Barriers to hydroxyurea use from the perspectives of providers, individuals with sickle cell disease, and families: Report from a U.S. regional collaborative.

Sickle cell disease (SCD) is an inherited blood disorder that affects about 100,000 people in the U.S., primarily Blacks/African-Americans. A multitude of complications negatively impacts quality of life. Hydroxyurea has been FDA approved since 1998 as a disease-modifying therapy for SCD, but is underutilized. Negative and uninformed perceptions of hydroxyurea and barriers to its use hinder adherence and promotion of the medication. As the largest real-world study to date that assessed hydroxyurea use for children and adults with SCD, we gathered and analyzed perspectives of providers, individuals with SCD, and families. Participants provided information about socio-demographics, hospital and emergency admissions for pain, number of severe pain episodes interfering with daily activities, medication adherence, and barriers to hydroxyurea. Providers reported on indications for hydroxyurea, reasons not prescribed, and current laboratory values. We found that hydroxyurea use was reported in over half of eligible patients from this large geographic region in the U.S., representing a range of sickle cell specialty clinical settings and practices. Provider and patient/caregiver reports about hydroxyurea use were consistent with one another; adults 26 years and older were least likely to be on hydroxyurea; and the likelihood of being on hydroxyurea decreased with one or more barriers. Using the intentional and unintentional medication nonadherence framework, we found that, even for patients on hydroxyurea, challenges to taking the medicine at the right time and forgetting were crucial unintentional barriers to adherence. Intentional barriers such as worry about side effects and "tried and it did not work" were important barriers for young adults and adults. For providers, diagnoses other than HgbSS or HgbS-ß0 thalassemia were associated with lower odds of prescribing, consistent with evidence-based guidelines. Our results support strengthening provider understanding and confidence in implementing existing SCD guidelines, and the importance of shared decision making. Our findings can assist providers in understanding choices and decisions of families; guide individualized clinical discussions regarding hydroxyurea therapy; and help with developing tailored interventions to address barriers. Addressing barriers to hydroxyurea use can inform strategies to minimize similar barriers in the use of emerging and combination therapies for SCD.

Fostering Oral Hygiene Habits and Self-Regulation Skills: An Intervention With Preschool Children.

The purpose of this study was to evaluate a program to promote self-regulation for self-care skills in preschool-aged children focused on oral habits and good oral health. Participants were 210 Mexican children aged 4 to 5 years who attended the Children's Assistance Community Centers (CAIC in Spanish). Findings showed that children who participated in the program, compared with those who did not, decreased significantly the teeth-bacteria plaque. The former also improved their self-regulation skills and dental hygiene habits. Data highlighted the key role of close adults in promoting young children's self-regulation for self-care focusing on dental hygiene habits.

Habilidades autorregulatorias e higiene bucal infantil con el apoyo de los padres / Self-regulatory skills and child oral hygiene with support from parents / Habilidades de auto-regulação e higiene bucal das crianças com o apoio dos pais

En este artículo se analizan diferentes variables que inciden en la conducta de auto-cuidado de los pacientes pediátricos que asisten a consulta médica, así como en la de sus padres, para una buena salud oral como son: las creencias de autoeficacia, la intención y el control del comportamiento. En el contexto mexicano, participaron 43 pacientes pediátricos, entre 6 y 13 años de edad, y 36 padres de familia, entre 21 y 47 años de edad, que acompañaban a sus hijos a recibir tratamiento dental. Los resultados muestran que los pacientes pediátricos presentan mayor autoeficacia que su progenitor encuestado; en cambio, los padres presentan mejores respuestas en intención de comportamiento y hábitos de higiene bucal. El control de la acción no presenta diferencias significativas entre los pacientes pediátricos y sus padres.

In this article the authors analyze different variables that influence the self-care behavior of pediatric patients attending medical consultations, as well as the behavior of their parents, in relation to achieving good oral health. These variables include: self-belief, behavioral intention and control. In this study conducted in Mexico, participants included 43 pediatric patients aged between 6 and 13 years old, and 36 parents aged between 21 and 47 years of age who accompanied their children to receive dental treatment. The results show that pediatric patients have higher self-belief than their parents. However, parents have better behavioral intentions and oral hygiene habits than their children. There were no significant differences between pediatric patients and their parents in action control.

Neste artigo se analisam diferentes variáveis que influenciam o comportamento de auto-atendimento de pacientes pediátricos que frequentam consultas médicas, bem como seus pais, para uma boa saúde bucal como são: as crenças de autoeficácia, a intenção e o controle comportamental. No contexto mexicano, participaram 43 pacientes pediátricos entre 6 e 13 anos de idade, e 36 pais entre 21 e 47 anos de idade, que acompanharam seus filhos para receber tratamento. Os resultados mostram que os pacientes pediátricos tem maior autoeficácia do que seu progenitor correspondente. Os pais têm melhores respostas na intenção comportamental e hábitos de higiene bucal. O controle da ação não apresenta diferenças significativas entre pacientes pediátricos e seus pais.

Propiedades psicométricas de la versión mexicana del Cuestionario para la Evaluación de Metas Académicas (CEMA) / Psychometric properties of the Mexican version of the Academic Goals Questionnaire

Las metas académicas constituyen una de las variables más importantes desde el punto de vista motivacional para explicar las diferentes razones de que los estudiantes se impliquen en las tareas y actividades de aprendizaje. Al mismo tiempo, están relacionadas con distintos patrones de pensamiento, emociones y acciones de los estudiantes y, además, con su logro académico. De ahí la importancia de incrementar los trabajos empíricos en esta área y contar con instrumentos de evaluación que permitan una mayor comprensión de los procesos involucrados en el aprendizaje de los estudiantes, particularmente en la enseñanza superior. Es por ello que en este trabajo se examinan las propiedades psicométricas del Cuestionario para la Evaluación de Metas Académicas en una muestra de estudiantes universitarios mexicanos. Este instrumento de autoinforme valora la orientación personal de los estudiantes hacia las metas académicas. Para ello, se llevó a cabo un análisis factorial confirmatorio (AFC) con una muestra de 735 estudiantes universitarios mexicanos del área de ingenierías. Los resultados obtenidos corroboran en general la estructura factorial del cuestionario original y garantizan suficientemente la consistencia interna de la escala para emplearla en la investigación dentro del contexto mexicano.

Academic goals are one of the most important variables from a motivational point of view to explain the different reasons and motives of students to get involved in learning tasks and activities. At the same time, academic goals are related to different patterns of thoughts, emotions and actions of students, as well as their academic achievement. Hence, it is important to develop empirical work in this area in order to construct evaluation tools that allow a better understanding of the processes involved in student learning, particularly in higher education. The psychometric properties of the Questionnaire for the Evaluation of Academic Goals were examined in a sample of Mexican university students. This self-report instrument evaluates the personal orientation of the student towards academic goals. To achieve this goal, a Confirmatory Factor Analysis (CFA) was conducted, with a sample of 735 Mexican higher education students in the engineering area. Findings corroborate the original questionnaire factor structure and demonstrates reliability for using the scale in the research within the Mexican context.