Important Factor In Adherence Research Articles

Taste Perceptions of Common Pediatric Antibiotic Suspensions and Associated Prescribing Patterns in Medical Residents.

Palatability of medication is an important factor for adherence, especially in pediatric populations that tend to use oral suspensions for antibiotic therapy. Our study is the first to evaluate the impact of taste on prescribing patterns of antibiotic suspensions. The objective was to determine if taste testing common antibiotic suspensions altered prescribing patterns of medical residents, through data extracted from the electronic health record. After assessing 5 "primer" tastes (sweet, salty, bitter, sour, umami [savory]), residents were randomized to sample 6 antibiotic suspensions to rate their taste perception. A 12-month retrospective and prospective analysis of outpatient prescribing practices of the residents followed, and the results were compared to the resident cohort randomized to no taste test. The 43 residents prescribed 207 liquid antibiotic prescriptions for 176 patients, with no difference in patient characteristics between residents in the taste test versus non-taste test group. Although amoxicillin was most preferable and amoxicillin-clavulanate least, the only significant finding was a greater prescribing rate of cefdinir among those who had tasted it and an inverse relationship between cephalexin taste preference and percentage prescribing amoxicillin in the taste group. Residents who tasted were poor in identifying primer tastes, but this did not impact prescribing patterns. Among 6 commonly prescribed antibiotic suspensions, amoxicillin remains a highly preferred taste among prescribers. Interestingly, after the taste test there was a significantly greater prescribing rate of cefdinir among those who had tasted it and somewhat lower prescribing rate for amoxicillin-clavulanate.

“If they can do it, I can do it”: experiences of older women who engage in powerlifting training

ABSTRACT Older adults’ participation in resistance training is low. Recent research suggests social aspects are important determinants of exercise engagement. In this study, 13 older women (50 years and older) were interviewed to examine their experiences of powerlifting training. Data were thematically analyzed revealing two main themes: Challenging Beliefs and Positive Social Influences. Peer advocates were essential for uptake, with social interactions in group resistance training, and having a skilled trainer, identified as important adherence factors. Strategies to improve resistance training uptake in older women could leverage off the experience of others and powerlifting training culture and practices.

Perception on facilitators and benefits of participation in body practice groups

Abstract The practice of physical activity has been considered as an important factor in the area of public health, as it helps in the prevention and treatment of various diseases. Thus, understanding the facilitators for participation and benefits from healthy lifestyle can contribute to population awareness. The aim of this study was to analyze facilitators for body practice and benefits perceived by participants of body practice groups of two basic family health units of Santa Rosa/RS. This qualitative research included 25 participants. Data were obtained by the focal group technique. Motivation/incentive, mainly linked to family support, the pedagogical practice of the Physical Education professional, good health status and social life were aspects considered facilitators for adherence to body practice groups. Physical and psychological gains, prevention and control of diseases, lifestyle changes, cognitive improvement and decreased use of medications were pointed as benefits. Motivating participants to participate in body practice programs is an important factor for adherence and participation in these activities can provide biopsychosocial benefits that can contribute to health promotion and quality of life of users of basic family health units.

The Role of Reciprocity in International Humanitarian Law Training: Examples from Historical and Contemporary US Practice

While scholars assert that reciprocity is a force that influences international humanitarian law, the literature has yet to include a detailed analysis of its role in military training. This presents two limitations. First, a substantial quantity of primary source material pertaining to state practice goes underutilized. Second, the methods by which international humanitarian law are promulgated and disseminated to soldiers during training are overlooked. Thus, a potentially important factor in adherence remains under-examined. This article analyzes historical and contemporary military training material including manuals, pamphlets, circulars, and films. Research results suggest that reciprocity impacts international humanitarian law training in varied, nuanced, and dynamic ways. In particular, an emphasis on reciprocity remains a consistent message in post–Vietnam War training. Furthermore, positive reciprocity in the form of a golden rule rationale is often used to justify adherence and remains prevalent in post-9/11 training material.1

Distribution of Major Pilin Subunit Genes Among Atypical Enteropathogenic Escherichia coli and Influence of Growth Media on Expression of the ecp Operon.

