Condition-related Factors Research Articles

Risk Factors for Non-Adherence to Medication for Liver Transplant Patients: An Umbrella Review.

Background/Objectives: Liver Transplantation (LT) is the second most common solid organ transplantation. Medication adherence on LT patients is key to avoiding graft failure, mortality, and important quality of life losses. The aim of this study is to identify risk-factors for non-adherence to treatment of liver transplant patients according to reliable published evidence. Methods: An umbrella review within the context of adherence to immunosuppressant medication of LT patients, was conducted. The review was performed in accordance with the principles of the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Results: A total of 11 articles were finally included for the review. Non-adherence factors were identified and allocated using the WHO classification of factors for non-adherence. Each of these groups contains a subset of factors that have been shown to influence adherence to medication, directly or indirectly, according to literature findings. Conclusions: The results of the review indicate that sociodemographic factors, factors related to the patient, factors related to the treatment, condition-related and health system-related factors are good categories of predictors for both adherence and non-adherence to immunosuppressive medication in LT patients. This list of factors may help physicians in the treating and recognizing of patients with a potential risk of non-adherence and it could help in the designing of new tools to better understand non-adherence after LT and targeted interventions to promote adherence of LT patients.

Assessment of nutritional status - related factors among students at Cuu Long University, Vietnam

Nutrition is the most important factor for humans to survive, to grow, and to be active. Nutritional care for the community is a key to health for each age group. It has rarely been found studies on nutritional status among university students in the Mekong Delta, Vietnam. This study aims to assess the nutritional status-related factors among students at Cuu Long University. Being a cross sectional research study, the subjects of the study consisted of 329 students in 6 majors. They were recruited using a systematic and multistage sampling technique. Face-to-face interviews and data collection were conducted through a questionnaire. Nutritional status was measured based on BMI. Minitab 20 was used to describe and analyze the data. The chi-square test was used at p = 0.05. The findings showed that the percentage of students with nutritional status according to BMI CED level (Chronic Energy Deficiency) – thin was 24.32% with CED grade 1 was 14.29% and CED grade 2 was 7.29% and CED grade 3 was 2.74%; the percentage of students with nutritional status according to BMI level of overweight - Obesity was 13.98%, of which obesity was 3.04% with obesity grade 1 was 2.43% and obesity grade 2 was 0.61%. The findings also showed that students’ majors, gender, sleep duration, and playing sports were four factors associated with the students’ nutritional status. Appropriate measures should be taken to improve the nutritional status of students.

A Systematic Review and Classification of Factors Influencing Diabetic Foot Ulcer Treatment Adherence, in Accordance With the WHO Dimensions of Adherence to Long-Term Therapies.

Effective treatment of diabetic foot ulcers (DFUs) involves a multidisciplinary treatment plan to promote wound healing and prevent complications. Given the lack of consensus data on the factors affecting patient adherence, a systematic review was performed to identify and classify factors according to the WHO Dimensions of Adherence to Long-Term Therapies. Six hundred and forty-three articles from PubMed, Embase, and Scopus were reviewed. The inclusion criteria included qualitative and quantitative studies which discussed factors affecting patient adherence to DFU treatment, had study populations that comprised patients with either prior history of or existing DFU, and had either prior history of DFU treatment or were currently receiving treatment. Factors, and associated measures of adherence, were extracted and organized according to the WHO Dimensions of Adherence to Long-Term Therapies. Seven quantitative and eight qualitative studies were included. Eleven patient-related factors, seven condition-related factors, three therapy-related factors, five socioeconomic factors, and five health system-related factors were investigated by the included studies. The largest proportion of factors studied was patient-related, such as patient insight on DFU treatment, patient motivation, and patient perception of DFU treatment. There was notable overlap in the range of discussed factors across various domains, in the socioeconomic (including social support, income, social and cultural acceptability of DFU therapy, cost) and therapy-related domains (including duration of treatment, offloading footwear, and reminder devices). Different studies found that specific factors, such as gender and patients having a low internal locus of control, had differing effects on adherence on different cohorts. Current literature presents heterogeneous findings regarding factors affecting patient adherence. It would be useful for future studies to categorize factors as such to provide more comprehensive understanding and personalized care to patients. Further research can be done to explore how significant factors can be addressed universally across different cohort populations in different cultural and socioeconomic contexts.

