Implications For Adherence Research Articles

Characterizing the interplay between Acinetobacter baumannii, A549 cells, and anti-Omp34 antibodies: implications for adherence, internalization, and cytotoxicity.

Acinetobacter baumannii thrives within eukaryotic cells, influencing persistence, treatment approaches, and progression of disease. We probed epithelial cell invasion by A. baumannii and the influence of antibodies raised to outer membrane protein 34 (Omp34) on epithelial interactions. We expressed and purified recombinant Omp34 and induced anti-Omp34 antibodies in Bagg albino or BALB/c mice. Omp34 was evaluated for acute toxicity in mice through histological analysis of six organs. The host cell line, A549, was exposed to both A. baumannii 19606 and a clinical isolate. The study also investigated serum resistance, adherence, internalization, and proliferation of A. baumannii in A549 cells, with and without anti-Omp34 sera, utilizing cell culture techniques and light microscopy. A549 cell viability was evaluated by A. baumannii challenge and exposure to anti-Omp34 sera. Actin disruption experiments using cytochalasin D probed microfilament and microtubule roles in A. baumannii invasion. Omp34 prompted antibody production without toxicity in mice. The serum showed bactericidal effects on both strains. Additionally, both A. baumannii strains were found to form biofilms. Omp34 serum was observed to decrease biofilm formation, bacterial adherence, internalization, and proliferation in A549 cells. Furthermore, the use of anti-Omp34 serum enhanced the post-infection survival of the host cell. Pre-exposure of A549 cells to cytochalasin D reduced bacterial internalization, highlighting the role of actin polymerization in the invasion process. Microscopic analysis revealed various interactions, such as adherence, membrane alterations, vacuolization, apoptosis, and cellular damage. Anti-Omp34 serum-exposed A549 cells were protected and showed reduced damage. The findings reveal that A. baumannii can significantly multiply intracellularly within host cells. This suggests the bacterium's ability to establish an environment conducive to its replication by preventing fusion with degradative lysosomes and inhibiting acidification. This finding contributes to the understanding of A. baumannii's intracellular persistence and highlights the role of Omp34 in influencing apoptosis, autophagy, and bacterial adherence, which may impact the development of effective treatments against A. baumannii infections.

The Adolescent Transplant Recipient: An Overview of Neurocognitive Functioning and Implications for Long-Term Outcomes.

Solid organ transplantation (SOT) offers improved long-term survival for youth with end-stage organ disease. From a neurodevelopmental, cognitive, and academic perspective, children with solid organ transplant have a number of unique risk factors. While cognitive functioning may improve post-transplantation, it is important to understand the trajectory of neurocognitive development starting in transplant candidacy to evaluate the implications of early deficits. The aim of this paper is to describe the neurocognitive risks and long-term implications for adolescent transplant recipients. This paper provides an overview of neurocognitive functioning in youth with end-stage organ dysfunction with discussion of implications for adolescent transplant recipients. Post-transplant, adolescent, and young adult solid organ transplant recipients exhibit significant levels of executive dysfunction, with implications for decision-making, regimen adherence, and transition to adult transplant care. Transplantation may reduce the risk for poor long-term neurocognitive effects, yet adolescent transplant recipients remain at increased risk, particularly in executive functioning, which has implications for adherence and transition to adulthood. Baseline and follow-up assessments for youth with end-stage organ disease and transplant are important for the monitoring of neurocognitive development and may be used to mitigate risk for low adherence to post-transplantation treatment regimens and reduce barriers to transitioning to adult transplant care.

Mental Health Impacts of Multidrug-Resistant Tuberculosis in Patients and Household Contacts: A Mixed Methods Study.