Atypical enteropathogenic Escherichia coli (aEPEC) strains are unable to produce the bundle-forming pilus (BFP), which is responsible for the localized adherence pattern, a characteristic of the pathogenicity of typical EPEC strains. The lack of BFP in aEPEC strains suggests that other fimbrial or non-fimbrial adhesins are involved in their adhesion to the host cells. The aim of this study was to investigate the distribution of major subunit fimbrial genes known to be important adherence factors produced by several E. coli pathotypes in a collection of 72 aEPEC strains. Our results demonstrate that a high percentage (94–100%) of aEPEC strains harbored ecpA, fimA, hcpA, and lpfA fimbrial genes. Other fimbrial genes including pilS, pilV, sfpA, daaC, papA, and sfa were detected at lower frequencies (1–8%). Genes encoding fimbrial subunits, which are characteristic of enteroaggregative E. coli or enterotoxigenic E. coli were not found. No correlation was found between fimbrial gene profiles and adherence phenotypes. Since all aEPEC strains contained ecpA, the major pilin gene of the E. coli common pilus (ECP), a subset of ecpA+ strains was analyzed for transcription of ecpRABCDE and production of ECP upon growth in three different culture conditions at 37°C. Transcription of ecpRABCDE occurred in all conditions; however, ECP production was medium dependent. In all, the data suggest that aEPEC strains are highly heterogeneous in terms of their fimbrial gene profiles. Despite lacking BFP production, other mechanisms of cell adherence exist in aEPEC strains to ensure host colonization, e.g., mediated by other prevalent pili such as ECP. Moreover, the production of ECP by aEPEC strains might be influenced by yet unknown post-transcriptional factors.

Persistent low adherence to hypertension treatment in Kyrgyzstan: How can we understand the role of drug affordability?

It is well known that cardiovascular diseases (CVD) are a growing cause of mortality and morbidity in low-and middle-income countries (LMIC). While hypertension (HTN), a leading risk factor for CVD, can be easily managed with widely available medicines, there is a huge gap in treatment for HTN in many LMIC. One such country is Kyrgyzstan, where HTN is a major public health concern and adherence to medication is low. The reasons for low adherence in Kyrgyzstan are not well understood, but some evidence suggests that HTN medicines may be unaffordable for low-income families, resulting in inequitable access to HTN treatment. With data from the 2010 Kyrgyzstan Integrated Household Survey, we estimate the prevalence and factors associated with adherence to HTN medication in Kyrgyzstan. We then investigate the hypothesis that affordability may be an important factor in adherence to HTN medication. Using the coarsened exact matching approach, we estimate the economic burden faced by households with at least one member with elevated blood pressure (EBP) in Kyrgyzstan and their risk of catastrophic spending on health care. We find that EBP households have significantly higher total expenditure on health, as well as on medicines, and are more likely to experience catastrophic health spending, suggesting that out-of-pocket expenditure for EBP may be prohibitively expensive for the poorest in Kyrgyzstan. Our findings also reveal a high prevalence of self-medication (i.e. purchasing and using medication without a doctor's prescription), and increased expenditure due to self-medication, among those with EBP. Our research suggests that affordability of HTN medicines may be an important factor in low adherence to treatment in Kyrgyzstan. Low affordability may be due partly to the prescription of medicines that are not reimbursable under the national drug benefit plan, but more research is needed to identify solutions to the affordability problem.

Adherence in orthodontic settings: understanding practitioner views in a UK sample.

To explore predictors of adherence in adult orthodontic patients as reported by orthodontists in the UK. Twenty-three orthodontists (47% female and 53% male) from the UK with approximately 15 years of experience each (M = 14.7; SD = 1.73) completed a questionnaire regarding the importance they give to a number of factors signaled in the literature as adequate predictors of adherence. This cross-sectional quantitative and exploratory survey consisted of four parts, requesting orthodontists to rate a list of predictors of adherence on (1) evaluation-how important they thought the predictor was to assess patient adherence, (2) application-the extent to which they used each predictor to assess adherence in their daily practice, (3) open-ended questions to collect any other perceived predictors of adherence, and (4) demographics. All participating orthodontists agreed that patients' regularity in attending appointments, maintenance of good oral hygiene, and utilization of dental appliances are the most important factors for predicting adherence. In the open-ended portion of the questionnaire, orthodontists also highlighted perceived cost of treatment as an important factor. The remaining factors included in the questionnaire were also rated as important or utilized, though they yielded a more varied pattern of response. Appointment keeping, cooperating in the use of removable appliances, and oral hygiene were rated as the most important factors by orthodontists when assessing adherence in adult patients. The perceived cost of treatment was also highlighted by orthodontists as an important factor for adherence.

CT colonography for population screening: ready for prime time?

