagner, Glenn J; Galvan, Frank H; Klein, David J

    2014-01-01

    African-Americans living with HIV show worse health behaviors (e.g. medication adherence) and outcomes (e.g. viral suppression) than do their White counterparts. In a 6-month longitudinal study, we investigated whether medical mistrust among African-American males with HIV (214 enrolled, 140 with longitudinal data) predicted lower electronically monitored antiretroviral medication adherence. General medical mistrust (e.g. suspicion towards providers), but not racism-related mistrust (e.g. belief that providers treat African-Americans poorly due to race), predicted lower continuous medication adherence over time (b=−.08, se=.04, p=.03). Medical mistrust may contribute to poor health outcomes. Intervention efforts that address mistrust may improve adherence among African-Americans with HIV. PMID:25293970

  1. Effectiveness of a focused, brief psychoeducation program for parents of ADHD children: improvement of medication adherence and symptoms

    Directory of Open Access Journals (Sweden)

    Bai GN

    2015-10-01

    Full Text Available Guan-nan Bai,1 Yu-feng Wang,2,3 Li Yang,2,3 Wen-yi Niu1 1Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, People’s Republic of China; 2Peking University Sixth Hospital/Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health, Beijing, People’s Republic of China; 3National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, People’s Republic of China Objective: To evaluate the efficacy of a psychoeducation program for parents of children with ADHD in enhancing adherence to pharmacological treatment and improving clinical symptoms. Methods: We developed a psychoeducation program based on the theory of planned behavior (TPB. Eighty-nine children with ADHD were cluster randomly assigned for their families to receive 3 months of well-structured psychoeducation (intervention group, n=44 or only general clinical counseling (control group, n=45. Parents in the intervention group were given an expert lecture (with slides and a parent manual, attended two expert-guided parent group sessions, and were invited to join a professional-guided online community. Measurement of parents’ knowledge about ADHD, components of the TPB model, and child ADHD symptoms were taken before and after intervention. Medication adherence was assessed thoroughly at the end of the first and third months. Satisfaction with the psychoeducation program was assessed only in the intervention group. Two-independent-samples t-test, ANOVA, and chi-square test were employed to compare differences between groups. Results: Compared to the control group, medication adherence in the intervention group was significantly higher after 1 and 3 months (97.7% intervention vs 75.6% control, P=0.002, and 86.4% intervention vs 53.3% control, P=0.001, respectively. Accordingly, the ADHD rating scale scores were lower in the intervention group than the control group after

  2. Assessing educational priorities in genetics for general practitioners and specialists in five countries: factor structure of the Genetic-Educational Priorities (Gen-EP) scale.

    NARCIS (Netherlands)

    Calefato, J.M.; Nippert, I.; Harris, H.J.; Kristoffersson, U.; Schmidtke, J.; Kate, L.P. ten; Anionwu, E.; Benjamin, C.; Challen, K.; Plass, A.M.; Harris, R.; Julian-Reynier, C.

    2008-01-01

    Purpose: A scale assessing primary care physicians' priorities for genetic education (The Gen-EP scale) was developed and tested in five European countries. The objective of this study was to determine its factor structure, to test scaling assumptions and to determine internal consistency. Methods:

  3. Age span challenges: adherence in pediatric oncology.

    Science.gov (United States)

    Landier, Wendy

    2011-05-01

    To review published literature to determine what is known about adherence to oral antineoplastic agents in children with cancer, to identify adherence-related challenges, and to examine the implications of these challenges for clinical practice. Published literature identified through the MEDLINE, CINAHL, and PsycINFO databases. Oral antineoplastic agents are frequently used in childhood cancer treatment; supportive care regimens for children with cancer also rely heavily on the administration of oral medications. Adherence in pediatric oncology is a complex process involving both parent and child, and requires knowledge and understanding of proper and safe home medication administration in the context of multiple developmental and behavioral concerns that may change over time. Nurses play an important role in adherence by providing patient and family education and psychosocial support targeted to the child's diagnosis, developmental stage, and specifics of the child's treatment regimen. Copyright © 2011 Elsevier Inc. All rights reserved.