Multidrug-resistant tuberculosis (MDR-TB) patients experience disproportionately worse mental health, with implications for adherence, outcomes, and families. Comprehensive assessments of comorbid depression/anxiety and related factors remain limited. This study aimed to assess the prevalence, predictors, and qualitative experiences of depression and anxiety in MDR-TB patients and household contacts. A sequential explanatory mixed methods study was conducted in Gujarat, India, with 403 smear-positive MDR-TB patients and 403 contacts. The quantitative phase administered structured questionnaires on sociodemographic factors, clinical history, depression/anxiety symptoms, and psychosocial stressors (like stigma and social support). Logistic regression models were used. The qualitative phase included in-depth interviews with 30 purposively sampled patients for thematic content analysis. Results were integrated to contextualize quantitative findings. High rates of depression (37.5%, n = 151) and anxiety (45.2%, n = 182) were documented among the MDR-TB patients, significantly greater than household contacts (20.1%, n = 81and 25.1%, n = 101, respectively). For depression, older age (adjusted odds ratio (AOR) 2.03, 95% CI 1.01-4.05), female gender (AOR 2.5, 95% CI 1.1-6.0), divorced/widowed status (AOR 3.8, 95% CI 1.1-8.0), financial constraints, substance abuse (AOR 1.7, 95% CI 1.1-2.7), greater disease severity (AOR 1.8, 95% CI 1.5-2.2), medication side effects (AOR 2.4, 95% CI 1.2-4.6), and perceived stigma (AOR 3.2, 95% CI 1.1-5.3) emerged as significant risk factors. For anxiety, significant predictors were less social support (AOR 0.81, 95% CI 0.71-0.86), higher perceived stigma (AOR 2.2, 95% CI 1.1-6.3), greater disease severity (AOR 2.6, 95% CI 1.3-4.0), and more medication side effects (AOR 3.3, 95% CI 1.1-5.5). Prominent themes included psychological impacts like depression and anxiety, experiences of stigma and caretaking challenges, and recommendations for comprehensive patient support services. MDR-TB patients experience a substantially higher dual disease burden of depression and anxiety, elevating the risk for adverse outcomes and transmission. Improving psychosocial support is vital to patient-centric care pathways for vulnerable groups. Mixed methods provide comprehensive evidence to inform integrated physical and mental health services.

Loneliness Among Black/African American Adults Living with HIV: Sociodemographic and Psychosocial Correlates and Implications for Adherence

Loneliness, an emerging public health problem, is higher among people living with HIV and is associated with negative health outcomes. Black/African Americans have a high burden of HIV, and little is known about the characteristics of loneliness among Black adults living with HIV; therefore, this study sought to understand the sociodemographic and psychosocial correlates of Black adults living with HIV who are lonely and the implications of loneliness for their health outcomes. A sample of 304 Black adults living with HIV (73.8% sexual minority men) in Los Angeles County, CA, USA, completed the survey items assessing sociodemographic and psychosocial characteristics, social determinants of health, health outcomes, and loneliness. Antiretroviral therapy (ART) adherence was assessed electronically with the medication event monitoring system. Bivariate linear regressions analysis showed higher loneliness scores among those with higher levels of internalized HIV stigma, depression, unmet needs, and discrimination related to HIV serostatus, race, and sexual orientation. In addition, participants who were married or living with a partner, had stable housing, and reported receiving more social support had lower levels of loneliness. In multivariable regression models controlling for correlates of loneliness, loneliness was found to be a significant independent predictor of worse general physical health, worse general mental health, and greater depression. Loneliness was marginally associated with lower ART adherence. Findings suggest that Black adults living with HIV, who experience multiple intersectional stigmas, require targeted interventions and resources.

Using a Smartphone 3-Dimensional Surface Imaging Technique to Manufacture Custom 3-Dimensional–Printed Eyeglasses

Finding a suitable fit in glasses for pediatric patients with congenital and acquired craniofacial abnormalities is difficult; consequently, these children are at high risk of vision loss secondary to refractive amblyopia as they often have poor adherence to daily glasses wearing. Custom 3-dimensional (3D)-printed glasses may have an improved design and fit, but access is limited by the availability of computed tomography and magnetic resonance imaging (MRI). To describe a method for using a commercially available smartphone 3D surface imaging (3DSI) technique to capture facial anatomy as a basis for custom glasses design. This quality improvement study analyzes data from a case series in a primary academic center with multiple referral centers throughout the United States. The evaluation included reported fit descriptions from patients with poor glasses adherence due to craniofacial abnormalities. Key anatomic parameters for glasses fit (face width, distance from ear bridge to nasal bridge, distance from center of pupil to center of nasal bridge, distance from lateral to medial canthus, ear vertical offset, and nasal bridge width) were compared between scans. A 3DSI scan was considered successful if these key parameters could be determined and the difference in measurements was less than 5% between MRI and 3DSI. A second outcome measure included the fit of glasses designed by the 3DSI method as reported by the patient, parent, or guardian. Measurements of key parameters for glasses fit were similar across MRI and 3DSI scans with a mean (SD) difference of 1.47 (0.79) mm between parameters (range, 0.3-4.60 mm). Among 20 patients aged 1 to 17 years with craniofacial abnormalities, all achieved a successful fit (reporting daily glasses adherence without irritation) as judged by the patient, parent, or guardian. A mean of 1.7 revisions were made from initial prototype to final frame production using 3DSI technology. This study demonstrated that smartphone-enabled 3DSI coupled with widely available 3D printing technology can produce custom frames with a successful fit for patients with craniofacial anomalies. This accessible and well-tolerated imaging process may have implications for adherence with glasses wearing among patients at risk of vision loss due to amblyopia.