In conclusion, CTC matches or exceeds optical colonoscopy in terms of the key criteria for a colorectal screening test, yet it remains vastly underutilized, largely due to lack of coverage by CMS and other payers. CTC is equivalent to colonoscopy for the screen detection of advanced adenomas, whereas the non-invasive stool-based tests largely lack this preventive benefit. CTC is considerably safer than colonoscopy as a primary colorectal screening test and would result in fewer hospitalizations and urgent surgical repairs. CTC is generally preferred over colonoscopy by individuals undergoing screening, which is an important factor for adherence. CTC is likely more cost-effective than optical colonoscopy for primary colorectal cancer screening, particularly if sub-cm polyps are not aggressively managed. The re-assessment of CTC screening by the USPSTF will be critical for a subsequent favorable national coverage determination by CMS. Once CTC screening is covered for Medicare beneficiaries, other third-party payers would presumably follow suit for the key 50–64 year-old demographic. At that point, CTC will be “ready for prime time”.

Identification of Bacterial Factors Involved in Type 1 Fimbria Expression using an Escherichia coli K12 Proteome Chip

Type 1 fimbriae are filamentous structures on Escherichia coli. These structures are important adherence factors. Because binding to the host cells is the first step of infection, type 1 fimbria is an important virulence factor of pathogenic E. coli. Expression of type 1 fimbria is regulated by a phase variation in which each individual bacterium can alternate between fimbriated (phase-ON) and nonfimbriated (phase-OFF) states. The phase variation is regulated by the flipping of the 314-bp fimS fragment, which contains the promoter driving the expression of the genes required for the synthesis of type 1 fimbria. Thus, the bacterial proteins able to interact with fimS are likely to be involved in regulating the expression of type 1 fimbria. To identify novel type 1 fimbria-regulating factors, we used an E. coli K12 proteome chip to screen for the bacterial factors able to interact with a 602-bp DNA fragment containing fimS and its adjacent regions. The Spr protein was identified by the proteome chip-based screening and further confirmed to be able to interact with fimS by electrophoretic mobility shift assay. Deletion of spr in the neonatal meningitis E. coli strain RS218 significantly increased the ratio of the bacterial colonies that contained the type 1 fimbria phase-ON cells on agar plates. In addition, Spr interfered with the interactions of fimS with the site-specific recombinases, FimB and FimE, which are responsible for mediating the flipping of fimS. These results suggest that Spr is involved in the regulation of type 1 fimbria expression through direct interaction with the invertible element fimS. These findings facilitate our understanding of the regulation of type 1 fimbria.

Many ways of communication: from Helicobacter pylori adherence to death, disruption, migration and escape

Many ways of communication: from Helicobacter pylori adherence to death, disruption, migration and escape

Predicted antigenic regions of Streptococcus uberis adhesion molecule (SUAM) are involved in adherence to and internalization into mammary epithelial cells

Streptococcus uberis is a significant cause of bovine mastitis throughout the world. Previous work from our laboratory demonstrated that S. uberis adhesion molecule (SUAM) is an important factor in adherence to and internalization of S. uberis into bovine mammary epithelial cells. Antibodies directed against SUAM significantly reduced bacterial adherence to and internalization into bovine mammary epithelial cells implying that SUAM is surface exposed. Objectives of this research were to: (1) predict surface exposed peptides, and (2) select peptide sequences for production of synthetic peptides with the final aim of evaluating their role in adherence and internalization and immunogenic potential. The Kyte/Doolittle hydropathicity prediction method; Chou/Fasman β-turn prediction method; and output from Coils, Paircoil and MultiCoil scores for prediction of secondary and tertiary structures were used. Prediction algorithms resulted in identification of five overlapping regions of the SUAM sequence with the most hydrophilic valleys and the highest peaks for β-turns. The five 15-mer SUAM epitopes selected by bioinformatic analysis were produced to evaluate the immunogenic value and pathogenic role of these putative domains. Peptides were bound to fluorescent latex beads, incubated with MAC-T bovine mammary epithelial cells, and internalization into MAC-T cells was evaluated using confocal laser and transmission electron microscopy. All peptides evaluated induced some degree of internalization of fluorescent beads into MAC-T cells; however, 2 peptides induced significantly more internalization of fluorescent beads than the other peptides evaluated. These peptides, designated III and IV, were located in the central region of SUAM, between two coiled-coil regions. Convalescent sera were tested against these biotinylated peptides for SUAM specific immune response using an indirect ELISA format. Among the 5 peptides evaluated, peptides I, II and V elicited significant serological response suggesting that the N-terminal region (peptide I), central region (peptide II) and C-terminal region (peptide V) are immunodominant epitopes of SUAM. Results will be useful to design immunotherapeutic tools based on immunodominant epitopes.

