Barriers and strategies to medication adherence amongst people with multiple sclerosis and cognitive problems.

BACKGROUND: Adherence to disease-modifying treatment (DMT) amongst people with multiple sclerosis (MS) varies greatly. Although research often identifies 'forgetting' as a reason for poor adherence, few studies have considered how cognitive problems impact adherence. OBJECTIVES: To investigate prevalence of and barriers to adherence, including for people with MS-related cognitive problems, and to identify adherence-related strategies. METHODS: Recruited via the UK MS Register and MS Society groups, participants completed a Medication Adherence Questionnaire and the Perceived Deficits Questionnaire. A subset were interviewed. RESULTS: Of 257 participants, 94 % reported being adherent, although 59 % missed ≥1 dose, and 25 % reported cognitive problems. Adherence was lower amongst those with cognitive problems, who experienced more barriers: memory problems; negative feelings about taking medication; and not wanting medication to interfere with activities. Such barriers, along with mood, cognition, and method of DMT administration, explained 17 % of variance in adherence, with intravenous treatment a significant predictor. Cognitive problems explained a unique proportion of variance; however, was non-significant when anxiety was factored in. Interviews highlighted how anxiety about side-effects and injections, and difficulties accepting the diagnosis, hindered use of reminders. CONCLUSION: Interventions for cognition and mood problems, minimising treatment burden and supporting adjustment to diagnosis, may improve adherence.

Prevalence of chronic respiratory diseases in Aboriginal children: A whole population study.

BACKGROUND: The burden of bronchiectasis is disproportionately high in Aboriginal adults, with early mortality. Bronchiectasis precursors, that is, protracted bacterial bronchitis (PBB) and chronic suppurative lung disease (CSLD), often commence in early childhood. We previously reported a 10% prevalence of PBB in Aboriginal children aged 0 to 7 years, however there are no data on prevalence of chronic lung diseases in older children. Our study aimed to determine the prevalence of PBB, CSLD, bronchiectasis, and asthma in Aboriginal children living in four communities. METHODS: A whole-population cross-sectional community co-designed study of Aboriginal children aged <18-years in four remote communities in Western Australia across two-time points, a month apart. Children were assessed by pediatric respiratory clinicians with spirometry undertaken (when possible) between March-September 2021. Children with respiratory symptoms were followed up via medical record audit from either the local medical clinic or via a respiratory specialist clinic through to March 2022 to establish a final diagnosis. FINDINGS: We recruited 392 (91.6%) of those in the selected communities; median age = 8.4 years (interquartile range [IQR] 5.1-11.5). Seventy children (17.9%) had a chronic respiratory pathology or abnormal spirometry results. PBB was confirmed in 30 (7.7%), CSLD = 13 (3.3%), bronchiectasis = 5 (1.3%) and asthma = 17 (4.3%). The prevalence of chronic wet cough significantly increased with increasing age. INTERPRETATION: The prevalence of PBB, CSLD and bronchiectasis is high in Aboriginal children and chronic wet cough increases with age. This study highlights the high disease burden in Aboriginal children and the urgent need for strategies to address these conditions.

Compassion-focused therapies for self-esteem: A systematic review and meta-analysis.

PURPOSE: To identify whether compassion-focused therapy (CFT) or compassion-based interventions are effective in improving self-esteem. METHODS: Databases (CINAHL, MEDLINE, and PsycINFO) were searched, along with OpenGrey literature. Experts were also contacted and handsearching of reference lists and citing articles undertaken. To be eligible, papers had to include an intervention identified as being compassion-based and mention 'self-esteem' as a variable or outcome. Papers were quality appraised using the Mixed Methods Appraisal Tool. Data were analysed using a random-effects meta-analysis model, with sensitivity analysis conducted in relation to the quality of studies. RESULTS: Ten eligible papers were identified. Within-group analysis of data from eight studies demonstrated a medium, significant overall effect size (g = 0.56, 95% CI [0.19-0.93], z = 3.54, p < .001), which increased slightly and remained significant (g = 0.61, 95% CI [0.05-1.17], z = 2.82, p = .005) when the lowest quality studies were removed. CONCLUSIONS: Compassion-focused therapy or compassion-based interventions may be effective in improving self-esteem. However, there is large clinical and methodological heterogeneity amongst studies making further conclusions difficult. PRACTITIONER POINTS: CFT/compassion-based interventions appear to be effective in improving self-esteem. Transdiagnostic concepts (such as low self-esteem and compassion-focused therapy) should be considered in supporting people with their mental health.