Strategies commercially-insured families use to manage the cost of asthma care: a qualitative interview study

Objective Families affected by asthma report difficulty adhering to care regimens because of high medication costs, coupled with increased cost sharing required by some insurance plans. To inform efforts to support adherence, we conducted a qualitative study to explore how families manage asthma care costs. Methods We conducted phone interviews with commercially-insured, US adults (n = 59) who had asthma and/or a child with asthma. Our purposive sample included participants with high- and low/no-deductible health plans. We analyzed data using thematic content analysis to identify strategies for managing asthma care costs and to assess strategies’ implications for adherence. Results Our analysis identified four overarching strategies for managing asthma care costs. First, participants used prevention strategies to avoid costly acute care by minimizing exposure to asthma triggers and adhering strictly to preventive medication regimens. Second, participants used shopping strategies to reduce costs, including by comparing medication prices across pharmacies, using medication coupons or free samples, and switching to lower-cost medications. Third, budgeting strategies involved putting aside funds, including in tax-exempt health savings accounts, or taking on debt to pay for care. Finally, some participants sought to reduce costs by forgoing recommended care, including by skipping medication doses or replacing prescribed medications with alternative therapies. Conclusion Commercially-insured families use a wide range of strategies to manage asthma care costs, with both positive and negative implications for adherence. Our typology of asthma cost management strategies can inform insurance redesign and other interventions to help families safely reduce costs and maximize adherence to recommended care.

Association between secessionist tendencies and perceived intragroup conflict: implications of adherence to regionalist and essentialist beliefs

This study focuses on the relationship between secessionist tendencies, which are understood to be the desire of a set of certain individuals to cease being part of an ingroup in order to form a new class or identity, and perceived conflict within the original affiliation. The working hypothesis is that there is a positive correlation between these variables. Two hundred and twenty-four volunteer participants responded to five questionnaires that measured the main variables of this study and supplied feedback through other questionnaires related to social identity: regionalism (a form of ethnocentrism), group identification, and essentialism. The main results indicate that secessionism is positively associated with the perception of conflict between the ingroup and the superordinate ingroup, and that both variables in turn correlate with the other variables studied. The results are discussed in terms of the possible causal determination between the variables drawn from the aforementioned empirical evidence and the supporting theory.

Comparative optimism about infection and recovery from COVID-19; Implications for adherence with lockdown advice.

BackgroundComparative optimism, the belief that negative events are more likely to happen to others rather than to oneself, is well established in health risk research. It is unknown, however, whether comparative optimism also permeates people’s health expectations and potentially behaviour during the COVID‐19 pandemic.ObjectivesData were collected through an international survey (N = 6485) exploring people’s thoughts and psychosocial behaviours relating to COVID‐19. This paper reports UK data on comparative optimism. In particular, we examine the belief that negative events surrounding risk and recovery from COVID‐19 are perceived as more likely to happen to others rather than to oneself.MethodsUsing online snowball sampling through social media, anonymous UK survey data were collected from N = 645 adults during weeks 5‐8 of the UK COVID‐19 lockdown. The sample was normally distributed in terms of age and reflected the UK ethnic and disability profile.FindingsRespondents demonstrated comparative optimism where they believed that as compared to others of the same age and gender, they were unlikely to experience a range of controllable (eg accidentally infect/ be infected) and uncontrollable (eg need hospitalization/ intensive care treatment if infected) COVID‐19‐related risks in the short term (P < .001). They were comparatively pessimistic (ie thinking they were more at risk than others for developing COVID‐19‐related infection or symptoms) when thinking about the next year.DiscussionThis is one of the first ever studies to report compelling comparative biases in UK adults’ thinking about COVID‐19.