Steroid Phobia and Adherence—Problems, Solutions, Impact on Benefit/Risk Profile

Adherence is important with all medications. It can be more difficult with inhaled steroids in light of concern about adverse effects. Although the degree of fear regarding inhaled steroids is difficult to quantify, it appears to be an important factor in adherence. These fears exist for several reasons, including misinformation obtained from such sources as the Internet. To improve adherence and decrease morbidity and mortality, it is vital that health care providers are aware of potential barriers to adherence. Measures such as simplifying and properly explaining medication regimens are helpful. Just as important is the establishment of a strong patient-provider relationship. This makes it easier to convince patients of the need for recommended medications. If the provider is able to effectively communicate and convince the patient of the benefit/risk ratio of steroids, improved patient outcomes can be achieved.

Virulence characteristics of Escherichia coli isolates obtained from broiler breeders with salpingitis

Thirty isolates of Escherichia coli from broiler breeders with salpingitis were studied. Using the slide agglutination test, the isolates were found to belong to serogroups O1, O2, O5, O36, O45, O53 and O78. Pathogenicity for day-old chicks was determined by air sac inoculation and isolates were categorized as having high, intermediate or low virulence. Growth on iron starvation medium was observed together with aerobactin production. Based on the results of in vitro adherence tests, attachment to oviduct epithelium from old birds was found to be superior to that observed using corresponding material from young birds. DNA hybridization testing for type 1, P, and S fimbriae revealed predominant expression of type 1, correlating with mannose-sensitive hemagglutination using guinea-pig erythrocytes. In this study, P and S fimbriae were not considered to be important adherence factors. Study findings would suggest that, as far as salpingitis is concerned, type 1 fimbriae can play an important role in E. coli infection in breeders. An interesting result to emerge from the study was the observation that E. coli isolates were completely resistant to serum from young breeders, whereas they were completely sensitive using serum from older breeders. Based on serogroups involved, pathogenicity for day-old chicks and virulence indicators, the salpingitis isolates were similar to those from cases of chronic respiratory disease.

Palatability of antiretroviral drugs in children with HIV a 16-year retrospective study in a large urban centre

Poor adherence to antiretroviral therapy (ART) contributes to viral resistance and thus treatment failure in children with HIV. Adherence to antiretroviral medications among children is frequently suboptimal. Palatability is an important factor in adherence but there have been very few data in this patient population. The clinical records of all the children referred to a major urban HIV clinic between 1987 to 2003 were reviewed with attention to palatability problems in ART. There were 119 children (aged 0–18) who were HIV infected and treated with ART (66 male, 53 female). Most children were on more than one ART during their treatment (86%) and 14 different ART were used among these patients. Ritonavir (n=44) was the least palatable drug with 45.5% of treated children disliking its taste. In half of these ritonavir patients who disliked its taste, the problem with palatability led to treatment discontinuation. The taste of nelfinavir (n=51) was disliked in 11.8% of the 51 children it treated, didanosine in 14.3% of 42 children and amprenavir in 50% of 4 children. Didanosine (n=14), nevirapine (n=23), efavirenz (n=17), saquinavir (n=5), indinavir (n=8) and lopinavir (n=20) received no complaints regarding palatability. Since there are differences in ART palatability, a prospective study of the palatability of different ART in children is needed. Such data would allow pediatric clinicians to consider an important additional factor besides efficacy in ART selection. Clinical Pharmacology & Therapeutics (2004) 75, P14–P14; doi: 10.1016/j.clpt.2003.11.052

Assessment of readiness to initiate antiretroviral therapy

PURPOSE: An important factor in adherence to antiretroviral therapy (ART) is the patient's commitment to follow the regimen, which suggests that therapy should be initiated only when the patient is ready to make such a commitment. Because there has been no research on patient readiness for ART, this study was undertaken to investigate factors that influence the decision of an HIV-positive person to seek medical care and to initiate ART. METHOD: The investigators surveyed 83 HIV-infected patients on ART. Participants completed a questionnaire that obtained information on the length of time from when they learned of their HIV-positive status to when they sought medical care, the length of time from when they learned of their HIV-positive status to when they were ready to initiate therapy, and psychological and social factors thought to be associated with readiness. RESULTS: Respondents had a mean age of 37 years, 71% were male, and 65% were African American. Only 42% said they sought medical care immediately upon learning their HIV diagnosis. Fifty percent were ready to initiate therapy immediately upon learning their diagnosis, and 25% were ready within 1 year. Sixty-four percent of respondents experienced barriers that interfered with therapy initiation. Although 98% of respondents experienced at least one emotional response to HIV diagnosis, less than 25% of respondents thought that their responses interfered with readiness. However, five emotional responses demonstrated an association with readiness through chi-square analysis. CONCLUSION: Further research is needed to explain the relationships among emotional responses to HIV diagnosis, readiness to initiate ART, and adherence.

