Relationship between medication adherence and glycemic control in Japanese patients with type 2 diabetes.

A cross-sectional survey of 358 patients was conducted among type 2 diabetes patients recruited at medical institutions or via an online research company. Medication adherence was measured using the 8-item Morisky Medication Adherence Scale (MMAS-8). Univariate and multivariate regression analyses of glycosylated hemoglobin (HbA1c) were performed in addition to assessing demographic and disease characteristics and MMAS-8. In conclusion, medication adherence as measured by the MMAS-8 score independently contributes to altering the HbA1c level in the range of 1.12 %. The number of medications prescribed and insulin use are also related to HbA1c.

Reliability and known-group validity of the Arabic version of the 8-item Morisky Medication Adherence Scale among type 2 diabetes mellitus patients.

No validation study has previously been made for the Arabic version of the 8-item Morisky Medication Adherence Scale (MMAS-8(©)) as a measure for medication adherence in diabetes. This study in 2013 tested the reliability and validity of the Arabic MMAS-8 for type 2 diabetes mellitus patients attending a referral centre in Tripoli, Libya. A convenience sample of 103 patients self-completed the questionnaire. Reliability was tested using Cronbach alpha, average inter-item correlation and Spearman-Brown coefficient. Known-group validity was tested by comparing MMAS-8 scores of patients grouped by glycaemic control. The Arabic version showed adequate internal consistency (α = 0.70) and moderate split-half reliability (r = 0.65). Known-group validity was supported as a significant association was found between medication adherence and glycaemic control, with a moderate effect size (ϕc = 0.34). The Arabic version displayed good psychometric properties and could support diabetes research and practice in Arab countries.

Association between herpes zoster and end stage renal disease entrance in chronic kidney disease patients: a population-based cohort study.

The association between herpes zoster (HZ) infection and subsequent risk of end stage renal disease (ESRD) in chronic kidney disease (CKD) patients is unknown. We aim to conduct a population-based cohort study to investigate the risks of developing ESRD after a HZ attack in CKD patients. From the Taiwan National Health Insurance Research Database, we identified 1,144 CKD patients who had HZ over the period 1997-2008 as HZ cohort. We selected 3,855 age- and sex-matched CKD patients without HZ as comparison cohort. All subjects were followed until the end of 2008 or censored. Cox-proportional hazard regression model was used to estimate the effects of HZ on ESRD risks. A total of 396 patients developed ESRD during the follow-up period, of which 108 subjects were from the HZ cohort and 288 from the comparison cohort. The log-rank test demonstrated that the HZ cohort had significantly higher risk of developing ESRD than the comparison cohort (P = 0.0071). The adjusted hazard ratio of subsequent ESRD in the HZ cohort was 1.36 (95 % CI 1.09-1.70) and the hazard ratio increased to 8.71 (95 % CI 5.23-14.5) if the HZ cohort was with concomitant diabetes and hypertension. CKD patients with HZ are at an increased risk of subsequent ESRD. CKD patients with HZ, diabetes, and hypertension have extremely high risk of developing ESRD.

Primary non-adherence to bisphosphonates in an integrated healthcare setting.

UNLABELLED: We estimated primary non-adherence to oral bisphosphonate medication and examined the factors associated with primary non-adherence. Nearly 30% of women did not pick up their new bisphosphonate within 60 days. Identifying barriers and developing interventions that address patients' needs and concerns at the time a new medication is prescribed are warranted. INTRODUCTION: To estimate primary non-adherence to oral bisphosphonate medications using electronic medical record data in a large, integrated healthcare delivery system and to describe patient and prescribing provider factors associated with primary non-adherence. METHODS: Women aged 55 years and older enrolled in Kaiser Permanente Southern California (KPSC) with a new prescription for oral bisphosphonates between December 1, 2009 and March 31, 2011 were identified. Primary non-adherence was defined as failure to pick up the new prescription within 60 days of the order date. Multivariable logistic regression models were used to investigate patient factors (demographics, healthcare utilization, and health conditions) and prescribing provider characteristics (demographics, years in practice, and specialty) associated with primary non-adherence. RESULTS: We identified 8,454 eligible women with a new bisphosphonate order. Among these women, 2,497 (29.5%) did not pick up their bisphosphonate prescription within 60 days of the order date. In multivariable analyses, older age and emergency department utilization were associated with increased odds of primary non-adherence while prescription medication use and hospitalizations were associated with lower odds of primary non-adherence. Prescribing providers practicing 10 or more years had lower odds of primary non-adherent patients compared with providers practicing less than 10 years. Internal medicine and rheumatology providers had lower odds of primary non-adherent patients than primary care providers. CONCLUSION: This study found that nearly one in three women failed to pick up their new bisphosphonate prescription within 60 days. Identifying barriers and developing interventions aimed at reducing the number of primary non-adherent patients to bisphosphonate prescriptions are warranted.