High-efficacy therapies for relapsing-remitting multiple sclerosis: implications for adherence. An expert opinion from the United Arab Emirates.

The number of disease-modifying treatments (DMDs) for relapsing-remitting multiple sclerosis has increased. DMDs differ not only in their efficacy and safety/tolerability, but also in the treatment burden of, associated with their initiation, route/frequency of administration, maintenance treatment and monitoring. High-efficacy DMDs bring the prospect of improved suppression of relapses and progression of disability, but may have serious safety issues, and burdensome long-term monitoring. Studies of patient preferences in this area have focused on side effects, efficacy and route of administration. Adherence to DMDs is often suboptimal in relapsing-remitting multiple sclerosis and there is a need to understand more about how the complex therapeutic and administration profiles of newer DMDs interact with these barriers to support optimal adherence to therapy.

Agency. A response to Sørensen and Ribeiro

AbstractWhile agreeing to openness to other world views, the underlying premise of ‘otherness’ in ‘the other’ is questioned. It is argued that individual, intercultural and intra-cultural differences run criss-cross throughout the anthroposphere. The often convoluted language in symmetrical, Latourian and New Materialist directions in archaeology is criticized. One questions what their significant new contributions to archaeological research are. The importance of refined differentiations regarding agency and effects, and the living and the non-living, is maintained. Latour's claim of a universal dichotomization in Western thinking (both academic and common) is interrogated, and empirical proofs demanded. The concepts of ‘dichotomy’ and ‘binary thinking’ are discussed. The assumed political and ethical sequelae and implications of adherence to one or another theoretical position and research methodology are questioned. Ecological awareness can be acquired from various positions. In general, political correctness in academia is criticized.

A psychosocial perspective of medication side effects, experiences, coping approaches and implications for adherence in hypertension management.

IntroductionThis study examined whether psychosocial variables influenced patients’ perception and experience of side effects of their medicines, how they coped with these experiences and the impact on medication adherence behaviour.MethodsA hospital-based mixed methods study using quantitative and qualitative approaches was conducted with hypertensive patients. Participants were asked about side effects, medication adherence, common psychological symptoms and coping mechanisms with the aid of standard questionnaires and an interview guide.ResultsThe experiences of side effects—such as palpitations, frequent urination, recurrent bouts of hunger, erectile dysfunction, dizziness, cough, physical exhaustion—were categorized as no/low (39.75 %), moderate (53.0 %) and high (7.25 %). Significant relationships between depression (x2 = 24.21, p < 0.0001), anxiety (x2 = 42.33, p < 0.0001), stress (x2 = 39.73, p < 0.0001) and side effects were observed. A logistic regression model using the adjusted results for this association is reported—depression [OR = 1.9 (1.03–3.57), p = 0.04], anxiety [OR = 1.5 (1.22–1.77), p ≤ 0.001] and stress [OR = 1.3 (1.02–1.71), p = 0.04]. Side effects significantly increased the probability of individuals to be non-adherent [OR = 4.84 (95 % CI 1.07–1.85), p = 0.04] with social factors, media influences and attitudes of primary care givers further explaining this relationship. Personal adoption of medication modifying strategies, espousing the use of complementary and alternative treatments and interventions made by clinicians were the main forms of coping with side effects.DiscussionResults from this study show that, in addition to a biomedical approach, the experience of side effects has biological, social and psychological interrelations. The results offer more support for the need for a multi-disciplinary approach to healthcare where all forms of expertise are incorporated into health provision and patient care.

Intravenous versus Subcutaneous Drug Administration. Which Do Patients Prefer? A Systematic Review.