  4. An evaluation of the impact of memory and mood on antiepileptic drug adherence.

    Science.gov (United States)

    McAuley, James W; Passen, Nina; Prusa, Christine; Dixon, Joanne; Cotterman-Hart, Sheri; Shneker, Bassel F

    2015-02-01

    Antiepileptic drugs are the mainstay of treatment for patients with epilepsy. Adherence to the prescribed regimen is a major factor in achieving a reduced seizure burden, which can decrease morbidity and mortality. Patients with epilepsy oftentimes complain about difficulty with memory. Because little is known about the relationship between memory and mood and adherence, the purpose of this project was to determine the impact of the confounding factors of memory and mood on antiepileptic drug adherence in patients with epilepsy. One hundred adult patients with epilepsy were recruited from the outpatient neurology clinic for this cross-sectional study. Patients who met the inclusion criteria completed measures of subjective memory (subset of 6 memory questions from the QOLIE-89) and objective memory (Hopkins Verbal Learning Test - Revised), subjective adherence (Morisky scale) and objective adherence (medication possession ratio), and mood (Neurological Disorders Depression Inventory for Epilepsy). Refill records from each patient's community pharmacy were used to objectively assess adherence. Medication possession ratios were calculated based on the antiepileptic drug refill records over the previous 6months. Patients were considered adherent if their MPR was >80%. Women made up the majority of the sample (n=59), and, on average, patients had been living with epilepsy for nearly 20years. Approximately 40% of the sample were on antiepileptic drug monotherapy; most patients (>70%) took their antiepileptic drugs twice daily, and the mean number of total medications was 4.25±2.98. Based on the objective measure of adherence, 35% of the patients were nonadherent. Patients self-reported better adherence than what was objectively measured. Only the retention metric of the objective memory measure differentiated adherent patients from nonadherent patients. Patients in the adherent group had significantly lower depression scores (indicating better mood) compared with those

  5. Namibian prisoners describe barriers to HIV antiretroviral therapy adherence.

    Science.gov (United States)

    Shalihu, Nauyele; Pretorius, Louise; van Dyk, Agnes; Vander Stoep, Ann; Hagopian, Amy

    2014-01-01

    Little is available in scholarly literature about how HIV-positive prisoners, especially in low-income countries, access antiretroviral therapy (ART) medication. We interviewed 18 prisoners at a large prison in Namibia to identify barriers to medication adherence. The lead nurse researcher was a long-standing clinic employee at the prison, which afforded her access to the population. We identified six significant barriers to adherence, including (1) the desire for privacy and anonymity in a setting where HIV is strongly stigmatized; (2) the lack of simple supports for adherence, such as availability of clocks; (3) insufficient access to food to support the toll on the body of ingesting taxing ART medications; (4) commodification of ART medication; (5) the brutality and despair in the prison setting, generally leading to discouragement and a lack of motivation to strive for optimum health; and (6) the lack of understanding about HIV, how it is transmitted, and how it is best managed. Because most prisoners eventually transition back to communitysettings when their sentences are served, investments in prison health represent important investments in public health.

  6. Non-communicable diseases and adherence to Mediterranean diet.

    Science.gov (United States)