Adherence to anti-Parkinson drug therapy in the "REASON" sample of Italian patients with Parkinson's disease: the linguistic validation of the Italian version of the "Morisky Medical Adherence Scale-8 items".

Information about patients' adherence to therapy represents a primary issue in Parkinson's disease (PD) management. To perform the linguistic validation of the Italian version of the self-rated 8-Item Morisky Medical Adherence Scale (MMAS-8) and to describe in a sample of Italian patients affected by PD the adherence to anti-Parkinson drug therapy and the association between adherence and some socio-demographic and clinical features. MMAS-8 was translated into Italian language by two independent Italian mother-tongue translators. The consensus version was then back-translated by an English mother-tongue translator. This translation process was followed by a consensus meeting between the authors of translation and investigators and then by two comprehension tests. The translated version of the MMAS-8 scale was then administered at the baseline visit of the "REASON" study (Italian Study on the Therapy Management in Parkinson's disease: Motor, Non-Motor, Adherence and Quality Of Life Factors) in a large sample of PD patients. The final version of the MMAS-8 was easily understood. Mean ± SD MMAS-8 score was 6.1 ± 1.2. There were no differences in adherence to therapy in relationship to disease severity, gender, educational level or decision to change therapy. The Italian version of MMAS-8, the key tool of the REASON study to assess the adherence to therapy, has shown to be understandable to patients with PD. Patients enrolled in the REASON study showed medium therapy adherence.

Using motivational interviewing to promote adherence to antiretroviral medications: a randomized controlled study.

The primary aim of this study was to test an intervention to support antiretroviral medication adherence among primarily low-income men and women with HIV. The study was a randomized controlled trial (Get Busy Living) with participants assigned to treatment (Motivational Interviewing [MI]) and control groups. Participants were recruited from an HIV/AIDS clinic in Atlanta, Georgia, US. Of those referred to the study, 247 completed a baseline assessment and were enrolled with 125 randomized to the intervention group and 122 to the control group. Participants were patients beginning antiretroviral therapy or changing to a new drug regimen. The intervention consisted of five MI sessions delivered by registered nurses in individual counselling sessions. Participants were paid for each session attended. The intervention sought to build confidence, reduce ambivalence and increase motivation for ART medication-taking. Medication adherence was measured by the Medication Event Monitoring System (MEMS) from the time of screening until the final follow-up conducted approximately 12 months following the baseline assessment. Participants in the intervention condition showed a trend towards having a higher mean percent of prescribed doses taken and a greater percent of doses taken on schedule when compared to the control group during the months following the intervention period. This effect was noted beginning at about the eighth month of the study period and was maintained until the final study month. Although the finding was weaker for overall percent of prescribed doses taken, the results for the percent of doses taken on schedule suggests that the MI intervention may be a useful approach for addressing specific aspects of medication adherence, such as adherrence to a specified dosing schedule.

Health education program effects on the management of hypertension in the elderly.

Because the elderly are viewed as having more difficulty in complying with therapy, this analysis was directed at the effects of a health education program on their control of primary hypertension when compared with a younger population. The program consisted of three sequential interventions introduced in a randomized factorial design. Depsite the fact that elderly patients had more chronic disease, more complications from hypertension, and were receiving more complex drug therapies than younger patients exposed to the same experimental interventions, they demonstrated significantly higher levels of compliance with drug therapy, significantly higher levels of appointment keeping, and no difference in the proportion having their BP under control at two-year-follow-up. Longitudinal data collected at five-year follow-up indicate no decay effect. These results indicate such programs can be successfully implemented and equally effective for an elderly population.

Adherence to Antihypertensive Medications: Population Based Follow up in Eastern Nepal.

