Medication Worries Research Articles

Making sense of bowel care for patients with spinal cord injury

This article discusses the life-changing consequences regarding bowel function for patients with a spinal cord injury. In the UK, around 2500 people are newly injured each year (one every 4hours) ( Spinal Injury Association, 2023a ). Only one third of patients will gain access to a specialist spinal centre – there are 11 such centres in the UK. The Spinal Injury Association has launched their ‘This is #SeriousSh1t’ campaign to highlight the lack of continuity of bowel care for these patients on hospital admission. In the What Matters campaign ( Spinal Injury Association, 2023b ), bowel management was identified by 72% of respondents as their biggest medical worry.

Parenting in Israel amid COVID-19: the Protective Role of Mentalization and Emotion Regulation.

The global COVID-19 pandemic changed the life of numerous parents. The medical worry, the financial hardship, and the need to take care of children 24/7 caused an enormous burden on parenting, resulting in an elevation in parenting stress and in harsh parenting. In the current study, we were interested in assessing the role of parental emotion regulation and parental mentalization as resilience-promoting factors, by mitigating the harmful relationship between parental distress and negative and positive parenting. Seventy Israeli parents of children (aged 6-14) participated in the study. We assessed parental mentalization and emotion dysregulation before the COVID-19 pandemic. During the national lockdown in Israel in May 2020, we assessed parental distress, COVID-related financial risk, and parental practices. Results indicated elevations in parental distress compared to the population mean, alongside high rates of financial risk. The results indicated that although parental distress was significantly related to parenting practices, parental mentalization, and emotion regulation moderated these relationships in differential ways. Improved capacity for emotion regulation reduced the prevalence of negative parenting practices and higher parental mentalization increased the prevalence of positive parenting, these are despite elevation in parental distress. The results suggested that when parents are able to regulate their own negative emotions and think about a child's mind, they can remain available to support the child's needs despite the elevation in parental distress. Supporting parental capacity for mentalization and emotion regulation during stressful times may prevent the harmful consequences of parental distress on parenting.

Socioeconomic position and mental health during the COVID-19 pandemic: a cross-sectional analysis of the CovidLife study

Background: The coronavirus disease 2019 (COVID-19) pandemic has been linked to an increase in mental health problems. This study examined their association with socioeconomic position (SEP), as well as potential confounding and mediating factors. Methods: We analysed data from the CovidLife study (N=14,387; 66.4% female; mean [SD] age, 57.4 [13.9] years). Data were collected in an online survey of UK adults (aged 18 years or over) between 17 April and 7 June 2020. SEP measures included area deprivation (the Scottish Index of Multiple Deprivation [SIMD]), education level, household income, and employment status. Mental health was measured using the Patient Health Questionnaire-9 (PHQ-9) and the Generalised Anxiety Disorder-7 (GAD-7) scale. Worry indices were derived using principal component analysis. Logistic regression was used to estimate the associations between SEP and mental health. Results: Low SEP was associated with increased odds of depression and anxiety (odds ratio [OR] range 1.18-2.69). These associations remained significant after adjusting for age, sex, relationship status, and psychiatric history. Multivariable adjustment for medical worry and isolation during the pandemic had the largest attenuating effects (ranges 18-60% and 4-46%, respectively) on mental health outcomes. When adding further adjustment for the remaining SEP markers and all potential confounding and mediating factors, depression was associated with high area deprivation and low education level and income, whilst anxiety was only associated with low education level. No dose-response relationship was observed. Conclusions: SEP was inversely associated with mental health, which was mostly explained by medical worry and isolation during the COVID-19 pandemic. Mental health interventions might target these factors to prevent widening inequalities in mental health. Future studies should use longitudinal data to investigate the association.

An Examination of How People Appraise and Manage Health-Related Financial Uncertainty

ABSTRACT While health care is one of the largest stressors across all incomes and political affiliations, it is unclear how people with health-related financial uncertainty appraise and manage this ambiguity. Using the lens of Uncertainty Management Theory (UMT) and a thematic analysis of semi-structured, in-depth interviews with 17 individuals facing financial and health struggles, we uncovered how intersecting financial and medical uncertainty exacerbated participants’ medical worries, worsening and compromising their mental and physical health. Additionally, we revealed how participants managed health-related financial uncertainty through seeking social support, seeking information to reduce financial burden, enacting financial concessions, making health sacrifices, avoiding information and thoughts about health costs, and adapting to chronic financial uncertainty. This study extends UMT by foregrounding the ways individuals’ environmental resources (i.e., limited financial means) can jeopardize tending to their health, illustrating how uncertainty management is connected not only to communication strategies but also to health behaviors, such as tapering or skipping medications or procedures.