    Caretto, Antonio; Lagattolla, Valeria

    2015-01-01

    Non-communicable diseases (NCDs) also known as chronic diseases last for a long time and progress generally slow. Major non-communicable diseases are cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. Unhealthy lifestyles and food behaviours play an important role for determining such diseases. The change in unhealthy behaviours or the maintenance of healthy lifestyles has enormous value in the reduction of diseases and longer life expectancy not only on an individual level but for the community as a whole. Recent meta-analyses reported Mediterranean diet to be an optimal diet when adopted as a whole, in order to preserve and maintain a good health status. A greater adherence score to the Mediterranean diet (2-point increase) was related to induce an 8% reduction in overall mortality, a 10% reduced risk of CVD and a 4% reduction in neoplastic diseases. However, there is no direct method in quantifying and evaluating adherence, therefore a large number of indirect indices in several studies have been proposed, with a last unifying score. Recently more and more e-health techniques such as web communication or desktop publishing (DVDs and so on) are being used, obtaining good results in the Mediterranean diet adherence. For successfully changing the unhealthy lifestyles and food behaviours of the population, interventions at all levels are needed with the cooperation of Institutions, mass media, agricultural and food industry and healthcare professionals guided by expert scientific societies.

  7. Strategies to improve adherence to medications for cardiovascular diseases in socioeconomically disadvantaged populations: a systematic review.

    Science.gov (United States)

    Laba, Tracey-Lea; Bleasel, Jonathan; Brien, Jo-Anne; Cass, Alan; Howard, Kirsten; Peiris, David; Redfern, Julie; Salam, Abdul; Usherwood, Tim; Jan, Stephen

    2013-09-10

    Medication non-adherence poses a major barrier to reducing cardiovascular disease (CVD) burden globally, and is increasingly recognised as a socioeconomically determined problem. Strategies promoting CVD medication adherence appear of moderate effectiveness and cost-effectiveness. Potentially, 'one-size-fits-all' measures are ill-equipped to address heterogeneous adherence behaviour between social groups. This review aims to determine the effects of strategies to improve adherence to CVD-related medications in socioeconomically disadvantaged groups. Randomised/quasi-randomised controlled trials (1996-June 2012, English), testing strategies to increase adherence to CVD-related medications prescribed to adult patients who may experience health inequity (place of residence, occupation, education, or socioeconomic position) were reviewed. 772 abstracts were screened, 111 full-text articles retrieved, and 16 full-text articles reporting on 14 studies, involving 7739 patients (age range 41-66 years), were included. Methodological and clinical heterogeneity precluded quantitative data synthesis. Studies were thematically grouped by targeted outcomes; underlying interventions and policies were classified using Michie et al.'s Behaviour Change Wheel. Contrasting with patient or physician/practice strategies, those simultaneously directed at patients and physicians/practices resulted in statistically significant improvements in relative adherence (16-169%). Comparative cost and cost-effectiveness analyses from three studies did not find cost-saving or cost-effective strategies. Unlike much current evidence in general populations, promising evidence exists about what strategies improve adherence in disadvantaged groups. These strategies were generally complex: simultaneously targeting patients and physicians; addressing social, financial, and treatment-related adherence barriers; and supported by broader guidelines, regulatory and communication-based policies. Given their

  8. The Patient's Perspective: Adherence or Non-adherence to Asthma Controller Therapy?

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli; Backer, V; Soes-Petersen, U

    2006-01-01

    STUDY OBJECTIVE: Adherence with controller therapy poses a major challenge to the effective management of persistent asthma. The aim of this study was to explore the patient-related aspects of adherence among adult asthmatics. DESIGN AND PARTICIPANTS: The participants (n = 509 adult asthmatics...... that controller therapy is effective (p controller therapy is common among adult asthmatics. The reasons for suboptimal adherence seem to be accessible through education of both...

  9. Bacterial adherence to polymethylmethacrylate posterior chamber IOLs

    Directory of Open Access Journals (Sweden)