BACKGROUND: Poor adherence toward antihypertensive drugs is a worldwide problem that results in poor health outcomes and increased health care costs. Community based study related to adherence to antihypertensive medication is limited in context of Nepal. METHODS: This study was conducted to explore the extent of adherence towards prescribed antihypertensive treatment and to identify the factors of non adherence. Community based cross sectional study was conducted in Dharan Municipality of Eastern Region of Nepal from September 2009 to February 2010. Out of 975 hypertensive patients, 154 calculated samples were selected following simple random sampling method. Data was collected by interview method and adherence was measured by using four items Morisky Medicine adherence scale. Data was analyzed using SPSS by descriptive and inferential (Chi square and logistic regression analysis) Statistical method. RESULTS: Among the 154 hypertensive patients, only 56.5% patients were adherent to antihypertensive medication. The important predictors of non adherence by logistic regression analysis at 95% Confidence Interval were illiteracy (OR 5.34, CI= 1.23 -23 , P=0.025), expensive price of medicine (OR 5.14, CI=1.1-23.9, P=0.037), missed medicine due to cost (OR 0.143,CI=0.02-0.78, P= 0.025), no family history of hypertension (OR 4.46,CI= 1.21-16.4, P=0.024), irregular follow up (OR 6.39,CI=1.22-33.3, P=0.028), more than one pills per day ( OR 5.33,CI=1.19-23.7, P= 0.028). CONCLUSIONS: Around half of the population was non adherent towards antihypertensive medications so identified gap need to be addressed to increase adherence level.

A clinic and community-based approach to hypertension control for an underserved minority population: design and methods.

This paper describes the design and methodology of the Community Hypertension Intervention Project (CHIP). CHIP is investigating the environmental and psychosocial factors related to treatment adherence and examining the effects of combining usual hypertension care with the effects of three interventions designed to improve patient compliance with treatment for high blood pressure in a high-risk, underserved minority population. Thirteen hundred and sixty-seven inner-city hypertension patients (75% black and 25% Hispanic) have agreed to participate in the 4-year longitudinal study. These participants were randomized to usual care or one of three intervention groups: individualized counseling sessions; home visits/discussion groups; or computerized appointment-tracking system. Participants are representative of the surrounding, predominantly low-income minority community and are treated in a hospital-based clinic and in a private clinic in the community. About 65% have blood pressure levels considered to be out of control. It was concluded that structural changes at the clinic site, along with the targeted interventions, would improve patient satisfaction, increase treatment adherence, and improve blood pressure control.

Stability of blood pressure: is a sequential blood pressure reading protocol efficient for a large-scale community screening programme.

The purpose of this study is to assess the relative stability of the systolic and diastolic blood pressure (BP) measures obtained in a state-wide screening programme. A state-wide hypertension survey was conducted in California in 1983 in which a total of 6381 adults were interviewed in their homes. Three BP measurements were taken, with a 5-min interval between each measure. The BP screening protocol used by The Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure recommended a total of three measures, in which the second and the third measures are averaged. Results of the household survey indicated significant differences between the three subsequent BP measurements (P < 0.001), with much smaller differences between the second and third measure. This result implies that BP of an individual is approaching stability after the second measure and, consequently, two subsequent BP measurements may be sufficient to identify subjects with elevated BP. We compare the three-measure screening protocol with a two-measure screening protocol in which only the first two BP readings are taken and the second reading is used to indicate BP levels of subjects. The percentage of agreement between the three-measure and the two-measure screening protocols is 97.57%. Using the three-measure screening protocol as a standard, the sensitivity and false-negative rate are 98.73% and 0.43%, respectively. The two-measurement screening protocol is recommended as an equally sensitive and a more efficient procedure for a large-scale community-screening programme.

Acculturation and interrelationships between problem and health-promoting behaviors among Latino adolescents.

PURPOSE: To examine: (a) the effects of acculturation on a healthy lifestyle including problem behaviors (substance use and sex acts) and health-promoting behaviors (e.g., seat belt use, vitamin intake, hours of sleep per night) and (b) the interrelationships among problem and health-promoting behaviors among Latino adolescents. METHODS: Face-to-face interviews were conducted with Latino adolescents (n = 609) with questions covering the following areas: acculturation, sociodemographics, problem behaviors, and health-promoting behaviors. The participants ranged in age from 11 to 19 (mean = 15) years. Bivariate correlations and factor analyses were used to examine the relationship between problem and health-promoting behaviors. A combination of one-way analyses of variance (ANOVAs), Chi-square tests, and Student's t-tests were used to analyze the effects of acculturation on problem and health-promoting behaviors. RESULTS: Higher levels of acculturation were associated with an increased likelihood of exhibiting problem behaviors and a decreased likelihood of exhibiting certain health-promoting behaviors. Foreign-born Latinos were significantly less likely to engage in problem behaviors. Problem behaviors were likely to co-occur; however, the co-occurrence of health-promoting behaviors was not evident. The results also revealed the co-occurrence of problem behaviors with selected health-promoting behaviors. CONCLUSIONS: Among Latino adolescents, there seems to be evidence that problem behaviors and certain health-promoting behaviors do co-occur. To the extent that "healthy lifestyles" are conceptualized as the presence of health-promoting behaviors and the absence of problem behaviors, less acculturated Latino adolescents seem to fare better than those that are more acculturated. Interventions to promote "healthy lifestyles" among Latino adolescents should be tailored to take into consideration the effect of acculturation.