Do Expectant Mothers' Breastfeeding Plans Influence Provider Prenatal Contraceptive Counseling?

Breastfeeding and optimal birth spacing are associated with improved maternal and infant health outcomes worldwide. Provision of contraceptive advice that is aligned with recommendations for breastfeeding has potential to maximize maternal and infant health. Although there is broad agreement regarding the breastfeeding compatibility of specific postpartum contraceptive methods, it is not known whether maternal breastfeeding intention influences prenatal provider contraceptive counseling. We aimed to determine if maternal feeding intention is considered by prenatal providers during contraceptive counseling. This was a cross-sectional online author-created survey including all prenatal providers (N = 40) at two academic safety-net institutions in Cleveland, Ohio. Of 100 obstetrics/gynecology faculty members, 40 (40%) completed the survey, which included multiple-choice questions. Nominal and ordinal survey results were reported with percentages and frequencies, and categorical variables were compared using the Fisher exact test. Participants appropriately promoted breastfeeding-compatible postplacental intrauterine device placement, even though maternal feeding intention was specifically considered by just 12 (30%). Endorsed barriers to contraception for breastfeeding mothers included provider medical worries, patient concerns, and colleague resistance. Postplacental levonorgestrel intrauterine devices were recommended for all mothers by 92.5% of participants (n = 37). Recommendations regarding progestin-only and combined oral contraceptive pills were influenced by maternal breastfeeding versus formula-feeding intention. Asking expectant women about their feeding intentions within each contraceptive discussion may create opportunities for shared decision making that can optimize perinatal outcomes for both mother and infant worldwide.

Quality of life, socioeconomic profile, knowledge and attitude toward sexuality from the perspectives of individuals living with Human Immunodeficiency Virus.

Objectives: to analyze the quality of life of "patients" with Human Immunodeficiency Virus and relate it to their socioeconomic profile, knowledge and attitudes toward sexuality. Method: crosssectional and analytical study with 201 individuals who are 50 years old or older. The Targeted Quality of Life and Aging Sexual Knowledge and Attitudes Scales were applied during interviews. Multiple Linear Regression was used in data analysis. Results: dimensions of quality of life more strongly compromised were disclosure worries (39.0), sexual function (45.9), and financial worries (55.6). Scores concerning knowledge and attitudes toward sexuality were 31.7 and 14.8, respectively. There was significant correlation between attitudes and the domains of overall function, health worries, medication worries, and HIV mastery. Conclusion: guidance concerning how the disease is transmitted, treated and how it progresses, in addition to providing social and psychological support, could minimize the negative effects of the disease on the quality of life of patients living with the Human Immunodeficiency Virus.

Patient-Reported Quality of Life During Antiretroviral Therapy in a Nigerian Hospital

ObjectivesWe assessed the reported quality of life of patients with HIV/AIDS and explored the impact of patients’ sociodemographic profile on the quality-of-life domains. MethodsConsenting outpatients who met criteria were consecutively selected in a secondary health care facility in Benin City, Nigeria. Quality of life was determined in the nine domains of HIV/AIDS Targeted Quality of Life (HAT-QOL) instrument. Quality-of-life scores were computed on the scale of 0 to 100 and triangulated with a rated interval scale of 1 to 5 suited for quantitative analysis. Association between rated scores and each domain was explored by using Students’ t test and analysis of variance at 95% confidence interval. ResultsOut of the 403 patients, 82.1% were females; 147 (36.1%) belonged to the modal age group of 20 to 30 years; the mean age for grouped data was 39.2 years. About 239 (58.7%) were not married. Also, 338 (83.0%) earned below $1500 per annum and 303 (74.40%) had basic education (grade 1 to grade 9). HAT-QOL scores indicated the following: overall function (89.96 ± 5.62); life satisfaction (91.94 ± 3.62); health worries (87.06 ± 4.28); financial worries (81.00 ± 3.95); medication worries (91.65 ± 4.47); HIV mastery (71.00 ± 3.11); disclosure worries (27.50 ± 7.57); provider trust (91.63 ± 1.96); and sexual function (70.25 ± 3.51). Likert-type rated scores were in agreement with HAT-QOL scores. Provider trust was associated with gender, employment status, and educational level. Sexual function was associated with gender and age (P < 0.05). ConclusionsPatients reported satisfactory quality of life in the domains of overall function, life satisfaction, health worries, financial worries, medication worries, HIV mastery, provider trust, and sexual function. Quality of life was low in the domain of disclosure worries, indicating concerns for discrimination and stigmatization. Age, level of education, and employment status had a strong impact on the quality of life of patients with HIV/AIDs.