Identifying determinants of adherence to adjuvant endocrine therapy following breast cancer: A systematic review of reviews.

In oestrogen-receptor positive breast cancer, daily oral adjuvant endocrine therapy (ET) for at least 5 years significantly reduces risks of recurrence and breast cancer-specific mortality. However, many women are poorly adherent to ET. Development of effective adherence support requires comprehensive understanding of influences on adherence. We undertook an umbrella review to identify determinants of ET adherence. We searched PubMed, Embase, CINAHL, PsycINFO, Cochrane and PROSPERO (inception to 08/2022) to identify systematic reviews on factors influencing ET adherence. Abstracted determinants were mapped to the World Health Organization's dimensions of adherence. Reviews were quality appraised and overlap assessed. Of 5732 citations screened, 17 reviews were eligible (9 quantitative primary studies; 4 qualitative primary studies; 4 qualitative or quantitative studies) including 215 primary papers. All five WHO dimensions influenced ET non-adherence: The most consistently identified non-adherence determinants were patient-related factors (e.g. lower perceived ET necessity, more treatment concerns, perceptions of ET 'cons' vs. 'pros'). Healthcare system/healthcare professional-related factors (e.g. perceived lower quality health professional interaction/relationship) were also important and, to a somewhat lesser extent, socio-economic factors (e.g. lower levels of social/economic/material support). Evidence was more mixed for medication-related and condition-related factors, but several may be relevant (e.g. experiencing side-effects, cost). Potentially modifiable factors are more influential than non-modifiable/fixed factors (e.g. patient characteristics). The evidence-base on ET adherence determinants is extensive. Future empirical studies should focus on less well-researched areas and settings. The determinants themselves are numerous and complex in indicating that adherence support should be multifaceted, addressing multiple determinants.

Development and validation of a structured questionnaire for assessing risk factors of medication non-adherence among pulmonary tuberculosis patients in Indonesia.

Background: Medication non-adherence is a significant concern in tuberculosis (TB) treatment, requiring a precise understanding of the associated risk factors. However, there is a lack of appropriate means to assess the risk factors among TB patients in Indonesia, leading to the development and validation of a structured questionnaire for this purpose. Method: This study unfolded in two distinct phases, namely, the first included questionnaire construction through framework development, item generation, item screening, and pretesting (in 50 patients). The second comprised questionnaire validation with 346 participants using confirmatory factor analysis (CFA) and structural equation modeling-partial least squares (SEM-PLS). Additionally, reliability testing was conducted using Cronbach's alpha and composite reliability statistical techniques. Results: In the development phase, 168 items were defined, consisting of sociodemographic characteristics (8 items) and risk factors for medication non-adherence (160 items). Expert evaluation reduced the number of items to 60, which decreased to 22 after performing a pilot study. Subsequent SEM-PLS modeling resulted in the identification of 14 valid items, representing five major risk factors, namely, socioeconomics (4 items), healthcare team (4 items), condition (3 items), therapy (2 items), and patient (1 item). Only condition-related factors were found to influence non-adherence, and all constructs showed good reliability based on Cronbach's alpha (>0.6) and composite reliability (0.7) values. Conclusion: The final 22 items that emerged from this rigorous process indicated a valid and robust questionnaire for assessing risk factors of medication non-adherence among pulmonary tuberculosis patients in Indonesia. The developed questionnaire was positioned to be a valuable tool for healthcare professionals, policymakers, and scientists in creating patient-centered strategies and interventions to address non-adherence.

Lifestyle and Physical Condition related factors of Depression among Middle-aged and Older people

This paper offers a general review of the current studies on factors that can contribute to depression as applied to middle-aged and aged adults. With the aging trend of the whole world population, middle-aged and elderly adults’ mental health becomes an issue that needs to concern. The diversity of the factors is notable, which means people can prevent depression in several different ways. This paper mainly divided the factors into two parts: lifestyle-related factors and physical condition-related factors. Additionally, lifestyle factors include social isolation (SI), ambient temperature, and smoking. The factors that are related to lifestyle are complex and involve chronic disease, sleep duration, obesity, and muscle strength. SI and smoking positively relate with depression. A negative relationship has been found between depression and ambient temperature. Chronic disease and obesity have a positive relationship with depression. Short-term sleep has a significant effect on depression. Muscle strength negatively relates to depression. Overall, this paper highlights the different factors that are related to depression for people in midlife and aged adults.