Development of a tuberculosis education booklet for Latino immigrant patients.

The incidence and prevalence of tuberculosis are far more common among third world populations immigrating to the United States than among US-born citizens. Immigrants' failure to comply with an anti-tuberculosis treatment can impede completion of care and further confound this public health problem. Barriers to patient--provider communication can negatively influence adherence to a medical regimen. Patients who are unable to comprehend medical advice and do not see it as personally salient are less likely to follow their provider's medical advice. In this paper, the authors focus on efforts to develop a patient education tool targeting Spanish-speaking Latino immigrant patients to facilitate communication with tuberculosis clinicians. A description of the multi-stage developmental processes is presented including conducting a needs assessment, development of visual and written messages, review/critique by tuberculosis experts, field-testing, revisions, and distribution. Formative evaluation and field testing indicates promise for improving communication using this tool.

Are condom instructions readable? Results of a readability study.

The use of condoms has assumed a central position in the current strategy to prevent sexual transmission of the human immunodeficiency virus. The effectiveness of condoms in disease prophylaxis is dependent, to a degree, on their correct use. Condom manufacturers routinely include information on condom use either printed on the actual package or in an enclosed package insert. With the use of three readability formulas, the reading grade level was determined for 14 different sets of instructions included with 25 brands of condoms manufactured by 7 domestic and 1 overseas manufacturer. The readability formulas, when applied to instructions for condom use, estimated that, conservatively, 8 of the 14 instructions required at least reading at the level of a high school graduate and none required less than a 10th grade level. Clearly written instructions and simple concepts could assist current and future condom users in the correct use of condoms and improve the effectiveness of condoms in the prevention of AIDS and other sexually transmitted diseases.

Behavioral interventions for the control of tuberculosis among adolescents.

OBJECTIVES: Activation of latent tuberculosis infection into tuberculosis disease (TB), the primary killer among infectious diseases worldwide, can be prevented with six months of anti-TB medication. A large percentage of adolescents started on medication, however, fail to complete their treatment. The authors developed and tested the effects of innovative educational strategies on infected adolescents at two health centers serving ethnically diverse populations. METHODS: The authors used a randomized experimental four-group design to assess the independent and combined effects of peer counseling and a participant-parent contingency contract intervention. RESULTS: A total of 794 adolescents were recruited into the study, for a 79% participation rate. The overall rate of treatment completion was 79.8%. Self-efficacy for medication-taking behavior at post-test correlated strongly with completion of care (R = 0.367, p = 0.002). Participants randomized to the peer counseling groups demonstrated significantly greater improvements in self-efficacy and mastery than the usual care control group. Based on the study results, continuing education seminars and workshops were implemented for TB control staff at the two health clinics and for all TB Control Division staff at the Los Angeles County Health Department. Educational materials and a training manual for enhancing completion of treatment of latent TB infection through tailored educational approaches were developed and disseminated to the clinics. CONCLUSIONS: Health education and incentives are helpful adjuncts to the completion of treatment for latent tuberculosis infection in adolescents.

Data-based planning for educational interventions through hypertension control programs for urban and rural populations in Maryland.

As part of a statewide effort to coordinate existing resources for high blood pressure (HBP) control, a public health HPB control program was planned and implemented in two high-risk communities in Maryland. The selection of the two communities was based on epidemiologic data. The planning of the educational intervention program in these communities (urban and rural) was guided by organizational theory and health education principles. The framework for development, implementation, and evaluation of the program utilizes an educational assessment model which identified factors that predispose, reinforce, and enable individual persons to practice positive health behavior. Multiple data sources were used in assessing the extent of the problem and relevant approaches in the development of the coordinated HPB control program. These include statewide vital statistics and a random statewide household survey to assess the prevalence rates of awareness, treatment, and control of HPB. To supplement these data, telephone surveys were carried out in the two communities to assess knowledge, beliefs, and practices related to HPB control. Medical record reviews provided baseline information on appointment keeping behavior and BP correlates of hypertensive patients. The planning and implementation of the program was carried out under the direction of representatives of the health care systems, community leaders, and residents, and representatives of communitywide organizations involved in HPB control.

