Comparing medication attitudes and reasons for medication nonadherence among three disparate groups of individuals with serious mental illness.

This analysis compared medication attitudes and reasons for nonadherence in three distinct groups of patients with serious mental illness (SMI). Cohort 1 had 43 patients with bipolar disorder (BD) treated in a community mental health setting, cohort 2 had 43 patients with BD taking an atypical antipsychotic and treated in an academic medical center, and cohort 3 had 30 patients with schizophrenia or schizoaffective disorder who had been homeless in the last year. Standardized attitudinal scales found generally negative attitudes toward medication and limited illness insight. Although the three cohorts differed with regard to severity of symptoms, age of onset, education, baseline adherence, and race, the groups had similar medication attitudes before and after treatment. Despite group differences in demographic and clinical variables, our analyses found more similarities than differences in medication attitudes among these three discrete groups of poorly adherent, symptomatic patients with SMI. The common attitudinal characteristics have implications for delivery of health care services that can enhance treatment adherence in high-risk SMI patients.

The Effect of Iranian Customary Used Probiotic Yogurt on the Children's Salivary Cariogenic Microflora.

STATEMENT OF THE PROBLEM: Dental caries is the most common disease of childhood. Using probiotics has recently been introduced to reduce the incidence of dental caries.It consists of live microbial food supplements that beneficially affect the host, and hence are considered an alternative way to eradicate the infections. PURPOSE: The aim of this study is to evaluate the effect of consumption of probiotic yogurt on the children's salivary cariogenic microflora. MATERIALS AND METHOD: A double-blind randomized study was performed recruiting 2 parallel groups; 24 healthy children in the case and 25 children in the control group. All healthy children were followed- up over 4 periods. Periods 1 and 3 were wash-out periods with duration of 1 and 2 weeks, respectively. During periods 2 and 4 (2weeks duration each), the case group consumed 200g yogurt containing Bifidobacterium lactis (1×10(6) per gram) once daily and the control group consumed normal yogurt. Salivary Streptococci mutans and Lactobacilli were enumerated before and after the yogurt consumption periods. Pre- and post-treatment values within and between regimens were compared using the t-test and paired samples. RESULTS: There was a reduction in Streptococcus mutans and Lactobacillus counts in the control group, but for Streptococcus mutans, the count reduction between phases 1 and 4 was statistically significant (p= 0.009). In the case group, neither the Streptococcus mutans count nor the Lactobacilli count was significantly reduced. CONCLUSION: Based on the findings of this study, short-term daily consumption of probiotic yogurt containing Bifidobacterium lactis could not reduce the levels of salivary Streptococcus mutans and Lactobacilli in 6 to 12 year-old children, while normal yogurt could reduce the Streptococcus mutans counts significantly.

Effective antimicrobial stewardship in a long-term care facility through an infectious disease consultation service: keeping a LID on antibiotic use.

DESIGN: We introduced a long-term care facility (LTCF) infectious disease (ID) consultation service (LID service) that provides on-site consultations to residents of a Veterans Affairs (VA) LTCF. We determined the impact of the LID service on antimicrobial use and Clostridium difficile infections at the LTCF. SETTING: A 160-bed VA LTCF. METHODS: Systemic antimicrobial use and positive C. difficile tests at the LTCF were compared for the 36 months before and the 18 months after the initiation of the ID consultation service through segmented regression analysis of an interrupted time series. RESULTS: Relative to that in the preintervention period, total systemic antibiotic administration decreased by 30% (P<.001), with significant reductions in both oral (32%; P<.001) and intravenous (25%; P=.008) agents. The greatest reductions were seen for tetracyclines (64%; P<.001), clindamycin (61%; P<.001), sulfamethoxazole/trimethoprim (38%; P<.001), fluoroquinolones (38%; P<.001), and ß-lactam/ß-lactamase inhibitor combinations (28%; P<.001). The rate of positive C. difficile tests at the LTCF declined in the postintervention period relative to preintervention rates (P=.04). CONCLUSIONS: Implementation of an LTCF ID service led to a significant reduction in total antimicrobial use. Bringing providers with ID expertise to the LTCF represents a new and effective means to achieve antimicrobial stewardship.