Self-care behaviors and associated factors among individuals with type 2 diabetes in Ghana: a systematic review

BackgroundSelf-care remains an effective model for diabetes management and care in low-and-middle-income countries due to the limited resources available for the clinical management of the disease and its complications This study examined adherence to self-care behaviors and associated factors among people with type 2 diabetes in Ghana.MethodsPubMed, PsycINFO, Scopus, Web of Science, Embase and Google scholar were used to identify quantitative observational studies published between 1990 and September 30, 2023. Studies exclusive to persons with type 2 diabetes ≥ 18 years of age in a Ghanaian setting were included in this review. Findings of primary studies were analyzed using narrative synthesis.ResultsTwelve studies, presenting data on a total of 2,671 persons with type 2 diabetes, were included. All the studies were published in the last decade (2015–2022) and a majority of them were from the Greater Accra Region. The mean number of days (per week) participants adhered to a self-care behavior were in the ranges of 3.9–4.4 for diet, 4.2–4.8 for physical activity, 0.5–2.2 for self-monitoring of blood glucose (SMBG), and 2.9–5.0 for foot care. Adherence rates for medication were in the range of 33.5–84.5%. Patient-related factors, sociodemographic/economic-related factors, condition-related factors, and healthcare system-related factors were associated with various self-care behaviors.ConclusionAdherence to self-care behaviors among persons with type 2 diabetes in Ghana remains an ongoing challenge with significant variations in adherence among patients with different characteristics.

Facilitators and barriers to adherence to medical recommendations among adolescents with cancer: A systematic review.

We aimed to systematically review barriers/facilitators of adherence among adolescents with cancer (aged 10-24years), following a comprehensive approach to adherence that goes beyond medication-taking. Empirical studies published in English exploring determinants of adherence to medical recommendations among adolescents with cancer were identified in MEDLINE, PsycInfo, and Web of Science, up to October 2021. Records and full-text articles were reviewed by two independent reviewers, and results were classified according to the World Health Organization's (WHO) multidimensional adherence model. Eighteen studies were included. Despite heterogeneity in the definition and measurement of adherence, literature supported barriers/facilitators at patient, treatment, condition, healthcare team/system, and social/economic levels. Specifically, patient-related factors (i.e., psychological functioning and beliefs about disease and treatment) and social-related factors (i.e., family functioning) were major determinants of adolescent adherence. Few studies were conducted, and inconsistent findings were displayed for other dimensions (i.e., healthcare team/system, treatment, and condition-related factors). Adherence is a complex and multidetermined phenomenon. More research is needed to provide critical insights for policymakers and healthcare professionals in planning practices and interventions that effectively address meaningful barriers/facilitators of adolescents' adherence.

Cross-sectional analysis of factors associated with medication adherence in western Kenya

ObjectivesPoor medication adherence in low-income and middle-income countries is a major cause of suboptimal hypertension and diabetes control. We aimed to identify key factors associated with medication adherence in western...

Development and Validation of a Prediction Tool for Reoffending Risk in Domestic Violence.