Intravenous (IV) drug delivery is commonly used for its rapid administration and immediate drug effect. Most studies compare IV to subcutaneous (SC) delivery in terms of safety and efficacy, but little is known about what patients prefer. A systematic review was conducted by searching seven electronic databases for articles published up to February 2014. Included studies were randomized controlled trials (RCTs) and/or crossover designs investigating patient preference for SC versus IV administration. The risk of bias in the RCTs was determined using the Cochrane Collaboration tool. Reviewers independently extracted data and assessed the risk of bias. Any discrepancies were resolved by consensus. The search identified 115 publications, but few (6/115) met the inclusion criteria. Patient populations and drugs investigated were diverse. Four of six studies demonstrated a clear patient preference for SC administration. Main factors associated with SC preference were time saving and the ability to have treatment at home. Only three studies used study-specific instruments to measure preference. Results suggest that patients prefer SC over IV delivery. Patient preference has clearly been neglected in clinical research, but it is important in medical decision making when choosing treatment methods as it has implications for adherence and quality of life. If the safety and efficacy of both administration routes are equivalent, then the most important factor should be patient preference as this will ensure optimal treatment adherence and ultimately improve patient experience or satisfaction. Future drug efficacy and safety studies should include contemporaneous, actual patient preference where possible, utilizing appropriate measures.

Interventions to improve adherence to psychotropic medication in clients of Asian descent: A systematic review.

Fewer than half of Asian Americans prescribed psychotropic medication actually adhere to their medications. Poor psychotropic medication adherence among Asian Americans might be influenced by cultural beliefs about medication, mental illness, and stigma surrounding mental disorders, but the data are limited. Studies in Asian populations, whose belief systems are shared by many Asian American groups, may help broaden our understanding of medication adherence in Asian Americans. The purpose of this article is to synthesize existing research on interventions that might contribute to improved adherence to psychotropic medication among psychiatric patients of Asian descent. Searches of PubMed and PsycINFO for relevant articles published between 1960 and October 2010 yielded 1,520 potentially relevant studies. Nine intervention studies met the inclusion criteria for this systematic review. Most successful interventions used variations on psychoeducation that included both patients and family caregivers. Even in the absence of significant changes to adherence, patients often showed clinical improvement. Improvements in knowledge and attitude among patients and family caregivers coincided with clinical improvement. Findings highlight the effects of caregiver and patient causal beliefs on adherence outcome. Implications for adherence to psychotropic medication interventions among Asian Americans are discussed.

Patients' Ways of Speaking About Antiretroviral Medications and Possible Implications for Adherence

The medical literature reports that antiretrovirals (ARVs) are considered attitudinal objects (Dunbar-Jacob, 1995). Drawing on the pragmatics of emotion (Caffi & Janney, 1994), this study analyzes how patients' stances about their ARTs shape their emotional relationships with their treatments. The data, collected in a public hospital in Uruguay, are analyzed by means of qualitative (Halliday & Matthiessen, 2004) and quantitative methods. For several reasons, patients do not always report directly when their adherence to ARTs is suboptimal, but pharmaceutical adherence is essential for their survival. This study suggests that patients' emotional adherence might be anticipated by their linguistic choices used to refer to ARVs. It is observed that emotional alienation from the ARTs is expressed either by overt (e.g., devil terms) or covert linguistic choices related to a non-ego, non-hic, or non-nunc perspective. The implications for medical providers are in developing awareness of their patients' linguistic choices in talking about ARTs, since emotional (non)adherence might anticipate pharmaceutical (non)adherence.

WS4.2 CF patients’ beliefs about nebuliser treatment: implications for adherence to treatment

WS4.2 CF patients’ beliefs about nebuliser treatment: implications for adherence to treatment

Differences in taste between three polyethylene glycol preparations: a randomized double-blind study

Background and aimPatients suffering from chronic constipation require long-term, regular therapy with laxatives. Literature regarding patient preference and acceptance in polyethylene glycol preparations is scarce. Therefore, this research aimed to identify preference between the three polyethylene glycol 3350, namely Molaxole®, Movicol®, and Laxtra Orange®. Furthermore, taste is one of the most important factors leading to patients’ adherence, particularly when the treatment lasts for a long time.MethodsIn this randomized, cross-over double-blind study, 100 volunteers were recruited by advertisement. The volunteers were invited to taste the preparations and grade the taste using a five-point hedonic scale (extremely poor taste [1] to extremely good taste [5]). The volunteers were then asked to choose the most palatable preparation.ResultsOne hundred volunteers with a mean age of 35 years (range 20–61) were randomized (76 females). Molaxole®, Movicol®, and Laxtra Orange® had a mean hedonic score of 2.76 (SD: 0.82), 2.81 (SD: 0.76) and 3.12 (SD: 0.82) respectively. The hedonic taste score for Laxtra Orange® was significantly better than Molaxole® (P = 0.001) and Movicol® (P = 0.001). No difference was found between Molaxole® and Movicol® (P = 0.61). Molaxole® was the most preferred preparation for 19 volunteers (19%), Movicol® for 24 volunteers (25%) and Laxtra Orange® for 55 volunteers (56%). Two volunteers had no preference. The order in which volunteers tested the preparations had no influence on the taste results. No significant differences in age or gender were observed.ConclusionLaxtra Orange® was most palatable preparation. This may have implications for adherence in patients with chronic constipation.