P6.076 Quality of Life and Its Relationship with the Clinical Aspects People Living with HIV/AIDS in Brazil

The objectives of this study were to evaluate the quality of life of people living with HIV/AIDS and its relationship with clinical factors. This cross-sectional analytical study was performed with...

Quality of life in people living with HIV/AIDS in Niger Delta Region, Nigeria

Background: Despite the global efforts and huge financial investment in HIV/AIDS, the quality of life in people living with the disease continues to deteriorate, posing serious problems with increased mortality.Aim: The objectives of the study were: (i) to assess the quality of life in people living with HIV/AIDS, and (ii) to compare quality of life in males and females living with the disease.Methods: A total of 309 people living with HIV/AIDS from the HIV clinic, University of Uyo Teaching Hospital were randomly assessed for quality of life, using HIV/AIDS-Targeted Quality of life (HAT-QOL) questionnaire.Results: A total of 265 (85.8%) respondents consisting of 113 (36.6%) males and 152 (49.2%) females were analyzed. The mean age for males was 36.8 ± 4.0 years and females 31.9 ± 3.3 years. The difference in mean was statistically significant (t = 31.831, p < 0.01), occupation was statistically significant (χ2 = 11.348, p < 0.02). Females showed lower quality of life in comparable domains than males. The differences in life satisfaction (χ2 = 10.362, p < 0.01) and health worries (χ2 = 9.944, p < 0.01) were statistically significant.Conclusion: The results showed impairment in quality of life, except in medication worries and sexual function in people living with HIV/AIDS. Improvement in HAT-QoL indices will enhance positive quality of life.

HIV Stigma and Missed Medications in HIV-Positive People in Five African Countries

The availability of antiretroviral medications has transformed living with HIV infection into a manageable chronic illness, and high levels of adherence are necessary. Stigma has been identified as one reason for missing medication doses. The objective of this study was to explore the relationship between perceived HIV stigma and self-reported missed doses of antiretroviral medications in a 12-month, repeated measures cohort study conducted in Lesotho, Malawi, South Africa, Swaziland, and Tanzania. Data were collected from 1457 HIV-positive individuals at three times between January 2006 and March 2007. Participants completed a series of questionnaires. Of the 1457 participants, 698 were taking ARVs during the study and are included in this analysis. There was a significant relationship between perceived HIV stigma and self-report of missed medications over time (t = 6.04, p </= 0.001). Individuals who reported missing more ARV medications also reported higher levels of perceived HIV stigma. Individuals reporting fewer medication worries reported decreased stigma over the one year period (t = -4.79, p </= 0.001). While those who reported increased symptom intensity also reported increased stigma initially (t = 8.67, p </= 0.001) that remained high over time. This study provides evidence of a significant and stable correlation that documents the relationship between perceived HIV stigma and self-reported reasons for missed medications over time. These findings suggest that part of the reason for poor adherence to ARV medications is linked to the stigma experienced by people living with HIV.

Tradução e validação de um questionário de avaliação de qualidade de vida em AIDS no Brasil

To translate the HIV/AIDS-Targeted Quality of Life Instrument (HAT-QoL) into Brazilian Portuguese, culturally adapt it, and evaluate its psychometric properties (validity and reliability) as a Brazilian version. This cross-sectional study was carried out at the laboratory of infectious diseases at Escola Paulista de Medicina (Universidade Federal de São Paulo). Data were collected on clinical and sociodemographic characteristics of 106 HIV-infected individuals who answered the HAT-QoL and the SF-36. Pearson's correlation coefficient was used to measure construct validity. Reliability was assessed using Cronbach's alpha and intraclass correlation coefficients. The sample was 70.8% male. The mean age was 39.9 years, with 40.5% of the participants being homosexual or bisexual. Eleven (10.4%) patients had a CD4 cell count <or= 200 cells/mm(3). A substantial ceiling effect was observed in 7 of 9 HAT-QoL domains (overall function, life satisfaction, health worries, medication worries, HIV acceptance, provider trust, and sexual function). Sexual function was the domain with the highest ceiling effect (63.2%). A substantial floor effect (30.2%) was observed for financial worries. Statistically significant associations were observed between the HAT-QoL domains and clinical and sociodemographic characteristics, as well as with SF-36 domains. Internal consistency was satisfactory (Cronbach's alpha = 0.73-0.90). Inter- and intra-observer reproducibility was very high (0.87-0.98 and 0.82-0.97, respectively). The Brazilian Portuguese version of the HAT-QoL is valid, reliable, and may contribute to evaluating the impact of HIV infection on the quality of life of patients in Brazil.