Current risk assessment tools for domestic violence against family members were developed with small and selected samples, have low accuracy with few external validations, and do not report key performance measures. To develop new tools to assess risk of reoffending among individuals who have perpetrated domestic violence. This prognostic study investigated a national cohort of all individuals arrested for domestic violence between 1998 and 2013 in Sweden using information from multiple national registers, including National Crime Register, National Patient Register, Longitudinal Integrated Database for Health Insurance and Labour Market Studies Register, and Multi-Generation Register. Data were analyzed from August 2022 to June 2023. Arrest for domestic violence. Prediction models were developed for 3 reoffending outcomes after arrest for domestic violence: conviction of a new violent crime (including domestic violence), conviction of any new crime, and rearrest for domestic violence at 1 year, 3 years, and 5 years. The prediction models were created using sociodemographic factors, criminological factors, and mental health status-related factors, linking data from multiple population-based longitudinal registers. Cox proportional hazard multivariable regression was used to develop prediction models and validate them in external samples. Key performance measures, including discrimination at prespecified cutoffs and calibration statistics, were investigated. The cohort included 27 456 individuals (mean [SD] age, 39.4 [11.6] years; 24 804 men [90.3%]) arrested for domestic violence, of whom 4222 (15.4%) reoffended and were convicted for a new violent crime during a mean (SD) follow-up of 26.5 (27.0) months, 9010 (32.8%) reoffended and were convicted for a new crime (mean [SD] follow-up, 22.4 [25.1] months), and 2080 (7.6%) were rearrested for domestic violence (mean [SD] follow-up, 25.7 [30.6] months). Prediction models were developed with sociodemographic, criminological, and mental health factors and showed good measures of discrimination and calibration for violent reoffending and any reoffending. The area under the receiver operating characteristic curve (AUC) for risk of violent reoffending was 0.75 (95% CI, 0.74-0.76) at 1 year, 0.76 (95% CI, 0.75-0.77) at 3 years, and 0.76 (95% CI, 0.75-0.77) 5 years. The AUC for risk of any reoffending was 0.76 (95% CI, 0.75-0.77) at 1 year and at 3 years and 0.76 (95% CI, 0.75-0.76) at 5 years. The model for domestic violence reoffending showed modest discrimination (C index, 0.63; 95% CI, 0.61-0.65) and good calibration. The validation models showed discrimination and calibration performance similar to those of derivation models for all 3 reoffending outcomes. The prediction models have been translated into 3 simple online risk calculators that are freely available to use. This prognostic study developed scalable, evidence-based prediction tools that could support decision-making in criminal justice systems, particularly at the arrest stage when identifying those at higher risk of reoffending and screening out individuals at low risk of reoffending. Furthermore, these tools can enhance treatment allocation by enabling criminal justice services to focus on modifiable risk factors identified in the tools for individuals at high risk of reoffending.

Threatening men, threatened women and vice versa: Job and status-related risk factors for experiencing sexual harassment in the media and cultural sectors

ABSTRACT Using an extensive survey filled out by 2023 people working in the media and cultural sectors of Flanders, we analyse how job and status-related factors influence the likelihood of experiencing different types of sexual harassment in the media and cultural sector and how the effects may differ for male and female workers. We differentiate between three types of workplace-related sexual harassment: sexual communication, infantilization and physical advances. First, we look at two factors related to working in the media and cultural sector. A competitive work environment increases the likelihood of experiencing sexual harassment for both men and women. Doing artistic work has a small but significant effect on infantilization for women. Second, we use Blumer’s group position model to understand how awareness of unequal career opportunities for women in the cultural and media industries influences the experience of sexual harassment. Women who perceive unequal career opportunities experience more sexual harassment; this is not the case for men. Having more professional recognition decreases the likelihood of experiencing sexual harassment for men but not for women, which is also in line with the group position model.

Medication adherence trajectory of patients with chronic diseases and its influencing factors: A systematic review.

To synthesize the published studies on medication adherence trajectories among patients with chronic diseases and identify the influencing factors. Systematic review. Medline (Ovid), Embase (Ovid) and Web of Science core collection were searched from database inception to 1 July 2022. Potentially eligible articles were independently screened by three reviewers using set inclusion and exclusion criteria. The Joanna Briggs Institute critical appraisal checklist for cohort studies was used to appraise the quality of the included articles. Three reviewers independently evaluated the quality, extracted data and resolved differences by consensus. Results were presented using descriptive synthesis, and the prevalence of recategorised medication adherence trajectories was calculated from the published data. Fifty studies were included. Medication adherence trajectories among patients with chronic diseases were synthesized into six categories: adherence, non-adherence, decreasing adherence, increasing adherence, fluctuating adherence and moderate adherence. Low and moderate evidence showed that (1) patient-related factors, including age, sex, race, marital status and mental status; (2) healthcare team and system-related factors, including healthcare utilization, insurance and primary prescriber specialty; (3) socioeconomic factors including education, income and employment status; (4) condition-related factors including complications and comorbidities and (5) therapy-related factors including the number of medications, use of other medications, and prior medication adherence behaviours were factors influencing the medication adherence trajectory. Marital status and prior medication adherence behaviour were the only influencing factors with moderate evidence of an effect. The medication adherence trajectory among patients with chronic diseases varied widely. Further studies are warranted to determine contributory factors. Healthcare providers should be aware that patients' medication adherence has different trajectories and should take appropriate measures to improve patients' medication adherence patterns. None. As a systematic review, patients and the public were not involved.