Adhesin expression in matched nasopharyngeal and middle ear isolates of nontypeable Haemophilus influenzae from children with acute otitis media.

The HMW1 and HMW2 proteins, Hia, and hemagglutinating pili are important adherence factors in nontypeable Haemophilus influenzae. To gain insight into the relative importance of these adhesins in nasopharyngeal colonization and localized respiratory tract disease, we assessed their expression in matched nasopharyngeal and middle ear isolates of nontypeable H. influenzae from 17 children with acute otitis media. In all patients, including 11 with bilateral disease, the matched isolates were isogenic based on total protein profiles and genomic fingerprints. Of the nasopharyngeal isolates, 14 expressed only HMW1/HMW2-like proteins, 1 expressed only Hia, 1 expressed only pili, and 1 expressed both Hia and pili. Further analysis revealed concordance between nasopharyngeal isolates and the matched middle ear isolates for expression of the HMW1/HMW2-like proteins and Hia. In contrast, in the two children whose nasopharynges were colonized by piliated organisms, the corresponding middle ear isolates were nonpiliated and could not be enriched for piliation. Nevertheless, Southern analysis revealed that these two middle ear isolates contained all five hif genes required for pilus biogenesis and had no evidence of major genetic rearrangement. In summary, the vast majority of isolates of nontypeable H. influenzae associated with acute otitis media express HMW1/HMW2-like proteins, with expression present in both the nasopharynx and the middle ear. A smaller fraction of nasopharyngeal isolates express pili, while isogenic strains recovered from the middle ear are often refractory to enrichment for piliation. We speculate that the HMW adhesins and Hia are important at multiple steps in the pathogenesis of otitis media while pili contribute to early colonization and then become dispensable.

Adhesin Expression in Matched Nasopharyngeal and Middle Ear Isolates of Nontypable Haemophilus influenzae from Children with Acute Otitis Media † 866

The HMW1 and HMW2 proteins, Hia, and hemagglutinating pili are important adherence factors in nontypable H. influenzae. To gain insight into the relative importance of these adhesins in nasopharyngeal colonization and localized respiratory tract disease, we assessed their expression in simultaneous nasopharyngeal and middle ear isolates of nontypable H. influenzae from 17 children with acute otitis media. In all patients, including 11 with bilateral disease, the matched isolates were isogenic based on total protein profiles and genomic fingerprints. Of the nasopharyngeal isolates, 14 expressed only HMW1/HMW2-like proteins, one expressed only Hia, one expressed only pili, and one expressed both Hia and pili. Further analysis revealed concordance between nasopharyngeal isolates and the matched middle ear isolates for expression of HMW1/HMW2-like proteins and Hia. In contrast, in the two children with piliated organisms colonizing the nasopharynx, the corresponding middle ear isolates were nonpiliated and could not be enriched for piliation. Nevertheless, Southern analysis revealed that these two middle ear isolates contained all five hif genes required for pilus biogenesis and had no evidence of major genetic rearrangement. In summary, the vast majority of isolates of nontypable H. influenzae associated with acute otitis media express HMW1/HMW2-like proteins, with expression present in both the nasopharynx and the middle ear. A minority of isolates express Hia, again both in the nasopharynx and the middle ear. A smaller fraction of isolates express pili, which are irreversibly inactivated upon transit from the nasopharynx to the middle ear. We speculate that the HMW adhesins and Hia are important at multiple steps in the pathogenesis of otitis media, while pili contribute to early colonization and then become dispensible.

Isolation and characterization of a capsular polysaccharide adhesin from Staphylococcus epidermidis.

We isolated a polysaccharide adhesin from Staphylococcus epidermidis strain RP-62A. The adhesin was composed of a complex mix of monosaccharides (with galactose and glucosamine predominating), bound well to silastic catheter tubing, inhibited adherence of strain RP-62A to catheters, and elicited antibodies that both blocked adherence and stabilized an extracellular structure (visualized by transmission electron microscopy) that appeared to be a capsule. Two of three heterologous, highly adherent strains of coagulase-negative staphylococci also produced this adhesin, and their adherence to catheters was inhibited by both purified adhesin and antibody to adhesin. In contrast, the adherence of one highly adherent and two poorly adherent heterologous strains was unaffected by the RP-62A purified adhesin or antibody, a result suggesting the expression of alternate adhesins by these strains. We conclude that the capsular polysaccharide of some strains of coagulase-negative staphylococci is an important factor in adherence to catheter tubing.