    Tyagi Shalini

    2001-01-01

    Full Text Available Purpose: Bacterial adherence to intraocular lenses (IOLs has been incriminated in the pathogenesis of postoperative endophthalmitis. Staphylococcus epidermidis is the most common organism isolated. We studied the in-vitro adhesion of Staphylococcus epidermidis to Polymethylmethacrylate (PMMA IOLs and the effect of duration of exposure to adherence. Methods: Two groups of 10 IOLs each were incubated in Staphylococcus epidermidis suspension for 2 minutes and 20 minutes respectively. Adhesion of bacterial cells was determined by counting the number of viable bacteria attached to IOLs. Results: The mean bacterial adherence with 2 minutes incubation was 12,889 ± 7,150 bacteria / IOL and with 20 minutes incubation was 84,226 ± 35,024 bacteria/IOL (P< 0.01. Conclusion: Our results show that Staphylococcus epidermidis adheres to PMMA IOLs in vitro and the degree of adherence is less for shorter duration of exposure. We conclude that viable bacteria irreversibly adherent to IOLs may play a role in the pathogenesis of postoperative endophthalmitis. Shorter duration of operative manipulation and exposure to contaminating sources may decrease the chances of postoperative endophthalmitis.

  10. Developing a Measure of Therapist Adherence to Contingency Management: An Application of the Many-Facet Rasch Model.

    Science.gov (United States)

    Chapman, Jason E; Sheidow, Ashli J; Henggeler, Scott W; Halliday-Boykins, Colleen; Cunningham, Phillippe B

    2008-06-01

    A unique application of the Many-Facet Rasch Model (MFRM) is introduced as the preferred method for evaluating the psychometric properties of a measure of therapist adherence to Contingency Management (CM) treatment of adolescent substance use. The utility of psychometric methods based in Classical Test Theory was limited by complexities of the data, including: (a) ratings provided by multiple informants (i.e., youth, caregivers, and therapists), (b) data from separate research studies, (c) repeated measurements, (d) multiple versions of the questionnaire, and (e) missing data. Two dimensions of CM adherence were supported: adherence to Cognitive Behavioral components and adherence to Monitoring components. The rating scale performed differently for items in these subscales, and of 11 items evaluated, eight were found to perform well. The MFRM is presented as a highly flexible approach that can be used to overcome the limitations of traditional methods in the development of adherence measures for evidence-based practices.

  11. Psychometric properties of scales in the General Nordic Questionnaire for Psychological and Social Factors at Work (QPS): confirmatory factor analysis and prediction of certified long-term sickness absence.

    Science.gov (United States)

    Wännström, Ingrid; Peterson, Ulla; Asberg, Marie; Nygren, Ake; Gustavsson, J Petter

    2009-06-01

    Psychometric properties, particularly predictive validity, of scales in the General Nordic Questionnaire for Psychological and Social Factors at Work (QPS(Nordic)) were assessed. The analysis is confined to the scales in the QPS(Nordic,) and 24 of the 26 scales are included. A large group of Swedish county council employees (n= 3,976; response rate = 65%) participated in a study and were given the QPS(Nordic). Register data for long-term sick leave (>90 days), with diagnosis, were used for predictive analysis. The following main results were obtained: Reliability was generally satisfactory, confirmatory factor analysis indicated good fit, concurrent validity was good, some less often investigated organizational variables predicted sickness absence, and scales were differentially associated with absence due to psychiatric and musculoskeletal disorders. In conclusion, the psychometric testing of the QPS(Nordic) so far suggests that it is a good instrument for assessing health-related factors at work.

  12. Green-house gas mitigation capacity of a small scale rural biogas plant calculations for Bangladesh through a general life cycle assessment.

    Science.gov (United States)

    Rahman, Khondokar M; Melville, Lynsey; Fulford, David; Huq, Sm Imamul

    2017-10-01

    Calculations towards determining the greenhouse gas mitigation capacity of a small-scale biogas plant (3.2 m 3 plant) using cow dung in Bangladesh are presented. A general life cycle assessment was used, evaluating key parameters (biogas, methane, construction materials and feedstock demands) to determine the net environmental impact. The global warming potential saving through the use of biogas as a cooking fuel is reduced from 0.40 kg CO 2 equivalent to 0.064 kg CO 2 equivalent per kilogram of dung. Biomethane used for cooking can contribute towards mitigation of global warming. Prior to utilisation of the global warming potential of methane (from 3.2 m 3 biogas plant), the global warming potential is 13 t of carbon dioxide equivalent. This reduced to 2 t as a result of complete combustion of methane. The global warming potential saving of a bioenergy plant across a 20-year life cycle is 217 t of carbon dioxide equivalent, which is 11 t per year. The global warming potential of the resultant digestate is zero and from construction materials is less than 1% of total global warming potential. When the biogas is used as a fuel for cooking, the global warming potential will reduce by 83% compare with the traditional wood biomass cooking system. The total 80 MJ of energy that can be produced from a 3.2 m 3 anaerobic digestion plant would replace 1.9 t of fuel wood or 632 kg of kerosene currently used annually in Bangladesh. The digestate can also be used as a nutrient rich fertiliser substituting more costly inorganic fertilisers, with no global warming potential impact.