Practices, beliefs, and attitudes of clinicians in prescribing direct oral anticoagulants for obese adults with atrial fibrillation: a qualitative study.

Atrial fibrillation (AF) and obesity affect over 60 and 650 million people, respectively. This study aimed to explore clinician practices, beliefs, and attitudes towards the use of direct oral anticoagulants (DOACs) in obese adults (BMI ≥ 30kg/m2) with AF. Semi-structured interviews via video conference were conducted with multidisciplinary clinicians from across Australia, with expertise in DOAC use in adults with AF. Clinicians were invited to participate using purposive and snowball sampling techniques. Data were analysed in NVIVO using thematic analysis. Fifteen clinicians including cardiologists (n = 5), hospital and academic pharmacists (n = 5), general practitioners (n = 2), a haematologist, a neurologist and a clinical pharmacologist participated. Interviews were on average 31 ± 9min. Key themes identified were: Health system factors in decision-making Disparities between rural and metropolitan geographic areas, availability of health services, and time limitations for in-patient decision-making, were described; Condition-related factors in decision-making Clinicians questioned the significance of obesity as part of decision-making due to the practical limitations of dose modification, and the rarity of the extremely obese cohort; Decision-making in the context of uncertainty Clinicians reported limited availability, reliability and awareness of primary evidence including limited guidance from clinical guidelines for DOAC use in obesity. This study highlights the complexity of decision-making for clinicians, due to the limited availability, reliability and awareness of evidence, the intrinsic complexity of the obese cohort and limited guidance from clinical guidelines. This highlights the urgent need for contemporary research to improve the quality of evidence to guide informed shared decision-making.

Predictors of Nonadherence to Planned Coronary Angiography: A Retrospective Analysis

Objective: This study aimed to determine the predictive power of patient-related factors, socio-economic factors, condition-related factors, treatment-related factors, and health care system-related factors for nonadherence to planned coronary angiography (CAG). Material and Methods: A retrospective analysis was conducted on electronic medical records (EMR) of 665 patients appointed for elective CAG at Naradhiwas Rajanagarindra Heart Center from January 2018 to December 2019. One hundred and thirty-three patients with nonadherence to planned CAG were assigned to the study group; the control group consisted of 532 patients with adherence to planned CAG. Results: The retrospective data analysis revealed that divorced or widowed status (OR=3.07; 95% CI 1.54, 6.12), cerebrovascular disease comorbidity (OR=4.37; 95% CI 1.74, 10.96), prescribed diuretics (OR=2.24; 95% CI 1.26, 3.97), CAG wait time three months or longer (OR=3.34; 95% CI 1.46, 7.64) and history of parental cardiovascular disease or death from heart disease (OR=0.12; 95% CI 0.01, 0.95) were co-predictors of nonadherence to planned CAG. Socioeconomic- related factors had no predictive power for planned CAG nonadherence. Conclusion: The findings of this study may contribute to the improvement of nursing service by screening groups at high risk of nonadherence and developing appropriate interventions aimed at increasing adherence to planned CAG as well the rate of positive health outcomes.

Medication adherence and associated factors among psychiatry patients at Asella Referral and Teaching Hospital in Oromia, Ethiopia: Institution based cross sectional study.