Patterns of adolescent alcohol, cigarette, and marijuana use over a 6-month period.

In the current study, alcohol, cigarette, and marijuana use among adolescents (N= 794, 48.6% female) was assessed at two time points, and four patterns of use were identified: (1) abstainers: no lifetime use; (2) new users: no use at baseline but had used by the follow-up period; (3) experimenters: use prior to the baseline but no use in the period up to the follow-up; and (4) consistent users: self-report of use prior to the baseline and the follow-up. Mean levels of psychosocial variables (mastery, self-esteem, and parental social support) were compared across the four patterns of use for each substance. Only analyses including parental social support as the dependent variable were significant. Adolescents with higher levels of social support were more likely to be classified as abstainers or experimenters of alcohol than consistent users. More frequent users of cigarettes at baseline were likely to be classified as frequent users at the follow-up. The discussion focuses on the identification of the situational context of substance use for alcohol, cigarettes, and marijuana.

Effects of acculturation and psychosocial factors in Latino adolescents' TB-related behaviors.

OBJECTIVE: To determine the effect of acculturation and psychosocial factors (self-esteem, social support, mastery, and self-efficacy of medication taking) on Latino adolescents' adherence (completion of treatment, percent of appointments kept, number of treatment weeks, and number of days missed medication in past week) to tuberculosis (TB) treatment. METHODS: Participants (N = 618) were recruited from two clinics located in Los Angeles, California, after receiving a positive diagnosis for Class II TB. RESULTS: Adolescents with high linguistic acculturation and ethnic identification had high mastery, self-esteem and self-efficacy. Teens with high ethnic identification perceived more support from parents. Almost 81% of participants completed treatment and the percentage of appointments kept was 76.3%. A high proportion of those completing the treatment regimen had their parents helping them to remember to take the medication. Older teens were less acculturated, less likely to complete treatment, and had a lower rate of appointment keeping. Age and difficulty in getting to the clinics were predictors of adherence. CONCLUSIONS: This study highlights the importance of parental support and sociocultural factors in adherence to TB treatment in this population.

Condom sales at public universities in California: implications for campus AIDS prevention.

Public health officials have called for increased use of condoms to protect Americans from sexually acquiring human immunodeficiency virus (HIV) infection. To investigate the availability of condoms for sale on college campuses, we asked student union directors and bookstore managers from all 28 public universities in California, with a combined enrollment of half a million students, to complete a detailed questionnaire in August and September 1987. Two thirds of the campuses reported having condoms for sale in either their bookstores or convenience stores; one third said condoms were available in the men's and women's restrooms in their student unions. On most campuses, sales were instituted in the past year in response to the AIDS (acquired immune deficiency syndrome) epidemic. However, very few campuses provided AIDS education at the point of sale, and condoms were not easily available outside of store hours. Respondents felt that the most important obstacles to increasing the distribution of condoms on campus included concern about presenting a negative image of the university and the low priority assigned to this issue by the university administration and others on campus. This study suggests that although condom availability has improved in the past year, the opportunity exists at most California public universities to increase the distribution of condoms and improve associated AIDS-related health education efforts.

PIP: Public health officials have called for increased use of condoms to protect Americans from AIDS. Students are important targets for AIDS-prevention education because of their ignorance of the association between AIDS and sexual behavior. This study inquired: 1) Have California public universities made condoms available for sale in college bookstores, campus convenience stores, and restrooms? 2) Are educational materials on the prevention of AIDS available at the point of condom sales? and 3) What do the people who can sell condoms on campus think about condom sales? During the months of August and September 1987, each student union director and bookstore manager from the 28 public universities in California (combined enrollment almost 500,000) were asked to complete a 75-item questionnaire on campus condom distribution. Two-thirds of the campuses have condoms for sale in bookstores or convenience stores; one-third make condoms available in restrooms in their student unions. On most campuses, sales were instituted within the past year in response to the AIDS epidemic. However, very few campuses provide AIDS education at the point of sale, and condoms are not easily available outside of store hours. Respondents reporting the most important obstacles to increasing the distribution of condoms on campus cited concern about presenting a negative image of the university and the low priority assigned to this issue by the university administration and others on campus. Although condom availability has improved in the past year, opportunities exist at most California public universities to increase the distribution of condoms and improve associated AIDS-related health education efforts.