Empowering young patients with long-term conditions to take control of their medicines

Despite an increasing focus on empowering people with long-term conditions to take greater responsibility for their health and disease management, it is recognized that the voices and perspectives of young patients in these initiatives are often missing. However, in recent years a number of researchers and practitioners have found that children and adolescents often take an informed and active role in the management of their condition including the use of medicines, and many advocate that they should be encouraged to do so. This article provides an overview of the evidence on the roles and perspectives of young patients with long-term conditions in their use of medicines and associated decision making. This includes the implications for adherence, their participation in healthcare consultations, sources of information and interventions designed to enhance self-efficacy in the use of medicines.

Treatment of moderate to severe asthma: patient perspectives on combination inhaler therapy and implications for adherence.

Symptom control in patients with moderate to severe persistent asthma is essential to reduce the significant morbidity associated with the disease. Poor adherence to controller medications has been identified as a major contributing factor to the high level of uncontrolled asthma. This review examines patient perspectives on, and preferences for, controller medications (inhaled corticosteroid and long-acting β(2)-agonist combinations [ICS/LABA]), and how this may affect adherence to therapy. Fluticasone/salmeterol and budesonide/formoterol, the currently available ICS/LABA combination products, have similar efficacy and tolerability based on a recent meta-analysis of asthma trials. Adherence is higher with the combination ICS/LABAs than when the components are administered separately. Investigations into patient preferences for desirable attributes of asthma medications indicate that an effective reliever with a fast onset and long duration of action is preferred and may lead to improved adherence. This rapid onset of effect was perceived and highly valued in patient surveys, and was associated with greater patient satisfaction. Thus, future research should be directed at therapy that offers both anti-inflammatory activity and a rapid onset of bronchodilator effect. To further improve patient adherence and treatment outcome, the effect of these characteristics as well as other factors on adherence should also be investigated.

Assessing lay beliefs about generic medicines: Development of the generic medicines scale

The aims of this study were to develop a scale to assess lay beliefs about generic medicines, and to investigate whether these beliefs differ according to demographic factors in an opportunistic general public sample. In the pilot study, the participants were 92 men and 136 women, and in the main study there were 314 men and 505 women. At both stages, the participants completed a questionnaire measuring beliefs about generic medicines, preference for medicines and demographic information. The scale has good face validity, showing a satisfactory level of internal consistency. An exploratory principal component analysis revealed a two-factor structure concerning beliefs about generic medicines, comprising two core themes (efficacy and similarity to brand medicines), in two different samples. Older participants showed a stronger belief in similarity with brand names than the younger group. Higher educated participants showed a stronger belief in the efficacy of generics. The opportunity to assess beliefs about generic medicines may have implications for adherence, for the implementation of health policies and for decision making about medicines.

Local perceptions of dengue fever in northeast Thailand and their implications for adherence to prevention campaigns

The government of Thailand has invested heavily in community-based dengue fever prevention campaigns, yet community participation has been inadequate to prevent transmission. This ethnographic study explored local understandings of dengue in rural northeast Thailand, and their implications for adherence to government-initiated prevention measures centred around mosquito control. While community members recognised the most severe manifestation of the disease – dengue haemorrhagic fever (DHF) – as life threatening, they were unaware of the existence of the milder form of dengue fever (DF) that makes up the majority of cases. Consequently, milder fevers were believed to be something other than dengue, such that dengue was perceived as a rare illness, hindering participation in prevention. Furthermore, a local illness category, khai mak mai (‘fruit fever’) complicated the diagnosis, treatment and prevention of dengue fever, as people viewed it as both difficult to distinguish from dengue, and untreatable by biomedicine.