  13. Perspectives on adherence and simplicity for HIV-infected patients on antiretroviral therapy: self-report of the relative importance of multiple attributes of highly active antiretroviral therapy (HAART) regimens in predicting adherence.

    Science.gov (United States)

    Stone, Valerie E; Jordan, Jamie; Tolson, Jerry; Miller, Robert; Pilon, Tom

    2004-07-01

    Adherence to highly active antiretroviral therapy (HAART) of 95% or greater seems to be required for successful treatment of HIV/AIDS. Efforts to simplify regimens to improve adherence are ongoing, including the advent of once-daily (QD) dosing regimens, which are presumed to be beneficial, although data regarding their overall impact on adherence are not yet available. To assess patient perceptions of the impact on adherence of 10 attributes of HAART, including QD dosing, and to compare 7 actual regimens based on patients' perceptions of their likelihood to promote adherence. Two hundred ninety-nine highly treatment-experienced patients with HIV/AIDS completed a questionnaire that evaluated perceptions of the impact on adherence of 10 HAART regimen attributes using a modified adaptive conjoint analysis. Patients' perceptions of the likelihood that they would adhere to 7 actual HAART regimens were scored on Likert scales. : Pill count, dosing frequency, and adverse events had the greatest impact on patients' perceived ability to adhere to antiretroviral medication regimens. QD was the preferred dosing frequency, but QD dosing regimens did not score better than other regimens. Among actual regimens, predicted adherence was highest for a twice-daily (BID) regimen with 2 pills daily, no dietary restrictions, and 1 prescription and copayment and lowest for a BID regimen with 13 pills daily, food requirements, and 3 prescriptions and copayments. All HAART regimen attributes studied were perceived to have an impact on adherence, but pill count, dosing frequency, and adverse events had the greatest perceived impact. These data are of potential importance to clinicians as they seek to structure HAART regimens to which their patients are most likely to adhere.

  14. Adherence: a review of education, research, practice, and policy in the United States

    Directory of Open Access Journals (Sweden)

    Brown TA

    2010-03-01

    Full Text Available Objective: To describe the education, research, practice, and policy related to pharmacist interventions to improve medication adherence in community settings in the United States.Methods: Authors used MEDLINE and International Pharmaceutical Abstracts (since 1990 to identify community and ambulatory pharmacy intervention studies which aimed to improve medication adherence. The authors also searched the primary literature using Ovid to identify studies related to the pharmacy teaching of medication adherence. The bibliographies of relevant studies were reviewed in order to identify additional literature. We searched the tables of content of three US pharmacy education journals and reviewed the American Association of Colleges of Pharmacy website for materials on teaching adherence principles. Policies related to medication adherence were identified based on what was commonly known to the authors from professional experience, attendance at professional meetings, and pharmacy journals.Results: Research and Practice: 29 studies were identified: 18 randomized controlled trials; 3 prospective cohort studies; 2 retrospective cohort studies; 5 case-controlled studies; and one other study. There was considerable variability in types of interventions and use of adherence measures. Many of the interventions were completed by pharmacists with advanced clinical backgrounds and not typical of pharmacists in community settings. The positive intervention effects had either decreased or not been sustained after interventions were removed. Although not formally assessed, in general, the average community pharmacy did not routinely assess and/or intervene on medication