Self-Efficacy as Moderator and Mediator Between Medication Beliefs and Adherence in Elderly Patients with Type 2 Diabetes.

Purpose: Poor antidiabetic medication adherence remains a great barrier to effective diabetes self-management among aging adults. This study investigates the mediation and moderation effects of self-efficacy on the relationship between medication beliefs and adherence in elderly patients with type 2 diabetes. Methods: This cross-sectional study evaluated a sample of 309 hospitalized elderly patients who completed the assessment of medication beliefs, self-efficacy for medication uses and medication adherence in a tertiary hospital in Shanghai, China. A bootstrapping sampling method and hierarchical moderator regression analysis were used to verify the hypothesis of mediation and moderation effects of self-efficacy on the relationship between medication beliefs and adherence. Results: Self-efficacy for medication use acted as a moderator (B=-0.063, t=-2.215, p=0.028) and partial mediator (CItotal effect=4.5-16.63, p=0.001; CIindirect=1.524-5.323, p=0.014; CIdirect=2.151-11.817, p=0.001) on the relationship between general harm medication beliefs and medication adherence. Participants with lower general harm medication beliefs may develop higher self-efficacy, which, in turn, results in a higher level of medication adherence, and higher self-efficacy may attenuate the negative effect of high general harm medication beliefs on medication adherence. Conclusion: Self-efficacy for medication use not only mediated the relationship between general harm beliefs about medication and medication adherence, but moderated it negatively. The findings of this study indicate an opportunity to improve the prognosis of elderly Chinese patients with type 2 diabetes through improved medication adherence by strengthening factors such as self-efficacy for appropriate medication use and general harm beliefs about medication.

Validation and psychometric properties of the self-efficacy for Appropriate Medication Use Scale in elderly Chinese patients.

Background Self-efficacy for appropriate medication use is an important construct when evaluating the optimal use of medications. However, no instrument that assesses this construct in elderly Chinese patients has been shown to have valid psychometric properties. Objective To investigate the psychometric properties of the Chinese version of the self-efficacy for Appropriate Medication Use Scale in elderly patients with type 2 diabetes. Setting Geriatric patients were recruited from the endocrinology department of a tertiary hospital in Shanghai, China. Method Self-efficacy was assessed by the Chinese version of the Self-Efficacy for Appropriate Medication Use Scale in subjects who were at least 65 years old. Exploratory and confirmatory factor analyses were used to develop a psychometrically sound model of the scale. Main outcome measures Internal and test-retest reliability; convergent and discriminant validity of the scale; model fit indices of the factor model. Results The two-factor model of the self-efficacy for Appropriate Medication Use Scale was not suitable for elderly patients with respect to both item factor loadings and model fit indices. Conceptually overlapping scale items emerged when the scale was used in these patients. The final model developed appeared to achieve an ideal model fit and presented acceptable convergent and discriminant validity. Conclusions This study presented a Chinese version of the self-efficacy for Appropriate Medication Use Scale with psychometrically sound properties that will enable pharmacists, nurses and physicians to prospectively evaluate the impact of medication self-efficacy on a variety of health outcomes in elderly patients with type 2 diabetes.

A Re-evaluation of the Taxonomy and Classification of the Type III Secretion System in a Pathogenic Bacterium Causing Soft Rot Disease of Pleurotus eryngii.

Pantoea beijingensis, a gram-negative pathogenic bacterium, causes soft rot disease in the fungus Pleurotus eryngii in China. However, the taxonomic classification of this pathogen is controversial due to close relationships between bacteria of the genera Pantoea and Erwinia. This study aimed to resolve the identity of P. beijingensis using phylogenomic and systematic analyses of Pantoea and Erwinia by whole-genome sequencing. Single-copy orthologs identified from the Erwinia/Pantoea core genomes were used to delineate Erwinia/Pantoea phylogeny. P. beijingensis LMG27579T clustered within a single Erwinia clade. A whole-genome-based phylogenetic tree and average nucleotide and amino-acid identity values indicate that P. beijingensis LMG27579T should be renamed Erwinia beijingensis. The hrp/hrc genes encoding type III secretion system (T3SS) proteins in Erwinia and Pantoea were divided into five groups according to gene contents and organization. Neighbor-joining-inferred phylogenetic trees based on concatenated HrcU, HrcN, and HrcR in the main hrp/hrc cluster showed that E. beijingensis T3SS proteins are closely related to those in Ewingella americana, implying that E. beijingensis and E. americana have a recent common hrp/hrc gene ancestor. Furthermore, T3SS proteins of Erwinia and Pantoea were clustered in different clades separated by other bacterial T3SS proteins. Thus, T3SS genes in Pantoea and Erwinia strains might have been acquired by horizontal gene transfer. Overall, our findings clarify the taxonomy of the bacterium causing soft rot in P. eryngii, as well as the genetic structure and classification of the hrp/hrc T3SS virulence factor. We propose that T3SS acquisition is important for E. beijingensis emergence and pathogenesis.