Comparison of HIV/AIDS-Specific Quality of Life Change in Zimbabwean Patients at Western Medicine Versus Traditional African Medicine Care Sites

The rollout of antiretroviral treatment (ART) for the 25 million sub-Saharan Africans living with HIV/AIDS has been hampered by the lack of a western medical infrastructure. Given limited infrastructure, many Africans seek and receive HIV care from traditional African healers. This reality calls for culturally sensitive approaches to ART rollout that make use of local alternative health care providers, and an assessment of the potential quality of life (QOL) benefits of traditional African care (TAC) is imperative. To examine changes in self-reported health status resulting from TAC and western medical care (WC). QOL in 254 consecutively sampled Zimbabwean patients seeking care at TAC and WC sites was assessed over 1 month. Shona translations of the HIV/AIDS-targeted QOL instrument and Medical Outcomes Study HIV Health Survey. After adjustment for baseline QOL scores and variables that differed across care sites, all dimensions of both instruments revealed QOL improvements only in the 155 (61%) patients from TAC sites when compared with the 99 (39%) patients from WC sites. These improvements were significant (P<or=0.01) for the HIV/AIDS-targeted QOL instrument dimensions of overall function, health worries, illness mastery, medication worries, and provider trust, and for the Medical Outcomes Study HIV Health Survey dimensions of general health perceptions, physical function, role function, pain, health distress, and energy/fatigue (range of regression coefficients, 10.0-18.3). Patients from TAC versus WC sites demonstrated significantly greater health status improvement across the majority of QOL dimensions assessed over 1 month. Though these data are from 1 rural community and capture only 1 month of disease progression, they strongly suggest that the potential benefit of integrating TAC sites in ART rollout programs-particularly in resource-poor settings-may go well beyond cultural sensitivity to impact on health itself and the likely related issues of ART adherence.

Evaluation of the medical orientation for the benzodiazepine side effects

Benzodiazepines are among the most prescribed drugs indicated as anxiolytics, hypnotics, myorrelaxants or antiepileptics. Their main side effects are: reduced psychomotor activities, interaction to other drugs, like alcohol, and the development of dependence. In the present study it was evaluated the quality of the medical directions given to patients about those side effects. One hundred and twenty patients (39 men and 81 women), mean age of 48 years old, who visited pharmacies in Curitiba to buy prescribed benzodiazepines, were interviewed by an open or directive questionnaire designed to obtain the medical directions about benzodiazepines side effects. Directions about the three main benzodiazepines side effects were observed only in 13% of the patients, 27% had received at least two and 40% only one, while 19% reported no directions. It suggested that the medical orientation was precarious and its quality was not influenced by the patients' educational level, the kind of medical attendance or the specialty of the physician. The main orientation cited was "don't drink" (85%), followed by "don't drive or operate machines" (46%), while few orientations about the risk to develop dependence on benzodiazepines was observed (31%). This suggests that physicians were worried about the alcohol interaction risk, which can be dangerous for the patients. The high number of patients using benzodiazepines continuously for more than one year (61%), the unsuccessfully attempt to stop using BZD (94%) and the poor information about the duration of the treatment (22%) were all related to the low medical worry about dependence on benzodiazepines.

Personality, quality of life and HAART adherence among men and women living with HIV/AIDS

Very few studies have documented relations between personality traits and quality of life among individuals living with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). Some have shown that poor perceived quality of life as determined by a sense of purpose may be associated with inadequate adherence to highly active antiretroviral treatment (HAART) in this population. Although adequate HAART adherence is critical to achieve the full therapeutic effects of newly and highly effective regimens, very little is known of how both personality factors and HIV-specific quality of life may impact adherence to these medication regimens. This study evaluated relations among personality traits, quality of life and HAART adherence among 116 men and women living with HIV/AIDS. Results showed that personality traits such as neuroticism were significantly associated with poorer quality of life, whereas conscientiousness and extraversion were associated with better quality of life. In contrast, personality traits were not directly related to HAART adherence. Both higher overall functioning and lower medication worries scores were significantly associated with HAART adherence. Findings suggest that personality traits are associated with HIV-specific quality of life on the one hand, and that HIV-specific quality of life is related to HAART adherence on the other. Future studies assessing the efficacy of psychosocial interventions in improving quality of life and HAART adherence should consider the role of personality traits in promoting better quality of life.