Medication adherence is the first and main determinant of treatment success. It is defined by world health organization as "the degree to which the person's behavior corresponds to the agreed recommendations from a health care provider". Non-adherence is a multi-factorial phenomenon that can result from five major interacting factors. These are health team and health system-related factors; patient-related factors; therapy-related factors; socio-economic factors; and condition-related factors. The prevalence of non-adherence in mental illness was found to be 40% to 60% world wide. In developing countries, the magnitude of poor adherence is expected to increase. So this study aimed to assess medication adherence status and its associated factors among psychiatric patients in Asella Referral and Teaching Hospital in Oromia, Ethiopia. An institution-based cross-sectional study was conducted from March 18, 2022 to May 25, 2022, with a total sample of 422 patients. Medication adherence was measured by a modified version of the medication adherence rating scale in the psychiatric setting to determine treatment adherence status, and unstructured questionnaires were assessed by interviewing the patient. Additional data concerning the medication-taking behavior of the patient was collected from caregivers. Bivariate logistic regression was performed to see the association between each explanatory variable and the outcome variable. The odds ratio and 95% confidence interval were used to see the association between treatment adherence and the strength of the link. A total of 395 study participants were interviewed, making a response rate of 93.6%. The prevalence of treatment adherence was 246(62.3%). Medication adherence show high association with lifetime alcohol use [AOR: 3.18, 95% CI:1.31-7.72] compared to those who had no alcohol use histroy, and perceived stigma [AOR (95% CI: 2.31 (1.01-5.31)] compared with those who had no perceived stigma, where as adherence show low association with having slight or superficial insight about illness [AOR (95% CI: 0.25 (0.12-0.53)] compared to those who reported cured off their illness and belief in medication [AOR: 0.36, 95% CI: 0.16-0.81)] compared to those who didn't belief in the medication they are taking. The prevalence of mediation adherence was found to be lower. In this study, factors such as having the slight insight or poor insight about their illness and belief in the medication decreased medication adherence, whereas having an alcohol use history in their lifetime and perceived stigma increased medication adherence. For a better health outcome, awareness creation at an insight level needs to be worked on by psychiatric professionals working on the follow-up psychiatric patients at psychiatry clinic of Assela Referral and Teaching Hospital to enable them to well adhere to their medication.

Emotion Regulation Is Associated with Anxiety, Depression and Stress in Adults with Cerebral Palsy

Emotion regulation difficulties are associated with many neurological conditions and negatively impact daily function. Yet little is known about emotion regulation in adults with cerebral palsy (CP). Our aim was to investigate emotion regulation in adults with CP and its relationship with condition-related and/or socio-demographic factors. In a cross-sectional study of adults with CP, participants completed a survey containing the Difficulties in Emotion Regulation Scale (DERS), Depression Anxiety and Stress Scale-21 (DASS-21), and socio-demographic and condition-related questions. Descriptive statistics, chi-squared and Mann-Whitney tests were performed. Of the 42 adults with CP (x31.5 years, SD13.5) that were tested, 38 had within normal limits DERS total scores; however, a significantly higher proportion of participants experienced elevated scores (i.e., more difficulties with emotion regulation) than would be expected in the general population across five of the six DERs subdomains. Moderate-extremely severe depression and anxiety symptoms were reported by 33% and 60% of participants, respectively. The DERS total scores for participants with elevated depression, anxiety, and stress scores were significantly higher than the DERS totals score for those without elevated depression, anxiety, and stress scores. DERS and DASS-21 scores did not differ significantly by condition-related nor socio-demographic characteristics. In conclusion, emotion regulation difficulties were associated with elevated symptoms of depression and anxiety, which were overrepresented in the adults with CP participating in this study.

Prognostic factors of adherence to home-based exercise therapy in patients with chronic diseases: A systematic review and meta-analysis.

Patients with a chronic disease may have an increased risk of non-adherence to prescribed home-based exercise therapy. We performed a systematic review with the aim to identify variables associated with adherence to home-based exercise therapy in patients with chronic diseases and to grade the quality of evidence for the association between these prognostic factors and adherence. Cohort studies, cross-sectional studies and the experimental arm of randomized trials were identified using a search strategy applied to PubMed, Embase, PsychINFO and CINAHL from inception until August 1, 2022. We included studies with participants ≥18 years with a chronic disease as an indication for home-based exercise therapy and providing data on prognostic factors of adherence to home-based exercise. To structure the data, we categorized the identified prognostic factors into the five WHO-domains; (1) Patient-related, (2) Social/economic, (3) Therapy-related, (4) Condition-related, and (5) Health system factors. Risk of bias was assessed using the Quality in Prognostic Studies (QUIPS) tool. Prognostic factors of adherence were identified and the quality of the evidence between the prognostic factors and adherence were graded using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework for predictor studies. We performed a meta-analysis of the obtained information. A total of 57 studies were included. Within patient-related factors moderate- and high-quality evidence suggested that more self-efficacy, exercise history, motivation and perceived behavioral control predicted higher adherence. Within social-economic factors moderate-quality evidence suggested more education and physical health to be predictive of higher adherence and within condition-related factors moderate- and low-quality evidence suggested that less comorbidities, depression and fatigue predicted higher adherence. For the domains therapy-related and health-system factors there was not enough information to determine the quality evidence of the prognostic factors. These findings might aid the development of future home-based exercise programs as well as the identification of individuals who may require extra support to benefit from prescribed home-based exercise therapy. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=277003, identifier PROSPERO CRD42021277003.

Outcomes for children and adolescents with Juvenile idiopathic arthritis addressed by occupational therapy services in specialist rheumatology clinics in South Africa

Introduction: International guidelines for best practice indicate specialised treatment is required for Juvenile idiopathic arthritis (JIA). While occupational therapy intervention for functional limitations in this chronic condition is conditionally recommended, the extent to which this is provided in public specialist rheumatology clinics in South Africa is unknown. The aim of this study was to determine which needs related to outcomes for occupational performance or functional status, condition-related factors and health-related quality of life, reported by children and adolescents with JIA were addressed by current occupational therapy services. Methods: The study used two descriptive, quantitative studies with limited samples of 37 clients with JIA attending specialist rheumatology clinics and nine occupational therapists who currently provide intervention for clients with JIA. Results: Functional deficits reported by 30–63% of clients with JIA were increased symptoms of active disease and difficulties with school activities. Occupational therapy services addressed condition-related factors and participation in personal management but not many related to the social, educational and psychosocial needs of clients with JIA. Conclusion: Occupational therapy services followed international guidelines but based on the reductionist biomedical model approach used within specialist services in tertiary hospitals, which limit context-based therapy for children and adolescents with JIA in the community.

Barriers and facilitators to maintaining a high level of polypharmacy adherence in people living with HIV: A scoping review.

Objectives: With the prolongation of life span and increasing incidence of comorbidities, polypharmacy has become a challenge for people living with HIV/AIDS (PLWH). This review aimed to identify barriers and facilitators to maintaining a high level of polypharmacy adherence in people living with HIV/AIDS. Methods: Nine electronic databases were searched for studies from 1996 to October 2021. Studies were included if they were conducted with adults living with HIV/AIDS and reported barriers and facilitators to maintaining a high level of polypharmacy adherence. This review presents a conceptual framework model to help understand the barriers and facilitators. Results: Twenty-nine studies were included. The majority of publications were observational studies. Eighty specific factors were identified and further divided into five categories, including individual factors, treatment-related factors, condition-related factors, healthcare provider-related factors, and socioeconomic factors, based on the multidimensional adherence model (MAM). Conclusion: Eighty factors associated with polypharmacy adherence among people living with HIV/AIDS were identified and grouped into five major categories. Healthcare providers can make decisions based on the five categories of relevant factors described in this paper when developing interventions to enhance polypharmacy adherence. It is recommended that medications be evaluated separately and that an overall medication evaluation be conducted at the same time to prevent inappropriate polypharmacy use.

Using Self-Regulation Assessment to Explore Associations between Self-Regulation, Participation and Health-Related Quality of Life in a Rehabilitation Population.

Self-regulation, participation and health-related quality of life are important rehabilitation outcomes. The aim of this study was to explore associations between these outcomes in a multi-diagnostic and heterogenic group of former rehabilitation patients. This cross-sectional survey used the Self-Regulation Assessment (SeRA), Utrecht Scale for Evaluation of Rehabilitation-participation (USERParticipation) and the Patient-Reported-Outcome-Measurement-System (PROMIS) ability and PROMIS satisfaction with participation in social roles, and the EuroQol-5L-5D and PROMIS-10 Global Health. Regression analyses, controlling for demographic and condition-related factors, were performed. Respondents (n = 563) had a mean age of 56.5 (standard deviation (SD) 12.7) years. The largest diagnostic groups were chronic pain disorder and brain injury. In addition to demographic and condition-related factors, self-regulation subscales explained 0-15% of the variance in participation outcome scores, and 0-22% of the variance in HRQoL outcome scores. Self-regulation subscales explained up to 22% of the variance in satisfaction subscales of participation (USER-Participation and PROMIS) and the mental health subscale of the PROMIS-10. Self-regulation subscales explained up to 11% of the restriction and frequency subscales of participation (USER-Participation) and the physical health subscale of the PROMIS-10. Self-regulation is more strongly associated with outcomes such as satisfaction with participation and mental health compared with outcomes such as restrictions in participation and physical health.